Author

Thomas Wiest

CEO, Aspirience Home Care

State health officials are threatening to withhold the license of the troubled Minneapolis Veterans Home, saying the problems in care uncovered last year require new state scrutiny.

The 402-bed home’s license expires today, Monday. The home has taken steps to correct the problems, but state officials said Wednesday that after decades of violations at the home, they want more assurance that the cycle will end. The Minnesota Veterans Homes Board is negotiating an agreement with the Health Department over the state-owned home’s license.

One provision of the agreement will include spending about $1 million over the next two years for an outside consultant to monitor the home’s progress and report monthly to the Health Department. The action was more fallout from a state inspection in late 2006 that found 34 violations of care standards and other regulations. Inspectors this year cited the home for medical errors connected to the deaths of three veterans at the home. One death involved a man with diabetes who died when his blood sugar plummeted after he received improper treatment.

The state violations led to $40,700 in fines this year when many of the problems were not corrected. Nine of the fines were for $200 or more, and under state law, four fines of that size trigger action to suspend, revoke or not renew a nursing home license.

I would be seriously concerned about the care at the Minneapolis Veterans Home.

Earlier, Gov. Tim Pawlenty ordered the Health Department to begin monitoring care at the home until an outside consultant was hired to provide that help. He has also named a commission to study the problems and governance of the state’s five veterans homes.

Although the Minneapolis Veterans Home’s license expires today, Monday, it will continue in effect until an agreement is reached with the Veterans Homes Board, possibly by early August.

The home is unlikely to lose its license, but the threat is an indication of how serious health inspectors consider the history of care problems at the home. Shortcomings at the home included inadequate therapy for bedsores and physical rehabilitation, failure to follow care plans, medical errors and violations of residents’ rights to privacy and dignity.

In 2005, a similar annual inspection found 27 violations of state care and other rules. The home, a complex of historic buildings overlooking the Mississippi River, has had regulatory problems dating to the 1970s. Even though you hear the employees at the the home say things like, “This is a very serious situation,” and “We’re taking all due steps to make sure we’re meeting the requirements of the Department of Health,” this battle has raged on for years.

The home, which has 341 beds in its nursing home and 61 in assisted living, stopped taking new admissions in January until its care problems have been fixed. There are 45 vacancies in the nursing home portion, with 342 people on the waiting list to get in.

The Health Department issued its demands in a letter June 20 but did not make a public announcement. News of the license problems surfaced in minutes of a special July 3 meeting of the Veterans Homes Board, which met again last week to work things out.

While details of the home’s new requirements still are being negotiated, they will include monthly reports from the home’s consultant, Health Dimensions Group, of Minneapolis. The reports will summarize problems, concerns, complaints, its recommendations to the Minneapolis Home, the home’s progress in meeting those recommendations, and staff training.

The Health Department could have charged the Homes Board thousands of dollars for reinspecting the Minneapolis home after all these problems surfaced. But officials there decided not to do so unless serious problems show up again. Again?? “We decided that, in this instance, it was all state money, going from one pocket to another,” one inspector said. “We already had to defend that we had fined them.” Problems since the 70’s, a failed inspection in 2005 and another in 2007?

What’s your take on this scenario?

It’s good to know, Aspirience Home Care can help assist your transition to safer home care in many ways, anywhere, anytime.

Author

Thomas Wiest

CEO, Aspirience Home Care

Many people start needing care earlier on than we think to safely live at home. Not just seniors but also adults, young adults and most importantly, children. Their adult children can only do so much to directly help out because they work, have their own families and often live out of town.

When the time comes, what decisions should they consider?

Whether the need for care arrangements is sudden (a stroke, broken leg from a car accident, etc.) or gradual (dementia, autism in a child, etc.), the adult children/parents need to decide what their roles will be as much as possible. How will they help out on a day-to-day basis? What outside resources are needed? How will they oversee and evaluate the care?

That might sound simple, but it usually is difficult and stressful for several reasons: The senior parent requiring care may resist family or outside help; the adult children might not agree on an overall plan and their respective roles; they usually have no experience in making such decisions; and their busy lives allow limited time for any of this.

If there is more than one adult child, discussion and agreement of roles can prevent contention and bitterness. We have worked with family caregivers who neither asked for nor received offers of help from siblings. When more than one pitches in, the roles need to be collaborative, not necessarily equal.

It helps to develop a list that may include such tasks as arranging physical rehabilitation, checking in and monitoring medications, accompanying the parent or child to medical appointments, keeping the home stocked with food and supplies and preparing bills to be paid.

Usually, the list includes items that require outside resources; for example, arranging paid home care to assist with such activities as bathing, dressing, toileting, meals and safely moving about the home.

