RESUMO
This paper covers the possibilities of organizing community services and obtaining funding to make small group homes available to the poor. Statistics show that many frail elderly in nursing homes could function well in less protected environments if transition options for housing and services were available, such as the small group home, which fosters self-direction and "mainstreaming" of older persons in an age-integrated community. It fills a major gap in the continuum of health services at about 2/3 the cost of nursing home care. Only a few states are experimenting with alternative Medicaid regulations which permit payment for health related services, maintenance, homemaking and ADL assistance. None are known to be testing the small group home concept. Thus many older persons requiring some services must be institutionalized, although there may be no need for intensive nursing care or 24-hour supervision. The poor older person's choice, in particular, is restricted by Medicaid regulations. Demonstration small group homes are proving both cost and care effective. Home Care Research in Frederick, Maryland has several such homes. Such alternative "family style" living, with health related services, should be made available to all persons who qualify, regardless of income.
