- Associated Press - Saturday, April 15, 2017

MISHAWAKA, Ind. (AP) - At 73, Janice Ramsey’s legs and feet have been giving her more trouble. An old problem with swelling, or lymphedema, made it hard to hobble around her house in Elkhart to sweep and cook.

“I’ve fallen a couple of times,” she said, unable to keep her balance.

She searched for an assisted living apartment, looking for ones that accepted payment from the government’s Medicaid waiver for people with low income. The closest she found in Elkhart County was in Goshen, putting her farther from family and friends.

Just over a year ago, she moved into the Vannoni Living Center in Mishawaka, thinking that family and friends would be more likely to visit if they’re in the area to shop. A few of them have.

Ramsey’s move across the county line points to the growing demand for assisted living, particularly for people who hold Medicaid waivers. Developers are responding with new apartment complexes around Indiana, most recently in Mishawaka, where they are seizing opportunities for government financing.



That’s a healthy trend since “far fewer” of the local assisted living apartments accept Medicaid, said Becky Zaseck, president and CEO of the nonprofit REAL Services, which serves area seniors.

The following three assisted living complexes wouldn’t have come about without Medicaid waivers, say their organizers. A Greek-American men’s society, called AHEPA, plans to build a 136-unit assisted living apartment building at the northeast corner of Dragoon Trail and Logan Street. Vermilion Development of Chicago plans to build yet another assisted living complex with 119 units on Hickory Road, just south of Edison Road.

Mishawaka’s city council approved rezoning for those two projects in February and March.

The Mishawaka Housing Authority hired staff to create the Vannoni Living Center in 2012, now with 39 units for assisted living out of the 113 total apartments in its River View 500 building at 500 Lincoln Way E., on the eastern edge of downtown.

But state officials suggest the assisted living trend has more to do with an aging population, rich or poor.

“I don’t think you can credit Medicaid waivers with driving that growth,” said Debbie Pierson, deputy director of the Division of Aging within the state’s Family and Social Services Administration.

Clients with the waivers make up a minority of the people living in assisted living, Pierson said. The rest are people paying out of their own savings or long-term care insurance.

Indeed, a South Dakota company finished an assisted living complex on Mishawaka’s far south side in 2015, though, unlike the others mentioned, it doesn’t accept the Medicaid waiver. Primrose Retirement Community is just northeast of the St. Joseph Valley Parkway and the Bremen Highway.

Also, Pierson said, only about 12 percent of Medicaid waivers are used for assisted living. The rest pay for “home and community-based services” that keep people in their homes, like meal deliveries, transportation, adult day care and help with cleaning, bathing and cooking.

Indiana removed a wait list for the Medicaid waivers in 2013, and that has led to 63 percent more people being served by the waivers now, Pierson said.

Nursing home care tends to cost much more than assisted living and other home-based care. Still, Indiana spends more on nursing home care.

The state’s focus, Pierson said, isn’t as much about controlling costs as it is about serving people in the “least restrictive” environment. When a family member lives in a home setting, the care changes with the person’s health. The upside, Pierson said, is that “it keeps families involved.”

Zach Cattell advocates for state legislation to extend the current moratorium on building additional nursing homes for one more year, which is now included in the state budget bill in the Indiana General Assembly.

Cattell heads up an Indiana trade group where most of its members are skilled nursing homes, though some offer assisted living, too. Having too many nursing homes, Cattell argues, makes it harder for those facilities to find enough qualified staff. That can lead to turnover in an industry where a stable staff leads to good, quality care.

“It fragments an already stretched staff,” said Cattell, who’s president of the Indiana Health Care Association/Indiana Center for Assisted Living. “It makes it difficult for nursing home providers to operate and keep their doors open.”

He said assisted living is a sustainable option since, as a whole, it relies on private pay. By contrast, he said, nursing homes depend more on federal funding - 85 percent on average - meaning that they’re susceptible to changes in funding. Still, he said, there continues to be a need for nursing homes.

The impetus

Vermilion chose the Hickory Road site as it does with its other assisted living projects around the state - by looking for parcels of land that are close to amenities like grocery stores, health care and shopping, said Ari Parritz, who’s on the company’s development team.

Before that, he said, Vermilion scans the market for census tracts that have enough low-income residents so that Vermilion’s project qualifies for Low Income Housing Tax Credits - a key source of its funding.

The assisted living complex that Vermilion wants to build in Mishawaka is among four that it has announced in Indiana, yet to be built, along with three under construction in Michigan City, Hammond and Muncie, and two more that have yet to be announced, Parritz said.

AHEPA, with the complex at Logan and Dragoon, also hunts for census tracts where it can land the tax credit, said Art Poly, president and CEO of AHEPA Affordable Housing Management Co., a for-profit company that manages on behalf of AHEPA.

AHEPA had built an assisted living apartment building in 2005 near Douglas Road and Indiana 23. And its sister organization, Daughters of Penelope, completed a similar building by the Kroger store on Merrifield Avenue in 2012.

Both tapped into the federal Section 202 financing for affordable senior housing projects, which is still active but that the feds stopped using to build new projects in 2012, Poly said. So, AHEPA now relies on tax credits, plus private debt financing.

AHEPA has 11 senior complexes across Indiana that were built with Section 202 money, he said. It has three more affordable senior buildings in the works across Indiana.

The impetus for the Vannoni Living Center, officials said, came as the River View 500 building saw several of its aging tenants move out earlier than they wanted. They’d lost the ability to shop and do household chores on their own, then ended up in nursing homes, where they quickly declined.

Diana Hunt, 65, suffered three strokes and started losing some of her short-term memory. It prompted her kids to move her from Niles into a Vannoni apartment three years ago. Staff make sure she takes her medications. She eats the center’s meals twice a day and joins the regular activities. Now, she said, her kids worry less.

“I like it,” she added, “because I’m around other people.”

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Source: South Bend Tribune, https://bit.ly/2ojGtfG

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Information from: South Bend Tribune, https://www.southbendtribune.com

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