AdvancingSmartly

Assited Living Overview
Assisted Living Checklist
Paying for Assisted Living
Nursing Homes
State Ombudsman
Lifecare Centers
Paying for Nursing Home care
Choosing a Long term care facility
Comparing Nursing Homes
Call First
Visiting the Homes

Assisted Living: Michigan's Adult Foster Care Homes and Homes for the Aged

It may be you are more comfortable in an atmosphere that provides more social contact and services-on-site than a privately owned home or apartment setting.  Many older people are turning to assisted living facilities as a step between "my own home" and a nursing home.

Assisted living is a marketing term used to describe a combination of housing, support services, and health care. Most people see assisted living as a place designed to serve older and disabled individuals who cannot or prefer not to live alone. 

There is no one definition or scheme for assisted living.  The services, accommodations, quality and costs vary widely. For example, some places offer very modest services while others provide extensive care comparable to that found at better nursing homes.

A pleasant setting is important but it cannot be a substitute for care. Assisted living facilities are not necessarily more effective at delivering personal services or nursing care than nursing homes. In some cases, the opposite is true. The more private living accommodations in some assisted living facilities may limit routine observation by caregivers and hinder timely help.

Make sure that offered services are available and match your needs.  Look beyond the name, the promotions and the promises.  Examine assisted living options as carefully as you would any other long term care service or real estate. Your local long term care ombudsman office can also help you determine if an assisted living facility is licensed.

Most assisted living in Michigan is provided by adult foster care homes and homes for the aged licensed by the Michigan Department of Community Health (MDCH). There are also a growing number of  businesses marketing and providing assisted living services without a state license or oversight. If you are unsure whether an assisted living facility is licensed, ask the operator to see a copy of the actual state license.

Under state laws, adult foster care facilities and homes for the aged provide room and board, special diets, supervision, and some personal care.  Personal care may include help with bathing, dressing and taking medications.  These homes serve people who need some help with daily activities but do not have complicated health problems requiring daily nursing care.

Homes for the aged (HFAs) serve people age 60 or older while adult foster care homes (AFCs) help adults of any age. Because of the broad age-range served, AFC residents have very diverse needs. Some AFCs cater to special populations, like people with developmental disabilities, mental illness, dementia, and other chronic illnesses or physical disabilities.

HFAs and AFCs have other distinctive characteristics. HFAs are larger facilities, with accommodations for at least 21 residents. Some HFAs house hundreds of residents. Many HFAs are affiliated with nursing homes, and sometimes are on the same campus or part of the same building. Many older HFAs are run by non-profit organizations, such as church groups, while more of the newer facilities are owned by private, for-profit companies. There are about 150 homes for the aged in Michigan.

In contrast, most AFC homes are very small often operating in houses converted for group living. Most AFCs are privately owned and operated. Michigan has over 4,600 licensed AFCs, each housing from 1-20 residents. There are four types of AFC homes:

A Family Home provides care for up to six adults in a private residence. The home's operator lives in the home and is a member of the household.

A Small Group Home also houses up to six residents. As with the remaining categories, however, the operator is not required to live on the premises.

A Medium Group Home offers care for 7-12 adults.

A Large Group Home provides care for 13-20 adults.

Although private rooms are available in some AFCs and HFAs, shared rooms are more common.

Services vary greatly. All AFCs and HFAs offer room and meals and some help with personal needs or supervision. Residents may be assisted with medications, bathing, toileting, eating, dressing, grooming and mobility. Some facilities offer little help, forcing residents to leave when their needs increase. Others offer a wide range of help, adjusting services as your needs and abilities grow or decrease.

Determine what services are available and to what degree they are offered. AFCs and HFAs are generally allowed to limit the services they offer, so if your needs surpass these limits, you may have to leave. Find out in advance exactly what types and amount of care the facility will deliver. Ask for this information in writing. If you sign an admission agreement or contract, make sure any details you have negotiated are included. Ask for a copy and keep it with your records.

HFA and AFC residents on Medicare and Medicaid are eligible for home health services and durable medical equipment covered by these programs, just as if they lived in their own homes. Check with the facility to see if it will assist with the delivery of these services if or when needed.

