How Minnesota Returns Nursing Home Patients to Their Communities

A nursing home in St. Paul, Minnesota.

A nursing home in St. Paul, Minnesota. Michael Hicks /


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The state’s pocketing $20 million over five years, and those eligible can hold on to their savings.

Seeing 70 percent of patients leave Minnesota nursing homes within 30 days annually, the state Board on Aging asked why, of the remaining 30 percent, those who should leave weren’t.

The Return to Community initiative, a collaboration between the Board and Department of Human Services, pairs patients wanting to go home with community living specialists to discuss options.

If the patient has been at the nursing home 90 days or less and isn’t receiving long-term care covered by Medical Assistance, they’re eligible for counseling up to five years.

“They still need continued therapy beyond what the nursing home can provide, so we come in and we bring in those other resources to them,” says Connie Pelzer, community living specialist, in this video. “We let them know what’s available in the community and what they can tap into.”

Ernie Opatz lost his leg below the knee due to poor circulation and then contracted an infection, but Pelzer learned he was a veteran and connected him with Veterans Affairs. The VA paid for his home walker, wheelchair and bath bench.

Medicare doesn’t always cover nursing home costs, and Opatz and his wife would’ve had to dig into their savings to keep him there.

“Some people can spend down in just a few months, and then they have to apply for Medicaid because they’re going to need to have someone pay for it,” says Krista Boston, Human Services director of consumer assistance programs. “And that really impacts all of us.”

Boston estimates Return to the Community will save the state $20 million in five years. That number doesn’t include patients’ savings, which hasn’t been calculated.

“Return to community is having a lot of success keeping people in their home,” Boston says. “In fact, of the 2,300 that we’ve served as of today, roughly about 74 percent in any given year are remaining successfully at home.”

(Photo by Michael Hicks / )

Dave Nyczepir is News Editor for Government Executive’s Route Fifty.

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