LTSS and Tribal Leaders—New Resources on CMS.gov

LTSS and Tribal Leaders—New Resources on CMS.gov


On behalf of the Centers of Medicare and Medicaid
Services, the Administration on Aging, and the Indian Health Service, I would like to
welcome everyone to the Long-Term Services and Supports webinar series. My name is Julie
Cahoon and I work for Kauffman and Associates. I will be the moderator for today’s webinar.
Before we begin, I would like to highlight the two main features of your webinar interface.
You can see the first PowerPoint slide of the presentation in the main window and the
Q&A box in the bottom right-hand corner. Today’s question and answer period will be at the
end of the presentation; however, you can enter a question for our presenter’s at
any time in the Q&A box. If you need technical assistance during the webinar, please enter
your tech-support question in the Q&A box. Our tech-support staff will be monitoring
these questions throughout the webinar and we’ll work to answer your tech-support questions
right away. You will receive an answer in the Q&A box. During today’s webinar, a video
will be shown. In order to watch the video and to hear the audio, you will need to be
logged into the Adobe Connect platform. Finally, please be aware that today’s webinar is
being recorded and that the recording will be made available online in the near future
on CMS.gov. With those announcements made, I would like to welcome everyone to today’s
webinar. Today’s webinar is titled, “LTSS and Tribal Leaders: New Resources on CMS.gov.”
Our presenters today are Josephine Keefe and Kim Blessing. Josephine Keefe is the Creative
Director at Kauffman and Associates. Josephine started out at KAI as a project specialist
working with at-risk communities on suicide prevention. Since then Josephine has moved
to the communications team as creative director. Josephine facilitates the creative process
on various projects, providing an eye for creative continuity on such tasks like the
Drop In (?unclear – 2:06) and some film production. Kim Blessing is the Vice President for Communications
at Kauffman and Associates and has nearly 10 years of experience in the communication
field. She has spent the last seven years at KAI working on communication products dealing
with education, public health, safety, and low-level populations. She works closely with
CMS on developing outreach tools related to healthcare for American Indians and Alaska
Natives, and will be providing an overview of the new section dedicated to tribal leaders
on CMS.gov. So now, I will turn it over to Kim Blessing.
Great, thank you, Julie. So we are very excited to present new resources on CMS.gov. We’re
going to talk about tribal leaders’ role in meeting communities’ Long-Term Services
and Supports needs. We’re going to show you how to navigate the new section and we’re
going to show you several new resources that are available in this section on CMS.gov.
Uh, for just a little bit of a background on this project, we… If you’re not familiar
with the Technical Assistance Center on CMS.gov, we’ve worked with CMS to develop a central
location for resources related to Long-Term Services and Supports in Indian Country. The
current section has a resource library. It has a roadmap for planning. It has programming
example videos, archival webinars, uh, this monthly webinar series and an archive of newsletters.
And what we found was that, with all of the resources being added, it was getting a little
bit unwieldy—a little bit more challenging to navigate. So, we worked with CMS to redesign
this section. It’s currently not live yet—the redesign—but we will… We’re hoping to
go live with it in the next couple of weeks and we wanted to give you all a preview of
a particular section. The Tribal Leaders Section is a new area that we’ve added during the
redesign, and it includes a toolkit to facilitate discussions, an overview of program concepts,
um, funding information, a guide to working with state and federal agencies, and examples
of successful tribal programs. And I’ll be walking everyone through this new section,
and we’ll be showing you the different resources. And as Julie mentioned, we have a video that
we’ve developed that we will be showing at the end, as well. So, the first thing I’m
going to show you is the new homepage of the website—and again this isn’t live yet,
but it will be soon. Right now I’m showing you a…the website on our development server.
So, this is not public, but it will be soon, and we’ll be sending out an announcement
to our listserv when it is live and when these resources are available. So, this is the new
homepage—or what will be the new homepage—of the TA Center. You can see that we have an
overview of what is Long-Term Services and Supports. We have a link to the webinars.
We have a video overview, a space for our newsletter archives… And then we divided
it into different sections where we have planning and evaluation, state and federal relationships,
program examples, resources, LTSS program structure, and financing. Um, so we really
wanted to make this… Our goal was to make this easy to navigate and easy to find what
you need, because it is such a complex topic and there are so many resources out there.
