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An
Assist for The Elderly Buffalo
Elaine Clark, a resident of
the Weinberg apartments: "I have no complaint with the nursing home,
but it wasn't for me. I felt as though I was sinking into oblivion." A nursing
home is a rough compromise at the end of life. Even in the better
facilities, older people give up the comforts of home to share small rooms
with strangers and strict schedules. Others have it
worse. They're trapped in
places where shoddy care slowly strips them of health and dignity. Call
bells go unanswered. The bedridden lie in urine. Pressure sores grow out
of control. Now, as the United
States faces an explosion in the number of frail seniors and the cost of
housing them, a dramatically different alternative to the nursing home is
starting to take hold. The goal is radical in an industry based on bricks
and mortar: Do the opposite of
institutionalizing the elderly. Instead, keep people
in their own homes for as long as possible and coordinate all of their
services - from doctor visits to meals to physical therapy. It's a fledgling
approach centered around adult day care that exists in a few cities around
the country and now in Buffalo. Weinberg Campus in
Getzville, a senior community that includes apartments, assisted-living
units and a nursing home, recently started offering this new service for
low-income seniors. If successful, the
movement away from institutional care may revolutionize the way the nation
treats its elderly and contain soaring costs. "The financial
interests of nursing homes conflict with the interests of residents,
because the sicker a person is, the more money the institution gets. For
the first time, this program gives us an incentive to keep people well and
at home," said David Dunkelman, president of Weinberg Campus. Nationally, the
strategy is referred to as the Program for All-inclusive Care for the
Elderly, or PACE for short. Weinberg Campus calls it Total Aging in Place.
The emphasis is on
prevention. PACE rolls into one package home care, medical care,
activities, meals, social work, therapy and transportation, as well as
hospital and nursing home care if needed. It is a solution to a problem
anyone with aging parents knows well - that services for senior citizens
in the United States are costly, uncoordinated and of inconsistent
quality. Moreover, families that want to care for an aging relative at
home can't find much help. "Nursing homes
are appropriate for some people. But we're trying to squeeze quality out
of a dinosaur. You can't be creative because of the rigidity of the
rules," said Shawn Bloom, president of the National PACE Association
in Alexandria, Va. In the
apartments Elaine Clark moved
into the apartments from a nursing home and reflects another aspect of the
country's long-term care crisis: Many nursing home residents don't need
such a high level of care but have no other option. A diabetic whose
kidneys eventually failed, Clark is 59. She was too ill to care for
herself, so she moved in with a 90-year-old aunt in North Tonawanda. She
received a kidney transplant in 2001 and then was transferred to a nursing
home. After she recuperated, she couldn't leave. Clark was too frail
to live alone and could no longer rely on her aunt. Her children were
young and lived out of town. Assisted-living facilities were too
expensive. "I have no
complaint with the nursing home, but it wasn't for me. I felt as though I
was sinking into oblivion," she said. "You share a little room
with a curtain between you and the other person. People walk in without
knocking. Everything happens on their schedule." Now she lives in one
of the new apartments, a small but comfortable unit that overlooks a grove
of trees. She can e-mail family from a computer near her bed. There are
photographs on the wall and books on the shelves. Three days a week, she
uses a walker to visit the day care center, where she sees the medical
staff, eats lunch, takes cooking classes and schmoozes with other PACE
enrollees. The new buildings
were designed with the disabled in mind. The sidewalk in front of the day
care center is heated to melt snow. Huge windows provide abundant
sunlight. To prevent falls and depression, sensors in the apartments
automatically turn on a light when the natural light dims. Refrigerators
are raised off the floor so individuals don't have to bend. "Independence
is important to me, and I feel as though I have a part of my life
back," Clark said. From California Asian families
wanted their elderly members to live at home instead of nursing
facilities. On Lok, which means "peaceful, happy abode" in
Cantonese, opened the nation's first adult day care that offered an array
of services. On Lok caught the
attention of the federal government, which in 1986 allowed 10
