GROUND-BREAKING REPORT SUPPORTS BETTER ACCESS TO HOME AND COMMUNITY-
BASED SERVICES 

If California’s challenging budget crisis needs some clear-headed answers, a landmark federally funded long-term care financing study tackles one vexing issue head on – how to provide financially sustainable long-term care services to seniors and persons with disabilities who wish to live independently in their community.   The extensively researched report, Home and Community-Based Long-Term Care: Recommendations to Improve Access for Californians, offers a comprehensive roadmap for how to fix a broken system – and save money in the long run.  

The powerful analysis is authored by nationally known long-term care policy and financing experts Robert Mollica, Ed.D. and Leslie Hendrickson, Ph.D. and comes out of the California Community Choices (CCC) project, a five-year grant funded by the Centers for Medicare and Medicaid Services.   California already spends more than $10 billion annually on long-term care, the study says, yet financial and structural barriers prevent many individuals in need from living in the setting of their choice. 

“The report is significant because it supports the federal goal of deinstitutionalization and what we as a state can do to help people age in the setting they wish,“ maintains Eileen Koons, M.S.W., a CCC Advisory Committee member and Huntington Senior Care Network director of government programs.    

According to the report, a funding bias toward expensive institutional care and a complex administrative structure seriously limit consumer access to home and community-based services, despite a well-known preference by many persons for just such care.   Thanks to various restrictions and regulations, it’s easier to receive care in a nursing facility than in the home and in times of “budget duress,” institutional budgets are protected despite their greater cost while home and community-based services budgets are reduced.   

To counter institutional bias and produce a more cost-effective long-term care system, the authors say that California needs to establish a framework for decision-making that addresses the system as a whole and cuts across multiple programs as other states have done.  A statewide strategic plan should be prepared that describes the populations, services and programs to be addressed and includes measurable goals to improve the balance between home/community-based services and institutional services.  

These and 26 additional short- to long-term recommendations target changes in the areas of financing, access and delivery system, and state-level organization.  One recommendation that could be implemented within a year, for example, is to conduct a study of need for waiver expansion.  Waiver programs, which are government-sanctioned special ways of getting services, are known for long wait lists.  “The lists tell of the desperate need people have for enhanced services to allow them to avoid going to a nursing home,” remarks Koons. 

Another recommendation that could be implemented in one to two years would allow certain persons new to the Medi-Cal system to have services started while eligibility determination proceeds.  “Other states have shown this can be done with few negative effects and people in need get started with services sooner,” Koons points out.

Koons says that there are actions with little or no funding impact that could be taken now.  “Just because we have economic challenges doesn’t mean things have to be put on hold,” she notes.  One example is to increase the home maintenance income exemption.  Medi-Cal recipients who want to return home after admission to an institution are allowed to keep only $209 a month to help them maintain a home.  “This isn’t enough to maintain a home you plan to go back to and can be the reason you end up staying long-term in a facility,” she asserts.

Koons believes the study is especially timely and deserves to be widely disseminated and discussed.  “In 2010 the first of the baby boomers turn 65, which opens up Medicare and the possibility of more persons with functional impairments.  As a state we’re not ready to address these needs.”

With the state budget problems, she adds, “tough painful decisions are going to have to be made and I hope this report will weigh seriously in decision-making and suggest priorities of what needs to be retained.  We forget that people have very real needs.   We also have to be thinking more long-range.  We’ve not planned where we want to be in 10 years and how we will get there.”

The California Community Choices project and Advisory Committee will be tracking the progress of the recommendations.

The report is available on the California Community Choices Web site at  http://communitychoices.info.

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Fast Fact: HSCN Resource Center specialists responded to 4,401 requests for information and assistance in 2009.

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FINDING A NICHE AT THE HUNTINGTON COLLECTION

Like many Huntington Collection shoppers, Kathy Kobayashi visited the hospital’s resale shop to find good quality and great prices.  With a new house to furnish, she came so often that manager Linda Stephens finally said, “You’re here all the time.  Why don’t you volunteer?”

That was the beginning for Kobayashi of “a job I love” and for The Huntington Collection, whose proceeds benefit Huntington Senior Care Network, of tapping into the talents of an enthusiastic and energetic volunteer.  “I started in the boutique section and took care of vintage things,” Kobayashi recalls.  “When we got low on things, I’d clean out my closet.”

Calling upon her background in visual merchandising and display, she soon presented Stephens with dozens of ideas for change.  Before long, the boutique, which features upscale, designer merchandise, was attracting a growing clientele. 

 “I wanted to make the boutique special,“ she says.  “I think of it as a separate little shop in the store.  We have our own racks and hangars and tags.”

Her creative flair and practiced eye for display and merchandise have made the boutique both popular and profitable, with a goal this year of bringing in over $80,000.  “We’ll showcase different things such as turn-of-the-century Victorian clothes and antique baby clothes,” she says. “We saved and collected dresses from the 1950s and had a special show.   Vintage is very popular.”   

If the boutique is a job for Kobayashi, it’s a fun job.  “It’s like my baby.  I’m very proud of it,” she remarks.  The delight of customers when they discover something unique is especially satisfying.  ”We’ve had several vintage wedding dresses and the girls who bought them were so excited.  That’s what I love – to see the reaction of people.”

Kobayashi’s commitment to brighten the Collection shows no signs of ebbing.  New ideas for the boutique just keep cropping up, including a hoped-for expansion in the future. “I still love it.  Everyday there’s something new.  If there are things you want to do here, you can find your niche."      

