'Huge gaps' reported in elder care

By Nancy Weaver Teichert

The Sacramento Bee.  Wednesday, April 2, 20 03

Retirees who are flocking to rural California in their 60s may not find the services they need to stay in that home when they're 85, according to a new study.

The study to be released today paints the first picture of how long-term care services for older Californians varies greatly from county to county.

"We see the haves and have-nots in terms of services," said Lydia Missaelides, executive director of the California Association for Adult Day Services, which prepared the report with a $100,000 grant from the California Department of Aging. "We have huge gaps."

What home health, residential care or other services are available to older people may depend on where they live -- instead of what they need.

State leaders have been working for the past two years on a statewide plan for the elderly, but county officials will get their first chance to compare their services and needs with others in the state.

"All long-term care is local," said Kathy Daigle, project consultant for the data book that will be handed out this week to county and state officials.

The Sacramento region shows a dramatic growth in the number of people 65 and older, especially in Placer County.

Retirees in rural areas don't get as much help as those living in urban areas, said Jack Hale, a member of the California Senior Legislature and Placer County Commission on Aging.

"If you're 65, a youngster like that, you don't think about the problems of when you get to be 85," said Hale, 80. There are as many services available in the urban areas of Placer County as in Sacramento, but rural communities in both suffer from a lack of services, he said.

"The costs go up so fast when you start to do home-delivered meals and each one lives 10 miles from the next one," Hale said.

For example, the data book shows that El Dorado County has no adult day health-care program available for the frail elderly while their caregivers work.

"There is a need. There is a lack of funding," said Doug Nowka Jr., director of the Area Agency on Aging for El Dorado County, which experienced double the state's rate of growth for people 65 and older and for 85 and older.

Nowka explained that there aren't enough older people clustered together yet to make such a program self-supporting financially.

Adult day health-care programs are required to provide transportation to people participating, and his residents may live 40 miles apart or an hour-and-a-half bus ride, he said.

El Dorado County has focused on helping its growing older population by centralizing a variety of senior programs in one Placerville location for "one-stop shopping." Those case management services are working to keep people in their homes as long as possible.

"The need already exceeds what we're able to offer there. We're already running out of space," he said.

There has been a lack of coordination of some senior programs because they are financed through a variety of sources, said Dawn Strubar, program manager for the Area 4 Agency on Aging, which covers seven counties, including Sacramento.

For example, her agency allocates money from the federal Older Americans Act based on several measurements, including the senior population. That means that Sacramento County gets 50 percent of the act's funds.

But Sacramento County also faces the challenge of addressing the needs of a large diverse senior population with various racial and ethnic populations. Those groups may face certain health risks, and other services need to be tailored to meet language or cultural differences, Strubar explained.

Yet, even in Sacramento County, it can be hard to get services in some communities like Galt and Elk Grove, she said.

Missaelides urged county and state policy-makers to take steps to plan for future needs because consumers often don't think about long-term care until a crisis.

Marion Faustman, 85, of Granite Bay saw the problem firsthand two weeks ago when she was ill and needed to get into town for a prescription and groceries.

Her neighborhood has no taxis or bus. A call for a special bus service would have cost her $50 for an eight-mile ride, she said. So she drove, despite not feeling well, and got into a small accident.

"I was a little put out. I just realized the situation, and I did the best I could," said Faustman, who is active in several local and state senior organizations lobbying for more services.

More state budget cuts will come soon due to the deficit, and counties don't have enough money to fund more services. The lack of services is a trade-off for rural residents, she said.

"The retirement areas don't get the finances that the businesses bring," she said. "It's a much better quality of life if you can overlook the fact they don't have those benefits."