Up at the top left of your screen, you’ll see a Tribal Leader Section. And this is the
area that we’re going to focus on today. I’m going to walk you through all the different
resources that are available. So, when you click into this link, you’ll see the Tribal
Leaders Section. So, at the top of the page, we have a little bit of an overview. And then
we can actually go into a more detailed overview in the first section. And it has an explanation
of what are Long-Term Services and Supports, why are they important. So, there’s some
facts about the needs growing and how programs can meet community needs…and then an overview
of funding. And there’s actually more detailed information on funding within the TA Center,
but there’s a little bit of an overview. And then there’s some links to additional
resources. We also have an area on how to use the Technical Assistance Center. So, we
really thought about… You know, because there are so many…so many resources. And
again, it’s such a complex topic, we wanted to give some directions on how to navigate
through the Center. So, it talks… It’s got an overview with links about what you
can find there. So, we talked about basics; we’ve got topics; um, there’s a map and
a database; there’s a financing area; and then there are planning tools. We also have
program examples and we highlight different programs throughout Indian Country. And if
you click into each of the program examples, you’ll see there’s a point of contact.
There’s an overview. It talks about services provided, eligibility… And then there’s
some funding information there, as well. You can go in each of those individual programs
and see that detailed information. And then the last section in the tribal leader’s
area is a toolkit. We’ve created several resources for tribal leaders to use in their
communities. We have a brochure. We have facts sheets. We have a PowerPoint presentation,
an infographic, and the video. And I’m going to go into each one of these resources and
show you a little bit more. So hold on just a second; I’m going to switch views. (Pause.)
And the first product I’m going to show you is a brochure. So, this can be printed
out and distributed in communities, and it’s just a nice overview of Long-Term Services
and Supports. It talks about what they are, why they’re important, how they improve
lives, how they meet community needs, and just a brief overview of funding and where
more information can be found. So, it’s a really nice overview that can be printed…downloaded,
printed, and distributed within communities. There’s also contact information on the
back with social media information, as well as a link to the TA Center. The next resource
is a fact sheet on how to use the Technical Assistance Center. So again, this can be downloaded
and printed out and distributed, and it’s nice to complement the new section and shows
what’s available there. So there’s an overview. We talk about the webinars, the
newsletter, um, examples and planning. And this also has social media and a link to the
website. So, there’s more information on where to go for additional resources. The
second fact sheet we have is just an overview of Long-Term Services and Supports model.
So, we talk about community-based LTSS and we have examples there. We talk about facility-based
care and we have some examples, Money Follows the Person, PACE, Medicare, and then some
stuff for addressing LTSS needs of your tribe. And, as with all the other materials, this
document has the social media and the link to the website. Another document that we’ve
created is an infographic—if you’re not familiar with these, these have become pretty
popular. They’re really great for sharing on social media. They’re very image-based
and they really break out the information into scannable, really easily digestible chunks.
And so I’ll scroll through here and you can see the different images that we’ve
used, different facts about LTSS, and this is really nice because it can be easily shared
on social media. You can post it on Facebook. We’re also going to have a downloadable
and print version. So communities can print it and disseminate that way. But it’s a
really nice snapshot of LTSS and where to go for additional information. I’m just
going to continue scrolling through here. And, like, all of our materials that have
social media and contact information. The last document I want to share with you before
we show you the video is a PowerPoint presentation, and this can be used by stakeholders in tribal
communities when they are starting the conversation or continuing a conversation about LTSS and
how tribes can build support for programs. This is a very comprehensive PowerPoint. We
give an overview and so you’ll see—if you’ve noticed—this is… We’ve stated
some, or found some facts about LTSS and numbers. So, these are things that you can…really
easy to start the conversation that you can share, um, within communities, and these are
on all of the different materials. So, the number of elders by the year 2030—so we’ll
have two and a half times as many American Indian and Alaska Native elders in the year
2030 as there were in 2012. Things like that, you know… Again, digestible information
that you can share. We have a brief overview and then we go into program examples. These
are similar to the program examples that we have posted on the website. So, just an overview
of each program, and we include quotes from different tribal leaders and healthcare providers.
Let me go into a little bit more detail about, “What is LTSS?” We have a list of services,
providers. We talk a little bit about providers, locations, so again, the home- and community-based
and facility-based. We talk a little bit about state and federal partnerships. Uh, then we
have a section on financing. We talk about FMAP, Medicaid waivers, other funding sources,
and we talk about program models. So, we go into a little bit more detail here about home-
and community-based services and facility-based, other models, so, examples. So, we really
wanted to… When we were creating all these materials, we really wanted to show that there
are…what all the exciting things and other programs are out there are doing so that everyone
could see examples and can see that it can be done and get inspired. Then, we have a
section on getting started—I think this is one of the most difficult things. So, early
steps that you can take and again, we mix in different quotes from people who are already
doing it. And then we have a Resources section. We talk about the TA Center and what’s there.
