Fighting to come home


By Al Normanalnorman_headshot

Last month I wrote about a 70- year-old friend of mine with diabetes who fought to return home after a hospitalization, instead of going to a rehab. Well, it has happened again.

A 61-year-old woman from Charlestown called me last week. Let’s call her “Laura.” She is a MassHealth member. She broke her leg, and was sent to a major hospital in Boston. She spent three days in the hospital. At discharge, the staff hospitalist gave Laura a list of three rehabs, and told her to pick one. Laura didn’t know what a rehab would be like, but she picked one facility she had heard of.

When she got to the rehab, it felt to her like a nursing home—because it was. Laura went up to her room. As she entered, she saw her roommate scramble quickly to “her side” of the room and pull her curtain divider brusquely behind her. Laura remembered how her mother had died in a nursing facility, and she did not want to suffer the same fate.

Laura refused to settle into her new room. She told the hospital staff, “I don’t want to be here. Please call my son and get me out of here.” The hospital called her doctor, who said it was fine with him if Laura was insistent on going home. They put Laura in a wheelchair, and her son came and took her back to Charlestown. She did not spend a single night at the rehab.

Once home, Laura called the hospital’s case management office and made a complaint. She was angry that they sent her to a nursing home. She said she was home now, but didn’t want her son to do all the caregiving for her. The hospital sent out a home health agency (that they own) to visit Laura, and the home health agency recommended that Laura get some physical therapy (also through a service that they own).

Then Laura called me—because she had seen my column in the Fifty Plus Advocate. She said: “Mr. Norman, it’s not right what happened to me. Does this happen to other people?” I asked her two questions: “What help do you want now?” and “Did anyone at the hospital tell you about your right to free counseling on your home care options?”

I quoted for her this 10-year-old state law: “A person seeking admission to a long-term care facility paid for by MassHealth shall receive pre-admission counseling for long-term care services, which shall include an assessment of community-based service options.”  This service is available to anyone, regardless of income.

Laura said no one told her about any home care—they had just given her a choice of rehabs. And her concern now was that her son, who lives on the first floor of the house she owns, was going to have to provide all her care. I told her to call Boston Senior Home Care, and to ask about their personal care attendant program. I said her son—or another family member—could be paid to be her personal care attendant.

After Laura was enrolled as an Aging Services Access Point client, I checked in on her about a week later. She said she was doing fine, that she was starting the personal care service, and that her sister was going to be paid as her caregiver. She told me again when I questioned her that no one had told her she could have a free pre-admission counseling session, or anything about the personal care attendant program.

I told Laura that most hospitals are unaware of this law, and that many people at MassHealth are unfamiliar with it as well. I told her the hospital was not trying to hide this from her—it’s just that hospitals don’t know of this service, and their goal is to get patients into the next care setting quickly.

The MassHealth program spends 29 percent more per capita on nursing homes than the national average.

“Massachusetts has a higher rate of discharge from hospitals to nursing facilities relative to the national average,” the Health Policy Commission has stated, “suggesting an opportunity to manage post-acute care more efficiently…there are opportunities to deliver more supports in home- and community-based settings, expanding options for patients to receive care in their preferred setting while potentially achieving savings over time.”

When Laura insisted on coming home, she not only helped herself, but also helped MassHealth, which is the largest payer for long-term services in Massachusetts. It might have been a struggle if she had seen a pre-admission counselor as called for under state law.

Al Norman is the executive director of Mass Home Care. He can be reached at, or at 978-502-3794. Archives of articles from previous issues can be read at