A New Home. A New Hope.

Fred was only in his 60s when he suffered a stroke and ended up in a nursing home. For 10 years, he had lived on his own in the Houston area, even as he struggled with alcohol addiction and mental health issues. He received support from his sister, but when he forgot to take his medications, it often led to behavior problems, which occasionally became brushes with the law.

When Fred entered the nursing home, he was unable to walk, dress or groom himself. He suffered from dementia and aphasia, an inability to communicate often caused by stroke. To many, it looked like he would spend the rest of his days there.

But Fred’s sister, Ann, didn’t see it that way. “She wanted to get him out and was very adamant about his receiving physical therapy,” said Toi Phillips, a registered nurse and service coordinator with UnitedHealthcare Community Plan.

With Ann’s help, Fred worked hard to recover his physical and mental health. After nearly two years, he had made a 95% recovery. “He still had some dementia and blood pressure issues, but he was functioning at a much higher level than was appropriate for nursing home care,” said Phillips.

Fred asked to leave the nursing home, which meant he had to select a managed care organization. With help from his sister, he chose UnitedHealthcare Community Plan, and Phillips enrolled him in the STAR+PLUS waiver program. 

When Fred became a Community Plan member, Phillips and her colleagues, Demetria Carrier and Rosalinda DeLeon, started looking for a safe, affordable placement for him. The three compose the Harris County Money Follows the Person (MFP) program, which works to move qualified Medicaid recipients out of nursing homes and into the community.

Despite Fred’s impressive recovery, Phillips knew it would be hard to find a place willing to take him. “He had a lot going against him, including a chart that documented his past behaviors and encounters with the judicial system,” Phillips said. “He also had cognitive limitations and no income.”

Like Ann, however, Phillips was determined to help Fred. “Everyone wants to be as independent as they can,” she said. “It’s my job to advocate for my members so they can have the most freedom and independence, while also getting the safest level of care.”

Phillips knew Ann was protective of her brother, so she focused on facilities that would meet her standards. “I know which places are the better ones in the area, so I gave her a list of ones I thought she’d like,” Phillips said. “She picked one, and I talked to the folks there and encouraged them to give him a chance.” The facility agreed to take Fred at a rate covered by his plan. 

The result? “The change has worked wonders,” said Phillips. “When you see him now, he looks like a new person. He gets up and gets himself ready for the day. There’s a bus that takes residents out for shopping and events, and he can leave for a few weeks to visit family without losing his bed – those are things that don’t happen in a nursing home. At the same time, he has the supervision he needs to take his meds on time and eat three meals a day.“

The new arrangement has also made life easier for Ann. “The nursing home was 50 miles from her house, and she thought it was her duty to visit her brother every day,” said Phillips. “Now she can get back to spending time with her husband and grandchildren.”

For Phillips, helping members return to the community is a reward in itself. “I’ll tell you, it’s like Christmas to see their joy,” she said. “It’s good for our members, their families and for us. It’s just a good feeling all around.”