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Archive for Saturday, November 16, 2013

Couple at center of November homicide may have fallen into resource ‘gap’

November 16, 2013

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At the center of Lawrence’s second homicide of 2013 were, allegedly, a man’s concerns over his wife’s ongoing health problems.

Larry L. Hopkins, 67, is scheduled to return to Douglas County District Court on Wednesday for a hearing that will determine whether a mental health evaluation will find him competent to stand trial in the Nov. 5 shooting death of his 61-year-old wife, Margaret.

For years, Margaret Hopkins suffered from arthritis, diabetes and nerve damage before knee problems further immobilized her. Neighbors recalled Larry Hopkins serving as her primary caregiver despite his own health history that includes heart problems and at least one recent stroke.

Area health care service providers say the Hopkinses fit a not uncommon profile of a caregiver reluctant to ask for help and a patient who fell into an age gap keeping her from some services. Though providers describe this area as rich with health options, they also describe waiting lists — mostly due to depleted funding — and age and income requirements as obstacles for some in need.

Falling into a gap

Along with Douglas County Senior Services, the Jayhawk Area Agency on Aging is among the most-referred providers of caregiver support in town. The JAAA’s caregiver support specialist, Michele Dillon, said services are typically for those 60 and older. But in many areas, those below the 65-year-old threshold are “kind of really stuck in a gap.”

Provisions such as the Senior Care Act, which is a non-Medicaid program that offers in-home care for residents 60 and older, have wait lists caused by low funding. And to receive Medicaid, Dillon said, one has to first apply for disability if the person is younger than 65.

“Yeah, it’s a struggle,” she said.

That leaves as one of the few remaining options for those above 55 but younger than 65 the Program of All-Inclusive Care for the Elderly, which expanded into Douglas County in January.

To become eligible, PACE Lawrence site director Beth McKenzie said, applicants must first participate in an evaluation to be declared “nursing-home eligible.” If they’re not overly dependent, patients will then work with the program and their caregiver to tailor attention to the types of care required. Those on Medicare or Medicaid can use PACE with a monthly co-pay a possibility based on the patient’s income.

One of the largest hurdles, Dillon said, is still the relative newness of the program — and the deluge of often dense health care news.

“People are just so overwhelmed with health care information in general,” Dillon said. “But we are definitely out there.”

The waiting game

Cynthia Lewis, the Visiting Nurses of Lawrence’s chief operating officer, said most insurance companies are able to cover home health service, typically short-term care. Often, she said, a patient must be deemed unable to leave the home. For those on Medicaid, she said, there is no such requirement but reimbursement is very limited. Meanwhile, Dillon estimates that there is a three-year wait list for the Physical Disabilities Waiver for Medicaid-eligible residents ages 16 to 65 who meet the criteria for nursing home placement because of a disability.

Lewis cited cuts in state funding as having spawned such long waiting lists — not uncommon for such services.

“As belts tighten at the state and federal level the ability at the local level to serve the people we want to becomes a challenge,” Lewis said.

It is still unclear what resources may have been available to the Hopkinses. Larry Hopkins retired from Kansas University Libraries in 2010 after 19 years, but Margaret’s work history — aside from accounts that she had a history in social work — is less clear. Jill Jess, a KU spokeswoman, said retirees are eligible for the state’s retiree health insurance plan if they were enrolled in the state’s program at the time of their retirement. Spouses, meanwhile, can be added to the plan during any open enrollment period.

Some low-income Kansans can qualify to receive care in their homes to be paid for with Social Security income — with a catch. In Kansas, those receiving Social Security income can keep only $747 of it to pay for food, shelter and other living expenses. That gives the state the eighth-lowest personal income allowance in the country, according to a 2010 AARP Public Policy Institute study cited in a Journal-World story last month.

“I don’t know a lot of people that can live on $747 a month,” Dillon said. “I think a lot of people have difficulty meeting that. Anything above that you have to pay some out of pocket for those services. If there are other expenses, they just may not choose (the services).”

