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  • Advance & Adapt – Eldercare Changes

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    Across the country, eldercare is changing. Here in the River Region, area eldercare businesses and organizations are shifting too, making many of their adjustments in response to growing demands.
    In case you haven’t noticed, modern health facilities and programs that serve area senior citizens are not your father’s nursing home, rehabilitation program or specialty care facility either. Federal and insurer regulations, consumer demand and tight government bud-gets all play a part in how providers and local nonprofit programs adjust to meet demand for services.
    The changes come partly as the result of federal Medicare and Medicaid requirements, health insurer rules and patient treatment innovations in a constantly changing world of care. “It is a different age; we have to be very diverse,” said Teri Sumbry, Communications Specialist with Turenne PharMedCo, a company owned by Turenne & Associates, the same company that owns Capitol Hill Healthcare and Rehab First in Montgomery. Bobby Stephenson concurred. He’s Corporate Administrator for Hillview Terrace and Rehab Select, a nursing home and rehabilitation facility. Both companies accept Medicare, Medicaid and private insurance patients, all drivers of health-care delivery regulations affecting how the businesses operate.
    In contrast to the nursing homes a decade ago, facilities once thought to be for end-of-life care now provide options for patients who may need different care, some very short term, some for months or longer. “In many ways, we are what the community hospital used to be,” Capitol Hill Administrator Sharon Baker said. Now, nurses trained to give intravenous medications and handle other medical devices are available 24 hours per day, she said.
    Capitol Hill holds dual certification, enabling the facility to adjust the 284-bed space for either nursing home or short-term rehabilitation, depending on demand, and also has agreement from Veterans Affairs to accept veterans when state VA facilities do not have room.
    Turenne, a private for-profit Alabama corporation, also operates a pharmacy program for facility patients in Alabama and Tennessee and a subscription-only website for facilities nationwide that Sumbry said constantly up-dates federal Centers for Medicare and Medicaid Ser-vices (CMS) nursing home regulations. CMS food ser-vice and dietetic procedures alone exceed 700 pages, she said.
    “CMS sets quality standards for nursing homes. Who you hire now is a person who is very qualified,” Stephenson said. The nursing facilities see much sicker patients than in the past, with doc-tors and/or nurse practitioners on call seven days a week. Specialty providers, including pulmonologists, cardiologists and others make “house calls.”
    Hillview has 93 nursing home beds and Rehab Select has 50 in a separate space in the same building. The private corporation that owns both is a company owned by Patti Wallace and her son, Chris Schmidt. The company owns five facilities, all in Alabama.
    A small, four-building specialty care provider, Angels for the Elderly cares for patients with dementia and Alzheimer’s disease, spokeswoman Kim Blackmon Wilson said. The facility has four “homelike” buildings, each housing 16 residents with care, activities and surroundings for people with a particular stage of dementia.  
    Wilson said Angels is for people who need more than short-term rehabilitation but less care than a nursing home including daily activities, exercise and music for mental and physical stimulation. Unlike the Medicaid programs of some states, Alabama Medicaid does not pay for assisted living care. Private payment and some health insurance plans that include assisted living do pay.
    Alabama nursing homes pay a special tax on each patient bed to help the state fund Medicaid services for poor and disabled Alabamians. According to Alabama Nursing Home Association Spokesman John Matson, this tax generated $112 million statewide in 2018. Nursing homes in Montgomery County pay an additional bed tax that generated $4.3 million for 2018.
    “They do it to support Medicaid because Medicaid is the foundation of health care in the state and without it, the system would collapse for all of us,” Matson said. Eldercare also requires and supports a large workforce. “In Montgomery County, nursing homes employ full- and part-time employees whose work hours add up to a work week of 1,100 full-time-equivalent employees,” Matson said.
    While eldercare is big business and always will be, area non-profit organizations provide essential services, too. The Montgomery Area Council on Aging (MACOA) pioneered senior services for the Montgomery area in 1972. The United Way agency’s services help senior citizens age in place, and its service area includes Montgomery, Autauga, Elmore, Tallapoosa and Coosa counties.
    Services in Montgomery County include two senior centers, a travel group, monthly luncheons for active seniors, stretching classes and computer training. MACOA is also home to the Retired and Senior Volunteer Program that places seniors in volunteer positions in five central Alabama counties.
    MACOA’s 2018 GuideStar annual report showed the agency provided 122,487 Meals on Wheels to 404 homebound seniors per day and 23,928 frozen meals. Of the agency’s 1,271 volunteers, 859 delivered Meals on Wheels.
    Executive Director Donna Marietta explained that even with an expanded meals programs and frozen meals, the agency always has a meals waiting list, now numbering more than 200. She said transportation for the pro-gram is the greatest unmet need.
    Central Alabama Aging Consortium (CAAC) is the area agency on aging for Montgomery, Autauga and Elmore counties. It gets funding from the Alabama Department of Senior Services, Alabama Medicaid Agency, local governments, donations and other grant funding. “We help individuals who are elderly or disabled who have challenges, medical and financial, with being able to perform daily tasks needed to remain in the community. Our services help them remain in the community longer,” Susan Seg- rest, Executive Director, said.
