Michigan works to close gaps in elder care, allowing more adults to age in place
COVID-19 has taken a massive toll on Michigan’s seniors — not just because seniors are more likely to die from the virus, but because social isolation, delayed medical care, and reduced activity physical diminished mind and body. On the bright side, the pandemic has raised awareness of how Michigan communities can close gaps in care and improve quality of life for older residents.
AARP Michiganthe Michigan PACE Associationand local organizations like the Portage Health Foundation (PHF) are among these agents of change. A major goal for each of them is to find solutions that allow older people to live longer in their own homes. AARP 2021 Home and Community Preferences Survey indicates that more than three-quarters of Americans aged 50 and older want to stay in their current home.
“The risk of food insecurity and lack of safe and nutritious food is an area [of need] that we see. Anecdotally, we are seeing an increase in demand for general health care, particularly end-of-life care, palliative care and respite care,” says Kevin Store, executive director of PHF in the Copper Country of the Michigan. “So many of our seniors have been locked down during the pandemic. There have been many chronic illnesses that have not been managed appropriately. The declining mental health of our seniors is of particular concern to us. »
To help address food insecurity, PHF supported the region’s Seniors Meal Program. In addition to plans to expand services to more older adults, the foundation has hired a dietitian, family physician, and functional medicine physician to staff the meal program.
“We want to assess nutritional value for health and mental health issues that we know are prevalent,” Store said. “What foods can we incorporate to help with mental illness or perhaps Alzheimer’s disease?”
The program also leverages relationships with meal recipients to better identify other needs, for example, home repairs, housekeeping or mental health issues.
“Our senior community represents about 12% to 13% of our overall population, but right now it represents about 18% to 20% of all suicides. We are seeing a 21% increase in suicides from 2019 to 2020,” Store said. “[Our older adults] report a 20% increase in depression and anxiety and that’s a segment of the population that historically doesn’t talk about that stuff.”
Helping Michigan catch up
According to Sarah Milanowski, head of registrations for circles of life All-inclusive senior care program (PACE) in Holland and Muskegon, Michigan, lags behind other states in supporting seniors who want to age in place. The PACE model provides comprehensive medical and social services at low or no cost to elderly people living at home. Fourteen independent PACE organizations serve 21 Michigan locations, covering more than 87% of the state. Still, many seniors cannot find the supports they need to stay in their homes.
“We’re late [providing] long-term home care for seniors compared to the rest of the country,” says Milanowski. “I think it’s a lack of knowledge. We need to look at how the system is working and be prepared to make changes.”
Sarah Milanowski with one of the LifeCircles buses. LifeCircles provides accessible medical transportation to the LifeCircles Day Center and other specialty medical providers.
Milanowski tells the story of an older man who wanted to enroll in PACE so he could continue living at home. Because his Social Security and pension income exceeded Medicaid limits for home care by $300, he was forced to live in a nursing home, where Medicaid covered costs his income could not cover. Additionally, Michigan’s Medicaid timelines require seniors applying for PACE to wait until the first of the month after services are approved, leaving some who need immediate home care waiting up to eight weeks before services arrive. ugly.
“We also try to educate healthcare providers. Sometimes they get really nervous about sending someone home after a hospital visit,” Milanowski said. “The conversation could be a little more nuanced around mom and dad’s mental health and the value of being in their own homes versus a traditional setting.”
To make home living a more viable option, Milanowski would like to see more resources devoted to making seniors’ homes more livable and preventative home maintenance services that keep the home safe for healthy occupancy. She says investing in keeping older people in their own homes would reduce their costs and the state’s costs to house older people in long-term care facilities.
On December 1, 2021, AARP Michigan staff testified before the Michigan House Appropriations Committee on the need for more in-home care for the elderly. They shared the findings of a EPIC-MRA survey that found 89% of Michigan voters want to avoid living in a nursing home. And they noted that Medicaid dollars could support nearly three seniors in home and community services for every person in a nursing home.
“When we look at taxpayer dollars spent on long-term care services, 68.5% of Michigan Medicaid spending on long-term services and supports goes to paying for nursing home care rather than in people’s homes, where they want to be,” says Lisa Dedden Cooper, advocacy manager for AARP Michigan. “Fundamentally, Michigan’s long-term care system is locked into this broken cycle in which we continue to spend too much taxpayer money on care in settings that are both more expensive than alternatives, not what that residents want for themselves and their families.”
Root bias against home care
Cooper points to an institutional bias in the system that assumes a nursing home is the normal place people go to when they need help with personal care tasks as they get older. This bias also influences older people and their families, leading them to believe that institutional care is the best or only option. Those who go against the grain by choosing to stay at home often face waiting lists, income and asset tests, limited insurance reimbursements and denials from service providers. well-meaning health care, which makes their choice even more difficult.
“It’s partly because funding for [in-home] programs is limited relative to demand,” says Cooper. “Some of them are these barriers to registration, including caps, and some of them are a limited supply of care options and more desirable alternative residential settings. Another problem is the labor shortage in direct care. »
Cooper commends the Michigan Department of Health and Human Services for looking for ways to increase the number of direct care workers, including home health aides. These workers tend to work very hard for low wages and little respect while performing difficult tasks like lifting patients, bathing them and changing their diapers.
“There’s no type of career path and usually no perks that these workers have,” Cooper says. “So part of the job is to look at what we can do to create a more sustainable direct care workforce in the future. Higher salaries are part of that, but also things like opportunities to offer benefits, career paths, training and credentials.”
The State of Michigan is also seeking to make positive changes for seniors through its Administration of Health and Aging Services (HAS A). Established in October 2021, HASA will provide more coordinated services to Michigan’s growing aging population. Nearly 25% of the state’s population is over the age of 60, with people aged 85 and over being the fastest growing age group.
“I think the state is aware of the shortcomings of the current system. And at the same time, there’s this new funding that’s available from the federal government to try to put in place changes, systemic changes,” Cooper said. . “Hopefully there will continue to be momentum with the decision makers.”
A writer and freelance writer, Estelle Slootmaker is happiest writing about social justice, wellbeing, and the arts. She is the development news editor for Fast growing media and The Tree Amigos chairs, City of Wyoming Tree Commission. Her greatest accomplishment is her five incredible adult children. You can contact Estelle at [email protected] or www.constellations.biz.
LifeCircles photos by Pat ApPaul. Photos by Kevin Store and Lisa Dedden Cooper courtesy of the subjects.