Asking for help

Then there is the need for more caregivers to ask for help in the first place: Lewis said many who are most in need of services are the least willing to request them.

“We have those sad circumstances where people need these services but don’t let people in to help,” Lewis said. “Those scenarios present themselves on a somewhat regular basis.”

Others maybe don’t know how to make the initial connection, or don’t have anyone to reach out on their behalf. Lewis said family, friends or services like Meals on Wheels do often reach out to the VNA, but the proper care for people needing help while living in isolation can be delayed for years.

“If people are more isolated, then no one may know,” Lewis said. “That’s a tragedy, but how do you identify all the many needs?”

At the JAAA, Dillon often encounters caregivers reluctant to ask for help. A lot of time, she said, they think they should be performing the task alone — something she constantly works to convince them isn’t the case.

“Otherwise, I get a call from them in a crisis saying I can’t do this anymore,” she said.

Comments

Kathy Getto 1 year, 1 month ago

It will only get worse as Brownback continues his cuts to critical services. Remember this as you vote your anti-choice agenda.

Amy Heeter 1 year, 1 month ago

First you have no idea how I vote. Next it is not your business to tell me how to vote. Now for staying in topic. I feel the District Attorney should remove thus man from the jail and place him in a care facility. He is not a danger to society.

Leslie Swearingen 1 year, 1 month ago

Amy thank you so much for your comment. No one has even mentioned that this man could be in emotional agony because of what he did, and he did it because he saw no way out, but only each day getting worse and worse.

The reality is that he did kill someone so the law must run its course. I would hope that we would all want true justice is that case. My question is, would any nursing home accept him and who would pay his bills. I would like to see him be put in one and have mental health care so the rest of his life is meaningful.

Mari Aubuchon 1 year, 1 month ago

Amy, I don't believe that Kathy Getto's comment was in reply to yours but to the article itself.

Kathy Getto 1 year, 1 month ago

That is absolutely correct, Mari. Maybe "Amy Heeter" is just having a bad day.

Melanie Birge 1 year, 1 month ago

This is very sad, but what is worse well it is going to get worse. I am sure that many are falling through many cracks, we don't need Nursing homes, what we need is to bring our loved ones home and care for them once again. I worked in Nursing Homes and they are lonely. You don't get to see how many people throw their parents or spouse away! Government needs fixing on all levels, and the best one to start with is Local and State! Remember Family values should come first.

Leslie Swearingen 1 year, 1 month ago

Think on this. A two parent family with both parents working full time and children. They don't have a spare room in the house. They don't have the spare time or the money to hire someone to come in and take care of someone who needs round the clock care. Who do you kick out of their room and where do they go?

On a practical level you would have to be wealthy to be able to have an elderly relative who has severe health problems live at home. Those who cannot do this should not be made to feel guilty. There used to be a saying that needs must when the devil drives. The stark reality is that all the love in the world can only do so much. Then we have to admit we are human and ask for help.

Bob Forer 1 year, 1 month ago

Leslie, couples who have elderly parents in need of assistance rareley have children still at home. Think about it. With today's better diet and health care, most elderly people don't need assistance until their mid seventies, and their children are usually in their fiftties. With a few exceptions, the grandchildren have already flown the coop.

It is cheaper for to care for an elderly person in their own homes or with their children than the cost of a nursing home. Believe me, I've done it.

The only problem is for people without financial means. Medicare will pay for a nursing home for them, but funding for in-home care is very scant. And it doesnt make sense, because medicare pays out a lot more for a nursing home than they would if the elderly person is able to be cared for outside an instiktution.

I understand some folks can't do it. But I think some of it has to do with our "throw away" culture. When folks are no longer productive, our culture tends to discard and ignore them. Very sad.

