LANSING – The elderly throughout the state may soon be able to approach a single office in their community for advice on long-term care options and assistance in processing Medicaid forms.

The Department of Community Health has designated single-points-of-entry (SPEs), or long-term care connection offices, to serve four areas – Southwest Michigan, West Michigan, the Upper Peninsula and Metro Detroit.

Most of the SPEs designated in these areas are Area Agency on Aging offices.

“SPEs are a one-stop shop that people can approach to find out everything they need to know about long-term care,” said Mike Head, director of the Office of Long Term Care Supports and Services. “The offices are a hub that strings together the web of all health care options available to the elderly and the disabled.

But the Health Care Association of Michigan, which represents about 240 nursing homes statewide, expressed doubts about whether these offices will provide unbiased advice about long-term health care options.

Head said, “This is a two-year pilot program. At the end of the pilot run, we will review the data on customers served by the SPEs.”

The most common long-term health care options are medical care at home, assisted-living communities or nursing homes.

Assisted-living communities are designed for residents who need help in some daily tasks but don’t require round-the-clock medical care provided by nursing homes.

Other tasks of the SPEs include advising the elderly on how to budget their money when making a long-term care health plan and assistance in filling and processing Medicaid forms.

SPE Opposition

Reginald Carter, president of the Health Care Association of Michigan, said that the SPEs might favor options in which the elderly receive health care at home.

“The Area Agency on Aging offices operate home- and community-based health care services,” Carter said. “I certainly think there may be bias.

“I’m suspicious, but that’s why these are pilot programs. At the end of two years, we can look at the data and see if there is no bias.”

Head said the Community Health Department has safeguards ensuring that the entities, which applied to be SPEs, won’t have vested business interests.

It is important for the SPEs to be independent because one thrust of the project is to make efficient use of the department’s annual $2 billion long-term care fund, he added.

“We think that there will be savings in the long-term health care budget with people choosing less expensive home care options instead of nursing homes,” said Head.

Carter disagrees.

“I don’t think there will be a decrease in the fund allocated for nursing homes,” Carter said. “People go to nursing homes because they’ve exhausted all other options and can no longer be safely cared for at home.

“It’s like breaking your nose. If you want it straightened out, you have to go to the hospital. You can’t have it straightened anywhere else. When that point comes when someone needs 24-hour medical care, nursing homes are the only place they can get it.”

Southwest Michigan SPEs

The Area Agency on Aging in Coldwater, the SPE serving St. Joseph and Branch counties, is taking calls from people seeking advice on long-term care options, said Laura Sutter, a coordinator for the office.

“We’re gearing up to provide all the services expected of us and we are thorough in our preparations,” said Sutter.

The agency is currently hiring staff and meeting with local home health providers, nursing homes, mental health organizations and government agencies to determine the most effective and efficient way to deliver services to older adults, she added.

“These meetings will help us streamline the information-gathering process for customers,” Sutter said. “For example, if customers need the services of five different health providers, it doesn’t make sense to have them fill in background information five times.

“That information can be shared by the health care providers. We want to avoid duplication.”

Three other Area Agency on Aging offices – in Kalamazoo, Battle Creek and St. Joseph – serve as SPEs for other counties in Southwest Michigan.

Legislation on SPEs

The SPEs were created under an executive order signed by Gov. Jennifer Granholm in June 2005.

The House has unanimously approved a bill, sponsored by Rep. Rick Shaffer, R-Three Rivers, setting operating guidelines for SPEs. The bill is awaiting Senate approval.

If enacted, the bill would prevent the government from opening additional SPEs until data from the present pilot projects are reviewed by the Legislature after two years, Shaffer said.

“Without SPEs, there would be no single neutral source that can educate families about the appropriate level of care for their loved ones,” Shaffer said. “When mom is in the hospital, families should not have to run to several different agencies to determine the level of care mom needs.”

That’s why it’s important to set parameters on the performance of SPEs and to have legislative input in reviewing the data at the end of the pilot run, Shaffer said.

“We don’t want to run into this with our eyes closed. Decisions on whether to open SPEs statewide and how they should be operated should be backed by hard data,” he said.

Lynn Kellogg, chief executive officer of the Area Agency on Aging in St. Joseph, the lead SPE for Southwest Michigan, said that making SPEs permanent would spur the diversification of long-term health care services.

“The industry providing living options for the elderly is still at its infancy,” Kellogg said. “There are many experiments being done to develop alternatives.”

In one such experiment in Massachusetts, for example, a group of elderly people pooled their resources, lived in a four-unit house and shared the cost of hiring someone to assist all of them, Kellogg said.

“There are so many other housing arrangements that are just emerging now,” Kellogg said. “SPEs can help the elderly find out that such options exist.”