Communities Struggle to Care for Elderly, Alone at Home

October 1st, 2015

At least three times a night during much of the long, harsh northern winter, Aldea Campbell gets out of bed, steps into her slippers, and descends a flight of frighteningly steep, narrow wooden stairs to the cellar to fill her wood-burning stove. She’s 82, a widow, and has lived in her 102-year-old house near the Canadian border for almost six decades.

She burns wood because she can’t afford enough oil to get through the cold months. When her arthritis is bad, she gingerly maneuvers the steps sideways to keep from falling. But still, she slipped on the stairs twice last year, once badly hurting her tailbone. “It happened so fast,” she said.

Such predicaments are increasingly common in Maine: the grayest, most rural state in the U.S., with housing among the oldest in the nation. Maine has another distinction: it is among the first states to experience challenges from a growing number of seniors who are “aging in place”, remaining independent rather than relocating to nursing homes or moving in with grown children.

More elderly across the nation are aging at home for a variety of reasons: they prefer to and are healthy enough to stay; they can’t afford other options such as assisted living; and states in some cases have imposed policies to limit nursing home stays paid for by Medicaid, which is a major funder of long-term institutional health care for older Americans.

But aging in place is proving difficult in places where the population is growing older, supportive services are scarce, houses are in disrepair and younger people who can assist have moved away. As a result, elderly people who live at home are having to rely more on neighbors,who sometimes are elderly, too and local nonprofits and public agencies are starting to feel the strain from increasing requests for help.

“It’s a huge issue,it couldn’t be bigger,” said Lenard Kaye, director of the University of Maine Center on Aging. “Ninety-nine percent of older adults say they want to stay right where they are until they’ve taken their last breath, but that doesn’t mean they are continuing to remain safe and remain well.”

Medicaid, a network of aging services under the federal Older Americans Act and state and community programs have long provided some assistance to elderly people who want to remain independent. But in general, people who choose to age at home “have always been on their own,” said Donna Wagner, dean of the New Mexico State University College of Health and Social Services and a researcher on aging. “I don’t think we’ve had a clear contract with the elderly,” she said.

Public and private entities are increasingly trying to offer more services but demand is outstripping supply because the population is aging, she said. In some poorer areas, services can be hard to find at all, she said. “This philosophy of remaining independent with the help of community-based services has been a little oversold,” said Ms. Wagner. “Lots of people have a hard time doing it.”

Maine, Pennsylvania, Kentucky and New York are among states now boosting programs that help the elderly live at home, while churches and communities are also implementing more initiatives.

There were 26.8 million households headed by someone 65 and older in 2013, up 24% from 10 years earlier, according to the U.S. Census. Households headed by a person 75 and older grew 13% to 12.2 million. Meanwhile, the number of older people living in institutions or with relatives has declined. Living alone has supplanted living with relatives as the most common scenario for women 75 and over, according to the Census’s official blog in July, describing a “gray revolution in living arrangements.”

The Centers for Disease Control and Prevention defines “aging in place” as “the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level.” These people may need assistance, but staying home, whether in the family residence or a downsized version, is a paramount goal. A 2010 AARP survey found 88% of respondents 65 and older said they wanted to stay in their current residence as long as possible.

Seniors remaining rooted isn’t new, but the accelerated growth of the senior population, with an estimated 10,000 baby boomers turning 65 each day, is fueling new questions about whether communities are prepared, Kathy Greenlee, the assistant secretary for aging at the U.S. Department of Health and Human Services, said in an interview.

“There is almost general agreement that this is a worthy goal,” Ms. Greenlee said. “The hard part is, how do we build the infrastructure that best supports it? Challenges range from adequate housing to transportation, and unfortunately they are very large issues,” she said.

Policy makers are grappling with these issues particularly in the northeast, which has the oldest median age of any U.S. region, as well as housing rife with hazards.

