The way long-term care is delivered to older Americans in Pennsylvania and individuals with physical disabilities is changing, and Tri-County Patriots for Independent Living in Washington is at the forefront of the movement.
TRIPIL’s caregiver training program offers friends, family and neighbors the opportunity to provide in-home care to loved ones, including those with Alzheimer’s disease and dementia, so they can remain independent. Upon completion of the training, graduates are placed on TRIPIL’s payroll.
Until several years ago, family members who cared for their relatives were not permitted to be compensated. But as the demand for services increased, as well as the cost of nursing-home care, it seemed like a more sensible solution for everyone involved – especially those who require the care – and the state is encouraging it.
“It’s all about consumer control and their needs,” said Kathleen Kleinmann, who founded TRIPIL in 1990 and now serves as its CEO. “The training center is an integral part of our work. We are the ones who receive the care, and we provide the care. We’re building relationships with people. We want those relationships to last long term.”
In January, Kleinmann was one of 25 people appointed by Gov. Tom Corbett to serve on his newly created Pennsylvania Long-Term Care Commission. The commission was formed to develop recommendations to improve the current long-term care system, including ways to provide a better-coordinated approach to delivering services and support, and ensuring quality health care for older Pennsylvanians and individuals with physical disabilities.
Kleinmann said that statewide, between 30,000 and 40,000 residents receive in-home care. The state wants to increase those numbers to achieve a more balanced level of care between in-home and nursing homes. She said it costs the same amount of money to hire two-and-a-half to three caregivers for multiple clients as it does to house one person in a nursing home.
“The state saves money, too,” she said. “The more federal money for this work we receive, the higher the match we get as we put fewer people in nursing homes.”
There is money available, Kleinmann said, and if Pennsyvlania doesn’t ask for it, another state will. “There are more strings attached, but it’s better than not having it,” she said.
TRIPIL collaborates with the Office of Long-Term Living and Southwestern Area Agency on Aging to provide personal care assistance and help older adults move out of nursing homes. The number of hours a caregiver can work with a client – up to 60 hours per week – is determined by guidelines established through the Office of Long-Term Living and Department of Health. Referrals for in-home care are made through Area Agency on Aging and funded by Medicaid.
“Nobody takes care of you better than the family member,” said Andrea Costello, supervisor of the Direct Care Program.
With rigid guidelines in place, chances of abusing the system are very low, Kleinmann said, noting that, “People don’t want more care than they need. It’s an intrusion.”
Betty Brooks of McDonald, who cares for her mother, Anna Snatchko, 86, of Burgettstown, is employed by TRIPIL. So is Betty’s niece, Kara Snatchko, and her daughter, Katie Fehl.
Betty, who is Anna’s primary caregiver, had trouble finding reliable workers to care for Anna when she started needing more oversight. Completing the TRIPIL training was her best – and only – option.
“Mom had a really rough time in the beginning,” her daughter, Katie, said. “When workers called off, my mom had to call off work. She couldn’t keep a job.”
That was three years ago. In February 2013, Kara completed the TRIPIL training program, and Katie shortly thereafter, when her son, Corbin, was born. Katie also works two other part-time jobs.
“When my mom suggested it, it worked out perfectly. It gives my mom a break,” Katie said. “In all honesty, I did it for my mother, and it works out well because I get paid to take care of her. I see when I put my Gram to bed that she would not get care like that in a nursing home.”
In the beginning, Anna was approved for two hours of in-home care a day, or 14 hours per week. As her dementia progressed, the number of hours increased. She now is approved for 56 hours of care per week.
Although Betty spends six nights a week at her mother’s home, averaging about 14 hours per day, she is not on TRIPIL’s clock during that time. She is paid for only her eight-hour daytime shift on Saturday. Kara and Katie each work eight-hour shifts three days a week.
Betty said someone recently called TRIPIL requesting her services, but Betty politely declined. She has no time. However, she said she may consider it after her mother passes away. Katie, on the other hand, doesn’t believe she could care for someone who is not a relative.
“This is my Gram,” Katie said. “She did it for me. Why not do it for her?”
Costello said TRIPIL serves 600 to 625 clients, with 558 attendants on the payroll.
The four-hour, four-day training is held twice a month and covers a variety of topics, said Jason Zubovic, training coordinator, such as confidentiality, maintaining consumer boundaries, understanding the independent living philosophy, nutrition and meal preparation and proper use of medical equipment. Attendants also must attend one refresher course per year.
The only people who are not eligible to provide in-home care for clients are their spouses and those who serve as their power of attorney. Caregivers also must pass a background check.
Costello said consumers are encouraged to meet the attendants in advance to see if they can work together. After a match is made, TRIPIL monitors the relationship. If a problem arises, Zubovic will visit the home to troubleshoot.
“You are offering peace of mind when you have a network,” Kleinmann said. “People who work here have a different sense of what we’re working for. You know you’re making an investment.”