Report from Santa Fe; Deborah Armstrong

Music Report from Santa Fe is made possible in part by a grant from New Mexico Tech on the frontier of science and engineering education. For bachelor's, master's, and PhD degrees, New Mexico Tech is the college you've been looking for, 1-800-428-TECH. And by a grant from the Healy Foundation, Taos, New Mexico. Hello, I'm LeRin Mills and welcome to report from Santa Fe. Our guest today is Debbie Armstrong, the cabinet secretary for the New Mexico Department of Aging and long term services. Welcome. Thank you for having me. Well, you do such wonderful work and yours is an agency and department that we've been so fond of. Over the years, we've interviewed your predecessor, Michelle Luhangrisham, I think for the last 15-20 years. And four years ago, the agency on Aging was elevated to a cabinet level position. That's correct.

Tell me who did that and why. It was actually legislation introduced during the previous administration that got vetoed. And it's one of Governor Richardson's campaign promises as he was campaigning for governor that he would elevate the state agency on Aging to cabinet level, which he did by executive order and followed up by legislation that supported the elevation and expansion. So it raised Aging to a cabinet level department and expanded our focus to also serve adults with disabilities and other related services for adults and charged the department with being the lead in policy for long term care services. So who do, who are your clients, who are your clientele, really? Our traditional clientele are seniors, but we also serve adults with disabilities and by adult, I mean, above age 18. And adult protective services also kicks in over the age of 18.

So we serve all ages of adults. And when you think about us serving grandparents who are raising grandchildren in a way, we have a connection in with children as well. And actually some of our programs that we oversee Medicaid programs offer services to children. So our disabled and elderly waiver program, there's not an age restriction. So there are some children on that. So we actually have some children we serve too. And so about you serve maybe what 200,000 people, more or less, it's a huge, huge body of folks to help. That's right. And one thing I was thinking about, as we know the boomers are increasing an age, what are your projections for people over 65 in New Mexico? And how will that affect your ability to deliver the services they need? Well, in New Mexico is projected to grow faster than the rest of the country. So we're projected to go from the 2000 census, we were 39th in the country.

And in the percentage of persons over the age of 65. And it was I think a little over 11% of the population of New Mexico was over the age of 65. By 2030 we're supposed to be fourth in the country with a little over 26% of our population being over the age of 65. You are kidding me, we're going to move from 39th to fourth. The real numbers will double. And the percentage of the population will go from fourth in the country to, I mean, from 39th in the country to fourth. Is there some built dynamics here? I mean, because people want to be more. Yes, it has to do with the immigration in and out of the state, not immigration, but movement of people in and out of the state. And the population that's here, the attraction in the Southwest for snowbirds, as well as economics of younger folks leaving the state for jobs and so forth elsewhere. Now, if we change all that around, there are some projections that with the current economic trends that it won't be, the numbers are still probably double, but the percentage may not be quite so high.

But that's also how are you preparing for this? Well, a number of things. We're really working a lot first on long-term care service system, really trying to promote home and community-based services. And more importantly, keeping people at home healthier, more active, more engaged, more independent, as long as possible so that we delay or prevent the need for the higher end long-term care services like nursing homes and so forth. And we have a new initiative this year about civic engagement, trying to engage older adults in employment in their second half of life, volunteerism, lifelong learning. Again, to keep people active, engaged, and we're going to need them. We're going to need older adults. I'm sorry to say we can't retire. We're going to need us in the workforce. But it keeps you healthier and less dependent on those social support systems and the health care system.

Now, you are your department. You're kind of national leaders, aren't you? In community and home-based services. We are. Tell me how you've come into that. And what are you doing that's different from, say, Florida or New York? Well, the most states do a lot more investment of their Medicaid dollars in particular in nursing home care. The national average is about 70% in nursing home care and about 30% in home and community-based services. And we're just the opposite. We have almost 70% of our Medicaid long-term care dollars invested in home and community and not nursing facility care. That has grown largely not because of a policy that decreases the amount of nursing homes, but because we've added Medicaid home-based services like the personal care option. So we've made this state the legislature and the governor's made great investments in expanding home- and community-based services.

