Native elder caregiver curriculum NECC: 3.2 Health care system

1. Caring for Our Elders: Health Care System: Accessing Resources for Native Elders 3.2 Native eldercaregiver curriculumNECC: 3.2Health care system Caring for Our Elders: Health Care System: Accessing Resources for Native Elders 3.2

2. Health Care System: Overview • “System” can be very confusing • Elders & Families have many questions about access • Who to go to? • Where to go? • How to pay? Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

3. Health Care System: Overview • Excuse me…Could you tell me how to access the health care system???? Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

4. By Understanding a Piece at a Time… Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

5. Health Care System: Overview • I.H.S. (Indian Health Service) • Medical, public health nursing, dental care, pharmacy services • Hospital & Clinic access • No nursing homes • No defined system of long-term care Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

6. Health Care System: Overview • I.H.S. (Indian Health Service) • Available services vary depending on: • Federal Budget • Alternative services • Contract care partners • Service Area Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

7. Health Care System: Overview • Tribal CHR Program (Community Health Representatives) • “Vital Link” between health care system & community’s access to services • Services vary by Tribe: determined by Tribal leadership • Some CHR programs are very dedicated to eldercare services Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

8. Health Care System: Overview • Tribal CHR Program • Need to know each Tribe’s priorities for the CHR program in their community • Potential for CHR programs to improve health care access is an untapped resource !! • Would be logical for CHRs to lead HCBS Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

9. Health Care System: Overview • Other Tribal Health-Related Programs • Access for all tribal members • Services vary Tribe to Tribe • Administered by Tribe directly • Variety of services dependent on available funding sources Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

10. Health System Overview • Contract Health Services • Mechanism to purchase health-care services • Services that cannot be provided by I.H.S. or Tribal facilities Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

11. Health System Overview • Contract Health Services • Person must be referred by I.H.S. • Eligibility is generally restricted to: • those living on or near their home reservations • students/dependents away at school • Because of limitations on funding • Priorities given to “life-threatening” & “urgent” needs Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

12. Health Care System: Overview • Diabetes Programs IHS • Special Diabetes Program for Indians(SDPI) • Administered by I.H.S. or Tribal Health Programs • Programs designed to be specific to local Tribal needs Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

13. Health Care System: Overview • Diabetes Programs I.H.S. • I.H.S. Department of Diabetes Treatment & Prevention • Clinical guidelines & public health approaches • Research & training & technical support • Develop educational materials Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

14. Health Care System: Overview MEDICARE & MEDICAID* *with appreciation to the following resources: 1)Baldridge, Benson, Carlson & Redford: 2004 “Tribal Guide for Elder Care: A Primer on Long-Term Care Services & Financing for Indian Elders” 2)“Building Partnerships: CMS, States, Tribes & Aberdeen Area I.H.S.” 2009 CMS Medicare & Medicaid Training, Sioux Falls, SD June, 2009 3) Wallace, S.P., Satter, D.E., Zubiate, A. 2003 “Medicaid Home Care and Tribal Health Services”: A tool kit for developing new programs. Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

15. MEDICARE as Health Insurance • A few slides about “Medicare”… Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

16. Health Care System: Medicare • Medicare: FEDERAL program • People 65 years and older • People who are disabled • Based on a work history of the individual (or the individual’s spouse) that entitles them to Social Security benefits Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

17. Health Care System: Medicare • Medicare: Special “eligibility” • If not 65 years old yet & need services? • For knowing about special eligibility, it is best to visit with: Contract Health (CHS) • Contract Health Services at IHS • IHS works with insurance eligibility and reimbursement issues full-time! • Easy to visit with CHS in own community Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

18. Health Care System: Medicare Medicare PART A Covers: • Hospitals for in-patient care • Including I.H.S. hospitals • Skilled Nursing homes • Home Health Care • Hospice Care • Blood transfusions Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

19. Health Care System: Medicare Medicare PART B Covers: • Outpatient medical/surgical services • Medical supplies • Diagnostic tests • Outpatient therapies Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

20. Health Care System: Medicare Medicare PART B Covers: (cont’d) • Hospital and clinics (including I.H.S.) for health care services from: • Doctors, nurse-midwives, clinical social workers, clinical psychologists, registered dieticians, physical therapists & occupational therapists Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

21. Health Care System: Medicare • Medicare PART B Services (cont’d) • Part B can also cover: • Outpatient Mental Health • Some Preventive Services • Other medical services Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