But the family might not be able to effectively make such decisions and spend a lot of time directly assisting the parent and arranging and overseeing outside services due to lack of available time or to living at a distance from the person needed care. There are approximately 5 million long-distance caregivers in the United States. Averaging 450 miles distance from their parents, or the person they are responsible of caring for. They often miss work, spend an average of nearly $400 per month on travel and other out-of-pocket expenses and feel stressed and worried.

We suggest long-distance family caregivers recognize what they can do from afar (scheduling appointments, paying bills, etc.) but, also rely on a local network of relatives, friends, neighbors and a reputable home care provider for checking in, reporting and peace of mind assistance.

We also recommend considering the help of a professional care manager (usually a nurse or social worker) who can assess the parent’s care needs and make recommendations, make and oversee care arrangements, provide medical advocacy and monitoring and report regularly to the family. A care manager can help overwhelmed local family caregivers in the same ways. Aspirience has an on site staff that can oversee all client care plans. Nothing gets overlooked.

Family caregivers generously jump in to help with care, sometimes with little thanks or support. They almost always experience stress and depression, and sometimes health problems due to lack of self-care.

Our advice is to avoid the “I can do it myself” syndrome by asking for help from your family and personal support system, and by finding outside information, support and service resources.

It’s good to know, Aspirience Home Care can help assist you in many ways with your home care needs, anywhere, anytime.

Author

Thomas Wiest

CEO, Aspirience Home Care

Some of you have recently heard of a state lawmaker that is learning about nursing home care by spending 24-hours as a patient at a home in rural Winthrop, Minn.

Rep. Terry Morrow’s injury, a broken hip, may be fake, but the lessons he is learning are very real.

“I dropped a pen on the floor and now I can’t pick it up,” said Morrow, D-St. Peter, as he pushed himself in a wheelchair. “I get an idea of somethings that can be changed just in the amount of paperwork, which I don’t think I would have really sensed had they just told me about it.”

Morrow underwent physical therapy and spent time hearing how residents value living in a hometown care facility where visitors, and friendly care, are more likely.

The state budget crunch resulted in many workers receiving little or no pay increase for the past four years in a row, a warning sign that a quarter of nursing homes in Minnesota are in financial crisis.

Most homes are not at immediate jeopardy of closing but, if there is not some financial assistance in the next few years I could definitely see that they would be at risk of laying off staff, downsizing or worst case, closing.

It’s especially tough for rural homes. Morrow already knew the economic puzzle before he checked in, now he has an up-close appreciation for what’s at stake.

The bottom line is nursing homes need to get more money than they’ve been getting. On the other hand, could this be a sign (again) that the state is directing us, albeit tactfully and quietly, that they are taking the same position as most other states are and moving towards more home care rather than institutional care?

One estimate I have heard is that 40 or so Minnesota nursing homes will close in the next year, including a few in the Minneapolis/St. Paul metro. On the flipside, home care services will grow by 15% in the state.

It’s good to know, Aspirience Home Care will be there to help you make the transition to home care a smooth one.

Author

Thomas Wiest

CEO, Aspirience Home Care

You know, I have been asked many times how does one go about getting Personal Care Assistant services in the first place. Who do you talk to? What needs to be done? Where do I go to begin with? It seems there are so many questions regarding this topic so I thought I would write a newsletter about it.

A person can receive PCA Services through one of the programs described below. Think of these as “doors” to starting PCA services, with each program differing in how it is administered.

PCA Programs

There are four different programs you can participate in to access PCA services:

• Alternative Care
• Home Care
• Home and Community-Based Waiver Programs
• Managed Care Programs

Alternative Care

Alternative Care is for people who are over 65 years but whose assets are too high to qualify for the Elderly Waiver.

Home Care

Home care is sometimes called Medical Assistance (MA) home care. PCA services are one of many services people on MA are eligible to receive.

Home and Community-Based Waiver Programs

A home and community-based waiver is an additional service that allows people to live in the community instead of going into or staying in an institutional setting. Types of waivers are:

• Community Alternative Care (CAC)
• Community Alternatives for Disabled Individuals (CADI)
• Elderly Waiver (EW)
• Mental Retardation/Related Conditions (MR/RC)
• Traumatic Brain Injury (TBI) Waiver

Managed Care Programs

Managed Care Programs are mandatory for people over age 65 years but an option for people with disabilities under age 65 years. Examples of managed care programs include the Prepaid Medical Assistant Program (PMAP) or Minnesota Disability Health Options (MNDHO).

Categories of PCA Services

There are four different categories of service you can receive in the PCA program:

1. Assistance with doing Activities of Daily Living (ADLs): These are things you do every day such as dressing, grooming, bathing, eating, positioning, transferring, toileting and mobility.

2. If your PCA assessment determines that you have a need for assistance with Activities of Daily Living, you may also use your PCA services for assistance with Instrumental Activities of Daily Living (IADLs), IADL assistance includes meal planning and preparation, managing your finances, shopping for food, clothing and other items, homemaking tasks, communicating by telephone or other means, getting around and participating in community activities.

