Seniors At Home: A Continuum of Care for Every Need

Amy Rassen, LCSW

The hospital discharge planner has a problem. Despite her most persuasive efforts, your patient, Mr. J., an 88-year-old with a broken leg and no friends or relatives to care for him, is adamant. He will not go to a board-and-care facility; he wants to go home. To resolve this impasse, you contact the Seniors At Home division of Jewish Family and Children's Services (JFCS) to do an assessment and either provide Mr. J with home care support, or help him make the transition to a board-and-care or assisted-living facility.

How Seniors At Home Solves the Problem
Sounds simple? Unfortunately, in addition to his physical injury, Mr. J. is also in the early stages of dementia. Consequently, he is unable to remember how long he has lived in his apartment, how much money he has, or even what bank he uses.

A Seniors At Home care coordinator (geriatric care specialist) meets with Mr. J. at the hospital and learns that he has a neighbor who has, on an informal basis, been helping him with bill paying. Later that day the care coordinator meets with the neighbor to enlist his continued involvement and support and works out a formal arrangement for the neighbor to assume durable power of attorney for Mr. J., with oversight from Seniors At Home, to help manage his financial affairs.

Through the neighbor, Seniors At Home also learns that Mr.J.'s house has not been cleaned for some time and has become not only unhealthy, but also dangerously cluttered for someone in Mr. J.'s physical and mental condition. Accordingly, the care coordinator arranges for a grant to pay for a single heavy cleaning prior to Mr. J.'s release from the hospital.

This accomplished and the support of the neighbor in place, Mr. J. is able to move back home to a safe, familiar living environment. To help him maintain independent living, the Seniors At Home care coordinator arranges for a home care worker to help Mr. J. on a regular basis with housecleaning, laundry and meal preparation. A Seniors At Home escort driver is also provided to take Mr. J. to doctors' appointments and shopping and he is able to remain safely at home until his death several years later.

This care is typical of hundreds of clients Seniors At Home handles each year-referred to us by physicians, health plans, hospital staff, family members and friends of the Bay Area's elderly. For the senior, Seniors At Home is affordable. Often health plans or long-term care insurance pays for these services and we have a sliding scale for people who pay privately.

Options: Staying At Home or Assisted Living
Luckily for the seniors who live in the Bay Area, many options are available to them. Our goal at Seniors At Home is to carry out the wishes of the seniors and their families, either helping them live safely at home or helping them move to a facility with an appropriate level of care. The Seniors At Home team of professionals works with seniors and their families-often in the language of their choice-to create a personalized assessment and a plan of care designed to meet their unique individual needs.

Staying At Home
Care provision at home is the method of choice for most elderly, so much so that Americans spend $100 billion a year out of their own pockets and 26 percent of caregivers spend up to 10 percent of their monthly income on caregiving. Twenty-six percent of home health and home care expenses for the elderly are paid out-of-pocket; 28 percent are paid by Medicare; 23 percent are paid by other government sources and 23 percent are paid by Medicaid.(1) Community-based care (versus institutional care such as skilled nursing facilities) has developed and expanded rapidly in the past decade. As a result of the increasing number of women in the work force-our country's primary caregivers for both children and elderly-fewer women are available to assume the on-site support of their aging parents. Increasing numbers of elderly are forced to rely less on "informal" support mechanisms and more on "formal" support systems.

Seniors' problems and needs vary greatly, too. If frail, they may need help with daily chores and transportation. If homebound and isolated, they may require ongoing care management as well as volunteers to bring them warmth and caring. If well, they may feel depressed because someone close to them died and need counseling. And if poor, they may need financial support including help with food and shelter. But regardless of their individual circumstances, they all need to feel that the community cares about them, understands their special needs, believes in their inherent value and is committed to providing services that are culturally appropriate and responsive. This is what we do at Seniors At Home.

Working with the physician, the senior, and his/her family members, our care coordinators arrange for and monitor the full spectrum of services needed to create a comfortable and safe environment and enable your patient to successfully manage at home. This involves using your patient's own informal network as well as community resources, such as Meals on Wheels or Paratransit, enrolling him/her in adult day health centers and providing private home health aides, counseling, and even durable medical equipment-everything that is needed to fulfill the agreed-to plan of care. Especially helpful to many seniors is our corps of dedicated community volunteers who provide companionship and help with out-of-the-home errands, transportation to medical appointments and reassurance through telephone contact.

Assisted Living
The unprecedented growth of the retirement industry is another reliable indicator of the shift from informal to formal care arrangements. Once only for the poor, senior services and senior housing complexes are developing all over the Bay Area. Most congregate and assisted living facilities are geared toward the moderately healthy senior who is financially independent, approximately 80 years old, requires some help with activities of daily living, but is no way immobilized.

Since Medicare and Medicaid do not pay for assisted living, accessibility to assisted-living facilities is restricted to seniors with the ability to pay an average of $3,500 to $4,500 per month for rent, food and services, or to those with several hundred thousand dollars to purchase their living unit at a life-care facility. These seniors now frequently choose assisted living settings before they experience declining health. It is the "next step" for those seniors who want the security of 24-hour professional staff, three meals a day, easy opportunities for socialization and help when they need it.

Seniors At Home Continuum of Care
Seniors At Home's continuum of care for seniors is both comprehensive and substantive and includes an extensive range of services that help seniors to live at home with a quality of life appropriate to their age and health. In-home assessments, long-term care planning, home care and skilled care, care coordination, counseling and bereavement services, money management (including conservatorship), adult day health, volunteer services and most recently, assisted living at Rhoda Goldman Plaza (2) are some of the many services that are available through Seniors At Home.

Rhoda Goldman Plaza is a residential community located at 2180 Post Street in San Francisco. The building is a well-appointed, seven-story, competitively priced rental community with 155 one- and two-bedroom residences, studios and alcove apartments. For the ever-growing number of elderly with dementia or Alzheimers, the Terrace, located on the fourth floor, is designed with suite-style rooms clustered in neighborhoods with additional staff available for personalized care and supervision. It offers many resources to nurture independent living. Residents are also able to take full advantage of Seniors At Home services because JFCS is located right next door at 2150 Post Street.

Amy Rassen, LCSW, is the associate executive director of Jewish Family and Children's Services of San Francisco, the Peninsula, Marin and Sonoma Counties. She initiated the SeniorsoAtoHome managed care division and has been responsible for ensuring its growth throughout JFCS' five county service area. She is responsible for the quality of services and new program development in a $24 million multi-county agency with 16 offices, 40 programs and over 800 staff. She provides vision, direction and leadership for strategic planning, priority setting and program development. She also develops and ensures revenue-generating streams, including fee for service income and grant funding, and is on multiple local and national boards of directors and task forces. Her phone number is 415/449-1219 and e-mail is arassen@jfcs.org.

References:
1. Through the Medicaid 1915 ( c ) waiver program, states provided home care services to approximately 135,000 aged and disabled persons in 1991. The Long Term care Campaign, P.O. Box 27394, Washington, D.C., 20038. 1996.
2. Rhoda Goldman Plaza was founded by JFCS and Mt Zion Health Fund and is incorporated as a non-profit licensed residential care facility (RCFE# is 385600125).