Both types of facilities are licensed by the Michigan Department of Community Health. Michigan standards govern their operations and give important rights to residents. AFC standards are more modern than the decades-old HFA rules, which primarily focus on building safety rather than on resident care. HFAs are to be inspected annually, while AFCs must be inspected every other year. In practice, these schedules are not always met because of a shortage of state inspectors.

A growing number of assisted living facilities are operating without an HFA or AFC license. If a facility lacks a state license, it means that no government office monitors its care and services. It also could mean that the owner is not willing to provide the kinds of services required of HFA and AFC owners.  While a license is no guarantee of quality or services, lack of a license suggests that the operator may be unwilling or unable to meet public standards.

Unlicensed assisted living facilities often rely on the appeal of their attractive buildings and accommodations. They are more likely to be run in apartment-style complexes or similar settings offering private accommodations. While privacy is indeed very important, it is largely the need for services, not privacy, that leads people to examine assisted living options. Make sure that the services, as well as the accommodations, are first-rate.

Don't assume that any facility that markets to older adults is licensed or inspected by the state. A facility's name and reputation offer little insight on its legal status. You can check the licensing status of facilities by contacting the Bureau of Health Facilities at the Michigan Department of Community Health, (517) 334-8408.

You may want to ask operators of unlicensed facilities why they don't have a license. Find out how facility management evaluates the quality of its services. Consider whether positive features of an unlicensed facility are offset by the absence of any public monitoring of its services. If you don't receive good answers and information, shop elsewhere.  If you select an unlicensed facility, you are putting your trust in the owner, in market pressures, and the terms and conditions of your rental contract to resolve any concerns you may experience.

[Back to Top]

Assisted Living Checklist

The following is a consumer checklist of important services, amenities and accommodations in assisted living communities. We recommend making several visits, at various times, to each residence you are considering. As you compare assisted living residences, we hope this checklist will assure you that the residence you choose will be one of the highest quality and meets your needs.

Consider the following as you assess an assisted living residence:

Atmosphere

• As you arrive at the residence, do you like its location and outward appearance?
• As you enter the lobby and tour the residence, is the decor attractive and homelike?
• Did you receive a warm greeting from staff welcoming you to the residence?
• Does the administrator/staff call residents by name and interact warmly with them as you tour the residence?
• Do residents socialize with each other and appear happy and comfortable?
• Are you able to talk with residents about how they like the residence and staff?
• Do the residents seem to be appropriate house mates for you or your loved one?
• Is staff appropriately dressed, personable and outgoing?
• Do the staff members treat each other in a professional manner?
• Are the staff members that you pass during your tour friendly to you?
• Are visits with the resident welcome at any time?
  

Physical Features

• Is the community well-designed for resident’s needs?
• Is the floor plan easy to follow?
• Are doorways, hallways and rooms accommodating to wheelchairs and walkers?
• Are elevators available for those unable to use stairways?
• Are hand rails available to aid in walking?
• Are cupboards and shelves easy to reach?
• Are floors of non-skid material and carpets firm to ease walking?
• Does the residence have good natural and artificial lighting?
• Is the residence clean, free of odors and appropriately heated/cooled?
• Does the residence meet local and/or state licensing requirements?
  

Needs Assessments, Contracts, Costs, and Finances

• Is there a written plan for the care of each resident?
• Does the residence have a process for assessing a potential resident’s need for services and are those needs addressed periodically?
• Does this process include the resident, their family and facility staff along with the potential resident’s physician?
• When may a contract be terminated and what are refund policies?
• Is there any government, private or corporate programs available to help cover the cost of services to the resident?
• Is a contractual agreement available to include accommodations, personal care, health care and supportive services?
• Are additional services available if the resident’s needs change?
• Is there a procedure to pay for additional services like nursing care when the services are needed on a temporary basis?
• Are there different costs for various levels or categories of services?
• Do billing, payment and credit policies seem fair and reasonable?
• May a resident handle their own finances with staff assistance if able or should a family member or outside party be designated to do so?
• Are residents required to purchase renters’ insurance for personal property in their units?
• Is staff available to meet scheduled and unscheduled needs?
  

Medication & Health Care

• Does the residence have specific policies regarding storage of medication, assistance with medications, training and supervision of staff and record keeping?
• Is self-administration of medication allowed?
• Is there a staff person to coordinate home care visits from a nurse, physical therapist, occupational therapist, etc. if needed?
• Is staff available to assist residents who experience memory, orientation, or judgment losses?
• Does a physician or nurse visit the resident regularly to provide medical checkups?
• Does the residence have a clearly stated procedure for responding to a resident’s medical emergency?
  

