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"I Don't Belong in a Nursing Home" Planning to Go Home

    1. My family thinks I need to be in a nursing home!
    2. How Much Does it Cost?
    3. How Does it Work?
    4. Who can I ask about this?
    5. What am I Going to Live On?
    6. What if it’s late and my attendant doesn't show up?
    7. What if the person working as your personal attendant is somebody you just don't trust?
    8. What if you fall but you can't get up?

1. My family thinks I need to be in a nursing home!

Your family probably wants what is best for you. Maybe they haven't heard the good news about attendant/personal care services that are available under Medicaid in D.C. Attendant services are most of what people get in nursing homes and they are available to people in their own homes under Medicaid. You don't need to be in a nursing home to get help with things like getting in and out of bed, getting dressed, going to the toilet, bathing and eating, called ADLs or Activities of Daily Living. You can also get help with taking medications, meal preparation and keeping up with housework, called Instrumental Activities of Daily Living. This is your choice. Even if you need a little help, nobody but you should make the choice for you. You are the expert on what you want and need.

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2. How Much Does it Cost?

If you are on DC Medicaid and your income is $604 per month (SSI) or less, you do not pay anything for attendant services. If your income is up to $1,812 per month (=300% of SSI), you should apply for the DC Elderly/Physical Disability Waiver and you do not have to pay for the attendant services under the Waiver program (see below).

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3. How Does it Work?

Attendant services can be provided in your home by people called personal attendants who do that for a living. Attendants work for agencies but they are assigned to work for you and they do things the way you want them done. The agencies are paid by DC Medicaid for the services provided. Under the DC Medicaid State Plan, everyone on SSI (=$579 per month or less) who receives DC Medicaid is entitled to a maximum of 8 hours of attendant-Personal Care Aide Services daily if s/he is assessed in need of a "nursing home level of care" which means assistance with at least two of the daily tasks mentioned above and three of the other tasks. The annual limit for these State Plan services is 1,040 hours of attendant services, after which the doctor may order more hours and Medicaid authorizes additional hours.

Additional attendant services are provided under a program called the Elderly and Physical Disability Waiver managed by DC Medicaid. Under the Waiver, you can get up to 16 hours of attendant services daily if you are assessed and you need them. Other services are also offered under the Waiver to assist people with chores, housekeeping, and meal preparation.

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4. Who can I ask about this?

Ask your social worker at the nursing home. Call one of the case management agencies to assess your eligibility for the Waiver services. Or call DC Medicaid at 202-442-9055. Call Marjorie Rifkin, 202-547-0198 ext.112 (University Legal Services), or Bobby Coward (DIRECT Action) at 202-397-1668.

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5. What am I Going to Live On?

If you live in a nursing home now, your Social Security checks go to the nursing home and you get about $70 a month to spend. When you live on your own, you get to keep the whole check, which you'll have to spend on rent, food and other living expenses.

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6. What if it’s late and my attendant doesn't show up?

Agencies that provide attendant services should send backup services in those situations.

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7. What if the person working as your personal attendant is somebody you just don't trust?

You can request that the agency send you another attendant to work with.

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8. What if you fall but you can't get up?

Everybody needs to be able to communicate in case of an emergency. Some people use portable or cell phones, others use a gadget called Personal Emergency Response System (PERS) where people are on duty 24 hours a day to help.

This document adapted with gratitude from material by the Topeka Independent Living Resource Center.

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