As baby boomers age and the workforce shrinks, there may not be enough people or money to care for all our elders, especially those with medical needs. In many ways, that reality has already arrived in Vermont.
A small but growing number of Vermont families are easing the burden by opening their homes to elderly strangers who need a lot of care.
Robert Bousquet didn't need to be in the hospital, but he was stuck there anyway — for two months — earlier this year. "It was a nightmare. I've never cried so much in my life," said Bousquet's wife, Joan Bousquet. "I would leave him to go home and sob all the way home."
Robert has Alzheimer's. Joan brought him to the hospital dehydrated, with a bladder infection: He had been refusing to bathe or eat. The hospital treated him quickly. But Joan felt she couldn't care for him at home any longer. And, she said, none of the many nursing homes in driving distance of their rural Vermont home would take him.
Robert qualifies for Medicaid for long-term care. But Medicaid doesn't pay enough to cover the costs of high-needs patients, like those with dementia, or behavioral problems. That's why it took a caseworker two months of daily inquiries to find a Vermont nursing home that would take him.
This happens all over the country.
In Vermont, where there's already more elderly patients than there are nurses to go around, nursing homes are especially picky.
Jane Suder heads up patient management at Northwestern Medical Center, a small hospital in St. Albans, Vt. Recently, she said, six of her hospital's 34 inpatient beds were taken up by people waiting for long term care.
"We've had people here from one month to, recently, four months," she said, "I know years ago, we had someone here almost a year."
A fast-growing program in Vermont called Adult Family Care is helping.
For eight years, David Calderwood lived in a residential care facility. Calderwood has lung disease and needs help managing his many prescriptions. When his facility announced plans to close, he spent three months trying to get into another facility. Finally, he moved into Crystal Abel's home, into a bedroom with walls still turquoise from when it belonged to the Abels' now-grown daughter.
"It's like my own family," Calderwood said, although he's 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 requirements, number of residents and compensation. Many programs allow up to five residents.
Here, families like the Abels can have up to two residents move into their home. The residents pay room and board. In addition, the state pays the family between $80 and $160 a day per person, based on the complexity of their needs.
The money comes from the same Medicaid dollars that would be going to a long-term-care facility. Per person, this program costs the state less than a facility would.
Crystal Abel isn't trained in health care. Before this, she worked at the local Dollar Tree and in a school cafeteria. But says she's earning more caring for Calderwood and another man than she had been. Still, she said, "even if we didn't have the money, we would find a way to make it work. You know, I can't imagine our lives without them."
Abel helps Calderwood with bathing and meals. She divvies up his 30 prescriptions and makes sure he uses his oxygen machine. It's a 24/7 job, save for the few days a week when the men go to day programs. She and her husband even took them on a family vacation to Florida recently.
At first, Calderwood said, moving into a stranger's house felt pretty weird. But, he said, "there is an openness here, a give-and-take, which I never had before," and he's come around. Plus, he said, the Abels are a mischievous bunch, and "Oh my God yes, I love to tease."
Some advocacy groups warn that badly managed programs can lead to neglect or abuse. That does not appear, for now, to be an issue with Vermont's program. A review by Vermont Public Radio of two years of records of complaints and regulatory violations against Vermont Adult Family Care providers found no instances of abuse or neglect. All complaints appear to have been dealt with swiftly.
Participation in the program has been growing by an average of 30 residents a year: a lot for a tiny state.
As demand grows, the challenge is persuading ever more families to open their homes.