Services

• Can the residence provide a list of services available?
• Is staff available to provide 24-hour assistance with activities of daily living (ADLs) if needed? ADLs include:
  • Dressing
  • Eating
  • Mobility
  • Hygiene and grooming
  • Bathing, toileting and incontinence
  • Using the telephone
  • Shopping
  • Laundry
• Does the residence provide housekeeping services in residents’ units?
• Does the residence provide transportation to doctors’ offices, the hairdresser, shopping and other activities desired by residents?
• Can residents arrange for transportation on fairly short notice?
• Are pharmacy, barber/beautician and/or physical therapy services offered on-site?
  

Individual Unit Features

• Do dining room menus vary from day to day and meal to meal?
• Are different sizes and types of units available?
• Are units for single and double occupancy available?
• Do residents have their own lockable doors?
• Is a 24-hour emergency response system accessible from the unit?
• Are bathrooms private with handicapped accommodations to accommodate wheelchairs and walkers?
• Are residents able to bring their own furnishings for their unit and what may they bring?
• Do all units have a telephone and cable TV and how is billing handled?
• Is a kitchen area/unit provided with a refrigerator, sink and cooking element?
• May residents keep food in their units?
• May residents smoke in their units? In public spaces?
  

Social and Recreational Activities

• Is there evidence of an organized activities program, such as a posted daily schedule, events in progress, reading materials, visitors, etc.?
• Do residents participate in activities outside of the residence in the neighboring community?
• Do volunteers, including family members, come into the residence to help with or conduct programs?
• Does the residence create a sense of community by requiring residents to participate in certain activities or perform simple chores for the group as a whole?
• Are residents’ pets allowed in the residence? Who is responsible for their care?
• Does the residence have its own pets?
  

Food Service

• Does the residence provide three nutritionally balanced meals a day, seven days a week?
• Are snacks available?
• May a resident request special foods?
• Are common dining areas available?
• May residents eat meals in their units?
• May meals be provided at a time a resident would like or are there set times for meals?

[Back to Top]

Paying for the Assisted Living

Assisted living costs vary widely, ranging from about $1,000 to several thousand dollars per month.  This service can easily cost as much or more than nursing home care.  Most people pay assisted living costs from their own income and savings, as government coverage is very limited.  Some long term care insurance covers it. Try to find a facility that you can afford.

If you are paying out-of-pocket, you will likely be able to stay only as long as your money holds out. Determine how long you can afford to stay at the facility, factoring in likely future price increases. Consider where you might go if you had to leave the assisted living facility due to lack of funds. Your other options,
including nursing homes, may be limited if you are out of money and must rely on Medicaid to help pay for your care.

Many assisted living facilities charge extra for certain services. Seek detailed information about prices and billing procedures. Ask the operator:

• What exactly is included in the monthly rate? What gets charged as an extra?

 

• Is a deposit required? Under what circumstances, if any, is it refunded?

• Are there other occasions for refunds, such as moving out before the end of the month?  How much notice is required before moving out?  If you find the facility to be unsatisfactory after a few days, can your money be refunded?

 

• Does anyone else have to sign the admission agreement on your behalf? If so, does this  person become responsible for paying for your stay out of his or her funds?

• What is the policy on or history of rate increases?

 

Read the admission agreement carefully. Make sure the information in it agrees with the answers to your questions. If not, ask the operator to make changes in the agreement. You and the operator should initial the changes.

Some government assistance to pay for assisted living is available for residents of licensed AFCs and HFAs who meet strict eligibility standards.

The Michigan Department of Community Health helps pay for AFC or HFA care needed by those who are developmentally disabled, mentally ill or mentally impaired. Information about this assistance can be obtained from your county community mental health agency or from Michigan Protection and Advocacy Services (800) 288-5923.

Special services are available to veterans.  The Veterans Administration (VA) provides pension benefits to veterans, their spouses, widows or widowers with limited incomes. Pension benefits are higher for persons needing daily assistance with personal needs. AFC and HFA residents may qualify for these benefits.  Information can be obtained from the nearest VA office or call the VA at (800) 827-1000.  The Michigan Department of Military Affairs operates two veterans homes, offering what it calls domiciliary care, in Grand Rapids (800) 642-4838 and Marquette (800) 433-6760.