The Roadmap—I mentioned that in the beginning. This is really where the Tech…TA Center
started. It was a Roadmap for Planning. So, a step-by-step that starts with an easy step
assessment and walks communities through the process for planning. And we really expanded
the TA Center around this, but we’ve kept the roadmap in there. So, that’s a great
resource that’s available to plan and use those steps and then as… Again, we have
ways to stay connected and resources for additional information of our monthly webinars, which
I’m sure you’re all familiar with. And then we have contact information and a link
to the TA Center. Okay, so the last resource that we want to show you is a video that we
developed with tribal leaders and I’m going to turn this over to Josephine Keefe, our
Creative Director, to talk a little bit about the process for, um, developing the video.
We are… We’re going to be playing this through Adobe Connect. So you’ll need to
be connected within the webinar interface and you’ll need to have your computer speakers
on. So, Josephine, do you want to talk a little bit about our process for the video?
Sure. Thank you, Kim. And thank you everyone for joining the webinar today. The LTSS Tribal
Leaders Video was a real pleasure to work on and there were a number of goals that…on
the protection side of things, we wanted to try and address with this video. Um, one of
which was to gather together tribal leaders from across the country who are actively or
were actively involved in the creation of the…and the success of the LTSS program
with their own community. So, we were able to successfully do that and, with that, we
wanted to film these tribal leaders having a conversation with each other, conversing
in a way that was both candid and for the viewers to get a chance to take a glimpse
at these conversations. It was… You know the running time of the entire production
of filming this conversation with these tribal leaders was over four hours. So you can imagine
what it was like for us within these…you know, the editing process to take four hours
of very, very rich material, lessons learned, hurdles along the way, ways in which technology
can be used to the benefit of an LTSS program, but so many different topics were reached
and we had to try and pull that into a film under ten minutes. Uh, there is enough information
within the raw cut of the film to make more for the LTSS research. And we hope we might
be able to have an opportunity to do; but this video series, we wanted to film them
having this conversation with each other about the successes of their programs, addressing
the unique qualities of their program that might work for some other communities. And
by doing that, another goal, the third goal, was for those who are viewing the video, our
viewers, um, to be able to connect or to connect with the tribal leaders who shared similarities.
To be able, as a viewer, to say, “Wow, you know, here’s a community that is actually
very reflective of my own community. Maybe they added some things like he is taking,
as how to create a successful LTSS program, that I can, in turn, use within my own community.”
So, I wanted… We, on the production side, wanted to make sure that, um, various voices
were heard within the film and, in turn, that our viewers would be able to connect with
various voices as well. So I’ll turn it back to Kim and she can play the video for
you guys. (Video begins – 18:30. Sound of Native American
voice singing and drumming.) Gatherings have special meaning in Indian
Country. For tribal leaders, they offer the opportunity to trade ideas; talk about policy;
advise federal agencies; and, certainly, to share anecdotes and laughter. Recently, leaders
Ron Allen, Cindy Nation, Michell Hicks, and Lynn Malerba met to discuss something near
and dear to their hearts and that echoes across Indian Country: how to care for elders and
those with disabilities long-term. When it comes to long-term care, our program
is kind of a makeshift from our housing, our healthcare, and just a small little program
that is designed to provide assistance for our elders. So we combined the…them together
to make it work for our elders. We don’t actually have a facility, but we have a very
strong housing program. So we… So elders who need housing who don’t already own their
own homes, we assist them. I represent the Doyon region, which is 42
villages. Tanana Chiefs Conference provides all the healthcare and the social programs
and those kinds of things. And our program started in 1992, um, with a small respite
grant. We provide homecare services, because our goal is to keep people at home. The first
time I went out into the villages, one of the first times, an elder told me their souls
didn’t rest unless they were able to die at home. So, I’ve never lost that.
You don’t want to send people outside of your communities so that if you don’t have
a nursing home or that next level of facility to care for someone, you’re kind of banishing
your elders a little bit, and isn’t that just kind of the opposite of the boarding
schools? You know, you’re sending people out of your community to accept care. So,
I think that is kind of the next evolution in terms of what we need to be thinking about.
