Weather The Storm

My friend, Erin Koebler, who lives in Pittsburgh, works in a Medicaid waiver program sponsored by Allegheny County’s Department of Aging. Her department is the payor of last resorts for home care and modifications, when both Medicare and private insurance have cancelled needed services for seniors in their homes. I spoke with her recently about her job;as the Pennsylvania governor;s Long-term Living System Initiative is trying get people back in their homes and save Medicaid dollars;and as Erin said, ” by July 1 of 2007, we are hoping that we can get 180 people out of nursing homes in Allegheny County alone.”  So I asked how she meets most of her clients. Her response: ” Usually a potential client or a concerned family member who contacts the Department of Aging or they are pointed in our direction by a concerned senior care social worker. Then they are pre-screened for income and medical eligibility.”

It is then that Erin or another geriatric care manager receives the client and then proceeds to talk with them once or twice on the phone to setup an appointment. I wondered what it was like to first meet a person at their home. ” Generally it is a polite situation. People think, ‘ She’s here to help ‘ and so they normally are quite welcoming to me. A lot of people are only annoyed by the lengthy processes of paperwork.”  That being said, Erin mentioned she is entering strangers, homes and as such has run across a few odd occurrences;or, worse yet, situations that are dangerous for the senior. Erin provides a much safer home for her clients in a very real physical sense.

She said before she started poking around, asking some basic questions such as how the elder bathes. “The lady I saw today had a bathtub only, and she had a hard time swinging her legs over tub. So we plan to demolish one side of the tub and put in a tub seat so she can get in and out easily. Mostly it is about adaptive equipment.”  Erin then started to explain that a personal emergency response system is given to most of the clients. So even if a client should wait for aid when bathing but does not, he or she can contact help in case of emergency. Erin admits she sometimes does lose sleep over clients. ” You know about Pittsburg toilets? “  I admitted my naivet. ” Well they are toilets in basements usually without surrounding walls and one client I know will walk down her stairs, even though she shouldn’t, to empty her commode. The idea of her on those stairs where she knows she shouldn;t be…it;s too much.”

Erin told me of another client who, when asked how she got out of the house, stated that she had stopped going outside as her daughter could no longer carry her down her steps. Erin continued, ” It’s sad and unfortunate that these people don’t realize they could have contacted us much sooner sometimes.”  Erin’s office also contracts with home health care and home care agencies, two types of long-term care providers. One of these main agencies will even act as an intermediary so the consumer is employer, but the agency assumes all of the responsibility of being an employer, with regard to taxes and insurance. This way, consumers can pick a relative, neighbor or a person they know to oversee their care. Erin explained that this program began with the younger disability community in mind, but has now expanded to address the needs of older adults: ” Many want someone they know in their home. I know I would.” As we spoke I knew that Erin’s work was admirable, but I couldn’t help but wonder if her efforts ever felt the least bit intrusive. “

Some clients refuse the help and if they are of sound mind there is little that I can do other than explain why a particular service would be beneficial.  ” But how do you get people to listen? “  Erin laughed, ” I’m not sure why, somehow they usually trust me. But with some I’ve definitely had to work harder than others. I always try to explain to them why the service would be helpful to them, and maybe this is why;I also tell them you don;t have to continue with any service, if you really hat having someone in your home, then we can simply get rid of them, just try it. “  When I ask her about adult day care she answered, ” The seniors I see are almost always reticent to try it. “  Erin pointed out again that it was about enhancing the positive aspects, ” It’s mostly daughters who act as family caregivers and many of these older adults worrying about the burden they are causing their daughters. Some want to meet people and others enjoy the activity schedule. “  Erin often takes her laptop with her on her visits. It is her responsibility to come up with a care and service plan. ” It used to be that you had to have a supervisor and a nurse sign off on your plan, but now if the cost is over $54.99/day then it needs to go through state. “

I quickly calculated what that meant: the people who need the most help have to wait the longest. ” Exactly! Because we want to keep people in their homes, but it;s problematic to get the funds for the neediest among them. “  Erin always remembers to check up on her clients every month if they have no caregiver support system, or every two to three months for those with an informal system set up. Every six months, all the clients are reassessed.

Many of her clients go in and out of nursing homes as their medical needs change. ” One woman I grew very close to, as I visited her often. She would never let me leave without a little gift. It was very sweet that she wanted to thank me each and every time I was at her house. “  As we are about the finish our conversation, I told Erin I had one more question for her.What;s the best thing about your job? Being able to go out and meet people who are so happy to stay in their home.

Tags: adult care, adult day care, long term care

Wednesday, June 24th, 2009 • General