The Michigan Department of Human Services (DHS) helps cover some of the costs of AFC or HFA care for very low-income people with temporary disabilities through the State Disability Assistance Program (SDA). Contact your local DHS office for information.

The Social Security Administration runs an income supplement program for low-income blind, aged and disabled people. This program, Supplemental Security Income (SSI), has special income limits for people living in an AFC or HFA, so you may qualify for help even if you did not while you were living at home.  This program is very complex, and it is hard to find an AFC home or HFA that will accept this very low payment.  Call the Legal Hotline for help in understanding this option.

Medicare does not help pay for assisted living care, and Medicaid payments are only available to certain low-income residents of AFCs and HFAs. However, while you are in an assisted living facility, Medicare and Medicaid continue to pay for covered medical expenses, such as hospital care and doctor visits. These programs also help pay for skilled home health services you may need during your stay.

[Back to Top]

Nursing Homes

Anxiety about nursing home life sometimes has little to do with the nursing home itself. Rather it may be fear of the variety of health problems and losses people often experience in late life that lead to nursing home care. Some facilities offer excellent care and virtually all have some dedicated, devoted employees who truly care about the residents. Better facilities focus just as much on quality of life as care, recognizing that all people need daily meaning in their life. Some nursing homes are finding ways to diminish institutional characteristics, creating more opportunities for resident autonomy, privacy and dignity.

The chance an older person will need nursing home care during their life is about fifty percent.  About 70 percent of residents are women, two-thirds of whom are over the age of 80. More than 40 percent of people living in nursing homes are age 85 or older.   

Nursing homes care for people who require more nursing or personal help than can be provided or is available in other settings. Nursing homes serve an increasingly fragile population. As home and assisted living options grow in popularity, nursing homes are left with those who are most dependent. Most residents require assistance with one or more activities of daily living, e.g. bathing, eating, dressing, etc. 

Many residents also have complex health problems requiring sophisticated medical and nursing treatments. A growing number of residents need tube feedings, respiratory care, special skin treatments, IV therapy, ostomy or tracheostomy care, injections, or specialized rehabilitative services. Most receive multiple medications that require careful monitoring.

The nursing home does not have to be your final destination. Nursing homes are often used for short-term convalescent or rehabilitative care. As hospitals rarely allow people to stay long enough to fully recover from accidents and illnesses, some nursing homes focus heavily on short-term therapeutic care that picks up where the hospital left off. Facilities with good therapy programs see their residents back to their homes or into assisted living settings.

At the time this version is going to print, there are emerging programs to assist with nursing home transitions.  These programs help people who have lived in a nursing home for awhile return to their own home or a new home in the community.  These programs are called nursing home transition programs.  Currently the Detroit Area Agency on Aging and the Area Agency on Aging of Western Michigan (Grand Rapids) offer these services.  They can include assistance securing housing, in home
services, and the basics needed to return to life in the community. See the resource directory section for their telephone numbers to call to inquire about the program.

Single Points of Entry:  At the time this version is going to print, Michigan is experimenting with new ways for consumers to access long term care services.  Pilot projects in four areas of the state are creating organizations called Single Points of Entry or SPE.  The idea is to have a place someone needing assistance with information or actual services for long term care can go to be screened for eligibility for publicly funded programs, assess actual care needs, learn what services are available in the private sector and general information on options. To find out if you have an SPE in your area, try your Area Agency on Aging.  If there is not one in your area, the Area Agency on Aging may have other services to assist you.

For some people though, the nursing home is their final home. If you are not discharged within the first several weeks of your stay, the chance that you will ever return home decreases dramatically. One study found that the average length of stay is about six months, but that one in five residents needs at least five years of care.

Nursing homes are not all alike. They vary widely in mission, ownership, customer needs, quality, services, methods, environment and cost. Most of the approximately 450 nursing homes in Michigan are for-profit businesses. Although some of these are owned by individuals, the majority are owned by Michigan or national corporations. Less than a quarter of Michigan nursing homes are operated by non-profit businesses or government. Most of the non-profit homes are owned by church- or hospital-affiliated organizations. About three dozen nursing homes, known as county medical care facilities, are owned and operated by Michigan counties. Many hospitals operate nursing homes. In rural areas of Michigan, some hospitals offer nursing home care in a unit attached to the hospital called a hospital long term care unit.

