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Inside The Senior Alliance: Housing Coordination & Transitioning Out of Nursing Facilities (Ep 7)

Jason Maciejewski:
Welcome to episode seven of Inside The Senior Alliance, a podcast exploring resources in the field of aging. I’m Jason Maciejewski chief advocacy and planning officer with The Senior Alliance Area Agency on Aging, serving Western and Southern Wayne County. Today I’m joined by Katherine Zurenko, The Senior Alliance has housing coordinator and nursing facility, transition support coordinator. Katherine, welcome to the podcast.

Katherine Zurenko (00:22):
Thanks Jason. Glad to be here.

Jason Maciejewski (00:25):
Let’s get right into it and find out what a housing coordinator does at an Area Agency on Aging.

Katherine Zurenko (00:31):
So, the housing coordinator at the Area Agency on Aging, it’s pretty simple. I assist with housing needs. So, we have a few different programs at The Senior Alliance, such as the MI Choice Waiver program or the care management program. And a lot of times those participants have a need for housing. That might be resources related to housing, actually looking for a new setting to move to, or issues with their current housing. Anytime somebody has something like that come up, the supports coordinators know that they are able to reach out to me and I’m able to assist their participant with whatever issue they might be facing. I also tend to have staff come to me if there’s any type of question related to housing that might need to be researched. And I do my best to find information and provide that to whoever needs it.

Jason Maciejewski (01:25):
And one of your roles is to assist people who are transitioning out of a nursing facility and into a new residence in the community. What are some of the obstacles people face in making this move?

Katherine Zurenko (01:33):
So the main obstacle for people transitioning out of the nursing facility is usually services and housing. So if somebody has a place that they are returning to, an apartment or a family member’s home, it’s setting up the services that would be able to assist them long-term, or if they do not have a place to return to, then it’s actually trying to locate appropriate and affordable housing for them that can meet their needs upon discharging from the nursing facility. Some other obstacles might be that they need somebody to help coordinate the discharge plan with the nursing facility, like ordering medical equipment or making sure that their prescriptions are ready, or that skilled care had been ordered. So, we kind of do an all-inclusive just to make sure that they have somebody working with them, that all their discharge plans go according to what was decided upon during the assessment.

Jason Maciejewski (02:29):
When you transition people back into the community, what are some of the resources that you draw upon?

Katherine Zurenko (02:32):
A lot of times, it’s a matter of using the resources that we have for housing. Like The Senior Alliance does offer a very comprehensive list on seniors, subsidized apartments. So I utilize that a lot, just so people know what options are available in our area. I also, if they’re going to be working with the MI Choice Waiver program, have a list of different assisted livings and AFC homes that they can choose from. So I work with those resources to give them that information. There’s also a very comprehensive, interactive map through HUD, that you can search anywhere in the country to find public housing options, subsidized housing options, or different apartments that accept Section 8 vouchers. And the one resource that I work with a lot in terms of just advocating for the resident within the nursing facility is the ombudsman. So she comes in very helpful when somebody is trying to be discharged too quickly and things aren’t set up. So, I call her a lot when I’m having issues like that.

Jason Maciejewski (03:34):
Is that HUD information available on the internet?

Katherine Zurenko (03:37):
Yes, the HUD information is available on the internet. So you can go to www.hud.gov and they have a pull-down bar for subsidized housing options. And that’s the first thing that they’ll take you to is the interactive map. It’s pretty new. I think they put it in about two years ago.

Jason Maciejewski (03:55):
It’s a really good resource for people. Thanks for mentioning it. You mentioned the long-term care ombudsman is one of the other people at The Senior Alliance that you work with when people go through a transition back into the community. Do they typically enroll in other programs that The Senior Alliance has to offer?

Katherine Zurenko (04:10):
Yeah, so usually when somebody is discharging from the nursing facility, when they’re in the nursing facility, we actually do a pre-screen and initial assessment to determine what programs they might be eligible for. So if they’re interested in the Waiver program, we do a screening for that. And if it turns out that they’re not actually eligible for the Waiver program, then that’s when we educate them on different programs like the care management program or adult home help or the pace program. So those are just different things that we kind of go over and in terms of what those programs can do for them, and if they’re not eligible for Waiver, then we do assist them with going through the intake process for some of the other community resources. And they’re all meant to help provide services to the participant after they discharge so that they can stay in the community as independent as possible with some assistance.

Jason Maciejewski (05:06):
How are people identified as wanting to transition out of a nursing facility? What are the ways that you come into contact with people?

Katherine Zurenko (05:13):
Yeah, so usually people, um, the social workers at the nursing facility, they’re familiar with our program. So if we do come across somebody that’s interested in transitioning, then they make a referral right to our intake line by sending a face sheet just directly to us. And then our intake person will contact them back and get the intake information that we need. But really anybody can contact us to make a referral. So a resident can contact us. Their family can contact us, the nursing facility, anybody is able to make a referral. And then once we receive it, I follow up with that person just to confirm that they are actually interested in working with our program. And then once I have that consent, we’re able to schedule the assessment. So it’s pretty easy to make a referral. It’s just a matter of double-checking that the person is actually interested in the program.

