Medicaid Beneficiaries Who Need Home and Community-Based Services: Supporting Independent Living and Community Integration

Mary B., Age 72, Kernersville, North Carolina

Medicaid HCBS enable senior with dementia to return home.

When Mary was diagnosed with dementia a couple of years ago, she decided to move into an assisted living facility. Since then, her dementia has worsened. Mary can remember her name and birth date and recognizes her daughter, Karen. She sometimes remembers the current date and day of the week. Mary also has renal failure, diabetes, and a history of high blood pressure and strokes. Mary uses a wheelchair if she needs to do a lot of walking, and at other times, she uses a walker. Mary is dually eligible for Medicare and Medicaid, which pay for her doctor visits and medications.

Waiver services help me take care of my mother better and make her life as comfortable and easy as possible.”
-Mary’s daughter, Karen

Some time ago, Mary asked Karen if she could return home to live with her. Karen agreed, and Mary spent about a year on the Medicaid HCBS waiver waiting list because services needed to be in place before she could move. During the time that Mary was waiting for services, Karen says that Mary was eager to come home. Karen felt badly because Mary would ask whether she could come home yet, and Karen would have to say no. Karen describes the wait as “kind of stressful.”

About two weeks ago, everything “fell into place,” and Mary was able to move into Karen’s apartment. The waiver provides 47 hours of home health aide services per week for Mary while Karen is at work. The aide helps Mary with preparing breakfast and lunch, dressing, and bathing. The waiver also paid for Mary’s bedside commode, bath bench, and wheelchair and provides supplies, such as pull-ups. Mary is currently on a waiting list for home-delivered meals, and Karen was told that that wait will be about a month. Karen also is looking into a day program for Mary through the waiver.

Karen believes that Mary is receiving better care at home than she did in the assisted living facility. She feels that the home health aide provides Mary with “more one-on-one attention” and that Mary is “receiving the correct attention” at home. At the assisted living facility, Mary had some falls, including one resulting in a bad gash on her forehead, because no one was around to watch her or help her use the bathroom.

Karen takes Mary out to family dinners and trips to the zoo. They spend a lot of time sharing stories and jokes and doing crossword puzzles with each other and Mary’s aide. Besides the services provided by the waiver, Karen provides additional care for Mary. She takes her to the bathroom every two hours overnight, helps with her personal hygiene, prepares her dinner, and helps get her ready for the day. Karen says that she is happy to have her mother at home because she gets to spend more time with her, and having waiver services has made Mary’s return home possible.