I think that’s really going to be different for what kind of communities you serve, because,
in Alaska, we have cities, um, that serve. You know our tribal city for us is in Fairbanks
and the services that are provided are to 42 villages that are only…most of them are
only assessable by airplane or boat, and there’re from 60 to 500 people. So, you can’t really
provide…you know, have an assisted living home in each community. So, what you want
to do is train up people in that community or really support the family and the whole
community in providing services for that elder. Yeah, I agree with both of you in terms of
outreach to the elders to have a better feel for, “What do you want? Do you want to live
at home? Do you want assistance at your home? Or are you interested in a facility that is
close to the community activities that are going on within the tribe, whether it’s
powwows or special cultural events and things like that that we might provide or activities
with the youth, which many of our elders love doing. They like to engage with the youth
with regard to our…some of our traditional programs that we have. It can be expressions
of the art. You know, we do carving and basket weaving and things like that.
In Indian Country, by 2030, there will be almost three times as many elders as there
were in 2012 and many of them will need programs of long-term services and supports, LTSS,
for things like cooking, dressing, medication, and money management. Younger people, too,
will need LTSS. Native adults of all ages have the highest rates of chronic disease
and disability in the United States. Elders, others with disabilities, and their families
prefer services that are delivered in their own homes or in community-based facilities.
Native people have a long tradition of meeting their needs. So, who better than the tribes
themselves to create and operate LTSS programs for their people? Different tribes take different
paths when it comes to LTSS and there are many decisions to make. That is why the Centers
for Medicare and Medicaid Services created a Technical Assistance Center especially for
tribes. The online site pulls LTSS resources together in one place and offers a roadmap
to guide tribes along the way. The first step is to seek input from each unique community.
We’ve adopted a number of assessment processes and, over the years, it’s been very helpful
to us to go directly to the elder and ask their opinions about, you know, “Where do
they see the current services?” We do an annual report to the people—15,000 tribal
members—and one of the things we asked for is, give us feedback on tribal services; again,
hospital, nursing home, you know, EMS, whatever it may be. And that’s also been a very valuable
piece of information gathering. The third piece that I think has been very successful
is just community club meetings. Outreach is critically important to make sure
that, you know, what they want. And not everybody is real vocal and so you have to put them
in an environment that you actually find out, “What are they thinking?”
I think that, as we think about long-term care services, it’s a value to the whole
community, not just to the people who are receiving the services. It also says to that
individual that, when I do need assistance and I do need help, that my family and my
tribe will be there, perhaps, when it’s my turn to need help.
It matters what’s in your heart and the passion that you have to provide those services,
and you’re going to have ups and you’re going to have downs and, um, if you just keep
looking at the successes in each elder that you’re able to help, you’re going to build
on top of that and use lots of prayer. I’ve always felt that, if tribes can benchmark
off of each other and improve the foundation that they have and make a better living conditions
for the people, then obviously we’re doing our jobs; but, you know, I’m also encouraged
about the future. The tribal systems are improving, whether it’s improving the relationship
at the state level, the federal level, you know, making sure that we’re utilizing all
the partnerships that potentially are out there—which personally I don’t think we
are. I think there’s plenty of opportunity there, but we’ve got to work harder to find
it. I’ve watched Indian Country grow into, what
I consider, a very impressive success compared to where we were 40 years ago, and that success
gives me encouragement. Yes, we have to temper that with “that success breeds higher expectations
that we’re always chasing,” but if we’re able to reflect back to where we were and
where we are today, we’re doing a lot of good things for our communities and elder
long-term care is among them. (Background sound of Native American voices
singing and drumming.) Caring for our elders and people with disabilities
is a growing concern and it can be difficult. How do we get started? Who can help? Where
do we get funding? The Centers for Medicare and Medicaid Services is working with American
Indian and Alaska Native communities to help answer some of these questions, to build programs
that enable individuals to remain in the communities where they feel safe, are valued, and surrounded
by those they love. There’s never been a better time. You’ll find technical assistance,
funding streams, program models, and training opportunities at the LTSS Technical Assistance
Center at GO.CMS.gov/AIAN-LTSS. Visit, explore, and get started today.
(Background sound of native singing and drumming continues until end of video.)