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A DETERMINED MOTHER CHOOSES CARE AT HOME

The desire to care for a loved one at home rather than place the person in an institution can be strong.   Families who make the choice, however, can face daunting challenges as they struggle to navigate a fragmented and often unsupportive service system (see Ground-Breaking Report story).  A Huntington Senior Care Network care coordinator can be the linchpin that holds the pieces together.

For Mrs. M, then 83, taking in her 63-year-old daughter who had sustained severe brain damage that left her totally dependent and unable to communicate, was the right – and only - thing to do. “I brought her into this world and I have to take care of her,” she says simply. 

Unfazed by the enormity of meeting her daughter’s basic everyday needs, including feeding and toileting, Mrs. M found and paid for extra help.  After finances became stretched, she learned that government assistance would help provide some services.  Still, she struggled to do all that needed to be done and continued to seek more help. 

Eventually she was referred to Huntington Senior Care Network.   The daughter was eligible for the publicly-funded Multipurpose Senior Services Program (MSSP), which helps low-income residents age 65 and older and certifiable for nursing home placement to live at home.   Especially important for Mrs. M’s daughter, the program allows for possible purchase of services when other informal and formal services have been exhausted.

Advocating strongly for more hours of in-home care, the care coordinator was able to obtain the maximum 283 hours.  Formal respite was put in place in addition to informal help through Mrs. M’s church to give Mrs. M some relief.  Over the years other assistance has ranged from coordinating services and counseling to getting transportation for doctor appointments and obtaining supplies and equipment.

The care coordinator says Mrs. M shows good judgment and knows when to ask for help.  She gives her daughter excellent care and, along with the caregivers, has readily learned new skills such as suction and wound care.   As a result of the care coordinator’s ongoing assistance and support, Mrs. M has been able to safely keep her daughter at home, as well as take care of herself, for nearly 10 years.

Now at the incredible age of 94, Mrs. M realizes she is slowing down, but is still adamant that her daughter, now bed bound and with a feeding tube, remain at home.  “I will know when the time is right, but it’s not now,” she says of institutional placement.  As the care coordinator continues to monitor the daughter’s needs, she is also helping Mrs. M plan for the future.   

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“(The care coordinator) is kind and caring and very helpful. I am so fortunate to have this excellent help.  Thank you.” – A MSSP client

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KEEPING FISCALLY FIT: AN INTERVIEW WITH CATHY GOYETTE

Cathy Goyette, fiscal and information supervisor at Huntington Senior Care Network (HSCN), has 25 years of accounting experience. Her responsibilities include ensuring compliance with fiscal requirements of grants, managing the resources of non-grant funds and overseeing HSCN’s information needs.

Perspective:   How is HSCN distinct, from a fiscal point of view?
Cathy Goyette:  As part of a large organization, we’re accountable to the hospital as well as to our funders, so we have two groups to respond to.  Also, the bottom line we look at is not fiscal, it’s community benefit – what kind of impact did we have on our clients or someone in the community.  

With budgets under constant siege, what are the key challenges for HSCN?
With grants, we have limited funds.  If a piece of equipment dies, for example, we have to look hard to find where we can cut.   We’re built on staffing, so a huge part of our budget is the cost of labor.  More recently, all hospital departments are being asked to cut back on unnecessary expenses.   We’re also seeing clients with higher than normal needs because family members who had been helping out are no longer able to do so.  Then there are the cuts in state spending and uncertainty in the state budget.  We try to see if we can still serve these people and sometimes we can’t.    

Everyone is searching for funds.  Are there helpful strategies?
We look for funding opportunities that fit within our mission to serve the community.  We ask what is it we plan to do and can we find funding to support it.  Of the funding we have, we see if we are spending it the most effective way possible.  

Why are donors attracted to HSCN?
A lot of our donors have had contact with us or have used our services.  They recognize the value of what our care coordinators do and the impact we have on enriching the lives of people in the community. 

What is the role of information and data collection in funding?
We collect data to talk more specifically about the people we serve and the outcomes.  These days you need to show the impact of what you do – not just talk about it.   We look at data to see if we can find those connections.  What we look at is determined by what our funders want or what our focus is.  For example, with fall prevention, writing a narrative about a fall doesn’t help us. You need some measure to report out, such as specific interventions and how they have or have not worked.

Although your impact on clients is usually indirect, at times you’ve been called upon to help out.
Whenever you have clients who are frail, there are times when they’re vulnerable and in crisis.  If they’re going to have their electricity turned off today unless there is a payment, it means I go out and get it done.  One time a care coordinator went for a home visit and discovered the client was dehydrated and her apartment was stifling.  A hot weekend was coming up.  Air conditioners were in short supply, but I finally found one, purchased it and had it installed by the next day. 

In these financially trying times, how do you strike a balance?
You need the ability to juggle and have a stress release.  I go running almost every day at lunch.  It’s important to recognize we’re talking about human lives.  When it’s overwhelming, I remember the role I get to play in supporting the care coordinators to keep clients safe.  We all have a little piece of it.

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Huntington Senior Care Network provides access to a complete range of medical, social and personal services for older and disabled adults and their families. For more information, call (626) 397-3110 or (800) 664-4664, visit our Website at www.seniorcarenetwork.com or click here to send us a message.

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Perspective is published two times a year by Huntington Senior Care Network of
Huntington Hospital.
Neena Bixby, M.S.W., L.C.S.W., Director
Gladys Gundrum, M.A., Writer/Editor