3. Assistance in Health Related Functions, which are services that must be delegated or assigned by a licensed health care professional such as a nurse or doctor. Health related functions must be provided under the direction of a qualified professional (QP) or a doctor. Examples of health related functions are special skin care, non-sterile catheter care, tube feedings and respiratory assistance.

4. Redirection and intervention for behavior issues, which require observation and monitoring. For example, reminders to do activities of daily living or redirection of behavior that is potentially harmful to you or others.

PCA Assessment

First things first, an assessment must be completed to determine your need for assistance. The assessment reviews the tasks and assistance that you need and assigns a unit of time for these activities. The home care program you are in determines who will do your assessment. Here is a list of people who can complete an assessment:

• County public health nurse for MA home care or MR/RC Waiver program
• County case manager/service coordinator for CAC, CADI, TBI, EW Waiver programs or AC program
• Someone from your managed care plan (such as PMAP) if you are in a managed care program

This assessment should happen within 30 days after you contact someone about your need for PCA services. The assessment is done before PCA services can start and every year after that. To find out about your eligibility for PCA services, contact your local county agency.

It’s important to know, Aspirience Home Care can help you navigate through the home health care field to secure PCA services for you or your loved ones.

Author

Thomas Wiest

CEO, Aspirience Home Care

It’s easy to see why nursing home insurance can be a hard sell. Who wants to buy a ticket to a place that most of us dread?

I have spoken to several people in the insurance business and they say clients who refuse to consider the product are cavalier. Many think that if they run out of money the government will take care of them.

Apparently, people are counting on that. Sales of long-term care insurance have decreased since September 11, 2001. Seventy-three percent of baby boomers in Minnesota have no long-term-care insurance at all. Recently, I wrote that the people who buy long-term-care insurance are those who have watched loved ones (and their lifetime savings) deteriorate in nursing homes. Many readers, especially those with loved ones in nursing homes, wanted more information about choosing a policy.

Unlike life insurance, long-term-care insurance premiums are not locked in. They probably will increase, but the amount has to be approved by the Department of Commerce. Consumers comparing policies should ask agents about any premium increases in the previous 10 years.

Most policies include assisted living and home health care in addition to nursing home care, but the coverage will vary.

Three important coverage items to consider are the maximum benefit per day, the length of coverage and the elimination period (the number of days you must wait before benefits begin).

Many policyholders choose a benefit of about $150 per day (which might not cover the full cost in some care facilities), but not all long-term-care policyholders choose coverage to cover the entire daily cost.

Most experts recommend a benefit period of three years or longer because the average stay in a nursing home is 2.5 years, but home health care or assisted living might last longer. Some policies have coverage as long as seven years.

Few policy’s have coverage on Day 1 in the care facility or at home. Most policyholders choose a 90-day elimination period, but with considerable savings, you might be able to wait 180 days or longer.

Verify that a policy includes ALL of the following types of care: nursing home, assisted living, home health, adult day care and alternate or respite care.

Get quotes from at least three companies. Ask your agent to compare the benefits, strengths and weaknesses of each policy.

Buy inflation protection unless you think you might need benefits within a few years. Many agents recommend 5 percent compounded inflation protection.

Check out flexible payment options. With the 10-pay plan, consumers can pay a higher annual premium for 10 years and pay no premiums after that. Another plan allows the premium to be paid in full when the insured is 65. Premiums can cost more than twice the normal price up front but render savings in the long run. For those who worry about paying premiums without ever collecting, “return of premium” policies offer a refund to the insured’s estate or beneficiaries if benefits are never collected.

Review exclusions with your agent. Red flags include: policyholder must be hospitalized first before being eligible to receive home health care or nursing home benefits, policyholder must first receive skilled nursing home care before receiving intermediate or custodial nursing home care, or policyholder must first receive nursing home care before being eligible for home health-care benefits.

Here are some costs to consider, average monthly rates for common long-term care options statewide as of 2006:

$5,340: Nursing home (private)

$4,890: Nursing home (semiprivate)

$2,430: Assisted living

$21 per hour: Home health aide (medical assistance)

$17 per hour: Homemaker services (cleaning, cooking and other household assistance)

Here are some long-term care options for those who don’t want to live in a nursing home:

Independent living/senior housing: Good for people who don’t need care. Typically apartments and facilities that provide security but no other services.

Assisted living facilities: Good for those who don’t require constant care but can’t live alone. Individual apartments with access to services such as meals, laundry and medical care.

Home health aides: Work in a private home and can give medication, check respiration, pulse and blood pressure.

Personal Care Assistants: Provide companion, bathing, housekeeping, cooking and other routine assistance.

As you can see, there are several items worth looking into for long-term-care but, rest assured we can help.

It’s important to know, Aspirience Home Care can help with long term care by keeping your loved ones at home where they are most comfortable and safe.