Introducing the Champions of Homecare Podcast

David Hancox, Podcast Host and Accra Chief Administrative Officer: Hi everybody, and welcome to our first episode of the Champions of Homecare Podcast. My name is Dave Hancox, and I’m the Chief Administrative Officer here at Accra. I’m joined by my co-host and a member of the Accra communications team, Jason Dorow. Jason, how’s it going today?

Jason Dorow, Podcast Co-host and Producer: I’m great. Thanks, David. I’m really excited to be co-hosting and producing this new venture with you. Hopefully, we can help a lot of Minnesotans learn about home care and access the services they need to live independently at home. And we’ll have a lot of fun along the way.

David: This is going to be great fun. I already know it. I can just feel it. But perhaps, to get started, we should answer the question, “What exactly is the Champions of Homecare podcast?” Well, we want the Champions of Homecare podcast to be a resource for caregivers of all stripes. So, if you care for yourself but need a little help, if you care for a loved one, if you’re a professional caregiver, or even if you’re a case manager or social worker whose clients need home care support, the Champions of Homecare podcast is definitely for you.

Jason: As we progress through each episode, you can expect a certain cadence. We’ll cover everything you need to know about home care in Minnesota, but each episode will feature an interview with an industry expert who explains the nuances of a service program, or delves into resources that help you unlock greater independence in your community. We’ll also share the latest home care news in Minnesota and provide you with some tips and tricks to make your home care experience as seamless as possible.

David: That’s right. Thanks, Jason. The Champions of Homecare podcast is produced by Accra Homecare. And you might be wondering, who exactly is Accra? Accra is a nonprofit organization that provides individualized homecare services to people with disabilities and older adults, most of whom are Medicaid enrollees. We operate in all 87 counties throughout Minnesota and have offices across the state, providing a familiar presence in local communities. Our self-directed services support children, adolescents, adults, and families who need help in their homes. We focus on treating each person as an individual, helping them to lead fuller lives in the community of their choice.

Jason: We’ll get into the various self-directed services at Accra that are available in your community, starting with this first episode. We’ll publish the podcast twice a month, every other week. You can catch every episode by subscribing to the Champions of Homecare podcast on Apple Podcasts, Spotify, Google Podcasts, or wherever you get your podcasts. Now, with that, David, should we welcome our first guest?

David: Absolutely. Thank you, Jason. Our first guest is Tyler Langenfeld. Tyler is the director of 245D waivered services here at Accra. And Tyler, why don’t you start out by telling us what is 245D and who should be paying attention to it.

Tyler Langenfeld, Director of 245D Waivered Services at Accra: Well, thank you, David. Thank you, Jason. I’m honored to be invited to the first podcast. So thank you again. I’m happy to talk about 245D services. As it happens, it is my favorite subject. So what is 245D? That’s a great question. Let’s start from the very top. Technically, 245D is the law that governs the way providers administer some of the services that are available on Home and Community-Based waivers, and they’re essentially the rules and regulations that providers have to follow to provide services. I don’t want to get too technical here, but there are two different types of 245D services or basic 245D services which are concerned with the health and safety of an individual. Then there’s intensive 245D service that, while they are also interested in the health and safety of an individual, there’s also an element of teaching involved, like skills teaching. Traditionally, Accra has been solely a basic 245D provider, and we offer several services that fall under that license. While the services are standalone services, they fall under an umbrella called 245D. That’s why we group them all into one department.

Jason: Tyler, you posed a great potential title for this episode in “245D or not 245D, That is the question.” And I think that kind of leads into our next question for you, who is 245D for? Who is going to use 245D?

Tyler: Well, to answer that question, yes, 245D is all day long, as much as you need, because there are great services. Who are they for? They’re really for individuals who are on a home and community-based waiver. Minnesota has Home and Community-Based waivers. This could be somebody who qualifies, is eligible for medical assistance, and has been assessed by the state of Minnesota, and they qualify for one of the disability waivers or the elderly waivers. What is a waiver? We get this question a lot. It’s essentially a menu of services. No providers out there provide every single service that is on a waiver, but Accra provides a lot of them, and many of them fall under the 245D license, which we talked about.