Some nursing homes are part of a larger retirement community offering a variety of living options. These retirement communities often assure that you will be offered care in whatever setting is most appropriate to your needs, and that you can move among various settings within the community as needed. They may be called life care centers or continuing care retirement communities. Life care centers and continuing care retirement communities generally charge a large entrance fee plus monthly rates that vary based on resident care needs and living settings.

[Back to Top]

State Ombudsman

An ombudsman assists long-term care residents and concerned relatives with resident rights, complaints, payment issues, guardianship, and nursing home placement and transition.

To find the ombudsman nearest you, contact your State Ombudsman office.

Sarah Slocum
State LTC Ombudsman
Michigan Office of Services to the Aging
7109 West Saginaw or
P.O. Box 30676
Lansing, MI 48909
Tel: (517)335-0148
Fax: (517)373-4092

[Back to Top]

Life Care Centers and Continuing Care Retirement Community

A life care center is registered with the Michigan Department of Consumer and Industry Services, which regulates life care contracts and monitors the centers' financial arrangements with residents.  If you are considering moving into a life care center or continuing care retirement community, evaluate the financial arrangements carefully, determine how the center is licensed, if at all, by the state, and make sure that it offers all of the types of services you may need, at a price you can afford now and in the future.

Nursing homes are regulated and monitored by both the state and federal governments. In Michigan, all nursing homes are licensed and inspected by the Michigan Department of Community Health (MDCH). MDCH evaluates whether all nursing homes, including county medical care facilities and hospital long term care units, meet Michigan Public Health Code standards.

MDCH also evaluates whether nursing homes that apply, meet the federal Medicare and Medicaid nursing home care standards for the federal Department of Health and Human Services (DHHS) and the Michigan Department of Community Health (MDCH), respectively.  Current federal nursing home standards were set in 1987 when Congress passed the nursing home reform amendments. This law is sometimes referred to as OBRA '87 (Omnibus Budget Reconciliation Act of 1987), the broader act that contains the nursing home reform amendments. With DHHS approval, a Michigan nursing home can accept Medicare payment. With MDCH approval, a Michigan nursing home can seek Medicaid payment for services.

The inspection results of all nursing homes accepting Medicare or Medicaid are a matter of public record, available on the web at www.medicare.gov.  Follow the instructions to "nursing home compare." Inspection results are also available through your local Long Term Care Ombudsman office listed at the end of this Handbook.  They can also tell you how to search for results on the internet.

You can file a complaint against a nursing home by calling the Bureau of Health Facilities of the Michigan Department of Community Health, at 1-800-882-6006.

[Back to Top]

Paying for Nursing Home Care

The average cost of nursing home care for private paying residents in Michigan, in 2007, is about $182.00 per day. Rates usually vary based on room size, number of roommates, and the type of care needed.

Government nursing home coverage through Medicare and Medicaid is limited to people who meet specified eligibility criteria.If Medicare and Medicaid or LTC insurance coverage is not available, you will have to use your own funds to pay for your care. Paying for care out of your personal funds is called private payment. Private paying residents usually pay higher prices.

Government programs that help pay for nursing home care recognize two types of nursing home care: skilled and basic. Skilled care requires the services of licensed health personnel, such as nurses and therapists, on a continuous basis. Basic care, sometimes called custodial care, includes many routine nursing services, such as medication management, and help with personal care needs. Most Michigan nursing homes offer skilled and basic care. Medicaid pays for both kinds of care, but Medicare pays only for skilled care.

Beware of hidden costs if you are paying from private funds. Many nursing homes follow hospital billing practices, by charging separately for routine supplies and nursing care. For example, nursing homes often charge extra if residents are incontinent or confused. These extra charges may come as a great surprise, because incontinence and confusion are very common symptoms for residents of nursing homes. What may seem basic or routine to you may be considered otherwise to the nursing home billing office. Ask for a copy of extra charges and review it carefully.  If possible, look into this prior to entrance into the nursing home.

Ask about pharmacy charges. Many Michigan nursing homes require residents to use a specific pharmacy. You may discover that your drug expenses increase dramatically because of very high prices charged by the facility-selected pharmacy.

