Doreatha Clemons felt a year ago like a 52-year-old woman trapped in a nursing home, depressed from diabetes, a heart condition, two amputated legs and an 80-year-old roommate with dementia.

She cried every day for weeks.

	John Heller, Post-Gazette Doreatha Clemons, 53, a double amputee, sits in a wheelchair in her apartment in Carnegie yesterday and talks about the new government-funded program that takes people out of nursing homes and returns them to the community. Renetta Wood, Ms. Clemons' personal care attendant, sits behind her to the left. Click photo for larger image.

The tears have since turned to a prevalent smile, despite the knowledge she will be in a wheelchair the rest of her life. She's a proud cheerleader now for the government-funded Nursing Home Transition Program, coordinated locally by the Three Rivers Center for Independent Living, which helped her out of the nursing home after a nine-month stay.

"I feel like I'm living again," Ms. Clemons said this week in a ninth-floor apartment in Carnegie's Honus Wagner Plaza, where she has been since September, receiving daytime help from a personal care attendant.

The former University of Pittsburgh secretary was a featured speaker yesterday at the Three Rivers Center's Wilkinsburg headquarters, where its staff and clients joined county and state officials in celebrating the transition program's early efforts.

Since the start of 2005, the program has reached into nursing homes to help 21 people in Allegheny County and about 200 statewide re-establish themselves in the community. More people than that are in the pipeline now, expected to receive assistance in the year ahead.

The effort reflects shifting emphasis in Pennsylvania in recent years to divert people where possible into community living instead of institutionalization, as it fits most people's preferences and is usually less costly to the government. Programs until now focused more on giving home care to keep them out of nursing homes in the first place, as opposed to approaching those already there.

"We don't think of this as rescuing people from nursing homes -- it's more of a public philosophy of looking to provide people with options, and give them a chance to make a good decision for themselves," said Dale Laninga, director of the Long-Term Living Project of the Governor's Office of Health Care Reform.

Using $1.5 million a year in state and federal funds, the transition program provides up to $4,000 per individual to purchase furniture and household necessities, set up utility accounts and cover security deposits and other essentials.

The program uses agencies across Pennsylvania, like the Three Rivers Center, to visit nursing homes and confer with the facilities' social workers about which individuals might be capable of leaving the homes. Individuals with that potential then receive visits and information about what state funding and community resources might be available to help them, as most of them need ongoing support.

Centers for independent living around the state already were attempting such moves for years, with about 10 per year initiated by staff of the Three Rivers Center. The level of government backing for the efforts is higher now, as is collaboration with other entities like area agencies on aging.

Many more of the people being helped locally thus far are young to middle-aged people with disabilities, as opposed to senior citizens. That's because more advocacy work for community living has historically been done on behalf of those with disabilities, and those younger adults generally have more energy and can better avoid complications from new health conditions, said Mildred Morrison, director of Allegheny County's Area Agency on Aging.

She does expect more seniors to begin transitioning out also, she said. Allegheny County is one of six locations in the state for a pilot program that will use nursing home medical data to identify people whose health needs are minimal enough to suggest ability to leave the facilities. They will be approached and offered that chance, although Ms. Morrison said more state funding for housing services may be needed to accommodate them.

As to why people are in nursing homes in the first place, if they need not be, officials said some come in after a hospital operation or for other rehabilitation. If they lacked home support beforehand, they may be unaware of Medicaid-sponsored "waiver" programs that provide comprehensive home assistance to both the disabled and elderly populations who have minimal incomes. Some disabled individuals enter at an early age because their families cannot care for them, and they stay indefinitely if no one intervenes.

Ms. Clemons, who also requires kidney dialysis three times a week, said it took months after amputation of her second leg last December for various phone calls and questions to lead her to the Three Rivers Center and its information about the transition program.

Her home before ManorCare Health Services-Green Tree was her 86-year-old mother's residence in Bridgeville, full of stairs and inaccessible for a wheelchair.

The Three Rivers Center staff identified a suitable apartment and used program funds to pay a deposit and the first month's rent, and take Ms. Clemons on a shopping trip to Value City for furniture and dishes. The day she moved into Honus Wagner Plaza, the center's staff purchased groceries to fill her kitchen.

With the help of an aide from the center, she's now visiting and receiving friends, and getting out for church meetings, errands and an occasional meal. Her next goal is becoming a mentor to other institutionalized people to make a similar move, if they have the capacity.

The Three Rivers Center, which oversees the Nursing Home Transition Program for people from Allegheny, Armstrong, Beaver, Butler, Indiana, Lawrence and Westmoreland counties, can be reached at 412-371-7700.