Developing In-Home Services in Tribal Communities

1. Developing In-Home Services in Tribal Communities AoA Training and Technical Assistance Field Forum Baltimore, Maryland April 30 – May 3, 2007 Kay Branch Alaska Native Tribal Health Consortium

2. Objectives • Define in-home services • Overview of funding for in-home services • Describe steps in developing in-home services • Identify workforce development challenges • Prepare preliminary budget

3. INTRODUCTIONS Tell us about an elder who has impacted your life

4. Definition of LTC • The care of an elder or individual with a disability who requires on-going assistance with daily living activities such as bathing, dressing, eating, shopping & cooking. • Supports elders and their families with medical, personal, and social services delivered in a variety of settings, ranging from a persons own home to institutional settings, to ensure quality of life, maximum independence and dignity. • In AI/AN communities, LTC also involves maintaining cultural values in the delivery system.

6. Funding In-Home Services • Medicare – provides limited funding for LTC. Time limited, skilled or rehabilitative services only—home health and nursing home.

7. Medicaid Primary revenue source for LTC. State Medicaid plans may include personal care or other related services that will be available to all who are eligible for Medicaid. Funds PCA, Durable Medical Equipment, pharmacy, skilled nursing and services through a Medicaid Waiver.

8. Medicaid Waiver Available in most states for clients who are income eligible for Medicaid and meet nursing facility level of care. Medicaid payment for a variety of services designed to help someone remain in the community rather than being placed in a nursing home.

9. Grants • Adminstration on Aging • Indian Health Service • Other federal agencies • State and municipal governments • State Units and Area Agencies on Aging • Private foundations

10. Individual assets/private pay • Social Security • Other retirement income • Long-term care insurance • Per cap payments • Private asset sale or reverse mortgage

11. Tribal resources BRAINSTORM IDEAS!

12. Focus: In-Home Services • Personal Care Services • Respite • Homemaker/chore • Case Management

13. Steps to Developing In-Home Services • Access regulations from your state’s website • Contact state office for enrollment packet, assistance • Write a plan for service delivery • Identify potential clients • Identify potential workers • Budget planning

14. Review Regulations • Client eligibility • Income eligibility • Types of services • Agency requirements • Employee requirements

15. Contact State Office • Dept of Health & Social Services • Division of Senior or Aging Services • Personal Care, Home Care or Waiver program coordinator • Obtain enrollment packet • Continue dialog with state office, submit paperwork

16. Service Delivery Plan • Identify types of services and funding source • Identify potential clients • Medicaid eligible? • Nursing home level of care? • Non-Medicaid eligible?

17. Service Delivery Plan • Identify potential workers • Different age groups and skill levels • Wage & benefit package • Full-time or part-time • Identify training resources • Technical school • Tribe

18. Workforce Challenges • Lack of respect • Lack of support • Low pay • Lack of benefits • Death of clients

19. Retention Ideas • Hire people who care about elders • Value all workers, let them know you appreciate them • Try to provide a benefit package to show them they are valuable • Send notes and newsletters regularly • Give them time to share experiences and talk about their job challenges • Discuss the importance of their work with others--tribal leaders, etc.

20. EXERCISE Create a budget for LTC services

21. Budget Planning

23. Summary - Feedback • What did you learn? • Is there anything you will do with this information when you return to your agency? • What other information do you need to begin developing in-home services?

24. Resources • CMS website - www.cms.hhs.gov • AoA website - www.aoa.gov • IHS Elder Care - www.ihs.gov/MedicalPrograms/ElderCare • UND NRC - www.med.und.nodak.edu/depts/rural/nrcnaa • UAA NRC – www.elders.uaa.alaska.edu • NICOA - www.nicoa.org • AI/AN LTC Conference - www.aianlongtermcare.org • Your State’s website – Dept of Health & Social Services • Aging & Disability Division • Medicaid Division

25. “Our goal should be to help elders live out their lives in comfort, not taking medications they don’t need and not living where they don’t want to.” Andrew Jimmie, Minto Alaska Native Elder Health Advisory Committee

26. Thank You! Kay Branch Alaska Native Tribal Health Consortium 4000 Ambassador Drive Anchorage, Alaska 99508 (907) 729-4498 pkbranch@anmc.org