And I think most people, you know, when they have a choice to stay at home and go to a nursing home, they're just begging and like, please, can you help me stay at home? And the investment that has been made over the years and particularly in the last few years under Governor Richardson in what we call the aging network services. Senior centers and meals and transportation and home-delivered home-based services like home-maker services and respite and as well as services like senior Olympics and volunteer programs, senior companions and foster grandparents and those kinds of activities. It's been a lot of investment in all of those services, which again are at the front end keeping people healthy, happy, engaged in their communities, more independent and helps prevent and delay that need for the higher end, more costly services. And once that people don't really want, I rarely ask, you know, an audience, how many people here would like to eventually live in a nursing home. That's not what anyone wants.

And that's not a totally negative on nursing homes. We're also working in great partnership with the industry in New Mexico to improve services, trying to promote more home-like environments, more residence-centered planning, really being cognizant of protecting people's rights and having autonomy to make the decisions that they can within a nursing facility. So we're really trying to partner. They are absolutely part of the continuum. But with the aging population, we can't rely on that being the only service or the primary service for. You mentioned, when you ask people, they don't say it's signing up for the nursing home. I understand that you do listening sessions. You travel around the state. And you tell me about them. I've had several, an Albuquerque, Gallup, Raton, every couple of months I go out and we try and get the word out to seniors, other interested people in the community to come.

A couple hours long, I do like a 10 minute, here's kind of what we do, and then I open it up to the audience. Whatever they want to talk about. What is it? What concerns? One of the number one concerns is housing, accessible housing, transportation, and how to find and link up with services that support families to keep their loved ones at home. That's the big things I hear about. I understand you put all these services together and sort of hotline. And so tell us what say someone's there and has an elderly parent and you just kind of want them on the brink of needing more services. What would that family do? Call us. We have a resource center and the numbers 1-800-432-2080. And we have about 20 people full time answering phone calls, 253-100 phone calls a day.

And we provide information about prescription drugs, how to access and decide about Medicare Part D plans. But if you're not on Medicare, we also have information about how to get from persons who are lower income assistance right from the drug manufacturers for free prescriptions and we provide some emergency assistance for drugs. It's the intake for adult protective services. It's also the intake for the Medicaid home and community-based waiver services. And we have counselors who can just try and talk to you about the benefits you might be eligible for, food stamps, utility assistance, Medicaid programs, and help connect you with what all the services are in your community, long-term care services, home-based supports, the senior center, what all they do, who are the transportation providers. So call us or go to our website. And we've also got much of that information on the website.

It's kind of daunting for anyone to look at the kind of regulations and to represent not only your own cabinet department, but there are other human services can help some people. And the whole Medicare Medicaid jungle, you can help people with that too. Because for an average citizen, you look at these regulations, you have no idea. It's really hard to figure it out, but it's not impossible to figure out. And we've got great staff and volunteers who have developed significant knowledge and expertise in this area. In fact, we've got about 300 or so trained volunteers who do nothing but around the state hold meetings and educational forums, have one-on-one meetings with people to help them figure out Medicare Part D in particular, but other benefits, long-term care insurance, how Medicare works for other things, Medicaid, that they may be eligible for. So we've got great volunteers and staff who do nothing but talk to people about the services.

You have a program called MiVIA, and I did go to the website and tried to understand that some thank goodness you're here. Tell me about the MiVIA program and who would use it. The MiVIA program is a Medicaid program for that's a home and community-based program. So first of all, you have to be eligible for one of our programs that we call Waver Program, which is you're essentially eligible for nursing home care, both financially and medically, but it's a program that offers services in your home instead. It doesn't make any sense, but there's a waiting list for that. There's not a waiting list to get a nursing home, but there's a waiting list for the home and community-based services. We're trying to fix that, but so if you qualify for those programs and you may have to wait, like I said, on the waiting list, but when you qualify for those programs, you can select MiVIA, which means my way, my path, and it's self-directed services. So you can decide who to hire, who to fire, how to spend your money that you would have under Medicaid that would have gone in one of the other programs only for very specific services by very specific kinds of providers.

