Staying in home longer with Home Care

For more than 60 years Maybell Rentschler has lived in her farmhouse along Highway 25 heading toward DeSmet. Since 1942, Mary Remacle has enjoyed her home in Howard on Highway 34.
For both seniors, that longer home stay has been made possible through the Madison Home Care Services.
“I don’t want to leave here,” said Rentschler, 80, who resides in a wheelchair and has ramps going into her home that allows her to get in and out with ease. “Home Care helps me stay in the home longer.”
Remacle, who turns 98 on Sept. 1, agrees. “I appreciate some silence,” she said. “I don’t want to go where there is activity all day.” Remacle would rather spend time playing cards with those who stop by each week to visit her.
The Madison Home Care Services started in 1996. Organizers saw a growing need for those who could stay at home but would need some oversight to keep them from going back into the hospital and also staying in their homes and communities longer.
“Home Care is a link between client and physician,” said Lynn Landeen, who coordinates the program in Madison. “Going into a home you can see the whole spectrum of how they are managing meals, personal care and things you might not see at a clinic or hospital appointment. It gives you a broader picture of what is going on with the patient.”
Dotta-Jo Walker is one of the registered nurses that visit clients on a regular basis. She stopped in to check on both Rentschler and Remacle in mid-June. Along with providing necessary temperature checks, blood pressure checks and listening to the heart and lungs, Walker also asks questions to find out what is been happening with each’s life since the last time she stopped by. Walker visits Rentschler every other month and Remacle every two weeks.
Remacle related to Walker her experiences for the morning. “Things weren’t going the way I was hoping,” she tells Walker. But just having Walker stop by helped ease some of the worry for Remacle.
“I think people capable of taking care of themselves are better off in their own homes,” Remacle states. “I just like it here.”
Since 1996, Landeen has seen increased consumer awareness for the different options available for Home Care. “Families are looking at how they can keep their parents in homes as long as possible, but still have piece of mind knowing that they are being taken care of,” she said.
Madison Home Care Services has three RNs and three aides that travel in a 30-mile radius around Madison. Since Landeen has been in charge for the past seven years, she has seen continued influx of people being aware of home services.
“The numbers are growing because of the knowledge.”
In 2009, there were 3,425 home visits by registered nurses and aides. So far in 2010, there have been 3,217 home visits logging 30,681 miles on the road. Last year, RNs and aides traveled to Miner, McCook, Kingsbury, Lake, Minnehaha and Brookings counties.
Madison Home Care Services has six different objectives:
• provide continuing care from hospital to home
• shorten hospital stays or prevent re-hospitalization
• expedite recovery and return to regular activities of daily living
• reduce the cost of illness
• collaborate with other community agencies to facilitate providing care in the home
• assist with maintaining the home environment.
The Madison services also provide skilled nursing including IV therapy and hydration, wound care and dressing changes, post operative care, health education and medication compliance and education, as well as physical therapy, speech therapy, occupational therapy, health maintenance and homemaker services. Many of the clients also use meals on wheels or adult daycare one to five times a week.
Clients pay for services either by Medicare or through private contracts.
A typical senior citizen using the program is declining in health or maybe a family member is spending more time advocating for them, said Landeen. “There are more doctor visits because health is declining rapidly or they’re not taking medications properly,” she said. “By more controlled management with collaboration of healthcare providers and family members, it saves the payer source and utilizes less healthcare dollars.”
The Home Care program is also an extension of the community services that are provided. “It is a vital service to the local area and being a hub to the appropriate levels of healthcare,” Landeen said. “We work with physicians and other levels of community health services to enable a better quality of life in their usual home setting. It is also a piece of mind for family members.”
There are two major challenges. One is finding the right balance of hours that the patient needs. “We want to keep consistent staff because they become an extension of the family,” Landeen said. “They are usually flexible and we are flexible.”
The other challenge is recouping costs for travel time to make it a feasible program.
Landeen said the program will continue to grow because the State of South Dakota is focusing on using Medicaid dollars to keep people in their homes longer than in assisted living or nursing homes.
“People want to be in their homes as long as they can,” she said. “With the national and state focus in growing home and community-based services, it will only continue to grow. We need to change and grow with it.”

