VA Maryland Health Care System
VA Maryland’s Alternative to Nursing Home Care
When Army Veteran Andrew Cornelius Harris, 94, began experiencing memory loss, his wife of 58 years Ester, 78, took care of him. Then after a bout of pneumonia in 2013 that landed him at the Baltimore VA Medical Center, clinicians - noting Ester's own struggles with aging - suggested that the couple consider moving Mr. Harris into a long-term care facility. Ester resisted.
"My husband can do a lot more," she told the clinicians. She added that they were not seeing him at his best because the pneumonia made him weak, and that when he wasn't sick, he possessed a great deal of physical independence. "I knew he did not belong in a nursing home," she said.
After his discharge from the hospital, Ester continued to care for her husband at home. He recovered from the pneumonia and returned to his independent self, but, unfortunately, the signs of dementia increased. Ester soldiered on, caring for him alone, until fatigue began plaguing her, and she realized she could not continue on alone without compromising her own health. "I was tired. I prayed about what to do, for a solution to our problems, because I reached the end of my rope," she said.
That's when she called VA clinicians asking for assistance that did not involve moving her husband into a long-term facility. "Something had to be done, but putting him in a nursing home was not the answer because he's still independent. We just needed a little bit of help."
Enter Nicole Trimble, MSW, a VA Maryland Health Care System social worker armed with information about an initiative known as a Medical Foster Home.
"I knew as soon as I walked in [to the medical foster home] that this was the answer to all my prayers. This proved to be the best choice for us," Ester said. "It's about a 10-minutes' drive from our house, and I can get there easily. My husband is still independent but he's getting the assistance he needs, and we still talk to each other every day. He phones me, or I phone him, and also, our family members can visit anytime they want." Family members can do more than visit. They can pick up Harris and take him to his own church on Sundays where he remains active, and they can take him to family activities and events, excursions that keep him involved in family life.
For Veterans enrolled in the VA Maryland Health Care System's Home Based Care Primary Care Service who prefer a home care setting, a medical foster home provides an alternative to institutional nursing home care. "If they are not already enrolled in the Home Care Based Primary Care Service, if they are eligible, we make sure that they become enrolled," said Trimble.
This enables Veterans to continue to receive their care from VA while remaining in the community for as long as possible. Located in private homes - Medical Foster Home trained care providers are the home owners who meet all state licensing and federal inspection requirements. Medical Foster Homes serve only a few individuals, and Veterans living in them are never left alone since the Medical Foster Homes are in operation 24 hours a day, 7 days a week. Caregivers help the Veterans conduct activities of daily living such as bathing and dressing. Some, but not all, residents are Veterans, although VA inspects and approves of all Medical Foster Homes and ensures that the caregivers are trained and equipped to provide VA planned care.
The Little Rock VA Medical Center piloted the initiative in 1999. Based on its success, two other VA facilities - Tampa Fla., and San Juan, P.R.—implemented Medical Foster Home programs in 2004. Afterward, the program spread. The VA Maryland Health Care System hired its first Medical Foster Home Coordinator and was officially recognized as a program in 2010.
"Adult medical foster home models exist in the community, too, but it does not appear that those community programs provide the medical oversight that the VA provides with the Home Based Primary Care Services," Trimble said.
"Medical Foster Homes keep Veterans in the community, which is so important and they are treated as if they are family members," said Trimble, who oversees the Medical Foster Home program for the VA Maryland Health Care System. "We match Veterans to the care providers and to the other residents in the home so that they are all compatible," she added.
Trimble and other VA social workers help Veterans and their family members determine if a Medical Foster Home is the right choice for them. They also help determine what level of assistance is needed for daily living, how much independence and privacy they need or want, what sorts of social interactions they consider important, and also what cost and level of care can they afford per month.
"Often by meeting with the caregivers and seeing the homes, family members are immediately put at ease with the notion that Medical Foster Home is the right alterative for their loved one," Trimble said.
For trained care providers like Wanda Williams, who operates a Medical Foster Home in her Catonsville dwelling, being able to provide care to others in her own house is a dream job. A longtime care provider in institutional settings, she found her calling as a young woman first helping her mother and then taking over care duties for a disabled brother. While working in an institutional setting, Williams always felt that she could better serve her patients with the same dedication and skill she used to care for her brother in a more residential setting. A coworker at her previous position gave her the information about establishing a Medical Foster Home, saying this innovation seemed like the perfect fit for her. Williams agreed, and after researching the requirements, she renovated her home to meet the criteria necessary to transform it into a Medical Foster Home.
As a licensed and trained care provider, Williams keeps detailed notes and medical records required by state law and federal regulation, and she ensures that resident Veterans in her care attend the various appointments and activities in their treatment plans. Care givers coordinate meals, activities and outings. Family members, who can visit anytime they want, also can pick up their loved ones to take them to family events and outings.
"I love what I do," said Williams. "I'm helping others, I don't have to travel to go to work, and I feel great satisfaction knowing I'm helping others."
For the Veterans and their families who can visit anytime they want, Medical Foster Homes can help them access the assistance they need without diminishing their worlds or their roles in the community.
"It's nice here. Wanda is like family," Ester said.