22. Health Care System: Medicare • Medicare PART C • A form of “managed care” insurance plan • Not really applicable to Tribal communities Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

23. Health Care System: Medicare • Medicare PART D • Prescription Drug Coverage • Available to all people with Medicare eligibility • IHS is approved as a prescription drug provider • Elders can get their medications from IHS Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

24. Health Care System: Medicare Medicare Regulations for Home Health: • Must require “skilled” care in the home • professional nurse, therapist skills, etc. • Must be “homebound”, but can go to: • religious services • an adult day care program • clinic or hospital Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

25. Health Care System: Medicare Medicare for Home Health • Will NOT be provided permanently • Will NOT cover Personal care services • Unless part of the “skilled care” package for a limited period of time only • May cover medical supplies & equipment • Will cover Hospice Care under Part A Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

26. Health Care System: Overview • Medicare: Federal program Standardized services are available across the nation according to national eligibility regulations • Medicaid: A Federal-State program • But is State administered • Eligibility is determined by states • Services are determined by states Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

27. Health Care System: Medicaid • Medicaid: STATE-ADMINISTEREDprogram… SO, • Services & eligibilityvary from State to State “could you say that again?” Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

28. Health Care System: Overview • Medicare & Medicaid are both government funded health-related programs • Medicare is FEDERAL Program • Same services across the nation in every state Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

29. Health Care System: Overview • Medicaid is STATE –ADMINISTERED Program… so, • Services vary from “state to state” • Eligibility is determined “state to state” • “thanks for the clarification!” Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

30. Health Care System: Medicaid Medicaid • Usually is the “Payer of last resort” • But in Indian Country, I.H.S. is usually the “payer of last resort” • IHS will pay for services after all other insurance options have been utilized for health care payment • Including CMS* payment • *Center for Medicare & Medicaid Services Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

31. Health Care System: Medicaid Medicaid: Eligibility for ELDERLY • Based on financial need • Not based on work-history • Elders 65 years of age & older • Elders who are disabled • Elders on Social Security Income (SSI) automatically are eligible for Medicaid Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

32. Health Care System: Medicaid Medicaid Eligibility for Elders (continued): • Elder must have extremely low amount of assets • Varies from state to state • Don’t have to count the elder’s home, car, clothing, household goods, burial plot Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

33. Health Care System: Medicaid Medicaid • Pays for nursing home care • The elder’s resources have to be extremely limited • they can keep their home, car, belongings Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

34. Health Care System: Medicaid Medicaid… (continued) • Can ask the “estate” for some “pay-back” after a person passes away… BUT Medicaid will NOT take Tribal land or income from Tribal land or items with spiritual or cultural significance to the Indian community Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

35. Health Care System: Medicaid Medicaid… (continued) • Home Health Care Options under Medicaid • Will pay for “personal care” if elder is eligible • Bathing, dressing, cooking, cleaning • Different from Medicare… more “non-medical” type of services in the home • Each State has its own mechanism for Personal Care Services through Medicaid • Some states are very generous with elder benefits for Home & Community-Based Services (HCBS) Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

36. Health Care System: Can feel confusing! Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

37. Health Care System • Challenge is to learn to navigate all of these agencies and services ! • It can be done… • Work with the “people” who are in the system… • A “system” is only as good as its people! Essential to Build partnerships! Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

38. Can Find the Way to Resources! Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

39. Health Care System: Overview • Know the PEOPLE • For every program, find the “key person” to “unlock the network resources” ! • Use the RESOURCES • MANY AVAILABLE! • Websites, literature, • Toll free phone numbers, etc. Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

40. Understanding a Piece at a Time Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

41. Health Care System: Medicare QUICK REVIEW ! Medicare A “standard” federal program Part A: Hospital insurance Part B: Medical insurance Part C: Medicare Advantage Part D: Prescription Drugs Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

42. Health Care System: Medicaid QUICK REVIEW ! Medicaid Federal-State Health Care Program, but… Services & eligibility determined “state by state” Need to find out what is available for elderly in EACH state Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

43. Health Care System • Resource people can be the “guides through the maze”: • Contract Health Services staff at IHS • Extremely knowledgeable of CMS funding resources, eligibility requirements, deductibles, monthly premiums, etc. • County Social Service Programs • Particularly well-informed about Medicaid funding & eligibility Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

44. Health Care System: Overview “Thanks very much…” Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

45. Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders

46. Caring for Our Elders: 3.2 Health Care System: Accessing Resources for Native Elders