Eldercare Development Partnership

The Eldercare Development Partnership (EDP) will provide technical assistance to local providers to develop and implement service delivery models in line with the priorities and outcomes established by the Minnesota Long-Term Care Task Force and the major themes for action identified in the Aging 2030 Framework. Priority technical assistance activities of the EDP include working with both public and private long-term services and supports (LTSS) providers to collaboratively develop sustainable proposals for systems change, accessing the State’s Live Well at Home Grants and/or other resources as appropriate.  Our EDP is committed to provide technical assistance to local providers to increase the capacity of local home and community-based long term services and supports for tribal elders, caregivers and families in accordance with applicable State, Federal and Tribal laws and regulations.

The EDP strategy will focus on four (4) priorities:

1. Expand and Strengthen Capacity of Home and Community Based Services (HCBS). The EDP will work to expand and strengthen capacity by assisting local providers within our service area to coordinate critical services targeted to our tribal elders.  We will assist local providers in maximizing the impact of natural supports and resources in the community such as family caregivers, neighbors/volunteers, and peer supports.  The EDP sees the need for more education and training for caregivers to learn how to better care for their elderly and the opportunity for peer support. The EDP will assist tribal services providers in maximizing the impacts of natural supports by utilizing our interdisciplinary methods while incorporating more cultural approaches, especially in using the Ojibwe value system called The Seven Gifts that include; wisdom, love, respect, bravery, honesty, humility and truth. Building partnerships with community providers and inviting them together to build a network with the goal of maximizing service delivery by working together in bringing education and training to the communities, as well as professional peer-support that increases their capacity.

2. Promote Risk Management Strategies. The EDP will promote risk management strategies to strengthen our service area capacity to identify high risk older adults and/or family caregivers and use proven risk management interventions.  The EDP will promote and assist tribal elders and care givers with implementation of the Live Well at Home framework and our intake and counseling process will include the Live Well at Home Rapid Screen and its components.  Utilization of these tools will provide the EDP with the capacity to measure and evaluate risks for nursing home placement, planning and follow up.  The EDP includes individuals trained in Senior Health Insurance Counseling, Powerful Tools for Caregivers, TCare, Matter of Balance, Chronic Disease Self-Management and have extensive training in dementia, nutrition, long-term care consultation, and health and wellness.  The EDP is committed to promotion of self-direction that helps our tribal elders and caregivers develop and monitor a risk action plan in order to prevent or delay nursing home admission or assisted living entry and spend down from Medical Assistance (MA).

3. Strengthen Care Transitions. The EDP will work to develop and enhance systems that will improve care transitions for high-risk older adults by providing technical assistance to HCBS or Long Term Services and Supports (LTSS) providers within our service area regarding their role in Minnesota’s Health Care Home initiative and related federal health care reform.   We will also assist health care providers and HCBS or LTSS providers to develop approaches for sharing care plans, monitoring outcomes and quality across settings, and coordinate services for our tribal elders.

4. Promote Sustainability of All Service Models. The EDP will focus on providing technical assistance and encouraging local providers to develop partnerships and creative strategies that will enhance sustainability of services to our tribal elders and caregivers.  As we continue to develop health, social and economic systems as a sovereign nation, we are increasingly looking for models of care which are consistent with the desires of our elders and cohere with our unique tribal culture and traditions as there is a cultural imperative to keep elders at home, in the community. Some of the traditional ways are changing, however, as the impact of non-Indian culture becomes more prevalent we must continuously adapt to changing models of care.

For more information, please contact:

Peggy Roy, Eldercare Development Partnership Coordinator
301 W 1st Street, Suite 626
Duluth, MN 55802
(218) 606-1115
Email:  proy@mnchippewatribe.org

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