Living Wills vs. Health Care Proxies

Aging in place
Helping Seniors Stay at Home
July 2007 Chronogram
by Abby Luby

When 66-year-old Josephine Halsteed was stricken with cancer that impaired her ability to walk, she needed someone who could get her to the doctor on a day’s notice. Halsteed, a 40-year Montgomery resident, was able to make a single call and enlist the help of volunteer Joseph Cardonne, a local retiree. For the last three months Halsteed has felt fortunate to have Cardonne’s assistance as well as his company. This is good news for the town of Montgomery whose ground breaking Seniors Independence Project was the program that initially connected Cardonne with Halsteed. “This project is a life saver,” said Halsteed. “It lets me stay here – I wouldn’t want to give up my home.”

Aging in place , a national movement among the elderly that helps seniors remain in their homes, fueled the Town of Montgomery to create the Seniors Independence Project. Growing numbers people 65 years and older favor living and aging in their homes over institutional housing or nursing homes. According to the American Association of Retired Persons more than 80 percent of Americans 45 and older say they want to stay home as long as possible. As the oldest baby boomers become senior citizens in 2011, the population of 65 and older is projected to grow faster than the total population in every state. Municipalities are realizing that they need to have resources in place for the aging baby boomers.

For the year 2015, the New York Census projects 3.7 million people will be 60 years old, 2.6 million people will be 65 years old, 1.1 million people will be 75 years old and more than a third of a million people will be 85 years or older. The growing senior citizen population in Orange County has reached beyond the 2000 US Census count of 62,721 for those 55 and over. Projections for 2015 say 89,003 senior citizens will be living in Orange, Sullivan, and Ulster Counties, a 25 percent increase from today’s numbers. The New York State Office for the Aging has projected that 25 percent of the working population will be at retirement age by 2012. “Very soon there will be different types of needs that will likely reach a crisis level,” said Susan Cockburn, town of Montgomery supervisor. “We need to be prepared.”

Cockburn was initially approached by Sandy Altman, who suggested the town formally assist seniors living at home. Altman, of the Walden- based law firm Jacobowitz & Gubits, practices elder law, estate planning, and probate, and volunteered his legal expertise for the town’s senior project. The effort quickly attracted community members, professionals, and local nonprofits, creating the Seniors Independence Project, the first broad-based assistance program for seniors run by a municipality.

Bewildering Smorgasbord of Services
For most seniors needing a ride to the store, the doctor, or help changing a light bulb, means they have to sort through an often bewildering smorgasbord of volunteer organizations until they find a good fit in terms of need and scheduling, often enlisting multiple groups to suit their needs. Ann Caldwell is completely bedridden in her home from her struggle with cancer, and the 69-year-old has a rotating assortment of people helping her on a daily basis. “My 24-hour homecare aide is from WellCare, who subcontracts other agencies for this and other services,” said Caldwell. (WellCare is a healthcare plan that manages different health services). She called Faith in Action, a national interfaith volunteer organization with a Middletown-based program, for someone to come and fix a leaky faucet and another call for someone to do her shopping.

Hilda Long, 63, a Montgomery resident of 38 years, called Faith in Action to get a home aide. “[The aide]helps me with my bathing and she helps me get dressed,” said Long, who has suffered a series of operations including open heart surgery. For transportation she calls Magda Skermo, who arranges rides for seniors and works for both Faith in Action and the Seniors Independence Project.

The Seniors Independence Project aims to offers “one-stop- shopping” for seniors, providing one number at Town Hall for their day-to-day needs. The project hopes to become a blueprint for local and state governments nationwide. The goal, Cockburn said, is to develop a program that coordinates volunteers and vendors who provide services to the elderly with the town acting as a logistical umbrella, overseeing essentials such as background checks of volunteers and liability issues.

Work on the project started in February, 2006, and got off the ground just a year later this past January. Getting the program started was a challenge. The town board had to be assured that additional liability insurance for volunteers would not be costly to the taxpayer and that the working partnerships between the private, nonprofit agencies would run smoothly. It took about eight months for the town to give the project the go-ahead. When Cockburn put the word out about the proposed town service, she was contacted by Doris Rubinsky, program director with Middletown’s Faith in Action. “The town of Montgomery is breaking ground,” said Rubinsky about the Seniors Independent Project. “There are no other municipalities doing this.”

Faith in Action has joined with Montgomery by offering to run background checks on volunteers and give them training before they actively join the project. “We provide two sessions where they learn the “dos and don’ts” of the program,” said Rubinsky. “It’s important that the volunteers keep everything confidential. They can’t tell anyone else in the community what they are doing. Also they can’t administer any medicines and they are not allowed to accept money or monetary gifts.” Rubinsky said volunteers also learn listening skills, what to do in emergencies, learn what it’s like being with a frail person and how to deal with the visually impaired. “We also need to make sure that our volunteers will be in a safe situation,” she explained, adding that volunteers need to monitor elderly people who are hoarders and live in a cluttered environment. “We have to make sure [seniors’]homes are safe and there is no risk of fire and that they can easily get out of their homes if they have to.”

Also involved with the project is the Orange County Office for the Aging (OCOA) who runs the Retired and Senior Volunteer Program. “Our role in the Seniors Independence Project is to offer support and benefits for volunteers,” said Mary Stewart of the OCOA, whose volunteer program is federally funded. “We are a clearing house for volunteers,” Stewart explained. “We give insurance coverage, including liability, to volunteers working with the nonprofit sector in case they suffer any kind of personal injury.”

