What's Working

No Place Like Home
Program Helps Transition from Facility to Community

  What's Working - Summer 2013 - No Place Like Home

Ed Milewski

Video Camera Health in Motion – watch our grantees tell their own story!

By Sandy Graham
Photography by James Chance

Ed Milewski's recumbent tricycle occupies center stage in the Boulder resident's compact, one-bedroom accessible apartment.

The sleek, 27-speed vehicle in the living room is both a symbol of Milewski's independence and a reminder of why he is there. On May 5, 2008, he was turning back from a bicycle ride near Morro Bay, Calif., when a car hit him. He awoke from a coma 26 days later. The man who had completed 11 "centuries" – each a 100-mile bicycle ride in a single day – had to learn to walk again.

His many injuries still make it difficult for him to speak, smell, taste, swallow and balance. For some, coping with such issues would mean life in a nursing home. Not Milewski.

With help from Boulder's Center for People with Disabilities and through the federal government's housing voucher program for low-income, elderly and people with disabilities, he moved to the apartment in 2009 after nearly a year in a Colorado nursing home. He uses the TerraTrike and the public bus system to get around, cooks his own vegetarian meals, reads (recently, "The Empathetic Civilization," by Jeremy Rifkin) and listens to music.

"When you're in a nursing home, you just fall apart," says Milewski, 64, who worked before the accident as a caretaker at a Buddhist center in California. "Everything is done for you. It's no way to live. I wasn't going to spend the next 30 years there."

Milewski is pleased that Colorado has received a five-year, $22 million federal grant that will give roughly 490 Medicaid clients the same chance he had. The new effort, Colorado Choice Transitions, will move people from long-term care facilities into home and community-based settings. It expands on Medicaid's and Colorado's earlier efforts to foster choice in living situations. It also will provide enhanced support services such as nursing care or meals. Greater independence is just one plus: Without round-the-clock institutional overhead costs, community care costs about half of the $60,000 Medicaid pays for a year of nursing-home care.

"It's a win-win," says Milewski, a consumer representative on a subcommittee of Colorado's Long-Term Care Advisory Committee and the Community First Choice Council.

The Transitions program is not for everyone, notes Tim Cortez, supervisor of the long-term care reform unit in the Colorado Department of Health Care Policy and Financing.

"I'd say the key determining factor is the client who has expressed an interest in moving back to the community," Cortez says. "They work with a transition coordinator who makes sure they know what it means for them to no longer live in a 24/7 care setting and ensure there are community supports to help that person achieve greater independence."

The new program is being instituted statewide, and the state is working with communities to develop the support services and accessible housing opportunities needed to assist transitions, Cortez says. Historically, home- and community-based services were paid by state and federal funds equally. Now, Colorado receives an enhanced federal match of 25 percent. The extra 25 cents per dollar spent on these services will go into a fund to expand services and supports available to clients statewide – an estimated total of $4.5 million through 2016.

"It's helping the system become a little bit better at helping people who want to move back into the community," he says.

Milewski moved to Colorado because his daughter Kristine lives in Lafayette. He feels lucky that a social worker in the nursing home gave him a pamphlet about the Center for People with Disabilities and its Community Transitions Services program. He continues to work on walking with the help of health care aides who come for an hour each morning and evening. A nurse and housekeeper also come weekly. The trike will move to his apartment building's parking lot once he has saved enough to buy a bicycle locker.

"Just like the Energizer Bunny, I keep going and expanding my parameters," he says.