Originally published in The Providence Journal on May 19, 2017

By Alison Croke

I have such vivid memories of my grandmother. We called her our “Nanny”, and she loved to go line-dancing, play cards, swim and travel. She was a strong, independent, willful woman who always seemed in control of her own destiny. After her husband, my grandfather, died, Nanny poured her considerable energy into supporting my mom and our family.

Years later, when it was our turn to support Nanny, I remember how hard it was to help her live independently in the home she loved. It felt like there were few resources for us as caregivers. Ultimately, my family felt it was the safest choice for Nanny to give up her house and move into a long-term care facility.

I think about my Nanny every day, not only because of the role she played in my life, but also because I’m now developing strategies to help families like mine — people who want to help their loved ones live independently, but lack the information and resources to make that happen.

Right now, 80 percent of every dollar spent on long-term care in Rhode Island goes to institutional settings such as nursing homes; the other 20 percent supports people living independently in the community. Neighborhood Health Plan of Rhode Island and our partners believe we should transform the way our state takes care of its oldest residents, moving away from that 80-20 split and closer to 50-50.

It’s critically important that people have the power to make choices. If you want to live independently, Neighborhood can support that decision. And when you require the level of care available in a nursing home, Neighborhood offers access to an excellent network of high-quality facilities in which we are also making big investments.

As we re-balance our long-term care spending, Neighborhood is working with our partners to develop a suite of options to support our state’s seniors — and the caregivers on whom they rely.

Driving our work are four distinct goals:

• Lowering overall admission rates to hospitals and nursing homes.
• Helping people live at home when it’s safe for them to do so.
• Reducing the length of time people remain in nursing homes post-rehab.
• Saving taxpayer dollars with creative contracts with provider partners.

Over the past three years, Neighborhood has made encouraging progress on all fronts. As the state’s exclusive partner in the Integrated Care Initiative, it has launched two new health plans specifically for Rhode Islanders who are eligible for both Medicare and Medicaid benefits. Neighborhood conducts health risk assessments for all of those members and connects them with personal care managers when needed.

Since late 2014, Neighborhood has transitioned close to 650 Rhode Islanders out of nursing homes and back into independent living — or helped them avoid long-term stays altogether — by proactively addressing their health- and social-care needs and connecting with interpreters, transportation, in-home care and much more.

Going forward, Neighborhood has an ambitious strategy to introduce still more innovations to the state’s long-term care continuum. Among our plans:

• Supplement current Adult Day Care programs with Adult Night Care, providing caregivers with a safe place for their elderly loved one during limited evening hours.
• Support shared living arrangements in which caregivers can receive financial assistance when their elderly family member lives with them.
• Develop availability for on-site medical professionals to be based in senior housing, successful elsewhere in New England, as such programs make it easier for older citizens to live in group housing, such as high-rises.
• Enhance access to respite programs to offer a break for adult children who care for their elderly parents as well as their own children.

If my family had access to resources like these, I have no doubt we would have been able to delay my Nanny’s entry into a nursing home. Eventually, moving to a long-term care facility may be the most appropriate choice for our loved ones. But until that moment comes, we owe it to them, and to our fellow taxpayers, to find better alternatives.

Alison Croke is Vice President for Medicare/Medicaid Integration at Neighborhood Health Plan of Rhode Island.