Addie Line 1 year, 1 month ago

How can someone who murdered his wife not be a danger to society? Regardless of the stressful circumstances that is obviously not an appropriate coping strategy. If deemed mentally incompetent to stand trial he then needs to be placed in facility equipped to provide mental health services, not just some random care facility.

Also yes, thank you to Kathy for pointing out that the Government has a role in this as well. They fund, or as of late do not fund the services that can be provided to keep someone safe in their home.

As for the DA, they assist the SRS protective agencies in determining whether to intervene in cases of elder abuse, neglect etc. We may never know if this case had been reported to APS but in general there has been a lack of concern to prosecute those found guilty of elder abuse. The cases can be referred to the DA but unless they've made elder protection a priority these criminals often are only found guilty through APS, which only affects them by putting them on a registry which would flag them if a registry caregiver check is done when applying at a nursing home, daycare etc. meaning they can still work privately for families who don't know to check the registry. I've seen people seriously abuse elders and not get prosecuted, since I used to work for APS. It would be a tradgey if the DA did not pursue this and would definitely send a message about our values of the sick and/or elderly's lives in our society.

There used to be a mental health nursing home in Edwardsville, not sure if it still exists but such a place I'm sure has accepted dangerous and mentally ill individuals.

Regardless, a good article highlighting the barriers to services, especially for those under 65 who likely be on a waiting list thanks to government funding cuts to essential programs that help disabled individuals stay in their homes.

Addie Line 1 year, 1 month ago

In home care can run $15-$20 an hour. And that is for a nurses aid, not an RN or LPN. So if someone is needing 24 hour care, without getting skilled nursing services, they're paying $360-$480 a day. My grandfather had Alzheimer's and eventually declined to the point where he was a two person transfer, something a nursing home can manage easily but not something a single CNA can do in home. At that point we would have needed to pay for 2 people to be on the clock 24/7, doubling our costs. Some people are fortunate enough to have LTC insurance which will pay a certain amount per day but usually not much for in home services.

A nursing home can cost about the same per day but once you run out of funds (less than $2,000 in assets), you can apply for medcaid which will leave you with $65 a month for personal effects, the rest of your income goes to the facility. The government supplements the the rest of the amount that the facility receives based on services provided overall at that facility, determined by an assement done on all residents called the MDS. They receive considerably less for a medcaid resident than a private pay resident. Medicaid barely provides any coverage for in home services, most people cannot afford to remain in home long term if they're truly needing nursing home level services.

I agree; more services should be in place to help people age in place instead of in facilities. But I have seen many a family have to place a loved one in a nursing home due to finances.

Sara Houk 1 year, 1 month ago

Midland Care provides the PACE program in Douglas County They also offer the Day Center on Perry Street, for the elderly or disabled person to have care during the day while their loved one works during the day.

Taking care of an aging or disabled individual at home is a huge commitment and I'm thankful for these programs that can help. It is a shame that insurances kick in the $$ when they go to a facility, but not when they are at home.

The cost to the government (taxpayers) is SO much higher when care is delivered through a facility. Never mind the price the individual has to pay by being in a lonely, isolated place away from their family and familiar surroundings.

Those that work at long-term care facilities, please don't take offense, I'm sure you do a fantastic job, but nothing is better than home and family (for most, anyhow).

Melanie Birge 1 year ago

Can't people work around the care and needs of family members? where were we 50 or 60 years ago when there was no nursing homes did they just drop off their family member in the ditch? We need to bring family's back together. Is our true priority's Job and Money? Where did Family go!!! ?

Addie Line 1 year ago

Unfortunately it's not realistic to expect that financially everyone can use FMLA, stop working or have the luxury of a job so flexible that they can manage taking care of a loved one full time. Often these are baby boomers who have their own bills, responsibilities and retirement to save for. There have to be affordable and accessible community services in place to supplement even family as a primary caregiver. Also it appears this couple did not have family who could step in to provide additional help. What about couples with no children?

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