Seniors in Rural Communities – Return on Investment

Information provided by the Rural Learning Center in Howard

Most rural communities are involved in economic development at some level. Many are trying to recruit businesses to their town, others are working to create new jobs, and all are trying to keep what they already have.
Sometimes opportunity is sitting right in front of you. That was the case during Miner County’s effort to create a strategic plan for itself – some of its greatest resources were sitting right there in the same room. The plan was a direct result of input from individuals from across the county from a wide range of backgrounds and economic circumstances. Input was sought from a wide range of age groups and that was an important key determinant because the senior citizens in attendance turned the spotlight on an important economic segment of rural communities – its seniors.
“I’d like to stay here in Miner County – it’s my home. My friends are here, my church, I’m comfortable. I think I still have things to do and ideas to share, but I worry about when I can’t anymore. What will happen to my house? Where will I go? I wish we had housing options besides skilled nursing home care,” said a senior committee member during a public engagement event. With that senior housing amenities and the system of life cycle housing became one of the primary strategies for Miner County’s economic growth.
“We’ve always recognized the importance of our seniors in terms of all that they’ve contributed to our community. They are the backbone of our social capital here. They set the bar very high in terms of being good community members. We always hated to see them leave for another community during their later years. What we had missed was the critical part our seniors played in our local economic development,” said Kathy Callies, member of the strategic planning committee.
All counties obtain their income from the same five sources – farm proprietors, nonfarm proprietors, wage & salary disbursements, dividends/interest/rent and personal transfer receipts. All are important to the overall economy. Dividends/interest/rent and personal transfer receipts are predominantly paid to our senior citizens. If they leave your community their income goes with them. This impact is felt in your churches, your civic organizations, your health care systems, your main street enterprises.
“In Miner County we determined the economic impact of our seniors to be staggering. In fact, losing one senior was equivalent to the loss of a job in our community; losing five seniors was like losing a small business. We started taking a long and careful look at what was needed. We also started listening really hard to what they were trying to tell us,” said Randy Parry, Rural Learning Center.
What resulted was the development of senior housing amenities including a corporation that built and manages independent life cycle housing. Individual investors stepped forward eager to invest in their local community and to help insure that housing options were available. When a firm built assisted living based on the demographic data for Miner County they missed the importance of connecting to the community. “It was not enough to post an ad in the local paper. Assisted living was a new idea in our community. People wanted help with selling their home to a younger family and all the things that go along with that decision. We created Miner County Development Corporation to own and manage the facility and shortly the business started growing. Today a local family partnership owns and manages the facility. It’s a great place and a real asset to our community,” said Callies.

State provides options for seniors

Information provided by Emily Currey, South Dakota Department of Social Services

The State of South Dakota, through its South Dakota Department of Social Services, provides programs that allow South Dakota senior citizens to continue to live independent lives while maintaining family and community ties.
The Division of Adult Services and Aging (ASA) provides services for adults age 60 and over and to adults age 18 and over with physical disabilities who are determined eligible for the various programs. Specialists evaluate each persons needs and respond to inquiries or requests for services.
Different programs include:
Adult Protective Services provides assistance to individuals residing in the community who are at risk of abuse, neglect, financial exploitation, or self neglect.
Caregiver Program provides assistance to caregivers who assist individuals with the tasks of daily living. ASA specialists can provide current information on opportunities and services available in your community and direct you to the appropriate resources.
In-Home Services makes it possible for older adults to live in their homes or return to their homes by providing assistance with tasks they are unable to manage on their own. Services may include: assistance with bathing, laundry, housekeeping, nursing services, emergency response services, assistive devices, medical supplies, and nutrition.
Ombudsman Program was established to advocate for and protect the rights or residents in nursing and assisted living facilities. ASA specialists serve as advocates for facility residents and investigate and work towards the resolution of their complaints. All reports and inquiries are confidential.
Senior Companion Program provides companionship and in-home assistance to older adults and those with disabilities. Services are provided, regardless of income.
For more information, please contact the Department of Social Services at 605-773-3656 or toll free 1-866-854-5465 or visit the department’s web site at http://dss.sd.gov/elderlyservices/index.asp.

