Commentary: Time to save a health care program that best serves our elders

Closeup of young hands holding older hands

Choices for Independence allows seniors to stay at home and not in congregate care where the COVID virus is flourishing. (Getty Images)

Imagine if, during this pandemic, you had the power to design a system to protect New Hampshire’s elderly residents. You would design a system that gave them choices on how to respond to their health care needs and allowed them maximum independence until the end of their lives. A system that minimized congregate care and maximized seniors living in their own homes. A system that would keep stress off overburdened nursing homes by enabling many of those individuals to remain in their own homes, and allowing hospitals to move their patients into nursing home care. 

Wouldn’t it be wonderful if such a system existed? Well, it does, and it’s called Choices for Independence. CFI is a Medicaid waiver program that gives low-income seniors the choice of receiving nursing home level care in their own homes. It is voluntary and costs a fraction of the cost of residency in a nursing home. More importantly, it allows seniors to stay at home and not in congregate care where the COVID virus is flourishing. Here is a personal story about the impact this program has on one individual and her family: 

Diagnosed with a severe and persistent mental illness in her early 20s, my aunt’s health care has been nothing short of complicated. Over the last three decades, she has cycled in and out of hospitals for both medical and psychiatric care. However, she does have periods of time when she is able to thrive in her community. And she is only afforded those opportunities when she is has the right care surrounding her, for which CFI is imperative.

For the last couple of years, she has had the same CFI home aide. With a smile, she greets my aunt every day. She takes care of her personal hygiene and living space. Later that same day, she returns to help her clean up and wrap up her day. If it were not for this patient, caring support, my aunt would be institutionalized in a facility far from family and other necessary community services.

This is just one of many success stories that CFI providers like Ascentria and Waypoint hear from families and our dedicated staff regularly. But, as much as this option is a win-win – for the individual, the family, the community, and the state – this in-home nursing home level of care is at risk of disappearing because the current CFI reimbursement rate is simply too low. Although both the providers mentioned here – and others – are impacted by low CFI rates, let’s look at one agency in depth. 

Waypoint, which serves nearly 800 older adults through its Home Care program, currently pays its CFI caregivers wages that are well below those of retailers and fast-food restaurants. Waypoint has not been able to hire new workers in months and has lost 30 workers from the Home Care program this year alone, resulting in a growing waiting list of people with growing need.

Waypoint’s Home Care budget is $2.3 million a year, and of that amount, nearly $700,000 needs to be raised through a combination of grants, events, endowment transfers and losses, to make the program whole. This is unsustainable for Waypoint. Since the beginning of the 2021 state fiscal year, CFI providers have been advocating for higher reimbursement rates from the state, meeting with legislative leaders and the leaders of the Department of Health and Human Services, to inform them that CFI providers can’t continue subsidizing the losses they incur when they provide CFI services. It is simply not possible.

We know that our leaders share the goal of ensuring that seniors in our state get the care they deserve, through a system that costs one tenth of what it costs to keep them in nursing homes. This is a system of care and compassion that allows individual caregivers to develop bonds with those they serve and for whom they become like extended family. It is not too late to save CFI if we do it now. And not just because it’s the season of doing good, but because it’s the good, right, and humane thing to do.

Our stories may be republished online or in print under Creative Commons license CC BY-NC-ND 4.0. We ask that you edit only for style or to shorten, provide proper attribution and link to our web site. Please see our republishing guidelines for use of photos and graphics.

Borja Alvarez de Toledo
Borja Alvarez de Toledo

Borja Alvarez de Toledo is president and CEO of Waypoint in Manchester.

Amy Moore
Amy Moore

Amy Moore is program director at Ascentria Care Alliance in Concord.