David: Tyler, let me interrupt for a quick question here. You mentioned being qualified for home and community-based services. I want to touch on that again. How would a person know if they’re eligible for home and community-based services? Or how would they even go about asking that question?

Tyler: Great question, David. We get this a lot. Often, I will get a phone call from somebody who says, “Hey, somebody gave me your number, or I saw your name on a website or I was looking at Accra. And I’d like to open one of your services,” and then we start talking to them. We realize, I have to break the news to them that we’re step four in the process, and they haven’t started step one, two, and three. So what are those steps? I let people know you really need to contact your county. The county that you live in, you contact them and you ask them, “I’m interested in learning more about waivered services. I would like to be assessed.” So you call your county, get your MNchoices assessment. Then a crucial third step that people often overlook is you will get assigned a county or a contracted case manager. Once you have that, a case manager is going to be that individual who really guides you through what’s available on the waiver. And once you have that, a case manager is going to be that individual who really guides you through what’s available on the waiver. And once you have that, you’re at the step of selecting a provider for that specific service that you chose. And hopefully, that’s Accra. I will say this, in my opinion, for somebody to have successful services, it really is a partnership between the county, the provider, and the family. The county brings that expertise about the waiver, as I mentioned, the provider, we bring that expertise about the specific service, but most importantly, the client or the client’s representative, they bring the information about the actual person that’s receiving the services. If all three of us are in line, then we can really help some people out.

David: So what I’m hearing you say, and I just want to verify this, is that for the listener, the important first step is making that connection with the county.

Tyler: Yes, and every county has a different number that you would call. If you look up Hennepin County, they have something called the Hennepin County Front Door. I get these calls every once in a while, and I will let people know to call that number and specifically say that you are interested in being assessed for waivered services. They really will take it from there. Those are the numbers that will get you to county staff who are trained to answer that question and to start those wheels turning. People jump to us early, which I give them credit, they’re Googling, they’re figuring out, they want some services, but sometimes we have to back them up. Maybe that leads to Accra. Maybe it doesn’t, but that’s okay. We just want people to get the services that they’re looking for.

David: Fantastic. And one of the services that I hear a lot of questions about, or that people ask me about, is respite care. So could you talk for just a moment about respite care, what it is, and maybe how it differs a little bit from night supervision services?

Tyler: Absolutely. Respite services, we’re well versed in that because it is our largest 245D service. Last time I checked, it was way out ahead, so I’m assuming that’s still the case. Technically, respite is a break for the primary caregiver. Let’s define what a primary caregiver is because it’s a technical definition that the state of Minnesota has. A primary caregiver is the person or people principally responsible for the care and supervision of the person receiving services. This is important because sometimes people think that if they’re in charge of their own services, they don’t have a primary caregiver or if they have a PCA (personal care assistant) who gives them most care, they’re the primary caregiver. In the respite world, the primary caregiver is the person principally responsible for your care and supervision. Respite is a break for that person. This break could be four hours on a Saturday, or it could be four straight days. It means hiring someone to come into your home to allow you to do what you want or to take the individual receiving the services to their home. At Accra, we provide respite either by hiring someone to come into your home or to bring the individual receiving the services into their home.

Now, you mentioned another service we offer called night supervision. The question often arises, “What’s the difference?” Respite staff can work at night, but what’s the difference between that and night supervision? It comes down to the level of care the individual needs. If someone needs a person there as a preventive measure, then respite staff could be there. However, night supervision is a higher level of care where someone is there because the client will need someone there at night. It’s not just a precautionary measure. They might need physical care throughout the night or need someone there to ensure they don’t leave. We don’t see it a lot, but when we do, it’s individuals who have pretty high medical needs. Night supervision might be the service that’s keeping them in their homes. It’s pretty powerful. It’s not very common, but when we do see it, it’s pretty significant.

