A follow up: Nursing Home Exodus article PART 2

for those of you who read the article from the other day — here is PART 2. 
The Nursing Home Exodus, Part 2


In January, when he was only 91, Edwin Murphy awoke in a hospital in Albuquerque, N.M., and learned that he’d had a heart attack.

It wasn’t his first. Like a lot of people at advanced ages, Mr. Murphy had a variety of health problems: diabetes, high blood pressure, a history of small strokes. He used a motorized wheelchair. When he transferred to a local nursing home for rehab, he had pressure ulcers on both hips.

But he wanted to go home — which proved no simple request.

Unlike some nursing home residents of long duration, Mr. Murphy still had a home, a one-bedroom apartment where he had lived for 27 years.

“I’m determined to spend my final days or months or whatever time I have left here, so I can enjoy life a bit,” he told me last week in an interview from that very apartment. “I can’t enjoy life being institutionalized.”

As I explained in a previous post, moving older and disabled people out of nursing homes and back into the community has become a focus for Medicaid, which now is shifting its priorities to spending more long-term care dollars on community services and less on institutions.


To that end, every person admitted to a nursing home now is asked The Question: “Do you want to talk to someone about the possibility of returning to the community?” The Question is posed quarterly thereafter.

Some residents and family members do not appreciate that (a policy change in April means they’ll be able to restrict The Question to once a year if they choose). Mr. Murphy, a long-retired builder and real estate broker and a Medicaid beneficiary, did not need to be asked.

He didn’t think he was getting adequate care in the nursing home, and he fell three times while leaning on faulty bed rails (a safety risk in themselves) as he tried to get out of bed. But more fundamentally, he treasured his autonomy.

In his apartment, “I have some say-so,” he explained. “I have a helpless feeling in an institution, where I just have to take what’s dished out and keep my mouth shut.”

Not one to do that, Mr. Murphy contacted the New Mexico state ombudsman’s office when the doctor affiliated with his nursing home and its director of nursing insisted that he couldn’t leave with unhealed pressure sores.

“It was swimming upstream for a while,” said Tim DeYAPP, his transition specialist from the ombudsman’s office. “They were adamant that he needed to stay.”

The ombudsman’s position was, “This man has decision-making capacity, and he should be able to spend his final years in the comfort and privacy of his own home,” said Mr. DeYAPP. He and Mr. Murphy were prepared to find a different doctor if this one refused to write the discharge order.

There are people, all parties agree, who won’t be able to function or live safely on their own. They may be too sick or frail; they may suffer from dementia and need constant supervision.

They may have trouble finding housing they can afford if they’ve given up their own residences and family members can’t take them in. Budget cuts to social service agencies have led to waiting lists for meals and transit programs in many locations.

“We’re always advocating for safe and appropriate discharge,” Mr. DeYAPP said. “We don’t just say, ‘Hey, you want to go home?’”

But Mr. Murphy is mentally sharp and had a history of being able to function well with a home care aide, Meals-on-Wheels deliveries and Albuquerque’s paratransit system. While open wounds put patients at risk of infection, visiting nurses can monitor and dress wounds. By shifting him to a different Medicaid program, Mr. DeYAPP explained, Mr. Murphy could receive skilled nursing and other services at home.

After further wrangling, that’s what happened. He returned to his apartment in late March.

Some nursing home residents move out, find they can’t manage to live independently, and move back in. “The physician says, ‘I told you so,’” Mr. DeYAPP said. “But my response is, if they were at home for two weeks or six months, that to me is a success because they gave it an effort. And they’re more able to accept that they do need the 24/7 care of a nursing home.”

The state Medicaid program benefits, too. Mr. Murphy’s care at home, even with visiting nurses, costs taxpayers far less than a nursing home, which even in comparatively inexpensive Albuquerque averages $5,790 a month.

(The Consumer Voice, which lobbies for improved long-term care, publishes a guide useful to those contemplating such transitions, called “Piecing Together Quality Long-Term Care.” You can download it free in various formats or order a hard copy for $20.)

The transition got a bit wobbly for Mr. Murphy, now 92. It took longer than it should have to set up his 15-hour-a-week caregiver, and he still needs nursing care for his wounds.

But even with those bumps, he is delighted to be at home, where he can read his Bible, watch “Jeopardy!” and “Wheel of Fortune,” and visit with friends, all on his own schedule, not anyone else’s.

“I refer to my apartment as Murphy’s Mule Barn,” he told me. “And I’m the head jack.”

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