Here it gives you much more flexibility, so you could save, you could have your daughter, for instance, come and help you with some personal care for a week or two, save what you would have spent on a personal care attendant or homemaker, and instead buy a microwave so that you can better able to prepare your own meals or a washer and dryer so you don't have to worry about transportation to get to the laundromat. Or if you can't find a physical therapist or that's taking too much of your budget, you may want to have a physical therapist who will set you up on a program and then use your funds to pay to join the local gym so that you can maintain your physical fitness that's on a program that's been designed by your therapist. I remember hearing about this many years ago and it seemed too good to be true that the individual could actually take responsibility and use their funds in a way that benefited them the best, the most.

That's right. And we have people to help. We have what we call consultants who meet with and work with the individual. Of course you can have your family or friends or whatever help you make decisions. But the consultant knows the rules, knows the paperwork, knows how to navigate you through and help you put together your plan, and we have a financial physical management agent who pays all the bills. And so if you hire someone, you don't have to know how to be an employer and pay the taxes and write the payroll. You just need you are the employer and the fiscal agent is your kind of employer agent who does all that for you and pays all the bills so we don't turn over cash to you. But if it's been something you've developed and put in your plan, we've approved it because it's not illegal or what and it's appropriate ties to maintaining your independence and connection in the community. Then they submit the invoices to the fiscal agent they paid a bill.

Wow. Well, what else are you doing? That's such a huge step forward to let the person, if he can choose what they really, really need. Because that's been one of the problems with Medicare for so long. They didn't cover eyeglasses and hearing aids and that's something that that age group needed so much. So just to have that kind of autonomy. Right. Because they could decide that too. Yes, that I would like to hear. Yeah. Yeah. And for someone who's younger, they could decide they really need help in pursuing some education so that they can get a job and then not the need the services in the same way. It's not we don't want people to be dependent on the services we want you to be as independent and engaged as possible. So it's a great program. Yes. Well, every year in the fall, you have the conference on aging and you bring in just the top notch people from all over the country and on transit are happening elsewhere. So what are the trends kind of nationally?

Trends nationally are the focus on long term services, but also beginning to focus more on the aging baby boomers and what they need, which is our kind of other end of the spectrum and focusing on civic engagement and supporting people to choose and stay in the workforce that may mean changing your careers. Working with employers to make them more friendly and supportive of an older worker by their policies and to let them know that there's a value to an older worker who's got enormous amount of experience and knowledge and a work ethic and they have a need to retain an income also, but need some more flexibility or different ways of how they want to work as they get older. So we're working on pulling together business leaders in the state to talk about that issue. Look at ourselves as a state employer and how we maintain older workers. Volunteerism is huge. Our whole system would fall apart if we didn't have people volunteering their time in helping in their communities and in social programs.

So building on that and the baby boomer generation was the Peace Corps generation. We need to engage them as they age to in those kinds of social commitments and just lifelong learning. Again, the best way to stay active, healthy and a good quality of life is to keep learning and stay connected. And in terms of mental acuity, there's where the use of their lose that really comes in and so people are actively engaged working or volunteering. So these are the people who should call you, anyone who has a family member or is among the member of the senior citizens and then the adult developmentally disabled. And you do, I want to talk to you about adult protective services. Tell me, who should call you?

Anyone who has any suspicion, you don't have to know for sure. And you can be anonymous. It's easier to follow up if you're not, but you can't absolutely can be. You have any concerns that someone is being abused, neglected or exploited, financially exploited, particularly among seniors, but or any vulnerable adult. So someone with a disability, some kind of a who is not fully in control of their own lives. So it's not the same, quite the same as domestic violence, but any adult who is vulnerable, so particularly with a physical or mental capacity issue or senior or elderly senior. Any suspicion and we send social workers, we do an intake and talk to you about that and figure out often it's self neglect. So someone's alone and people are concerned and that's all right to call us about that also because we also consider those cases of self neglect and whether someone still has the capacity to continue to make their own choices and decisions.

But maybe they just need some services. Half the cause we get, somebody just need is concerned and wants information about how to get more services. So that meals on wheels, if they're, right. So we do lots of social work, lots of social work in relation to adult protective services, but we also involve our partners at the Department of Health, law enforcement and others as needed. If there's real outright abuse or neglect or exploitation going on that's by someone against someone, or if it occurs in a facility or in a program, or as a family member, a neighbor, whatever, then we can investigate and try and intervene and get the right kinds of supports and partners in place. We provide some short term and emergency services in that regard. We'll also petition for guardianship if someone does not have anyone, it does not have that capacity anymore and doesn't have anyone to help make the decisions for them that we can, we can be the impetus to go to the court and get a guardian assigned.

