The Journal Gazette, 600 W. Main St., Fort Wayne IN

INDIANAPOLIS – Gladys LaBoy has taken care of her 84-year-old husband, Adelo, since he was first diagnosed with Alzheimer’s disease in 2002.

The 71-year-old Indianapolis woman helps Adelo get dressed, feeds him meals, helps him to the bathroom and stays with him at night when he’s walking around instead of sleeping. Sometimes Adelo doesn’t remember Gladys’ name, or that he’s been married to her for 35 years.

“It’s just so difficult,” she said. “When I get through taking care of him, I’m exhausted. Sometimes I just sit here and cry. I’m not feeling sorry for myself, but it hurts.”

State lawmakers say a proposed bill would help people like the LaBoys get quicker access to in-home care that most seniors prefer to nursing homes.

Currently, seniors have to apply for a Medicaid waiver to qualify for in-home care or care at assisted-living facilities. To get care in a nursing home, however, no such waiver is needed. Many seniors – and most of the state’s Medicaid long-term care funds – go to nursing homes.

The proposed legislation would allow Area Agencies on Aging to determine whether people are eligible for Medicaid waivers before the formal paperwork process is complete. Those predicted to qualify would be allowed to get in-home or community-based care before their Medicaid waivers were approved.

If a person was determined to be eligible for a Medicaid waiver but was later denied, the state would be left with the bill for the care they’ve already received, said Paul Chase, public policy director for AARP Indiana, which is pushing the legislation. But Chase said other states with so-called presumptive eligibility have error rates of less than 1 percent.

And because in-home care is less expensive than nursing homes, the state would have to have an error rate of almost 17 percent for it to be a bad financial deal, Chase said.

“By clearing bottlenecks in Indiana’s long-term care system, this legislation will help shift the entire system from an over reliance on nursing homes toward the kind of care that people want and need,” Chase said.

The Indiana Health Care Association, which represents nursing homes and other long-term care providers, supports the concept of presumptive eligibility for Medicaid waivers, association President Steve Smith said. The question is exactly where the money will come from if the Area Agencies on Aging turn out to be wrong about their predictions.

Four lawmakers – a Republican and Democrat from each of the House and Senate – joined AARP Indiana at a news conference Tuesday promoting the bill. Rep. Charlie Brown, D-Gary, said the legislation could face hurdles if it’s later determined to cost the cash-strapped state money.

But supporters said the legislation, which includes other efforts to promote in home care, is a step in the right direction. “Home care is where most people want to be unless they need that skilled nursing assistance that you get in a nursing home,” said Sen. Sue Errington, D-Muncie. “And yet Indiana is sort of upside down in where we put our priorities and our money for long-term care.”

In 2007, Indiana spent $46 million, or 5 percent of Medicaid long-term care funds, on home and community-based services, according to AARP’s Public Policy Institute. That ranks Indiana well below the national average of 27 percent, AARP said.

LaBoy, who says she’s waiting on her Medicaid application to be approved, doesn’t want her husband to have to go to a nursing home. He was in one for a few months when the couple moved to Indianapolis, and it was difficult for both of them, she said.

“He would beg me, ‘Don’t leave me in this place. I want to go home,’ ” she said. “It got so I would have to sneak away from him to leave. Every time I left there I would take 10 or 15 minutes in the parking lot to pull myself together. It was that hard on me. I’m not able to give him up.”