ROBERT SIEGEL, HOST:
A quiet but significant shift is happening in the way America cares for its elderly and disabled. States are tapping into federal dollars to help move people out of nursing homes. Sarah Jane Tribble of member station WCPN says it's happening in record numbers in Ohio.
SARAH JANE TRIBBLE, BYLINE: Donna Giron is breathing hard and shaking a bit. The 65-year-old nursing home resident is coming down the stairs of a two-story house that she might rent. Worry lines appear on the face of her transition coordinator, Melanie Spence, and the rental manager.
MELANIE SPENCE: Do you think you'll be OK with the stairs, Donna?
DONNA GIRON: Yeah. Yeah.
TRIBBLE: The bottom of the stairs, Giron looks out a window at the front porch. She can picture herself sitting outside, watching the neighborhood in this small industrial town where she grew up. Then, she turns the corner.
GIRON: Oh, we even got a dishwasher. Oh, my goodness gracious.
TRIBBLE: Giron is not just any house hunter. She has Crohn's disease, usually uses a wheelchair and has been in a nursing home since May. But she is doing something that was once almost unheard of - moving out of an institution to live her life. Using federal funds under a special project, thousands of elderly and disabled nursing home residents in 44 states have moved into their own home in recent years. And Giron is ready to join those ranks.
GIRON: I'm a very independent woman. I have been for most of my life. I mean, I've had to be.
TRIBBLE: But independence is difficult to achieve for someone who has trouble walking and has a chronic health condition. Still, Giron wants to be independent, and it's cheaper. The roadblock, though, has been her health insurance - Medicaid, the federal health coverage for poor and disabled residents.
JOHN MCCARTHY: It's the housing that's the hard part.
TRIBBLE: That's Ohio Medicaid Director John McCarthy.
MCCARTHY: Because Medicaid itself, the program at the federal level, will not pay for housing costs, meaning room and board. It will only pay for room and board for people in institutions.
TRIBBLE: If Giron participates, she will have to pay rent out of her small pension. But as part of this project, Medicaid will pay for the cost of setting up house - house hunting, deposits for rent and the purchasing of household items like furniture. And, perhaps most importantly, it provides a transition coordinator to help find a home and connect Giron to services, such as home health workers.
MCCARTHY: It is a lot of work. These are not easy cases they deal with. It's not like you just find somebody and move them. It takes a lot of time and effort to make this happen.
TRIBBLE: Many in the program are older and disabled like Giron, but most are younger than 65 with physical or mental challenges the make finding the right housing difficult. In every case, making it possible for them to live on their own will save money. In Ohio, McCarthy and his team estimate that the average cost for an individual is $49,000. Under traditional Medicaid, it costs about $64,000 annually for nursing home care in Ohio.
The state's Republican administration believes so strongly in this project that it stepped up efforts to transition people three years ago, right after the project was refunded under the Affordable Care Act. Ohio, together with Texas and Washington, account for 40 percent of the nation's home placements since the federal project began. Giron lived with her sister before a particularly bad episode of her Crohn's disease put her in the hospital. Then she needed rehabilitation at the nursing home. The staff there has deemed her healthy enough to leave, but her health demands make it difficult to move back in with her sister.
GIRON: I just want my own place. I don't want anything fancy - just something to call my own. I just want to live my life normally like most people do. I want to be on my own. I want to be happy.
TRIBBLE: Two weeks later, Giron found out she did not get the two-story house. But then she got some good news. She signed the lease on a one-story apartment just before Christmas and is slated to move in on January 1. For NPR News, I'm Sarah Jane Tribble in Cleveland.
SIEGEL: That story is part of a reporting partnership of NPR, WCPN and Kaiser Health News.
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