You mentioned law enforcement, I know the attorney general's office works a lot with scams that are directed at the elderly. And again, it's a clash of value system because older people are happy to help you, you know, they're not going to be suspicious and so they're often, you know, found to be gullible by these predatory people. Well, we need to have proper consumer controls and consumer education about all of those programs. So we do, we do a fair amount about that as well and in partnership with the attorney general's office about keeping people informed about protecting their identity and and where to get information and help weigh choices about long term care insurance or other kinds of the state planning things. We don't do a state plan, but we, we provide and do legal services, kinds of events all over the state as well in partnership with the state bar to inform people about, about a lot of those issues.

Living trust, living wills, living well, yeah, a state planning and all those kinds of legal issues and consumer issues. Well, I want to skip away from a state planning in the end of life because one of our favorite guests we've ever had on the show is your daughter Erin Armstrong. She came on our show as a patient rights advocate during the battle to legalize marijuana for medical necessity. So how is she doing because I know her few our viewers would like to know and how is that we kind of got in a cross mishmash between the feds and the state. So, but first tell us how Erin is doing. Erin's doing great. She's living in San Francisco, but still very engaged in what's going on here in New Mexico in relation to medical marijuana. I'm so proud of her. She is, you know, she's done this on her on her own, you know, just minor coaching from her mother, but mostly she can coach me.

She's just incredible. So great advocate she has from the time she was a teenager and got sick herself. She said she wanted to be a patient advocate and she's an incredible. She really is. Advocate for patients rights. And that's the medical marijuana. It's just one one facet of, you know, her interest in in patient rights and supporting those in need. Well, good, please give her our best. And so speaking of patient rights, because you represent so many of the old, the seniors, what is your message to seniors who might be watching this or people with family members? What do you want them to do? I want them to not feel alone. To call us if they are struggling and figuring out what to do if family as caregivers are struggling. There are support groups. There's respite. There's services available and call us.

So you've got someone caring for a spouse with Alzheimer's or, you know, someone with a degenerative disease. What kind of relief can you give them? There are a number of programs around the state that provide both in-home respite where you have a caregiver or a companion that comes in to be with your loved one so that you can just get away for a while. And those are various lengths of time that you may want to maybe just respite for a few hours or longer. There's respite available in nursing facilities. Actually, if you want to just a weekend away, there are adult daycare centers that provide daytime respite so that you can take your family member to a daycare center for older adults. And some who specialize particularly in persons with Alzheimer's who will watch on and to care for your family member during the day while you work or do other things and then you pick them up and take them back home. Well, you do so much. I'm so glad that you were elevated as an agency to the department to a cabinet level because the other thing is that the seniors are politically active too.

And so it was a wise move, but you offer so many services and I'm so grateful that you've taken the time today to tell us about them. So our guest today, we do have any final remarks for us? No, I think the only other big initiative that we're involved in is behavioral health. We're really partnering a lot in behavioral health services in the state to try and increase the focus and availability of services for older adults. And that includes what we really are concerned about in older adults is depression. Both of caregivers and persons facing decreasing function and chronic disease, so depression related to that is often substance abuse. Just more inappropriate or misuse of prescription drugs is what is behind much of that. And so that's really huge issues, I think, among older adults and we haven't paid enough attention.

Well, thank you. Thank you very much. Thank you. Our guest today is Debbie Armstrong, the cabinet secretary for the department of aging and long-term services. And I hope you'll come back and tell us what you're doing soon. We'd love to. Thank you. And I would like to thank you, our viewers, for being with us today on report from Santa Fe. I'm Larry Mills and we'll see you next week. Report from Santa Fe is made possible in part by a grant from New Mexico Tech on the frontier of science and engineering education. For bachelor's, master's and PhD degrees, New Mexico Tech is the college you've been looking for, 1-800-428-TECH. And by a grant from the Healey Foundation, Tows, New Mexico. Thank you.

And by a grant from the Healey Foundation, Tows, New Mexico. Thank you.