The first of the baby boomers turned 65 at the beginning of January. As the population ages, state and federal agencies are putting more emphasis on developing innovative ways to provide quality care for the elderly.

One of the areas they are focusing on is how to increase support for family members and friends who are already caring for elderly or disabled loved ones.

An in-home care program for veterans that was piloted in New Jersey has since spread to 14 states and is in development in about two dozen more this year, including Pennsylvania. The Veterans Directed Home and Community Based Services program follows the “cash and counseling” model, which means people who need care are given a set amount of money to use however they want: to pay friends or family to care for them or drive them to appointments, have meals delivered, or modify their homes to make them accessible.

 Keeping care in the family

Sebastian Pagano, 60, has multiple sclerosis and spends most of his time in a hospital bed set up in the den of his home in Warren, N.J. When he needs his son, he just pushes a doorbell that is hung on the wall within arm’s reach.

 “Where are you going to get that? Where are you going to get that!," Sebastian exclaimed when it works, as usual, and his son appears.

 A little over a year ago Sebastian says he spent most of his time on the green couch across from his hospital bed.

 "I couldn't care if I lived or died,” Sebastian said. “It really didn't matter."

 Last fall he enrolled in the in-home care program offered by Somerset County and the Veterans Administration. He uses the sum of money he is allotted to pay his son to care for him full-time and run the house.

 "You can pay anyone you want, so I pay my son,” Sebastian said. “I have a 24-hour [a day] nurse that's being paid for 40 hours [a week]. It’s a beautiful thing.”

 Sebastian said he has no idea where he would be if he couldn’t pay his son to care for him. But according to Anthony, they couldn’t afford for him to stay home full-time for long, and before they found the VA program he was looking into nursing homes for his father.

 "I was looking into options,” Anthony said. “I didn't want to tell him, because it would have upset him, and that's the last thing that any of us want for him."

 Through regular VA services, Sebastian also has a nurse practitioner come to his house, and she helps schedule visits with psychologists, eye doctors and other specialists. Sebastian said having that support network has given him a renewed will to live, and Anthony said the change in his father was noticeable.

 "With this program I've seen him come alive,” Anthony said. “He’s grateful and he has hope."

 

 A cost-effective alternative to a nursing home

 

Though coordinating this kind of care takes a lot of work for health and community workers, it can be a cheaper way to meet the needs of an aging population. A Somerset County official estimated that in-home care costs less than half as much as a nursing home. Mary Naylor, a professor of gerontology at the University of Pennsylvania School of Nursing, said she thinks these kinds of care models will grow in the future.

 "This notion of flexibility,” Naylor said, “both in the design of systems and in this case payment to the people who are taking on the yeoman's responsibility for their mom, their dad, sister, brother, I think is absolutely and should be a part of our future."

 As baby boomers age and in-home healthcare technology improves, there has been an increase in demand for in-home care services and fewer healthcare workers to provide it. The so-called "cash and counseling" model that the VA program uses started with Medicaid and started to be broadly instituted about four years ago. A long-term study on the model showed that it decreased the number of people who had to go into nursing homes and improved quality of life.

 "It really opened our eyes to the possibilities that families could play,” Naylor said, “and should be recognized for the role that they're playing in addressing loved one's needs."

According to Naylor it is important to constantly assess people who are getting in-home care to make sure their needs are being met. Sometimes, as the care required gets more complicated residential facilities become a better option.  Moving forward, Naylor says the challenge with models like this one is in scale: figuring out how to efficiently co-ordinate in-home care services and hospital stays for what she calls a tsunami of older adults who will soon need them.