Care in the family
State program offers financial incentive to help elders avoid nursing home
Her paintings are of fairies and unicorns. Her memories hold far darker images.
Rockport artist Louisa Poole has never forgotten the vision of her mother, with a broken hip and suffering from dementia, strapped to a bed in a nursing home. Until recently, Poole, 69, lived independently in senior housing, despite severe arthritis, curvature of the spine, and other health problems.
But a July heart attack changed all that.
Poole stopped breathing, suffered brain damage from the lack of oxygen, and was hospitalized for two weeks as doctors warned her family that she likely wouldn't pull through. But she did. And when Poole regained consciousness, the first thing she asked her daughter was whether she would have to go to a nursing home.
The family was determined not to let that happen. Poole's only child, Mindy Cabral, a single mother of two sons, ages 17 and 20, quit her full-time job as a kayak instructor and moved her bedridden mother into her Rockport home, setting up her painting studio all around her in the cramped living room. Emotionally they were intact. Financially, they were struggling.
Then a friend told Cabral about a new state program that would pay her about $18,000 a year, tax free, to take care of her mom at home. Cabral, 49, was just accepted into the program, called Enhanced Adult Family Care.
"This has allowed us to continue to eat and pay the mortgage," said Cabral, who works part time as Rockport's dog control officer.
It hasn't been easy. Cabral sleeps on a couch by her mother's bed, so she can help Poole to the bathroom as needed during the night.
"She can't walk for any amount of time without collapsing," Cabral said. "Even before the heart attack, I was over at her apartment all of the time - it's only two blocks away - doing her shopping and stuff."
The state's Executive Office of Elder Affairs expanded its rules last December, and for the first time allowed most family members to act as home caregivers. It also increased payments to participants who are caring for more seriously ill adults.
Precisely how many families have chosen these new options is tough to pinpoint. Jennifer Bergeron, who oversees the program at the elder affairs agency, said the state has not yet compiled all of the figures. She said 200 people have signed up since December to be caregivers and to receive the state's top-tiered payment of about $18,000. But the state does not know how many participants are caring for family members and how many of those cases involve seniors.
For Cabral, the details of daily life have become much more specific, including how much medication to give her mother and what time to dispense it - she is taking at least 10 prescriptions. Under the Family Care program, Cabral keeps a daily journal of each activity she must help her mom perform, from bathing, dressing and walking to eating and physical therapy.
"Last night, we had a steak," she said. "I had to cut her steak."
After weeks of being completely bedridden, Poole's muscles have atrophied. So Cabral helps her mother with daily physical therapy, holding her mom's walker while Poole grips the handlebars and gingerly rises to her toes a few times to rebuild her leg muscles. Poole's personal care plan was developed by Gloucester-based Adult Foster Care of the North Shore, one of a network of agencies helping disabled adults find community-based care.
While many senior advocates applaud the state's rules change, allowing families to take care of their elders, they say layers of complex new guidelines, coupled with income and asset restrictions that shut out many middle-class families, have made it difficult to get people into the program in a timely manner.
"We have to look at clinical eligibility, financial eligibility, what kind of relative you are, what degree of relation are you; it gets a little challenging," said Rosanne DiStefano, executive director of Elder Services of the Merrimack Valley, which serves 23 cities and towns from Newburyport to Dunstable. So far, the agency has enrolled just a handful of families in the new program, according to DiStefano.
"Meanwhile, the doors are wide open to nursing-home care. There are vacancies," DiStefano said. "But at $60,000 a year for nursing-home care, on the average, our policies are encouraging people to take that option, because those doors are wide open and our doors are not only not wide open, they have these hurdles in front of them you have to climb over."
For more information about Enhanced Adult Family Care, call 1-800-841-2900 or 1-800-AGE-INFO.
Kay Lazar can be reached at klazar@globe.com 