David: Would it be accurate to say that night supervision is available on a more consistent basis, whereas respite is more of a temporary or intermittent service?

Tyler: Yes, absolutely. At Accra, we have a diverse menu of services, and people can mix and match. We often see respite coupled with other services like PCA (personal care assistant), where maybe the PCA or another service meets their day-to-day needs, but the primary caregiver needs a break once a month or so. Respite is sprinkled in for a break every now and then. With night supervision, when we do see it, it’s quite consistent, typically seven nights a week because that individual needs someone there every night, not just in case they need them.

David: Thank you for that clarity. Jason, did you have a question?

Jason: I was going to mention how many different reasons there are that people need respite. We recently spoke with a mother in the Twin Cities whose son has a rare chromosomal deletion and requires a lot of care. She cares for him almost all the time, but she described respite as a lifesaver because she also has a full-time job that requires occasional travel. Sometimes respite allows her a vacation, but often it’s for her to go on a work trip, enabling her to do her job in addition to caring for her son.

David: That’s a great point. Not only are there many different reasons, but I think sometimes parents or caregivers are hesitant to ask for help because they don’t want to overburden others or appear needy. Respite is one of those intermittent services that can provide that breathing space. Thank you for bringing up that additional point.

Jason: Now, Tyler, there are many different options and nuances within 245D. Can you tell us about another one that we’ve talked about a lot in the past few years, Individual Home Supports (IHS) without training?

Tyler: Sure, that would be the top two services. If it hasn’t overtaken respite, Individualized Home Supports (IHS) without training is definitely close. IHS is a broader umbrella service that includes four different levels. The IHS without training is very focused on the health and safety of an individual. The people working in this service handle personal care and also facilitate community involvement.

The second level is IHS with training, which is an intensive service with an element of teaching involved. Then there’s a third one, IHS with family training. When you hear the term ‘with or without training,’ it refers to whether or not the client is receiving any training, not the staff. ‘IHS without training’ means that the staff member is there to ensure the client’s health and safety.

David: Tyler, how does IHS with or without training compare to Individual Community Living Supports (ICLS)?

Tyler: Good question. ICLS is one of my favorite services. It’s very similar to everything that we’ve been talking about. These services often get confused because they all involve hiring someone to come into your home and assist you. However, ICLS is a bundled service that includes many of the elements present in other 245D services. It’s specifically on the elderly waiver, so it’s not a service available on the disability waiver. This is important because it allows us to reach more people than before. Individuals on the elderly waiver do not have access to IHS without training, so this is their version of that service. It allows us to reach an entirely new population.

David: Does that mean that ICLS includes homemaker services as well, or is that yet another separate service?

Tyler: ICLS includes many elements. For an individual receiving ICLS on the elderly waiver, it covers personal care, community outings, and household chores. It’s a comprehensive service, which is why they call it a bundled service. It’s as if they’ve taken the best parts of everything and put them into one service. Over the years, the disability waivers have become almost mirror images of each other. However, the elderly waiver isn’t a disability waiver, so it still has standalone services.

Jason: Tyler, I believe there’s another program under 245D that’s somewhat different from these offerings. Could you tell us about the caregiver living expenses program and how it differs?

Tyler: Yes, and I’m glad you brought it up. The caregiver living expenses program is not seen often, but when it’s used, it’s a crucial part of someone’s service menu. Technically, it’s not a 245D service, but it usually involves an element of a 245D service, which is why we categorize it under this department.

Basically, it gives the client the ability to have a roommate who helps them, and this roommate is eligible for some reimbursement of their rent. I’ll give you a real-world example. I’ve worked with families who hoped their adult child could live independently. They made this possible by finding an apartment and a roommate for their child. This roommate provides a bit of IHS without training a few hours a week. But they aren’t ‘on the clock’ 24/7. However, as a roommate, there’s an understanding that they’re there to help when needed. In return for this, they can get their rent and some food reimbursed through the waiver.

