Legislators told TennCare Choices creating barrier to nursing homes

A TennCare process for deciding who qualifies for nursing home care came under fire at a legislative hearing Thursday when people complained about a program called Choices creating barriers, reports The Tennessean.

Choices gave families the option of deciding whether to put a loved one in a nursing home or get state assistance to provide at-home care when it was launched in 2010, but the program has evolved. Last year, it launched a new rating score for determining who qualifies for skilled nursing care. That system rates people according to deficiencies of daily living, such as whether they are able to walk or feed themselves. People are falling through the gaps because the scoring system is flawed, according to testimony before the Senate Health and Welfare Subcommittee.

Carol Westlake, the executive director of the Tennessee Disability Coalition, told about the plight of a Jackson man denied a nursing home slot even though he was paralyzed on one side from a stroke, in a wheelchair and unable to give himself insulin shots to control diabetes.
She said the new evaluation system and appeals process create lengthy delays for families when they are desperate for help.

“You need a process that works efficiently and effectively at the moment in which you need that,” Westlake said.

Patti Killingsworth, an assistant commissioner with TennCare, said the bureau is working to address the concerns raised.

…Since the launch of Choices, the number of people in home- or community-based care other than nursing homes has risen from 5,000 to 13,000, Killingsworth said in her testimony.
The cost can be half or a quarter less than the expense of nursing home care, she said.

“While 40 percent of our members are now receiving their services in home- and community-based settings, we still spend roughly 80 percent of the funding on institutional care,” Killingsworth said.