Choosing a long term care facility

Whether you are considering a nursing home, HFA, AFC or assisted living facility, there are basic steps and questions you need to take and consider when shopping for a long term care facility.

It is helpful to identify what features are most important to you. Since long term care homes are not all alike, you will want to find one that matches your needs and desires. Start by asking yourself these questions:

• What kind of care do I need?

• What type of lifestyle am I looking for?

Some people want a safe, comfortable place with basic services and pleasant companions. Others may need specialized nursing or rehabilitation services. You may want a home that places special emphasis on religious or ethnic traditions.

[Back to Top]

Comparing Nursing Homes

Medicare offers a nursing home comparison tool for English and Spanish speaking consumers. This tool may be found via the Medicare website. This website can be found at http://www.medicare.gov/NHCompare/Home.asp .

[Back to Top]

Call First

It is best to call homes first before visiting. Once you identify what you want and need in a home, simply telephoning those on your list may eliminate the need to visit them. Ask each home if it offers the services you are looking for. Request information on costs, including extra charges not included in the daily rates. Ask if it has a license and is inspected by the state.  If it is a nursing home, is it Medicare- and Medicaid-certified.

Just as you are trying to be particular about the home you choose, some homes are very selective about the applicants they admit. They are likely to ask you several questions before telling you if you will be considered for admission. Their questions will probably include:

• What are your care needs?

 

• How do you plan to pay for your care?

• How much income and resources do you have to help pay for care?

 

Your ability to get into many homes will depend on your answers to these questions. Many facilities favor applicants who have more money and need less care. While this type of discrimination is unfair and illegal at Medicaid- and Medicare-certified nursing homes, it is a widespread practice. You can save time by eliminating facilities that are not interested in you.

 

[Back to Top]

Visiting the homes

Visiting the homes on your list is the most important part of choosing one because it gives you an opportunity to see first hand the quality of life and care in the facility. 

On your first visit, make an appointment to see the admissions coordinator. This will give you an opportunity to ask questions about admissions policies and procedures as well as to see the home. Ask for a guided tour of the facility so that you can become familiar with its layout, programs and services.  Try to see the entire facility and the room that is available.  After the tour, ask if you can walk around unescorted, so you can observe meals or activities, and talk to residents and visitors.

Follow-up visits should be unannounced, at different times than your initial visit. Weekends and evenings are good times to evaluate how well the home is run. These visits will give you an opportunity to compare the level of attention that staff give to residents and whether the home is the same during the night and day and during weekdays and weekends. There are usually few administrative staff members present at night and on weekends. Observe if there is adequate staff to provide needed services.

During your visits, there will be many questions to ask and things to look for. Take time to make careful observations using your eyes, ears, and nose.  If you are arranging placement for a relative or a friend, try to put yourself in her shoes. Trust your instincts and perceptions. If you are uncertain or confused about the appropriateness of something you see, ask questions of the staff. It is a good idea to take notes, because it is easy to lose track of details during this difficult task.

Your review of each home should rate its quality of care, quality of life, medical services, food services, environment, administration and how it addresses your own special needs. 

If you have more questions about nursing homes or have a concern about your care and services in a nursing home, contact your ombudsman office or the Michigan Department of Community Health (MDCH) for assistance.  Both are listed in the Resource section of this website.

This section on long term care was written by Hollis Turnam based on information presented in The Michigan Long Term Care Companion, a 380+ page book published by Citizens for Better Care. This information was updated in 2006 by Elder Law of Michigan, Inc.  Elder Law of Michigan, Inc. is grateful to Citizens for Better Care for permission to use this material.  It is one of the best books on the subject and highly recommended to anyone desiring deeper coverage of this area.  You can obtain a copy of the book for $25.00, plus tax ($1.50) and shipping ($3.00).  It can be ordered by phone at (1-313-832-6387), or by fax at (1-313-832-7407) or by mail to:  CBC Publications, 4750 Woodward, Detroit, Michigan 48201-1308.

Another resource on this topic is The Baby Boomers’s Guide to Nursing Home Care, by Katharine Hsiao and Eric Carlson.  This publication is available from the National Senior Citizen's Law Center, (202) 289-6976, ext. 201 or www.nsclc.org.

 

(For assistance on these and other Long Term Care Issues, contact the Legal Hotline for Michigan Seniors at (800) 347-5297.  More resources are also located in the Resource Section of this website.