Starting in 2017, Pennsylvania will contract with managed-care organizations that will help tens of thousands of seniors eligible for long-term care under Medicaid remain at home. The goal is to direct a far larger portion of funds away from more costly nursing homes to efforts, even something as basic as adding a ramp to a house, that help the elderly live safely at home, said Pennsylvania Human Services Secretary Ted Dallas.
The New York 2015-16 budget, which took effect on April 1, includes one of the state’s largest investments ever in assisting seniors at home: more than $65 million for programs, from transportation to respite services for family caregivers. Kentucky is, for the first time, planning a program to deliver meals five days a week to the homes of nearly 4,000 low-income seniors.

In Maine, where the median age was 43.9 years in 2013, compared with 37.6 for the nation, a new law authorizes the state to ask voters in November to borrow $15 million to build affordable homes for seniors and repair older dwellings occupied by the elderly. In August, the state also said it would put an additional $3.2 million into home services for the elderly to reduce waiting lists, such as the 900 people who were waiting for basic help, from meal preparation to housekeeping assistance.

While polls show people prefer to age at home, some seniors have few other options: 88% of U.S. residents in assisted living pay privately, and the national median monthly rent is north of $3,500, according to the Assisted Living Federation of America and Genworth Financial Inc.

The number of people 65 and over living in nursing homes fell nearly 20% in the 2010 Census, from 10 years earlier, in part as states limited costly institutional stays. Maine, for instance, in 1994 adopted tougher criteria for admissions, meaning people had to be frailer than before that year to qualify for nursing-home stays funded by Medicaid.

 

Nursing-home eligibility

Maine officials are now looking at whether they need to re-evaluate the eligibility criteria. “Frankly it gives me great pause today when I look at, on a case-by-case basis, some of the individuals being denied access to nursing facilities,” Maine Department of Health and Human Services Commissioner Mary Mayhew said in an interview.

The delicate balance of protecting seniors while helping them stay independent is perhaps most evident in isolated places like Aroostook County, Maine’s northernmost county.

A stunning but economically struggling region of rolling green hills, forests and potato farms, Aroostook is a long drive and a stark contrast from southern Maine, where more affluent retirees flock to quaint towns on the rocky coast. It is larger than Connecticut and Rhode Island combined, but has less than 2% of their population. The closing of a military base in 1994 and automation in logging and farming drained jobs and population to 69,447 residents in 2014 from a peak of 106,000 in 1960, according to Census estimates. Unemployment is among the highest in Maine.

A shortage of opportunity has driven away the young. Between 2000 and 2013, Aroostook lost nearly 20% of its population aged 22 to 44 years old, according to Census estimates. Meanwhile, the number of people 65 and over grew about 11%.

“There’s such a state of out-migration that it’s difficult to fill certain positions, and that impacts the elderly,” said Aroostook County Administrator Douglas Beaulieu. Finding home-health workers in the county is a “constant challenge,” said Lisa Fuller, vice president of business development at VNA Home Health Hospice, a Maine organization.

More than 1,600 elderly households are on a waiting list to have insulation installed or broken or faulty heating systems fixed or replaced; potentially dangerous furnaces are a key worry, said Jim Baillargeon, senior manager for Aroostook County Action Program Inc., a local nonprofit organization. Many will be on the waiting list for years, he said.

Instead, the elderly in Aroostook often rely on other older people, making for a fragile support system. In the town of Mars Hill, 90-year-old Marion Miller lives alone and gets around using a walker after three falls. She counts on her son, Stillman, for day-to-day help. But he is 68, weakened from a heart attack in May, and said he worries about his ability to assist.

At the edge of the North Maine Woods, in Portage Lake, (pop. 391), Judy Moreau, who is 70 with heart problems, relies on her 80-year-old neighbor, who himself wears a pacemaker, to drive her the 42 winding miles to the doctor. Last year, the car veered into a ditch, leaving the pair shaken and flagging down passersby for help.

Many Aroostook seniors would be candidates for assisted living or downsizing into an apartment, but either can’t afford those options or can’t find them nearby, said Mr. Beaulieu. Many also resist moving out of pride, rugged Maine individualism and the hook of history: it is where they were born and raised, and where their ancestors and spouses are buried.