organizations to replicate it. In 1997, Congress gave PACE "permanent
provider status" under Medicare and made it a state option under
Medicaid, enabling programs to grow. PACE now serves 10,000 people in 20
states. Although there's no
guarantee PACE will flourish, it's one of the few signs of hopeful change
in a long-term-care industry that faces serious problems, say Bloom and
others in elder care. The country is
rapidly aging. The number of people ages 65 and older is expected to
increase from about 35 million in 2000 to 71 million in 2030, and the
number of people 80 and older is expected to increase from 9.3 million to
19.5 million, according to the Census Bureau. Already, this region
has one of the highest shares of older people in the nation. Nearly 16
percent of Erie and Niagara counties' residents are 65 or older, the
10th-highest ranking among large metropolitan areas. People are not just
living longer. Because of advances in medicine, fewer Americans are dying
from acute diseases than in the past. Today, such chronic conditions as
heart disease, asthma, arthritis and diabetes are major causes of
disability and death in the United States. Experts say many of
these aging people neither belong in nursing homes nor want them. The
nation can't afford to build more facilities anyway. "The problem
with nursing homes is not that people who run them are evil. It's that no
species has ever had individuals walking around in their 90s and
100s," Dunkelman said. "We're still learning what to do with
them." Traditional is
costly That's because
Medicare, the federal health plan for seniors, and Medicaid, the
state-federal health plan for the poor that also pays nursing home care,
provide coverage mainly for acute illness. Not only has the
health system not changed to help chronically ill people live at home, but
the services they now receive lack coordination. Patients can go from home
to a hospital to a nursing home and back to a hospital again, with little
communication among the nurses, therapists and doctors involved in their
care. Donna Hanzel used to
work as a nutrition consultant and recalls her sense of desperation as she
tried to manage something as simple as a diet for elderly clients who
bounced from one institution to another. She's now executive
director of the 5-year-old PACE program in Syracuse and sees a startling
difference. "Everyone - the
doctor, the therapists, the dietitians - is on one team, sitting around
one table and talking about the people we care for," she said. What sets PACE apart
is that Medicaid and Medicare are combined into a set per-person fee that
guarantees the government some savings. The government then contracts with
an organization, such as Weinberg Campus, to provide services to
individuals who qualify for the program. New care in
small groups A physician oversees
basic medical care. PACE pays for all medications. It coordinates home
health and social services, as well as hospital and nursing home care if
necessary. A team of people, from the medical director to the van driver,
is supposed to meet daily to check on enrollees. To qualify, a person
must be 55 or older, certified to need nursing home care, able to live
safely in the community with help from the program and eligible for
Medicaid or willing to pay out of pocket. Similar to an HMO, participants
must use the program's network of doctors. "In a nursing
home, everyone gets every service. It's to the point where care is based
on regulation, not on what a person needs. I can target money more
appropriately. If someone doesn't need physical therapy, I don't have to
provide it," said Randi Dressel, administrator of the Total Aging in
Place Program. Dressel is convinced
more grown children will help parents live independently if they receive
help from such programs. Facing
challenges Organizations must
spend millions of dollars to start a program and then take on the
financial risk of caring for frail seniors at a set rate. As a hedge
against losing money, Weinberg Campus built the apartments so enrollment
would grow quickly. To succeed, the
programs must attract individuals before they become seriously ill. But
relatively healthy people may refuse to attend a day care center and use a
limited group of doctors. Most importantly,
PACE pays only for the poor. It's not clear whether, when or how the
program will reach the middle class. "PACE is a
great idea, but it's still a boutique service for a small
population," said Robyn Stone, executive director of the Institute
for the Future of Aging Services in Washington, D.C. "Can
it reach a broader audience? Can it be more affordable to those who pay
privately?" she asked. "The potential is great, but changing the
way we pay for long-term care isn't on the government's radar
screen." Copyright
© 2002 Global Action on Aging |
