Long-Term Care in Indian Country: Oneida Nation of Wisconsin

Long-Term Care in Indian Country: Oneida Nation of Wisconsin


– If you look back historically, there were usually
very energized elders who felt the most important
thing to offer was long-term care services for our own people
on our own lands by our own people. And that’s a recurring theme. – As a tribe, one of the most
important relationships that we have is to work both
not locally– not just locally but state
and national and keep a handle on
all of those entities and how they play a part
in terms of what we plan to do, what direction we plan to go. And, you know, Oneida has always
been a pretty progressive tribe, and I think that has helped us
in terms of looking forward to say, “What kind of
relationship do we have to have to make it beneficial
for the tribe itself?” And what kind of model
can we put into place so that other people can benefit from the work
that’s been done here? – So one of the things
that I think is very critical for native programs
in long-term care is forging the relationships
with the departments in the state that they’re in–
their Medicaid directors, the directors
and the administrators of their
Department of Human Services and the policy analysts so you have a working
relationship with both sides of those programs in the state. Because those programs
are critical to long-term care funding
and long-term care needs. – It took us a number
of meetings to figure out that we were actually talking
past each other with the state. The state would be using
the same terms with a different definition. And so in order to fix that,
we did something very simple, was put together
a glossary of terms with common definitions. That really–that simple thing
of putting together a glossary made the education
go much faster, much easier, and it was the education
in the long run that allowed us to make a lot
of the inroads with the state. – I have come to believe
that once they are educated, once they understand,
it opens the doors. They want to collaborate.
They want to help. – So what we try to do is coordinate all these services
in such a manner that A: everybody knows
which person and which department’s providing
the service as well as being able to say, because of your age,
because of your income, you may qualify for funding
from, say, Elder Services and not Transit. So we try to appropriately
match the person with not only the services
they need– but from
a provider standpoint, we try to make the money
and the funding go as far as it possibly can. – When you have a long-term care
facility like a nursing home, what drives your rate
is an assessment called the MDS. Having your nursing staff know how to complete the MDS
correctly so that you capture
the highest rate of revenue– but then you have to work
very closely with the state and say, “How can we capture
that enhanced rate?” And working closely with them and double-checking
their calculations. – When we first tried to get
some more services eligible for 100% FMAP, we honestly thought
that our biggest fight was gonna be with CMS. And so we did arrange
a series of meetings with the tribe, CMS,
state representatives from the Department of Health,
and Indian Health Service. And much to our surprise, CMS and the state
were totally on board. They understood immediately
that this was a good thing and supported us. Once we were able to get
the 100% FMAP, that then allowed us to get
an enhanced rate. So instead of getting
the Medicaid fee screen from the state, we were able
to claim what’s referred to as a federal M.A. upper limit, which is closer
to a Medicare rate, which is much higher. We do the same thing
here at the health center for all the direct care services
we provide. – Throughout the years, what the tribe
has gotten much better at is formalizing needs assessments
of their elders. – I think one of the biggest
things as we move forward was basically incorporating,
you know, the support of our Commission on Aging
and presenting to the community and showing the numbers
and showing the data so that everybody could see
this was the justification for how we move forward. I think that was critical in terms of actually getting
our elected officials’ buy-in is showing: this is the need. Here’s the numbers. This is why we need
to support this. – Now we’ve gotten sophisticated
enough that we still do
community meetings and we solicit input
from the community at a regular interval,
but we’ve also partnered with some of the colleges
in the area, and we do a very comprehensive
five-year community needs survey that points out any gaps that we
happen to have in service. We’re trying to set up
the evaluations in such a way that not only do we create more
efficiency within the system but that we create more customer
and client satisfaction all at the same time. – Traditionally,
we’re a matriarchal society. And I think the planning that has gone into long-term
care services as well
as any of the other services is a piece of that culture. One of the teachings
always has to do with the seven generations– that we’re always planning
to look for the next seven generations
ahead in terms of what we do, and I think
that cultural component of that is what has driven us
to incorporate a lot of those things
that we do. I think one of the things
that was a critical element was their persistence. They didn’t give up. You know, they continued
to move it forward.

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