Okay, I’m going to go ahead and turn it over to Julie to get some instructions on
the Q&A portion. Okay, thank you. At this time, it is ready
for our question and answer session. Please enter your questions in the Q&A box located
at the bottom right side of your screen. So, we have a couple that have come in. One
was about the link. We did change layouts. So, you may have seen the link disappear,
but it should be there in the middle, about the middle, right-hand of your screen. That’s
the current link to the TA Center. So, if you’re not familiar with it, I highly recommend
going and checking it out. The new design with all of these new resources will… We’re
hoping to be live over the next couple of weeks. We’ll send out an announcement to
our listserv as soon as it’s live. If you are not signed up for the listserv, you can
sign up for that on the homepage of the TA Center, currently. So, we do a monthly newsletter.
We do all of our webinar announcements; so, if you’re not signed up, there’s a lot
of great resources there. So, I highly recommend doing that and you’ll be the first to hear
when the new site goes live. (Silence.) Uh, we have a question about resources available
in languages other than English. At this time, they’re only in English, but that is a question
I can definitely pass on to CMS and they can consider some other options, some other language
options. The video… Uh, another question about using the video. The video will be ready
about the same time as the website, here in the next couple of weeks. We are finishing.
We’re doing some accessibility work on it. So, we’re adding some captions and things
like that. So it’s not quite ready for dissemination, but we will send that out to the listserv,
as well. So, there will be a link. It will be available on YouTube. (Silence.) Also,
there’s another question about, um, where to find funding to pilot a community-based
LTSS. Um, I highly recommend going out and checking on the website. Look in the funding
section; look at the different models. We have the fact sheets, which will be live,
but there is some information live on the website currently. So, if you want to check
out the website… And then there’s a link to an email address. If you still have questions,
more specific questions, if you want to submit an email, we can have someone get in touch
with you with more specific information. (Silence.) Again, the video is not quite ready. I’m
glad everyone’s excited about that, though. Um, we’re very happy about it and we’re
seeing that it’s very well received. The link to the video is not quite ready. It will
be available on YouTube soon, as soon as we can get captioning, um, up there, and we’ll
send out a link to the listserv when it’s ready; so then you can use it and show it
and disseminate it however you want. (Silence.) So there’s a question about accessing “Money
Follows the Person Grant.” I will… I don’t have the answer to that question, but I will
get that question to CMS and they will follow-up with you. So, if there are specific funding
questions, then check out the website and if you need additional information, send an
email. If you have specific questions, you can put into the Q&A box right now and I will
pass them onto CMS. (Silence.) Uh, it looks like there’s another specific question about
options available for community members who aren’t eligible from enrollment…for enrollment.
Um, that’s a question that I will pass onto CMS and we’ll get someone to follow up with
you on that. Okay, another question about requesting information: if you have a specific
question right now that I can’t answer, I will certainly pass that on; if not, that
email address on the website is on the homepage and it is live currently—the contact information.
We have people monitoring that email closely, so we will get you an answer to your question
as soon as possible. And that’s the end of the questions in the Q&A box. I’ll pause
for just a moment in case anybody has any additional questions. (Pause.) And so, again,
I just want to remind everyone that the video and the new resources will be live on the
website here in the next couple weeks. We will send out notifications to the listserv.
So, if you’re not signed up to receive that, go to the website. The link is there to the
middle, right-hand of your page. It starts with CMS.gov and goes into “Outreach and
Education.” Go ahead and sign up for the listserv, if you have not already, and you’ll
be the first to hear when they are available. (Pause.) Another question about program tie-in
with state agencies. There is… There will be information on the website about state
and federal partnerships. So, if you… I will pass that question along. I don’t have
the answer to it right now, um, but if you don’t… Again, if you don’t find what
you need on the website, I will have…I will pass this along to CMS and we’ll have someone
get back to you. (Pause.) Okay, there’s another question about temporary assistance
and sustainability for LTSS, and I will pass that question along, as well. (Pause.) And
we’ll pause for one more minute to see if there are any additional questions. (Pause.)
Okay, I’m not seeing any other ones coming in. Just a reminder, check out that link.
Check out the TA Center now, because there is great information up there right now. The
read is nine (?unclear – 34:36.) We will let everyone know when it is live here over the
next couple of weeks, along with the video. Um, Julie, do you want to close us out?
Sure, thanks Kim. In closing, I would like to remind everyone that today’s webinar
was recorded and that the audio and PowerPoint will be made available online at CMS.gov.
Thank you again for joining today’s webinar. This session is now concluded.

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