What's next for Bethel Lutheran Home?

For nearly 50 years Bethel Lutheran Home has been providing a variety of services for those living in the Madison area. Now, the nursing facility is looking toward the future.
“No one has ever measured the economic impact of the elderly,” Administrator Jim Iverson said. “It has to be staggering.”
What is known is that Bethel Lutheran Home has been able to offer seniors choices over the years.
When Bethel first opened it was a retirement facility and is now one of 108 skilled nursing homes in South Dakota. In the 1970s it changed to skilled nursing with 24-hour nurses on staff.
Then in 1990, independent living apartments opened and then seven years later, assisted living became available. Also that year, an adult day program started.
There are 14 elderly adults in a program that has room for 20. The program provides meals, bathing, transportation and medications.
Then in 2000, an intergenerational daycare was launched. In 2008, the first twin home was constructed for independent living. Then in 2009, a child care facility was built.
Now in 2010, the Bethel Home Foundation is looking to use 8 ½ acres for more additions.
A recent study states that through 2025 there will be an additional 900 more seniors in Lake County. Now there are 100 seniors in the Bethel Home programs.
“The question is how we are going to meet the needs of folks without raising fees?” Iverson said.
The board is looking at building more independent apartments with garages, Iverson said. The house would not be as expensive or as large as the twin homes. “We also need to expand assisted living,” he said.
What has helped Bethel Lutheran Home over the years has been the medical presence in the area that includes pharmacies, clinics and the local hospital and the fact that Bethel Lutheran Home is locally owned and operated and is governed by a 19-member board of directors. Bethel is also unique in that it is one of two facilities that offer all private rooms.
The two things that have impacted seniors over the years has been eating right and taking the correct medications.
Another challenge in the future is access to transportation. “It is getting to be an issue.”
In addition, Iverson sees telemedicine as being a big issue in the next 20 years. “It will allow more options and more choices for seniors.”

Program provides meals for seniors

Since 1973, those over the age of 60 have been able to eat a nutritional meal at more than 30 locations in a 10-county area that includes those covered by the Rural Ventures publication.
The 60s Plus Dining program is a noon luncheon program for people ages 60 and over.
Sandy Vostad, who is the Site Manager for the 60s Plus Dining program, said the program’s main objective is to help senior adults remain healthy and independent through good nutrition.
“If we did not have this service there would be many seniors who would not have at least one nutritious meal a day,” she said. “Some would just snack on junk food.”
It is estimated that more than 850 people participate in the program.
“60’s Plus Dining provides balanced meals to help maintain a healthy body.” Vostad said. “People who are well nourished have more energy and fewer illnesses than those who are not.”
In addition, participants are able to socialize with friends and meet new people.
There are no age restrictions and no lengthy forms to complete. Reservations can be made by calling the nearest dining site listed in the local newspaper, or by calling the Inter-Lakes Community Action Partnership office in your area.
While there is no set charge for the meals, everyone is encouraged to contribute toward the cost of the meal, according to Vostad. “These contributions, combined with limited state and federal funding, enables the program to meet expenses,” she said. “Contributions are appreciated and remain confidential. EBT (food stamp) cards are gladly accepted.”
Vostad said in addition to our congregate dining sites, in many communities dedicated volunteers deliver meals to home-bound participants who are unable to come to the dining site. There is no charge for this special service. Carry out meals are also available.