Skip to main content

Medical Foster Homes: An exciting alternative to Nursing home care



A frail older patient has reached the point that living independently at home is no longer possible and family are not available to provide care. You prepare to discuss recommendations for a different site of care, and as you begin to broach the topic, you immediately hear, "But I don't ever want to live in a nursing home!" Wouldn't it be nice to have good alternatives!

Assisted living often is incapable of meeting the frailer patient's needs. The Green House model is one way of de-institutionalizing care facilities by creating small communities with high level care, and worth a look if you are not familiar with them, but there is still an institutional component to them.

A truly exciting alternative from the Department of Veterans Affairs is Medical Foster Homes. Watch the recent profile on NBC's Making a Difference and you will be won over. Like foster care for children, Medical Foster Home (MFH) places frail older patients into family homes. Medical Foster Home is a type of Community Residential Care home that provides family-style living with room, board and personal care. MFH caregivers open their homes and hearts to take in one, two, or three Veterans and provide 24 hour supervision and personal assistance as needed. Every MFH patient receives care from a VA Home Based Primary Care team with in-home medical care, oversight, and training and support for caregivers.

The program has been in existence now for 12 years, and was the brainchild of Tom Mclure and Judy Karlins of Little Rock, Arkansas. Over 1,500 Veterans have been cared for in MFH programs in 38 states with expansion underway to 102 VA facilities in 48 states.

The key to success lies in the caregivers. Unlike many assisted living settings, each VA MFH is a small personal home of the MFH caregiver who lives there, there are no more than 3 residents receiving care, and every MFH resident meets nursing home level of care. Caregivers are paid by the veteran, but the expectation is that this is a long-term commitment. I especially like the VA's Caregiver assessment tool and think it could be useful for GeriPal Providers. Watch the NBC video above and I think you will agree with the assessment of Dr. Tom Edes, that Medical Foster Homes are "where heroes meet angels."

by: Paul Tatum (@doctatum)

Comments

Anonymous said…
This sounds like a wonderful program. Does anyone have information on availability in Southern California?
Brenda Shorkend, MA
Geriatric Care Manager

Shorkend Care Management
Shorkendcare.com
brenda@shorkendcare.com
Helen Chen, MD said…
This is a great program, but one which so far has had limited adoption in California. This may be partially because of California state licensing requirements affecting small care homes (Residential Care Facilities for the Elderly) that provide services for unrelated persons. Contact your local VA facility to see if they are participating.
Anonymous said…
Love - love - love this! I hope it can be made world wide and extended to all ageing and even terminal people. A home full of love and ability is so much more than sadly most institutions can give!
I admire your work sooooooo much! Thanks..

Popular posts from this blog

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Length of Stay in Nursing Homes at the End of Life

One out of every four of us will die while residing in a nursing home. For most of us, that stay in a nursing home will be brief, although this may depend upon social and demographic variables like our gender, net worth, and marital status. These are the conclusions of an important new study published in JAGS by Kelly and colleagues (many of whom are geripal contributors, including Alex Smith and Ken Covinsky).

The study authors used data from the Health and Retirement Study (HRS) to describe the lengths of stay of older adults who resided in nursing homes at the end of life. What they found was that out of the 8,433 study participants who died between 1992 and 2006, 27.3% of resided in a nursing home prior to their death. Most of these patients (70%) actually died in the nursing home without being transferred to another setting like a hospital.

 The length of stay data were striking:

the median length of stay in a nursing home before death was 5 months the average length of stay was l…

Opening the Black Box of LTACs: Podcast with Anil Makam

What happens in Long Term Acute Care Hospitals, or LTACs (pronounced L-tacs)?  I've never been in one.  I've sent patients to them - usually patients with long ICU stays, chronically critically ill, with a gastric feeding tube and a trach for ventilator support.  For those patients, the goals (usually as articulated by the family) are based on a hope for recovery of function and a return home.

And yet we learn some surprising things from Anil Makam, Assistant Professor of Medicine at UCSF.  In his JAGS study of about 14,000 patients admitted to LTACHs, the average patient spent two thirds of his or her remaining life in an institutional settings (including hospitals, LTACs and skilled nursing facilities).  One third died in an LTAC, never returning home.

So you would think with this population of older people with serious illness and a shorter prognosis than many cancers, we would have robust geriatrics and palliative care in LTACs?  Right? Wrong.

3% were seen by a geriatrici…