Vermont's Adult Family Protection Program offers an alternative to retirement homes: NPR

As baby boomers get older and the workforce decreases, there may not be enough people or money to take care of all our seniors, especially those with medical needs. In many ways, this reality has already happened in Vermont.

A small but growing number of Vermont families are shedding the burden by opening their homes to seniors who need a lot of care.

Robert Bousquet did not need to be in the hospital, but he was stuck there – for two months – earlier this year. "It was a nightmare, I have never cried so much in my life," said Bousquet's wife, Joan Bousquet. "I would let him go home and I would cry to the house."

Robert has Alzheimer's disease. Joan brought him to the dehydrated hospital, with an infection of the bladder: he refused to wash or eat. The hospital cared for him quickly. But Joan felt that she could not take care of him at home anymore. And, she added, none of the many retirement homes located a short drive from their rural home in Vermont would take it.

Robert qualifies for Medicaid for long-term care. But Medicaid is not paying enough to cover the costs of patients with high needs, such as those with dementia or behavioral problems. That's why it took two months of daily surveys to a social worker to find a health center in Vermont.

This is happening all over the country.

In Vermont, where there are already more elderly patients than nurses, retirement homes are particularly difficult.

Jane Suder is responsible for patient management at Northwestern Medical Center, a small hospital in St. Albans, Vermont. Recently, six of the 34 hospital beds in his hospital were used by people waiting for long-term care.

"We have people here for a month, until recently, four months," she said. "I know that years ago, we had someone here almost a year."

A growing Vermont program called Adult Family Care is helping.

David Calderwood lived for eight years in a residential care facility. Calderwood suffers from a lung disease and needs help managing his many prescriptions. When his school announced his intention to close, he spent three months trying to enter another school. Finally, he settled in the house of Crystal Abel, in a bedroom with walls still turquoise of the time where it belonged to the now adult daughter of Abels.

"It's like my own family," Calderwood said, although he was not related to Abel or her husband.

About a dozen states have similar programs. Many are called "Adult Foster Home Care". They differ greatly in terms of eligibility and licensing, number of residents and compensation. Many programs allow up to five residents.

Here, families, like the Abels, can accommodate up to two residents. Residents pay for lodging and meals. In addition, The state pays the family between $ 80 and $ 160 per day per person, depending on the complexity of their needs.

The money comes from the same Medicaid dollars that would be paid into a long term care facility. Per person, this program costs less to the state than an installation.

Crystal Abel is not trained in health care. Previously, she worked at Dollar Tree and in a cafeteria. But says that she is gaining more care for Calderwood and another man than she was before attending the program. Nevertheless, she said, "even if we did not have the money, we would find a way to make it work, you know, I can not imagine our life without them."

Abel helps Calderwood take bath and meals. She divides her 30 different prescriptions and ensures that he uses his oxygen machine. It's a job 24 hours a day, 7 days a week, save a few days a week when guys go to day programs. She and her husband even recently took them on a family vacation to Florida.

At first, says Calderwood, moving into a stranger's house was rather strange. But, he said, "there is an opening here, a compromise, which I have never had before," and he returned. Plus, he said, the Abels are a mischievous group and "Oh my God, yes, I like to tease."

Some lobby groups warn that poorly managed programs can lead to neglect or abuse. This does not seem to be a problem for the moment with the Vermont program. A two-year RVP review of complaint files and regulatory violations against Vermont Adult Family Care providers revealed no cases of abuse or neglect. All the complaints seem to have been dealt with quickly.

Participation in the program has increased on average by 30 residents a year, much for a small state.

As demand grows, the challenge is to convince more and more families to open their homes.