Better Home Health Services for Tribal Members


There is nothing quite as anxiety provoking as being unable to do things for yourself. Whether it is getting around, moving from a bed to a wheelchair, learning to use oxygen, changing a bandage, caring for a catheter or remembering to take your medication. That is why home care is available through the Tribal Health Department for tribal members.

The Tribal Health Department has solely been responsible for payment of services in the past. The level of service and supervision or coordination of care from home to hospital and back were left in the hands of anyone making first contact or being available at that moment. Frequently our tribal members needed more than companion care or personal care services, during these difficult times.

As a result of availability, the type and quality of care a tribal member received was frequently not at the level they required. This meant more frequent hospitalizations, visits to the emergency department and in the worst case scenarios a decrease in the wellness level of the Tribal Member. This approach did not provide for the tribal member the best possible care. Additionally, it was very costly in not only its emotional and physical toll on tribal members and their families, but also monetarily to the Tribe.

The Tribe’s most recent contract for services was with Visiting Angels, the contract expired in May of 2017. Per Tribal policy a new Request for Proposal was developed and offered to all care giving agencies in the area. We received 5 responses. Based on numerous criteria: most importantly increasing the availability of skilled credentialed caregivers. Comfort Keepers was selected, based in Pagosa Springs, Colo.

We will be doing a transition to Comfort Keepers over the next 6-8 weeks. We have received several questions that we would like to answer for the Tribal Membership.

What is the process for a tribal member to receive Home Care services?

There are various ways for a tribal member to receive care. First a referral from a Doctor after or during an illness, hospitalization for a medical or surgical reason. Second, a referral from our Public Health Nurse, Clinic staff or CHR’s that a tribal member needs assistance. Third, a call from a tribal member themselves or their family with a concern… we then go to the home and assess the need and determine what care is actually needed. If Home Care is the answer, a care plan is developed and ordered by the physician. The case manager then makes the referral to the agency.

Why are we changing from Visiting Angels as our home care agency?

The first but not the most important reason is that the contract between Visiting Angels and the Tribe expired in May of this year. Per Tribal policy a Request For Proposal must go out on any contracts such as these before renewal where there are several providers available.

But Visiting Angels has never provided all the home care services to the Tribe, they were unable to provide any skilled services. We have always used the four other agencies in the area in addition to them.

The MOST important reason for the change is to improve and expand the level of care available to tribal members. We have very clearly defined the type of certifications, education and supervision we want our home care agency to be able to provide regarding services in the home.

Comfort Keepers is an independent, locally owned franchise that has had zero issues or problems of any legal nature in our area.

What kind of things are you requiring now that are different?

Most of our tribal members are unaware of the skill level of the home care providers in their home, we in the THD recognize a serious gap between the need and the available — as the prior contract did not address this.

At any given time, we can have more than 20 tribal members receiving some level of home care. This doesn’t include others who might be in facilities receiving care. We needed to make sure we could match the needs of the Tribe to the services available.

Most importantly: having an RN on staff to regularly supervise the companions and aides with regularly written reports on tribal members conditions.

Whenever a tribal member has 24 hour care, a certified HHA or CNA assigned for no less than 8 hours. They can do an educated assessment and accurately report issues before they become problems.

The need to help tribal members keep their medication schedule is essential. Unfortunately, we have had several errors in medication because of lack of knowledge on the care givers part. We want to prevent that as much as possible.

Our large diabetic population means we have a lot of wounds that need careful attention. A wound certified nurse is available. We wanted this as an essential.

What if a tribal member wants to keep Visiting Angels?

We understand that there might be instances where relationships have been established and the tribal member prefers to keep Visiting Angels. Of course the Tribal Health Department will continue to pay for those services.

However, please be aware that the Tribal Health Department will have no control over the delivery of those services, neither in quality or consistency. Issues with service and failure to show up are out of our hands as we have little to no say over Visiting Angel services.

What will be the transition for Visiting Angels to another agency?                 

The transition should be phased with our more complex tribal members first, then on through to those only requiring limited help daily. We expect this to take several weeks, at least 6-8 weeks before it is completed.

We had hoped that Visiting Angels would provide services during this period as they stated they would, but it appears they might fail to do so. We will address the needs as they arise should Visiting Angels not continue to service the tribal member.

What do you expect to be the outcome of this change and its impact on tribal members?

We have only one outcome in mind — better care for tribal members. We expect to better match the needs of the tribal membership with the services Comfort Keepers has available. We will have increased professionally licensed supervision and faster notifications of changes in a tribal members condition.

This was not always so. Sometimes we didn’t learn of a tribal member’s decline until they were in the hospital. We also hope to avoid needless trips to the Emergency Department because the new agency has a Nurse Practitioner on staff who can more effectively interact with other medical providers.

Comfort Keepers is also planning to open a local Ignacio office to better serve the Membership.

Bottom line we are bringing in a new agency because they have committed to delivering a higher level of care to our tribal members. They have the skilled component we think is essential and are a striving to make this transition seamless.

If there are any questions, who should a tribal member reach out to?

Our Case Manager, Michelina Paulek: 970-563-4581 Extension 2362, or Carole Veloso, Tribal Health Director: 970-563-2450


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