This service is a real game-changer. Families have told me that they never would have imagined their child could live in an apartment on their own without this service. While it’s not a service we often see used, we want people to be aware of it. If you don’t know it exists, you may not realize the potential living arrangements you could set up for your loved one. It’s a wonderful service.

David: It sounds like a very practical program that provides a win-win situation for both individuals involved. That’s great, thank you for sharing that. We’ve discussed the steps a person needs to go through to qualify and start receiving 245D services. I’d like to give you an opportunity to share any tips or suggestions related to 245D for our listeners.

Tyler: Thanks for this opportunity. As I’ve said, this is my favorite subject, so I do have a few tips. On a practical note, since we keep mentioning the 245D license and these being licensed services, your staff need to complete initial training to be qualified under the license, and they have to renew this annually. I think our Accra HR department does an amazing job reminding people when their annual 245D training is due. However, if you’re a responsible party, it’s in your best interest to know when your employees’ annual training is due to avoid any lapses in employment.

My next tip is to really explore your waiver. When you receive that waiver, think of it as a menu of services. Some services like the caregiver living expenses we just talked about, aren’t widely known simply because people haven’t delved deeper into what’s available. Don’t limit yourself to the three or four services that are most commonly approved. Pull up your waiver on the internet, look at the items that you’re unfamiliar with, and try something new every once in a while. Ask your case manager about it, you might be surprised at what’s there.

And finally, don’t be afraid to ask questions. I get a lot of calls from people who say, “I was given your number, but I don’t know what to ask.” That’s fine. You’re in the door. We can have a conversation about your situation and the situation of the individual you’re calling on behalf of, and we’ll figure it out. This might not ultimately lead to services with Accra, but that’s fine. Always call, always ask, explore your waiver, and ensure your staff completes their training on time. Those are my tips and tricks.

David: Well Tyler, thank you very much for joining us today for this first podcast edition of the Champions of Homecare podcast. I really appreciate the valuable information you’ve shared about 245D. I’m sure our listeners found it enlightening. As you were saying in your final comments, there are many services under the waiver that people might not know they’re eligible for. So, please be sure to ask about that. Thanks again for joining us today and providing such valuable insight into 245D and the related services.

Tyler: Thank you for inviting me, it was fun, guys.

David: Jason, I think we want to close out today by updating our listeners with some additional news and information. Would you like to start?

Jason: Yes, indeed. We will always provide a news and views segment so that our listeners can stay up-to-date with what’s going on. The latest news is about Medicaid coverage. At the end of the public health emergency, Minnesotans will no longer be continuously enrolled in Medicaid, also called Medical Assistance here in Minnesota, or MinnesotaCare. They will need to renew their coverage. All states, including Minnesota, have maintained healthcare coverage for its Medicaid enrollees during the pandemic. This continuous coverage helped Minnesotans access care and maintain high insurance coverage rates. These coverage provisions have led to a 30% growth in Medical Assistance and Minnesota Care, covering more than 1.5 million Minnesotans. But the end of the public health emergency is leading to a significant change, right?

David: Absolutely. And thank you for that. What a great point to bring up because I know that these renewals are in process right now. Many people may not be aware that they need to initiate this renewal. Congress recently passed legislation that requires states to return to standard Medicaid eligibility procedures. This means everyone who receives Medicaid services has to be re-certified for those services, including an annual eligibility review through the renewal process. Most of the 1.5 million Minnesotans enrolled in Medical Assistance and MinnesotaCare will need to have their eligibility for these programs reviewed through the renewal process. If you’re a Medicaid eligible individual, please reach out to your county case manager and initiate that renewal process. For those enrolled in Medical Assistance or MinnesotaCare, you can visit accrahomecare.org. Click on the banner at the bottom of the screen to find more resources and information about how to renew your coverage.

Jason: Sorry, David, I should clarify that the banner is at the very top of the screen.