 

Closed school

A dearth of young people forced the school to close in the town of Stockholm (pop. 253) in 2004. But Mrs. Campbell, a retired factory worker, is determined to remain in the home and community where she has attended the same Catholic parish for 56 years and raised six children.

Her husband, who was a mechanic, died in 2003. Three of her grown children still live in the area, but she values her independence too much to move in with them. Publicly subsidized affordable housing complexes in Caribou, the closest large town, have waiting lists, as does the nursing home there.

Mrs. Campbell had help with minor repairs from a Massachusetts church group that recently visited the county to assist seniors. But her routine overall is a “struggle,” she said, particularly staying warm in a remote region where consumers rely on expensive heating oil to warm their drafty old homes in cold seasons that run from October to May.

Mrs. Campbell received public fuel assistance last year, but exhausted it by midwinter, forcing her to heat with wood. Her budget is strained in part because she is already paying off a loan she took to fix a crumbling chimney. Most homes that receive fuel assistance don’t get enough oil to make it through the winter, said a spokeswoman for the Maine State Housing Authority, which administers the fuel assistance, which is meant to be supplemental help.

Public agencies are feeling the strain. The Presque Isle Fire Department, in a small city in Aroostook County, is getting “a lot more” calls from elderly residents than ever before, said Adam Rider, deputy chief. Falls are a common issue, as are problems caused by older residents burning wood to save money on oil, he said.

In the town of Van Buren, across the river from Canada, Robertine and Fernand Levesque are also finding it increasingly arduous to stay in the community where they have lived all their lives.

Married for 59 years, the couple has one adult child who lives five hours away. Mrs. Levesque, who is 78, acts as caregiver to her husband, also 78, who once ran a chain-saw business catering to loggers but who now struggles to walk after a heart attack and stroke. With a monthly income of $1,091, they “hardly have anything left after paying bills,” and struggle to pay property taxes, let alone home repairs, she said.

Having “worked hard all our lives,” they were reluctant to seek help, but now rely on food stamps and recently put their name on a waiting list with a nonprofit agency for a new roof, Mrs. Levesque said. Their current roof is deteriorating; “every time it rains, I pray,” she said.

Still, she can’t imagine going to a nursing home. “I don’t want to go now for sure, and he doesn’t want to go,” she said. “I’ll take care of him here for as long as I can.”

 

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2015 Flu Vaccine Reminder

September 23rd, 2015

With flu season coming up, it’s important for both seniors and caregivers to stay healthy and get their seasonal flu shot.

Most clinics have already started administering the 2015 flu vaccine. Once we are vaccinated, our bodies take about two weeks to develop antibodies that protect against the flu. Since the flu season can start as early as October, the Center for Disease Control recommends getting vaccinated as soon as the shot becomes available. Visit the HealthMap Vaccine Finder to locate where you can get a flu shot.

For those people without Medicare Part B or other insurance, there are many retailers that offer coupons and discounts for the flu vaccine. Here are some flu shot webpages from some major pharmacy chains and retailers:

Walgreens

CVS

Rite Aid

Walmart

Safeway

Real People, Real Lives: Selling Medical Students On The Joys of Geriatrics

September 23rd, 2015

When doctors told Robert Madison his wife had dementia, they didn’t explain very much. His successful career as an architect hardly prepared him for what came next.

“A week before she passed away her behavior was different, and I was angry because I thought she was deliberately not doing things,” Madison, now 92, told a group of nearly 200 students at Case Western Reserve School of Medicine here. “You are knowledgeable in treating patients, but I’m the patient, too, and if someone had said she can’t control anything, I would have been better able to understand what was taking place.”

Belle Likover recounted for the students how she insisted when her husband was dying of lymphoma that doctors in the hospital not make decisions without involving his oncologist. “When someone is in the hospital, they need an advocate with them at all times,” said Likover, who turns 96 next month. “But to expect that from families when they are in crisis is expecting too much. The medical profession has to address that.”

Madison and Likover were among six people all over the age of 90 invited to talk to the second-year medical students this month. The annual panel discussion, called “Life Over 90,” is aimed at nudging students toward choosing geriatric medicine, the primary care field that focuses on the elderly. It is among the lowest-paid specialties, and geriatricians must contend with complex cases that are time consuming and are often not reimbursed well by Medicare or private insurance. And their patients can have diseases that can only be managed but never cured.