Jason Maciejewski (06:05):
Katherine, could you share a success story about one of the people you’ve worked with, uh, how the transition back to the community has made a difference in their life?

Katherine Zurenko (06:11):
Yeah. So one of the more recent residents that I’ve worked with, uh, with transitioning back to the community is a younger man where he was in the nursing facility for about nine years, which means that he was in the nursing home for a better part of being in his forties. And when we received the referral, it was one of those things where, you know, this person could have discharged from the nursing facility a lot quicker. Had somebody been able to make a referral for him or help educate him on the program and the possibility of discharging from the nursing facility. So once we were able to do the assessment and he moved to an assisted living option that we work with, he was so excited to have his own apartment and be able to visit with his family in his own apartment and not have to be, you know, in a larger community area.

Katherine Zurenko (07:03):
And he’s actually still in the community. So a lot of times when people have been in the nursing facility for so long, that adjustment of not having everything be all inclusive, that Medicaid is covering in long-term care. It can be a difficult adjustment, but he is still in the community and his family is very supportive and he’s really enjoying the services that he’s receiving. And I just think it’s amazing how, you know, somebody can be in the nursing facility for so long and think that there’s not any other option available to them. But then there are a lot of options that can meet similar needs and service levels like transferring and toileting, things like that. A lot of times people don’t believe that that can be met in the community. And that’s, what’s so great about our program is that, I mean, there’s a lot of different housing options that are able to meet that need. And it’s just a little bit different environment where you have more privacy and are able to still get the care that you need.

Jason Maciejewski (08:01):
That’s a great story to think that somebody’s been in a nursing home for that long and was able to transition back into the community successfully. So if someone is interested or a caregiver for somebody who is interested in transitioning out of a nursing facility, what should they do and who should they call?

Katherine Zurenko (08:18):
So if they’re interested, they can reach out to the social worker or discharge planner at the nursing facility and request that a referral is made to us. It can be sent right to The Senior Alliance on our fax line, or if they aren’t having any luck there, they can call our main line and just say that they’re interested in services. And the participant is currently in the nursing facility and that automatically has an intake completed for the nursing facility transition program. And then they will be put on the wait list for that, which right now it’s about a two week wait list in terms of getting an assessment completed. So if somebody calls in, they won’t be waiting too long to be assessed for the different programs.

Jason Maciejewski (09:02):
How long does it take for somebody to transition out of a nursing facility?

Katherine Zurenko (09:06):
From the time that we get the referral? Like I said, it takes about two weeks until I’m able to schedule the assessment at this time. And once the assessment is scheduled from that point, we will figure out a discharge plan. And if somebody has to look for housing, that can take a lot longer, depending on what’s available and if any financial resources need to be applied for, to make financially available. Um, so that can take a little bit longer and vary, but if somebody is planning on, you know, returning home and just needs to enroll in services, that process can be quicker. So, after the assessment, we would reach out to our vendors with the, MI Choice Waiver program and see if they’re able to cover the case and the hours that have been authorized for that participant, depending on, you know, when a vendor is available to fill those hours, it can take anywhere from two days to maybe a month or more. So it really does vary from person to person and what the discharge plan is. But as long as we have the services and supports in place, then we’re able to move someone pretty quickly to the community with coordinating with the nursing facility and any medical equipment or prescriptions and skilled care that might be needed.

Jason Maciejewski (10:22):
So, Katherine, is there anything else you would like to add about your role as a housing coordinator?

Katherine Zurenko (10:28):
It’s definitely been an interesting topic to learn about, you know, there’s no, you know, you can go to various, um, conferences and stuff about housing, but a lot of it is trial and error and as different issues come up really researching what might be available for somebody that’s having a housing issue or what housing might be available. So over the last seven years, I mean, it’s, it’s been a matter of just building that information and resources and different partners in the community so that when I am helping somebody with housing, I’m giving them the best information that I know of, but there’s always more to learn.

Jason Maciejewski (11:06):
So, Katherine, thanks for joining me today on the podcast.

Katherine Zurenko
Thanks for having me, Jason.

Jason Maciejewski
If anyone has questions about services or programs we offer, you can call us at +1 800-815-1112, or email us at info@thesenioralliance.org. Information about our agency and the programs and services we offer can also be found on our website at www.thesenioralliance.org. Our Facebook page can be located by searching for The Senior Alliance. And finally, our Twitter handle is @AAA1C.

I’m Jason Maciejewski. Thank you for joining us for this episode of Inside The Senior Alliance.

Inside The Senior Alliance as a production of The Senior Alliance and Blazing Kiss Media.

 

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