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Keeping seniors in their homes
For nearly four years, Care Resources has been providing older adults in Kent County with an array of health services. The nonprofit organization follows the nationally recognized and extensive PACE model of care, which even includes rehab therapies and recreational activities, to fulfill its mission of keeping seniors in their homes.
The people receiving care from Care Resources are county residents who are 55 years of age and older, need the level of care normally given at a nursing facility, are eligible for Medicare or Medicaid, and are able to live in a community without jeopardizing their health or safety.
“We have 200 participants right now. We’re growing at a very steady clip. Every PACE program is capped at a certain number and we are working with the state of Michigan to get our cap lifted. We are capped at 230,” said Jennifer Feuerstein, community outreach representative for Care Resources.
Feuerstein said the organization wants the cap lifted so it can serve more residents. With much of the baby boomer generation having reached 55 years of age or older, she clearly sees a need. “At 200 participants, we aren’t even scratching the surface for the number of people that need our service.”
Care Resources gets its operational funding from Medicare and Medicaid. The money comes in a fixed amount for each participant every month. “That goes into a pool of funds and then we manage the money,” said Feuerstein. “So we’re the one that is paying out for all of the services that a person needs. So basically, anything and everything that they need, we pay for it.”
The list of services Care Resources provides includes physician, specialist and nursing care services; prescription and non-prescription drugs; medical equipment; hospital, emergency and nursing home care; rehabilitative therapies; social and recreational activities; and eye, foot and dental care.
“For people who are on Medicaid and can’t get dental services because there are no providers who will accept Medicaid as a form of payment, we provide all the dental services they need — their annual cleanings, their X-rays and their dentures, whatever they need. The same thing is true for podiatry and audiology. If they need glasses and they need hearing aids, whatever it is, we pay for it,” said Feuerstein.
There is no out-of-pocket cost for participants who are Medicaid and Medicare eligible as long as they stay with the providers that Care Resources offers. The organization has contracts with about 180 providers for the specialty services, but all primary care is done at the Care Resources clinic at 1471 Grace St. SE in Grand Rapids.
“The dentists, the podiatrists, the audiologists and the optometrists come here as well. We also have our full-service pharmacy for our participants on site, and our therapy gym and recreational day center,” said Feuerstein.
“The 180 different providers that we contract with send the bill to us and we pay them. So they’re not dealing with Medicare or Medicaid. Even though the payment is a Medicare or Medicaid payment, it is being paid by us.”
Feuerstein said Care Resources took a small cut in funding from the public insurers last year, but the organization made some budget adjustments and was able to make it through the year. Funding won’t be reduced for the 2011 fiscal year that begins Oct. 1, for a good reason: Feuerstein said it costs Care Resources $74 a day to provide care to each of its participants. In contrast, she said, Medicaid pays $167 a day for similar care given in a nursing home.
The model Care Resources follows is called PACE, an acronym for Program of All-Inclusive Care for the Elderly. There are 75 organizations nationwide that follow the PACE model. Care Resources is one of four PACE programs in Michigan. The others are in Wayne, Calhoun and Muskegon counties.
Care Resources is a 501(c)(3) corporation and is governed by a board of directors. Tom Muszynski is executive director. Care Resources also has a Participant Advisory Committee, which is largely comprised of participants and caregivers; it represents the interests of the participants.
Holland Home, Metro Health Hospital, Pine Rest Christian Mental Health Services, the Dominican Sisters of Grand Rapids and HHS Health Options founded Care Resources in October 2006. At least one member from each partner serves on the board.
“They saw a need for a PACE program in Kent County so they came together and financially brought the program into Kent County. So they are basically our financial backers. They put the money forward to get the program up and running,” said Feuerstein, who estimated the start-up cost at $2 million to $4 million.
The partners also are a source for credit for Care Resources. In the event a participant needs major medical care, such as a heart-transplant, the partners would pay for that expense and then Care Resources would reimburse them. So far, it hasn’t had to do that.
As for the recent reform of the health insurance industry, Feuerstein said she wasn’t certain what the legislation has in store for Care Resources.
“I guess the best answer I can give you is that nobody knows exactly what the health care reform will look like when it’s all said and done in 2014, because there is going to be legislative changes and elections and both will be playing key roles in that. At this point, we don’t expect there to be any drastic changes to our program,” she said.
“In fact, we do a lot of advocacy with legislators to educate them that this is a model of health care reform, because we have the case management model where we have the entire interdisciplinary team overseeing the person’s care plan, managing it, coordinating it. And we work with individuals who are very frail and keep them healthy and out of nursing homes. So we’re a very cost-effective program.”