Debt Weighs On Decisions About Specialties

Students often are attracted to more lucrative specialties such as orthopedics or cardiology, said Jeremy Hill, who was in the audience. Student loans are a burden for many medical students. The 35-year-old North Carolinanative may owe as much as $300,000 when he graduates, enough, he is quick to point out, to buy “a nice-sized house.”

Yet Hill is one of the few Case students who say they are leaning toward choosing geriatrics.

The American Geriatrics Society estimates that the nation will need about 30,000 geriatricians by 2030 to serve the 30 percent of older Americans with the most complicated medical problems. Yet there are only about 7,000 geriatricians currently practicing. To meet the projected need, thesociety estimates medical schools would have to train at least 1,500 geriatricians annually between now and 2030, or five times as many as last year.

The low number of geriatricians is not surprising considering that their average salary was $184,000 in 2010, almost three times lower than what radiologists earned, the American Geriatrics Society has reported.

Elizabeth O’Toole, a geriatrician and med school professor who arranged the panel discussion, acknowledged in her introduction that most students were interested in other specialties. Yet she warned them not to overlook the needs and outlooks of older patients.

“No matter what you’ll be doing, you are going to be working with these folks,” she said. More than 400,000 people 80 years old and older receive knee replacements last year, 35 percent of men over 80 and 19 percent of women have coronary heart disease and the most common medical procedure among people over 65 is cataract surgery. Successful outcomes depend on the patient’s cooperation and that, she said, requires “an understanding of who the patient is.”

Students who braced themselves for a solemn litany of medical problems from the panel were in for a surprise. It wasn’t just what the visitors said that made an impression, but how they said it.

Seniors Share Their Secrets With Budding Doctors

The group offered the students advice, telling the doctors-to-be to look at their patients instead of typing notes into a computer, take more time with older patients and answer their questions.

“Having to see so many patients a day is tragic,” said Simon Ostrach, 92, a professor emeritus of engineering at Case, who recalled being rushed through an appointment with an orthopedic surgeon who did little for “excruciating pain” after his hip replacement.

When it was her turn, Likover pushed back her chair, stood up and had no need for the microphone she was offered.

“Getting old is a question of being able to adapt to your changing life situation, having a little less energy, not being quite as healthy as were you were before,” said Likover, a retired social worker. Four years ago, she was hospitalized twice for congestive heart failure until she learned how to manage the disease through diet. She also has an occasional irregular heartbeat and only recently began walking with a cane. She swims at least three times a week, serves on several committees addressing seniors’ issues, and is a Jon Stewart fan because “getting a laugh every day is very, very helpful.”

Likover told students: “I have lived a very good and hopefully useful life and death does not concern me. It is going to happen. And I think that kind of outlook, not worrying about every little ache and pain makes a big difference and a very happy life.”

“That’s a perfect segue to my story,” Ostrach said. “I attribute my longevity to smoking, drinking and overeating,” he told the students. And doctors who tried to reform him “are all long dead and gone.” He was an athlete in college, wrestling and playing tennis. “But as I got past 60,” he said, “I found that listening to opera, smoking good cigars and having a little cognac was much more pleasant.” All in moderation, he added.

Efforts to introduce relatively healthy older adults to medical students can “reduce the sense of futility and show [the students] that there are real people with real lives who can benefit from quality health care,” said Chris Langston, program director at the John A. Hartford Foundation, which focuses on aging and health. Langston has beenanalyzing the trend for the past several years.

But Jeremy Hill and the roughly two dozen members of Case’s geriatric interest group are the exception. For them, the challenge of a complicated patient, “figuring out the puzzle,” as one student put it, is what makes geriatric medicine worthwhile, even when a cure is out of reach.

“I have such respect and admiration for this population, and if I could somehow give them one extra good day they would not have had otherwise,” said Hill, who then paused for a moment, “I would be privileged to work with them.”