Altman, who chairs the project, said taxpayers would also benefit from more seniors aging in place. “There is a strong desire on the part of seniors to spend their later years at home rather than in a nursing home or in even in assisted living,” he said. “There are many reasons aging in place is good for not only seniors but for the county as well.” Altman was referring to the Federal Deficit Reduction Act of 2005 which cut back available Medicaid funds by tightening the eligibility requirements.

“Medicaid is jointly funded by the federal, state, and county governments which means that part of federal, state, and county taxes go toward nursing homes costs. In our area nursing homes cost $10,000 to $12,000 a month [per senior],” Altman explained, adding that the bonus for helping seniors remain in their houses would eventually cut down government expenses spent on nursing homes.

The fledgling project seeks to efficiently administer each volunteer based group that participates in the project. “We hope to have the infra- structure in place soon,” said Cockburn. “That will tell me how well the project is working which makes me more confident in convincing the town to make this a budget line item.”

Cockburn and Altman said local taxes won’t be affected because most of the services are provided by volunteers. The only funding needed is for an office and a phone line staffed by a project representative for seniors to call or visit. “We have already received small donations,” said Cockburn. “And we will also be writing grants for additional funding.”

Flexible Living
That most seniors need rides more than other services was no surprise to Peter Galati, transportation program assistant for the town. Galati said the town’s transportation services for seniors includes the Dial-a-Bus and his statistics indicate that more and more seniors are moving into the area. “Montgomery provides about a total of 11,500 one way trips for seniors every year,” said Galati.

But transportation, the service most needed, is just one of the project’s goals in helping seniors; assisting with simple chores is the other. “It could be as mundane as giving them clerical assistance, picking up the mail or putting sheets on the bed,” said Faith in Action’s Rubinsky. “It’s the little things – like changing a light bulb.”

Cockburn said they were also working to connect volunteers with local vendors who might offer discounted services to seniors. “It’s a way that keeps local businesses local – which is part of Montgomery’s sustainability program,” she said. “We have a pharmacy that will deliver medications and we are contacting area supermarkets to see if they will deliver groceries.” The effort will benefit both business and seniors, she said.

The program is attracting attention from other state and county organizations who are gauging its progress as the word gets out. Anne Coon, program coordinator from the Orange County Office for the Aging, said she was intrigued when she first heard about the project. “The idea that a municipality was behind this indicated that we could use it as a model to replicate elsewhere in the county. Every county is going to need something like this because the senior baby boomers will not put up with being shut away just because they can’t get around. They want to be active.”

The only other program vaguely similar to Montgomery’s Seniors Independence Project is Beacon Hill Village in Boston. Now five years old, the nonprofit Beacon Hill provides services around the clock and is supported by sliding scale membership fees and grants. The popularity of Beacon Hill affirms that an active senior community is becoming the norm and local governments that support their seniors may see positive impacts their entire constituency.

Rubinsky clearly sees a shift in attitudes. “When I first started [at FIA]it was different. If seniors I knew went into a nursing home I wrote them off because they weren’t coming home,” she said. “But now with people wanting to age in place, my sole job here is to make them as independent as possible with a quality of life that brings in as many services as possible.” But even with help, some seniors loose the battle to stay at home. Beverly Stark is the sole caregiver of her husband, who suffers from Alzheimer’s disease. Although she has some help from outside groups, she can no longer to fully care for her husband on her own.

“My husband is 87 and I’m 85 and its too much now. He’s not getting any better,” said Stark, who lives in a small apartment complex in Walden. “I wanted to live at home for a long time and I thought I could manage it.” Stark said staying at home let the couple sleep and eat whenever they wished without conforming to any set schedule. “If we all of a sudden wanted to go for a ride we could do it. It’s just more flexible living at home.” But even though Stark enjoys where she lives, her husband’s deteriorating health make the day-to-day care too difficult for her and she is has started to look at some local nursing homes.

Volunteers helping senior citizens say that the real benefit of this type of project is befriending a senior citizen who needs that essential, social contact – something that diminishes as an unfortunate consequence of aging. If the match between volunteer and the person they help is a good one, sharing an hour or two together a few times a week can be personally rewarding and fulfilling.

“Volunteering is like eating chocolate without the calories,” said Rubinsky. “It creates the release of endorphins and gives you that good feeling.” And that may be the case for Joseph Cardonne when he helps Josephine Halsteed. Just after driving her to the doctor’s office a few weeks ago, Cardonne became a little more familiar with Halsteed and complimented her.

“I see you got a new hairdo – it looks great. And look how much better you are walking!”

“Thank you,” said Halsteed, smiling.

For a senior citizen like Ann Caldwell who requires a lot of help, there is no question that aging in place allows for certain freedoms never found in nursing homes or assisted-living residences. Caldwell is crippled after treatment for uterine cancer but she opted to stay at home despite her failing health and limited movement. She said the town of Montgomery has the right idea with their Seniors Independence Project because it helps people remain in their homes.

“Living at home provides me a greater opportunity to interact with my family,” Caldwell said. “With a little assistance I can do the usual grandmother thing with my five-year-old granddaughter when she comes to visit. We can bake cookies, play with makeup, watch TV together.”

After her cancer treatment Caldwell needed to go into a nursing home for rehabilitation. “I tried to do things in the nursing home with my granddaughter but it was extremely difficult,” she said. “Arranging for supplies and space so we could paint was hard and baking cookies was totally out. But here in my own home I have more accessibility and I can do a variety of normal activities that all families do.”