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Tri-County home care downsizing

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Tri-County's Home Health Care services aren't ending, just downsizing, according to hospital officials.

"There's been a little misinformation that we're entirely abandoning the home care service line and that's not at all true," said Joel Beiswenger, interim president and CEO.

However, inadequate state reimbursement for home health care services is forcing Tri-County to restrict its services in this area, he said.

The skilled nursing home care services, which typically serves about 40 clients, will remain unchanged. Long-term or maintenance home care services, which includes non-skilled nursing assistant care, will be limited to about 70 clients, Beiswenger said. Homemaking services, such as house cleaning, will be discontinued entirely.

Numbers of clients served will go from around 240 at any given time to approximately 100-120, he said.

The medical aspect of home care will be Tri-County's focus now, said Kathy Kleen, director of patient services.

"And it probably should be for a hospital," Kleen said.

A major reason the hospital decided to cut homemaking is because other agencies in the area can offer those services, she said. Home health aid and nursing care require more licensing.

In many cases homemaking is not truly a medical service, Beiswenger said. It has looser criteria for admission than services with a nursing component.

The hospital announced it was restructuring its home health care services in May. Tri-County is working closely with social services case managers to find alternative agencies for clients, Kleen said. Home health care primarily serves people in Wadena County with some in Otter Tail, Todd and Hubbard counties. Clients were given two months notice about the changes.

"We wanted to give clients that notice because they do get anxious about who's going to be coming to take care of them," she said.

The transition of clients will be complete by the end of June, she said. Tri-County also supplied laid off employees with the names of other home health care agencies, she said.

All 46 home health employees were initially laid off and all of them were eligible to reapply, Beiswenger said. The hospital chose to go through a reapplication process because it thought some people might wish to retire or do other work.

Tri-County rehired 26 employees back into home care. Others were hired into other parts of the Tri-County system either at the hospital or Fair Oaks Lodge, he said.

"So, in the end, there were 12 who didn't have positions," Beiswenger said.

Long-term home health care programs began in Minnesota in 1985, Kleen said, and really started to grow in the early 1990s.

"Those programs were put into place in Minnesota ... to prevent folks from having to go into nursing homes, to maintain their own homes," Kleen said. "That's where people want to be if they can is in their homes."

Tri-County started its program in 1987, Beiswenger said. Home health care is a much more cost-effective way to care for people than either an assisted living facility or a long-term care facility.

"So the program's made a lot of sense," he said.

And that is why Beiswenger said he is troubled by what he described as the "state's lack of vision" about properly reimbursing for services.

"Because in the end if they end up in those higher cost settings all of us pay," he said. "As tax payers we end up having to pay more and the other piece is that it takes those homes off the tax roll."

Home health receives both county and state funding, but the biggest issue is with the state funding, Beiswenger said. The state has whittled away the reimbursement rate for services over the years.

"And it's gotten to the point that the extent of the costs are just more than the revenue that the state's providing," he said.

Beiswenger encouraged family members to call Tri-County with any questions they have about the restructuring of home health care.

He said home health care staff has done a very nice job of keeping clients at ease and not alarming them about the changes, he said.

"Everybody's handled it in a very professional way and that's made a difficult decision, a difficult process simpler," Beiswenger said.