After the session, Hill chatted for a few minutes with Ostrach, who had said he’s been lonely since his wife died. “If you’d like to have lunch sometime, please call me,” Hill said, handing Ostrach a scrap of paper with his phone number.

Winter Safety for Seniors

January 26th, 2015

Brrr, it’s cold! During these harsh days of winter it’s important to stay healthy, warm, and safe.

Aside from hazardous conditions caused by snow and ice, the cold weather can cause frostbite, hypothermia, and other susceptibilities. Here are some tips for seniors on how to stay warm and protect yourself, including ways to keep your spirits high, during these dreary winter months.

The Center for Disease Control and Prevention also has helpful advice on winter safety:

Prepare your Home
Hypothermia
Frostbite
Indoor Safety
Outdoor Safety

A Call for End of Life Care Reform

October 3rd, 2014

According to a recent report, Dying in America, issued by the Institute of Medicine, the US health care system needs to overhaul its treatment of end-of-life care to focus less on acute care and more on palliative care.

Usually received in hospitals, acute care is the active but short-term treatment of severe injuries or episodes of illness. Palliative care focuses on improving the quality of life for patients with serious illnesses by relieving symptoms, discomfort and stress, either at home or in a health care setting. A 2010 study in New England Journal of Medicine demonstrations that terminally ill patients who receive palliative care live longer (in the case of this study two and a half months longer) than those who don’t.

Hospitals are currently motivated to provide acute care which often turn out to be costly and poorly suited to the needs and preferences of patients. Many elderly patients nearing the end of life would like to receive care at home, but as in this case of a daughter trying to bring her hospitalized father home, sometimes power-of-attorney and your loved one’s lucid wishes aren’t enough to achieve home-based palliative care.

In order to improve access to palliative care, the report committee recommends that the federal government and health care policy makers provide health care facilities with financial incentives to 1) use medical and social services that decrease the need for emergency room and acute care, 2) coordinate care across multiple care settings (e.g. patient’s home, hospice, nursing home), and 3) use advance care planning and shared decision making practices.

The report committee posits that improving access to palliative care will connect patients nearing the end of life and their families with medical services that are more in line with their needs, care goals, and values as well as reduce their health care spending.

A Universal Design Creates Accessible Housing for Seniors

September 23rd, 2014

Most senior home owners want to continue living in their homes as they grow older, but their homes may not be suited to the needs of an aging senior. Due to physical limitations that can arise with age, a senior might eventually find it too difficult to go up and down stairs or turn on/off a faucet. That’s why in an effort to ensure continued accessibility, architects, builders, and senior care professionals recommend renovating or building housing units using the universal design model.

The universal design model calls for:

  • All rooms to be on a single level
  • No-step entryways
  • Extra-wide doorways and hallway
  • Switches and outlets reachable from any height
  • Lever-style handles on doors and faucets

By removing the need to navigate stairs, providing room to maneuver wheelchairs, walkers and medical equipment, and making doors, faucets and switches easily accessible, the universal design model, in theory, allows people of all ages and physical abilities (especially those who have limited mobility and trouble turning knobs) to live in the same residence. According to a recent report from The Joint Center for Housing Studies of Harvard, only 57% of housing units today have more than one of these features.

Rather than remodel their homes to be more accessible, some seniors find it more practical to move. The same report notes that more than 90% of seniors who move in their 80s relocate to homes with single floor living, 63% move to homes with no-step entries and 35% to homes with extra-wide doors and hallways.

In some cases, other modifications (roll-in showers, slip resistant floors, additional lighting, etc.) are needed to make a home more accessible, but for many seniors incorporating universal design features will keep their homes comfortable and safe for years.

Flu Shots for Seniors: Standard-Dose versus High-Dose

September 8th, 2014

Flu season is looming and can start as early as October. Flu symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may also have vomiting and diarrhea while others may have respiratory symptoms without a fever. The Center for Disease Control (CDC) recommends the flu vaccine for everyone over 6 months of age, especially people 65 years or older as they are more susceptible to the flu virus than younger adults.

