LONG-TERM CARE CRISIS: Alternative options for indigent seniors

May 26—TRAVERSE CITY — Chris Boalf, 68, was rushed to Munson Medical Center with painful cardiac symptoms during last year's Christmas holiday.

"I basically died," she said. "My kids saved me."

When Boalf was out of immediate danger, she discovered she couldn't walk and needed ongoing physical therapy, among other services. That's when hospital staff referred her to the Grand Traverse Pavilions, Michigan's largest county-owned medical care facility for people over 60.

Located on the grounds of the former Traverse City State Hospital, the Pavilions is a lifeline for seniors who can't afford privately run long-term care.

"The people here are very supportive and friendly to me," she said. "The facilities are wonderful. I'm treated like a person here, not a profit opportunity."

THE COUNTY-OWNED MODEL

Today, Michigan has 34 county-owned medical care facilities serving citizens from all 83 counties in the state. They serve as a safety net for seniors who cannot afford the costs of private long-term care, although they have limits on capacity and availability.

"Our mission is to provide quality care to (older) people when they have exhausted their resources, which so often happens," said Pavilions CEO Gerard Bodalski. "They've worked hard their whole lives and may have some equity in their homes, but not much more.

"The vast majority of people in Grand Traverse County have modest incomes and limited means. They deserve to be treated with dignity just like the rest of us."

Most people who enter the Pavilions do so after a medical emergency, such as a fall, stroke, or because of a marked decline in ability that makes it unsafe for them to live alone, officials said. They're typically referred to the facility by hospital staff, social workers, doctors, family members and even some private assisted living centers in the area.

WHO PAYS?

The median monthly cost (per person) for an assisted living center in Michigan is $5,050, according to a 2023 study by Genworth. For a skilled nursing home facility, the median cost is $10,570.

In contrast, the Pavilions relies mostly on government funding for reimbursement.

Medicare pays for residents' time at the Pavilions when they're receiving rehabilitation services and have clinical proof of making progress (e.g, the ability to walk 5 to 10 feet).

When that period ends, residents either convert to Medicaid coverage or, in some cases, move to other accommodations, such as their original home or a family member's home.

If a resident can pay for services out of pocket, which is rare, they do so until their financial resources are depleted. Then they apply for Medicare or Medicaid coverage.

WRAP-AROUND CARE

The Pavilions consists of two main parts: 1) A 24-hour nursing facility that currently serves 165 residents; and 2) A nearby set of independent living "cottages" that serve 57 residents today.

Besides lodging and meals, it offers a broad range of therapeutic, recreational and nutritional services covering almost every aspect of senior care living, from nutrition and aqua therapy to life enrichment activities and speech therapy.

During a recent visit to the Pavilions, 10 residents gathered together in a tree-lined courtyard to sing "You Are My Sunshine" with a visiting guitarist. Some were in wheelchairs with IV drips. Others were monitored by onsite nursing staff and a program director.

Retired educator and artist Peter Balestrieri, 85, came to the Pavilions about 16 months ago. Currently using a wheelchair, the Milwaukee native and widower is getting rehabilitation services in hopes of restoring more ability to walk.

"What you find here is tremendous empathy from the people who work here," he said. "They treat us with dignity. It's not just a job to work here — it's a calling. It's the staff members who lack empathy who usually end up leaving."

Help needed by Pavilions residents varies significantly, he added: "Some people need help getting out of bed, washing themselves and getting dressed. Others can get around pretty well without a lot of extra help."

In recent decades, many government-run care facilities have been criticized for poor conditions and inadequate care. The Pavilions itself went through a period of serious financial instability and operational dysfunction during the pandemic. Retaining staff and maintaining quality levels of staffing is a persistent challenge.

After receiving long overdue reimbursement payments of more than $7 million, and hiring a new CEO, county officials say the organization has largely returned to stability, although some caregivers still complain anonymously about staffing shortages.

In fact, staffing shortages are a persistent problem across Michigan, according to the Michigan County Medical Care Facilities Council.

Even though wages are going up in many areas, MCF administrators face a constant challenge recruiting and retaining skilled staff, the council noted in a recent report to members.

The Pavilions has the ability to house 230 residents in its skilled nursing section, versus the 165 there now. But growing that number depends on hiring more skilled personnel, according to operations staff.

State law requires a maximum ratio of 8 patients to 1 nursing care specialist in a nursing home during the morning shift. That ratio changes to 12:1 during an afternoon shift and 15:1 during a nighttime shift.

Public senior care centers are not alone in their staffing challenges. In the past two years, several privately owned organizations serving area seniors have closed because of chronic staffing shortages, including a 65-bed facility called Northern Star Assisted Living. As of this week, that building is still on the market, 1.5 years later.

A SECOND ALTERNATIVE

Local leaders say there's no "single solution" to meeting the care needs of the region's growing senior population.

One part of that solution locally is called PACE North, which stands for "Program of All-Inclusive Care for the Elderly," a national model. It enables seniors to stay in their homes while providing daytime care and health services in a centralized location, with free shuttle bus transportation to both places.

PACE is primarily funded by Medicare and Medicaid, depending on the state. Participants typically pay no monthly premium for daytime long-term care services, although some services may include a fee.

To qualify for PACE, seniors must be at least 55 years old, need nursing-home level care (as certified by the state) and be able to live at home safely with PACE assistance.

The PACE model features an interdisciplinary team of health care professionals, social workers, therapists, dietitians and others who work together to create a customized care plan for each participant. Those services can include: Primary medical care, recreational therapy, nutrition, medicines, personal medical equipment, home chore services, acute care when needed (hospitalization and nursing care).

One of the key benefits of the PACE model is significantly lower costs than in-patient skilled nursing care, according to Mary Marois, chairwoman of the county's Health and Human Services board.

"We think PACE is a great thing for our community and we'd like to see it expand to other places nearby," she said. "It's not a replacement for the Pavilions, but a complementary service for those seniors who are 'nursing-home ready' but who prefer to remain in their own homes."

COMBATTING LONELINESS

Loneliness and social isolation are major problems for older adults today, affecting about 50 percent of seniors over 60, according to a study in the Annals of Long-Term Care. It's also a prime cause of depression in that age group.

That's why both the Pavilions and PACE North place such a high priority on social interaction.

"We try very hard to build an environment where people can make new friendships and enjoy each other's company," Bodalski said.

Instead of residents sitting alone in their rooms, glued to the television, program directors and staff at the Pavilions organize a myriad of activities throughout the year, from games and singing to visits by therapy dogs and special holiday celebrations throughout the year.

"It's about caring for the whole person — body, mind and spirit," he added. "For me, this kind of work is really a mission, not just a job. Our staff sees every day how they're making a positive impact and that gives us a true sense of purpose."

LOOKING AHEAD

Looking ahead to the "silver tsunami" — a growing demographic of aging adults — Bodalski says the nation must invest in the infrastructure and staffing needed to meet the demand.

"If I could speak before a joint meeting of Congress in Washington, I'd tell them to incentivize the work force to make a lifetime commitment to health care. And I'd tell them to finance organizations (like the Pavilions) that provide that care."