    Services in 2018 included 162,259 home-delivered meals for 1,100 clients at a cost of over $606,000 and area senior centers that served 1,133 clients more than 99,200 meals at a cost of more than $3 million. CAAC ombudsmen did troubleshooting for 189 clients who were at risk of or in abusive situations and 417 clients who receive assistance to help pay for their share of prescription drug costs.
    Segrest also pointed to transportation as an issue, but from a different perspective, noting that the greatest unmet senior service need in the greater Montgomery area is affordable non-emergency transportation.
    She stressed the work she and others do to help senior citizens is important. “We are so blessed to be able to come to work every day and just by doing our jobs, help make somebody’s life a little better,” she said.
    The River Region will soon have a new option for seniors looking for accommodations that are centered on them and their needs. With a price tag of $27 million, the facility will be built in Montgomery’s EastChase area and will include sections for independent living, assisted living and memory care with multiple activity and amenity offerings like a library, fitness center, a physical therapy room, even a pub. Its close proximity to the retail and restaurants of east Montgomery adds to its appeal. The facility is scheduled to be completed by late 2020.
    What advice can you offer on choosing inpatient rehabilitation hospital care versus other options when it comes to seniors? “Knowing what to look for in a rehabilitation services provider is important. You should ask providers about expectations, the level of care and programs offered for patients recovering from your specific condition and learn about the staff who will be a part of the treatment team during their stay. Facility tours are also important. Be sure to take a look at the patient rooms and the therapy gym and ask about how much time the patient will spend in therapy each day. If the patient has additional medical needs, find out how those will be treated during the rehabilitation stay. Keep in mind that not all patients qualify for every care setting, but looking at all available options will help you see the difference and make you a better-educated decision maker.” - RANDY THOMPSON, CHIEF EXECUTIVE OFFICER, ENCOMPASS HEALTH
    We asked a few local businesses that deal with eldercare and eldercare issues to share advice on their area of expertise.
    What advice can you give someone struggling to take care of themselves, but who’d like to stay at home? “There are resources available to help. Our Aging & Disability Resource Center will screen people for eligibility for services and bene-fits, including homemaker, personal care, companion, respite, adult day health and meals assistance.” - SUSAN SEGREST, EXECUTIVE DIRECTOR CENTRAL ALABAMA AGING CONSORTIUM
    What advice can you offer on choosing the right retirement community? Ask about the waiting list if there is one and what the community’s process is so you can give yourself options. I would also suggest touring communities during meal time or when there are activities going On. This way you can meet and engage with those who already live there. And ask plenty of questions. Are services advertised included in the monthly rate you’re given? Is the community licensed by the health department?  What’s the longevity of the staff? These are all things you want to know the answers to. - AMANDA FRANK, OAK GROVE INN
    What advice can you offer on choosing the right retirement community? “Our advice would be to look at many communities and drop by rather than making an appointment. An impromptu visit will give a more realistic picture of how the day-to-day looks. Also, look for longevity of staff and associate turn-over. This is something we are asked about by most families. We are so fortunate to have such a dedicated staff, including our nursing administrator at 15-plus years.” - RANDY ALLEN, ADMINISTRATOR, WESLEY GARDENS METHODIST HOME
    Bo Jinright, Owner and President of the The Jinright Group in Montgomery, weighed in on this important, but sometimes confusing, eldercare topic.
    What is long-term care insurance and why is it needed? Long-Term Care insurance (LTCi) typically covers a broad range of services including nursing home care, assisted living facilities, adult day care and/or home care. These types of custodial care are expensive and are generally needed for long periods. Without Long-Term Care insurance, these costs will fall to you or to Medicaid once finances become low enough to qualify. Medicare and health insurance do not cover most long-term care expenses.
    What advice/tips would you offer someone who’s looking to get long- term care insurance? Speak to an insurance or financial professional to answer your questions, weigh your options and ask for pricing. It’s always free to request this information. The sweet spot for planning is your 50s and 60s but don’t delay too long. LTCI must be medically underwritten to qualify, so a higher age can mean a higher premium.
    Today, many who are hitting “advanced senior status” are finding fewer of their adult children available to help with their growing needs, creating a dilemma for countless families. As a result, deciding how to best allow for and even assist employees as they care for aging parents is a human resources issue that’s on the rise for most employers.
    If your company doesn’t currently have any official eldercare policies in place, you’re not alone. According to a recent Forbes article, only 12 percent of companies offer caregiver-support resources for their employees. But that number is higher than it once was and continues to rise, as employees make it clear that eldercare is a priority and as companies compute the dive in productivity that balancing caregiving and work can cause in employees.
    As more and more companies recognize how important elder care is to employees and how costly not being proactive can be, expanded leave periods are becoming more common as are efforts to defray expenses associated with elder care, making it a human resources trending topic no business can afford to ignore.
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