People 65 years or older can choose to receive the standard-dose flu vaccine or a high-dose vaccine called Fluzone High-Dose. Fluzone High-Dose contains four times the amount of antigen — the part of the vaccine that prompts the body to make antibody — contained in regular flu shots. Since the human immune system becomes weaker with age, the additional antigen is intended to create a stronger immune response (more antibody) in seniors. A study published in the New England Journal of Medicine found that the high-dose vaccine was 24.2% more effective in preventing flu in seniors than the standard-dose vaccine.

While the CDC strongly encourages seniors to get vaccinated, it does not endorse one dose over the other. Talk to your doctor or pharmacist about the risks and which dose is right for you.

2014 Flu Vaccine Reminder

August 29th, 2014

With flu season looming ahead, it’s important for both seniors and caregivers to stay healthy and get their seasonal flu shot.

Most clinics have already started administering the 2014 flu vaccine. Once we are vaccinated, our bodies take about two weeks to develop antibodies that protect against the flu. Since the flu season can start as early as October, the Center for Disease Control recommends getting vaccinated as soon as the shot becomes available. Visit the HealthMap Vaccine Finder to locate where you can get a flu shot.

For those people without Medicare Part B or other insurance,??there are many retailers that offer coupons and discounts for the flu vaccine. Here are some flu shot webpages from some major pharmacy chains and retailers:

Walgreens

CVS

Rite Aid

Walmart

Safeway

Why Are Some Seniors Food Insecure?

August 22nd, 2014

Studies indicate that there are a variety of reasons for food insecurity in seniors. According to a study recently published in the Annals of Emergency Medicine, seniors aren’t getting enough to eat and cite depression, difficulty eating and difficulty buying groceries as the dominant reasons. This echoes a 2003 study which found that although lack of money is a major reason for food insecurity, some seniors who have the money to buy food are still food insecure due to lack of transportation, inability to prepare food, and/or medical problems.

Ideally, once the cause of food insecurity is identified, seniors can be paired with services (like those listed below) to help them regularly obtain and eat nutritious meals.


Resources to Help Seniors Stay Food Secure

Meals On Wheels
Meals On Wheels supports a national network of more than 5,000 Senior Nutrition Programs. They deliver nutritious meals that helps keep 2.5 million seniors healthy, safe and living independently in their own homes each year. Find a Meals On Wheels near you.

Salvation Army
The Salvation Army serves 60 million meals to anyone in need through its many soup kitchens, sit-down meal programs, food pantries, mobile meals and community gardens. Contact your local Salvation Army Corps Community Center for information on specific programs and locations.

Mom’s Meals
Mom’s Meals is a leading national provider of fresh-made, home-delivered meals and nutrition services for individuals desiring convenience or independent living and for patients recuperating at home or managing a chronic disease. For more information on Mom’s Meals visit www.momsmeals.com or call 1-877-508-6667.

Local Food banks & Food Pantries
In most communities, food banks and food pantries distribute food to those who need it. Feeding America’s Food Bank Locator and FoodPantries.org are a good start to finding pantries, soup kitchens, food shelves, and food banks in your area.

SNAP
Supplemental Nutrition Assistance Program (SNAP) helps millions of seniors supplement the cost of nutritious food. There are an estimated 5.2 million seniors eligible for SNAP who aren’t enrolled. Go to www.benefitscheckup.org/getsnap/ for more information and to see if you’re eligible.

Dial 2-1-1
Call 2-1-1 for information and referrals to local health, human and social service organizations such as food banks, adult day care & recreation centers, medical services, transportation providers, and much more. Check here to learn more about your local 2-1-1.

See if SNAP Can Help You

July 22nd, 2014

Did you know the Supplemental Nutrition Assistance Program (SNAP) is not only for families with children? Each day SNAP helps 4 million seniors buy healthy food. The average senior using SNAP receives $119 each month on a special debit card to buy nutritious foods. The SNAP debit card is accepted at over 250,000 grocery stores, farmers markets and neighborhood stores across the country.

Depending on where you live, you can apply online, by mail, or in person. Visit https://www.benefitscheckup.org/getsnap/ to see if SNAP can help you save money on groceries.