It Takes a Village to Serve Elders

Mom's 90th Birthday  

Many seniors want to do everything they can to stay in their homes as they get older. But often they need help to handle various responsibilities including getting to medical appointments, shopping, socializing with friends, preparing meals, and managing things around the house.

They usually have two choices to get these services. First they can rely on family members to help them. This is often difficult if their children are working or are not in the immediate area. Second they can hire aides to come to the home. But this can be very expensive. Aides often cost $20 an hour or more and many seniors just can’t afford them.

But a new alternative is emerging. It is a volunteer nonprofit organization created by a community to allow neighbors to help other neighbors. Each senior pays a fee to become part of the network. Fees vary by community and services offered . They range from $175 to $900 a year. Community members volunteer to provide most of the services. Discounted fees are available to people with lower incomes.

Beacon Hill in Boston was probably one of the first neighborhoods to offer such a program. Beacon Hill Village was founded in 2001.( www.beaconhillvillage.org) in 2001

A group of friends in the neighborhood started to talk. What if they banded together and created a network of like-minded people who were aging, but who knew they didn’t want to go to a nursing home? They could help one another when they needed it, recommend plumbers and doctors and home-care aides to each other, and schedule social events so no one would be isolated at home. The network would mean they wouldn’t have to be a burden to their children, and they wouldn’t have to go to a nursing home, either.

Services offered to members include:

  • Referrals to discounted, vetted providers for everything from dog walkers to plumbers
  • A volunteer to assist you in your home or around town
  • Geriatric care management for you or your family members anywhere in the US
  • Rides home from a medical procedure that are required by the hospital/doctor
  • Personalized grocery shopping—we will drive you or deliver groceries to your home
  • Discounts to all providers: Electricians, plumbers, organizers, personal trainers, massage therapists, homecare specialists

A similar program was started on Cape Cod in 2011. It is called Nauset Neighbors (www.nausetneighbors.org) that states “One call does it all”. It is staffed by 320 volunteers and serves over 260 seniors in the lower Cape. Volunteers provide transportation, light home maintenance, technical support, and other support tasks

There are now eight open villages in Massachusetts. Each village is unique to its area and resources.  Nauset Neighbors is part of the Village to Village Network (http://www.vtvnetwork.org/) which now is composed of 190 open villages with another 185 in development around the country.

Major Breakthrough in Medicare Coverage for Chronic Illnesses

hands of old and youngFor years we have accepted the fact that Medicare will only cover physical therapy for patients who are continuing to improve. When my mother broke her hip the therapists informed her doctor that Medicare coverage for rehabilitation would cease after only three weeks of therapy. They told us that she would have to return to her assisted living residence even though she was still not able to walk. Their conclusion: She was no longer improving and it was likely she would never walk again.

Of course this was complicated by the fact that she had dementia and couldn’t remember the exercises they had prescribed for her a few minutes after she left the therapy room. But we accepted their conclusion without making a fuss and she has been in a wheelchair for the last five years.

But a major change has recently occurred in Medicare. One that has been kept very quiet but will have a huge impact on patients who have chronic illnesses. Medicare officials updated the agency’s policy manual in January. This is the rule book for everything Medicare does.  They stated that Medicare will now pay for physical therapy, nursing care and other services for beneficiaries with chronic illnesses like Multiple Sclerosis, Parkinson’s and Alzheimer’s disease in order to maintain their condition and prevent deterioration.

This dramatic change is due to the settlement of a class-action lawsuit filed in 2011 against Kathleen Sebelius , the Secretary of Health and Human Services by the Center for Medicare Advocacy and Vermont Legal Aid on behalf of four Medicare patients and five national organizations, including the National Multiple Sclerosis Society, Parkinson’s Action network and the Alzheimer’s Association. The settlement affects care from skilled professionals for physical, occupational or speech therapy and home health and nursing care, for patients in both traditional Medicare and private Medicare Advantage plans.

The change will have the greatest impact on seniors who want to avoid having to go into an institution to get care. People with chronic illnesses like Parkinson’s or MS may be able to get the care they need and stay in their own homes.

Existing eligibility criteria for Medicare rehabilitation benefits have not changed however. To be admitted to a rehab. facility or nursing home for covered care the patient must have spent three consecutive midnights in the hospital as an admitted patient and the patient must be referred by a Doctor’s order prescribing skilled nursing home care not custodial care.

For home health coverage, the beneficiary must have a Doctor’s order for intermittent care ( every few days or weeks) provided by a skilled professional or outpatient therapy, social work services or a visiting nurse. Beneficiaries receiving skilled services at home are also eligible for home health care aides for assistance with bathing, dressing and other daily activities.

The settlement also provides for a review of claims that were denied in the past three years solely because patients were not improving. Officials have posted a form on the Medicare site to repay beneficiaries for the care they paid for themselves. This form must be submitted by July 23, 2014 for claims that were denied from Jan. 18, 2011 to Jan. 24, 2014. Claims denied between Jan. 25, 2013 and Jan. 23, 2014 must be submitted by Jan. 25, 2015

No Nursing Homes for Baby Boomers!

retirement communityMany families choose to stay in their home if one spouse needs long term care. But some can no longer stay there due to their needs or just the difficulties of moving about in the house. As 10,000 baby boomers reach retirement age every day, most who need care will not plan to enter a assisted living residence and will never step foot into a traditional nursing home. Increasing numbers will seek out new alternatives for independent living where care can be provided.

Intentional communities for philosophical, religious, and lifestyle groups are emerging. Wikepedia describes an intentional community as “ a planned residential community designed from the start to have a high degree of social cohesion and teamwork. The members of an intentional community typically hold a common social, political, religious, or spiritual vision and often follow an alternative lifestyle. They typically share responsibilities and resources.”

Alex Mawhinney (jamlll@charter.net) , a developer of retirement communities  for over 25 years, reports that “intentional elder neighborhoods are becoming the new paradigm for elder living.” He states that boomers will no longer be interested in “the older generation of elder living options that were available to our parents that follows this model:.

  • Age in place — in a home not designed for aging in place, and eventually aging alone
  • Move in with children or other relatives
  • Move to an institution — and pay dearly for care delivered by strangers, under their rules and according to their schedules. The institution might be a nursing home, an assisted living facility, a rest home, a retirement hotel, or a continuing care retirement community with multiple levels of care.

These elder neighborhoods are taking many different forms. It would behoove you to determine if any of them have been created in your community.

There are SOTELs (service-oriented technically enhanced living—like an upscale Embassy Suites); ecovillages; senior cohousing; and the new lifestyle communities like those being developed by Canyon Ranch.

The common traits of these new alternatives are that they are:

  • Human scaled ( not large and impersonal)
  • Relationship based
  • resident managed/centered, with an overlay of lifelong learning, later-life spirituality
  • giving back to the community