Joan Wills-Birch is the executive director of The Little Red House, an adult day care services program in Spring Lake. The Little Red House (TLRH) receives funding through Senior Resources for some of its participants, so Joan knows about the MI Choice Waiver program. Or so she thought.
“I’ve never had a bad experience with Senior Resources,” Joan said. “I haven’t met a person in 25 years from Senior Resources who isn’t right for their job. (The supports coordinator) was amazing; she did so much.”
Joan has been with The Little Red House for almost 25 years and has been executive director since January of 2025. While she has known about the MI Choice Waiver program – which provides services that help people stay in their own homes, rather than live in a skilled nursing facility – she learned even more about the benefits of the Waiver program when she needed help caring for her mother, Sharon.
“My mom retired from Hospice of North Ottawa, where she was an aide,” Joan said. “Then she worked here for seven years, about three hours a day, before she became a participant. She came in the morning for about three hours a day. Then COVID hit. She lived by herself, and she wasn’t really understanding COVID.”
One day, Sharon went out to get the newspaper and she passed out on the ground. She was horribly dehydrated, Joan said. Due to COVID, Joan hadn’t been inside her mom’s house in months. “I was cooking and delivering meals to her, but she wasn’t eating. She was feeding them to her dog or throwing them out. The next week she passed out again. I took her to the doctor, and they found she had broken her pelvis.” That kind of break couldn’t be repaired, and Sharon started using a walker. A friend who checked on her later called Joan and said ‘your mom can’t walk.’ We took her to the hospital, and she was out of it. They found she had a life-threatening sodium deficiency.
“Mom can’t walk, she doesn’t know who people are,” Joan recalled of that time. “So I called Theresa (a nurse friend who worked at Senior Resources at the time) and she told me to call Senior Resources. I didn’t know anything about Mom’s money, but she had been getting the COVID money, thank goodness.”
Joan said something had been wrong with her mom, but COVID made it worse. “The life-threatening sodium deficiency alerted us to many issues and then dementia really took over,” Joan said. Sharon needed 24-hour help, which was paid privately from her mom’s money. “We worked with her big-time and she was coming back. She asked not to be put in a home. She was going through her money fast” with the around-the-clock help.
Theresa told me about Primary Care at Home (the Senior Resources home-based medical practice). That was life-changing. They were amazing people. Even when Mom came here (to The Little Red House), they came here for her.”
Due to Joan’s work at TLRH and previously with hospice, she was aware of caregiving needs. “When you’re taking care of someone, it’s hard. You have to decide who you are – daughter or caregiver? You can’t be both – it will kill you. Resentment builds.” Joan was unable to help with her grandchildren as she wanted, due to the care her mother needed.
“Jody (the previous executive director at TLRH) said to bring her here” during the day when Joan worked. That provided some stability, but she was still using her private funds for care at home and she was going to run out of money.
“She was capable of staying home with help,” Joan said. That’s when they started the enrollment process in MI Choice Waiver. She described the process as “daunting, but painless” due to the help from Senior Resources staff members. And she is thankful for that assistance, as she said it made a huge difference in both her mother’s care and in providing support for Joan and her brother.
Costs for things like Ensure, the liquid nutritional supplement Sharon needed to ensure she got nutrients each day, were high. “We were paying $325 a month for Ensure and incontinence products were at least $250 per month. (Waiver) had it sent to her house. Briefs and pads (needed for incontinence) – we didn’t need to pay; Waiver did.
“We needed her to come here (to TLRH) and get showered. She did 8 hours a day here” with the Waiver program. “It was so hard. I’d pick Mom up at 6 a.m. and she’d stay here all day.” Sharon, the former aide at TLRH, became a participant three days a week for 8 hours a day. Eventually, even that wasn’t enough, Joan said.
The Waiver supports coordinator asked what else was needed. “She asked what I need. ‘Do you need in-home help?’ I didn’t think they would get help, people who would show up. We needed an aide – oh, did we get an aide! We had her for months and months and months. She came from 3-6 p.m. and got (mom’s) food and sat and ate with her, would chat with her. She got her ready for bed – dentures, washed. She came every day.
“I can’t believe the help my mom got. We were doing weekends, and they started covering weekends. That allowed my brother and I to see our grandkids. We were both mentally and physically exhausted – working full-time jobs and trying to care for mom, and for me, grandchildren, as there was no available daycare due to COVID. His family lives across state and he was not seeing them due to the responsibilities of caring for my mom. Oh my goodness that would be life-changing for us. They never did not show up.”
Joan was especially grateful for the companionship, which Sharon craved. “Mom needed company,” Joan said. “We couldn’t put her in a home; she was too aware. She said she would die in a home. My mom knew her routine at home.” Joan said her brother, who was a vital care partner, told her he was prepared to consider putting their mother in a skilled nursing facility if they hadn’t received help. They both had their own health issues that they needed to address, along with their families needing help, and they were both feeling exhaustion and stress.
While Joan’s work gave her an understanding of older adults and their caregivers, she said she wasn’t truly prepared for it, despite that knowledge.
“Caregiving is the hardest thing,” she said. “You don’t know until you go through it. They (caregivers) are just exhausted. Physically, emotionally, financially – it all adds up quickly. Isolation is a killer, which COVID taught us.”
While Sharon had dementia, Joan believes COVID hastened that. “Everything changed so quickly. Her coming here (to TLRH) gave her a purpose. She would talk to people. She’s a social person. She was fantastic here. The participants knew her. So as she progressed it was lovely to watch them take care of her. She said ‘What would I do without it (TLRH). I would die!’
Sharon was enrolled in Waiver on March 6, 2024, after her assessment in early February that year. Her services began with the adult day care services at The Little Red House twice a week and community living supports four hours a week, then expanded to include liquid nutritional supplements, increased community living supports and additional hours at TLRH. Sharon remained a Waiver participant until her death on March 6, 2025 – exactly one year.
Joan expressed her concern about potential changes or reductions in Medicaid funding. “I can’t believe it’s even a question, stopping these funds,” Joan said. “Until you need it, you have no conception. No idea. We serve the caregiver” at The Little Red House. “It does change everything. How can this be happening?”