Local HCBS Program Provides Alternatives to Nursing Homes


Under a pilot project set to begin shortly, some Tucson-area long term care patients will find that they are able to receive financial assistance in supportive residential complexes. The Arizona Long Term Care System (ALTCS) is set to begin placing patients in apartments at Villa Maria in Tucson, with additional centers likely to be added in the next few months.

Most people familiar with programs available for the elderly and disabled are aware that nursing home care is subsidized by Medicaid (or, in Arizona, the ALTCS program). Less familiar to many is the Home and Community Based Services (HCBS) program. HCBS permits subsidies to be paid for other levels of care, which means that at least some patients receive care in less institutional settings. In fact, some patients already receive HCBS services in their own homes.

Federal law restricts the number of HCBS recipients in the state to 40% of the total number of patients served. The Tucson area has approximately 2400 ALTCS patients enrolled; nearly 900 of them are served through the HCBS program. By far the largest group of those patients receive care in their own homes.

Among the services available for a qualified home-care recipient are attendant care, home health nurses and aides, meals, home modifications, and the Lifeline emergency alert system. Although attendant care is one of the available components, it is effectively limited in most cases to about 40 hours per week (or less); the calculation of that limit is based on the comparative cost of nursing home care and home care, rather than the level of the patient’s need.

Already in place are provisions for two other levels of care: HCBS recipients can be cared for in adult foster care homes or adult care homes. In both cases, the facilities must be licensed. Adult foster homes (there are currently 53 licensed to provide ALTCS services in Tucson) can house up to four residents. Adult care homes (of which there are currently 19 in the Tucson area) can house up to ten residents.

Under the newly-created program, however, patients may be placed in assisted living facilities, known as “supportive residential living centers.” Placements are expected to be available within the next few weeks; officials expect the apartments at Villa Maria Geriatric Care Center to be the first to be licensed under the new program.

Under the new rules for supportive residential living, HCBS recipients may live in their own apartments or share space with a spouse or other family member. The licensed facilities will provide full-time nursing, personal care, housekeeping and laundry services. In addition, meals and social activities must be provided.

A key element of all HCBS services is that ALTCS’ costs must be substantially lower than nursing home costs for the same patient. In fact, ALTCS usually requires that the alternative placement cost the agency no more than 80% of what a nursing home would cost.

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