David: Top of the screen. Yes, I’m sorry. That’s a good clarification.

Jason: No worries. Yes, there’s a small banner at the top that says Medicaid enrollees will need to renew their coverage. If you go to Accrahomecare.org and click on that, you’ll find a variety of links with resources. There are links to update your contact info, to find out when you need to renew, and to renew your coverage. Now, in other news, we have important legislative outcomes from the latest Minnesota legislative session, starting with a significant increase in PCA wages, right?

David: Absolutely, it’s fantastic news for PCAs working under choice programs. The approved collective bargaining agreement between the State of Minnesota and SEIU, the Service Employees International Union, will increase PCA base wages, if they’re employed by choice providers, to $19 an hour starting January 1, 2024, and $20 an hour from January 1, 2025. However, this only applies to PCAs employed by choice providers. Also, starting January 1, 2025, a tiered PCA base rate will be implemented based on the number of years of service by the PCA. There’ll be five tiers, and you can contact us for more information about that. The collective bargaining agreement also provides other benefits like training stipends, retention bonuses, and one-time bonuses for direct care workers who are members of the bargaining unit. For more information, members of the bargaining unit can contact SEIU.

Jason: A lot of work has gone into this. Many advocacy efforts have been made to make this happen. A shoutout to you and the team for helping push for a raise in PCA wages.

David: Yes, our internal public affairs team spent a lot of time and energy on this issue during the legislative session. We’re very pleased with this outcome.

Jason: And another outcome that’s significant for parents, step-parents, and spouses paid to perform PCA services is that it appeared their ability to provide those services might expire in May this year, with the public health emergency ending. But that’s not the case, right?

David: That’s correct. The Minnesota Department of Human Services was granted an extension by CMS, the Centers for Medicaid and Medicare Services, to allow parents, step parents, unpaid legal guardians, and spouses to be paid to perform PCA services through November 11, 2023. This may seem like an unusual extension date, but CMS only grants extensions in six-month increments. This is fantastic news for families and individuals receiving PCA services from these providers, especially since the workforce crisis continues. Many individuals have significant difficulty finding caregivers. Allowing parents and step-parents to continue providing services is essential for these individuals to receive the services they need in the home of their choice, preventing unnecessary out-of-home placements.

Jason: I recall a conversation I had with a parent in early spring. We’ve shared her story on the Accra blog – she has a couple of kids with autism, and she’s the primary caregiver for them. She emphasized the need for this extension because finding caregivers right now is extremely challenging.

David: Absolutely, Jason. It’s also important to mention the critical role Accra has played in keeping this issue at the forefront during the legislative session. More than 200 of Accra’s clients reached out to their legislators, contacting over 70 legislators during the legislative session. Such participation by our clients, co-workers, and friends is critical and can lead to significant changes. Their efforts, the letters they drafted, the contacts they made with their legislators – over 200 letters sent to over 70 legislators – have made a difference. They’ve played a direct role in this extension as well. They should be recognized for their part in this success.

Jason: It indeed demonstrates the power of collective action.

David: Absolutely. Creating that relationship with your elected official can make a difference. I know sometimes it feels like your single voice may not matter, but this is an example of how it really did matter. Contacting legislators about a specific issue really has an impact.

Jason: Most definitely. As we wrap up, I want to remind everyone to visit our website at Accrahomecare.org if you want to get in touch or need more information. If you’d rather call, our number is 866-935-3515. If you have any questions about 245D, or other Accra home care services, don’t hesitate to call. Now, any final thoughts as we wrap up our first episode, David?

David: I think this was an excellent first episode. I’m really glad we chose this topic, because it provided a lot of valuable information to our listeners. It was a pleasure doing this initial broadcast with you, Jason, and I’m looking forward to being your co-host.

Jason: It’s been an absolute pleasure. Tyler has certainly set a high standard for our future guests.

David: Indeed, he has.

Jason: We’ll be back in two weeks. Thank you for listening to the first episode of the Champions of Homecare podcast.