American Rescue Plan Act: Tribal Long-Term Care System Enhancements

Investing in home and community-based services

Tribal nations in Wisconsin received more than $23 million in federal American Rescue Plan Act (ARPA) funds to improve and enhance home and community-based services (HCBS) for their members who are aging or have a disability. The funding supported home, service facility, and infrastructure improvements. Each Tribe could also hire a dedicated Aging and Disability Resource Specialist (ADRS).

Home improvements to support independence

Home improvements make it possible for Tribal members to stay in their homes as they age. Common HCBS home improvements included:

Roofing
Siding
Heating and plumbing repair

Ramps
Mold removal
Window and door replacements

Those who qualified have HCBS services now or were at risk of needing these services in the future. They also must be 55 or older and have at least one functional need. "At risk" means they have a medical diagnosis that may keep them from living on their own.

Infrastructure and facility improvements

These improvements helped deliver specialized care and services to the Tribal community. Durable medical equipment is one example. Many Tribes maintain a supply of wheelchairs, walkers, crutches, hospital beds, and more. With this funding, they repaired or replaced equipment so it's ready when needed. Other common investments include:

Generators. Power outages, often caused by severe weather, can cause serious health complications. Medical devices, like oxygen or home dialysis equipment, need electricity to function.
Air conditioners and refrigeration appliances. In the summer heat, people with respiratory issues need air conditioning, and refrigeration is often needed to store insulation and other medications.

More significant capital investments to enhance and strengthen HCBS included:

Renovating, expanding, or building facilities. This eased overcrowding and accommodated the demand for services.
Purchasing a shuttle and paving parking lots for improved transportation.
Investing in technology such as tablets and laptops to improve communication and promote telehealth.

Aging and disability resources

An Aging and Disability Resource Specialist (ADRS) answers questions and helps members who are aging or living with a disability access resources and apply for programs and benefits. With the ARPA funding, Tribal nations were able to hire their own Tribal Aging and Disability Resource Specialist or partner with an Aging and Disability Resource Center (ADRC). Tribal ADRS:

Create awareness of Tribal ADRS services within the tribal communities through marketing and outreach.
Counsel Tribal members on community resources available to meet their individual needs.
Promote health and wellness activities.
Create and maintain a loan closet program for durable medical equipment.
Assess community needs.
Use technology and other equipment to enhance and support educational and programming services.
Collaborate with the ADRC to provide services to members in their community.

The funding also covered vehicles, technology, and other equipment to support ADRS educational and programming services.

Impact highlights

All 11 Tribal nations benefitted.

$23,000,000 was available and $21,500,000, or 93%, was spent.
Hundreds of homes of tribal members were restored. The leading repairs included:
- Roof and siding repairs.
- Skirting around trailer homes.
- Other home improvements for accessibility in bathrooms, ramps/decks, floorings, and doors.
1,000 estimated members were served.
Tribal facilities were upgraded to enhance the delivery of long-term care services.

In addition:

The number of Tribal ADRSs was increased from four to 11. Six of these provide the full scope of allowable services, including long-term care program eligibility determination.
All Tribal nations had funding to employ a Tribal ADRS if they choose.
Tribes invested in infrastructure to support services Tribal ADRSs provide.
Collaboration among Tribal nations and ADRCs improved.
Gaps between these services were bridged: Tribal ADRS, dementia care specialists, disability benefit specialists, elder benefit specialists, fiscal, and leadership.