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Get ready for community-based long-term care

March 1, 2006
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Get Ready for Community-Based Long-Term Care

This has to take into account the changes in physical as well as mental health that contribute to reduced independence. Such changes result in predictable occurrences, including increased needs for affordable home care, homes that offer the physical environment conducive to the needs of increasingly frail seniors, and the identification and treatment of depression and other mental health problems.

The county's Office on Aging, therefore, brought together three additional partners in creating its "team." Family and Children's Services of Central Maryland assumed responsibility for the provision of home care. Older Adult Consultation Services addressed the mental health of seniors. And Our House youth home offered home modifications designed to enhance the ability of the client to function safely in his or her own residence.

A steering committee (on which I was privileged to serve), consisting of representatives from all of the component organizations, provided ongoing oversight and coordination. The committee was also responsible for providing joint training for the agencies involved, determining the best way to track and monitor the project and the progress of clients being served, developing community awareness and outreach, and making necessary changes to increase the initiative's effectiveness.

Because of the multiple needs of seniors, a key element in the initiative was the coordination of intake and referrals though the Office on Aging. A client who came to the attention of one component-say, for example, home modification services-might also be referred to Family and Children's Services for home care, or Older Adult Consultation Services for a mental health evaluation. The Office on Aging was responsible for ensuring that information about all clients was entered into a county tracking system used by all agencies providing services to them.

This coordination and collaboration across all components of the initiative "expands our ability to help older people stay in their homes," says Sallie Hedenstad, MA, director of elder services at Family and Children's Services. For example, if one of her staff made a home care visit and found that the client had a fall, or was depressed, one could easily tap the initiative's other components-mental health services and home repair-to provide necessary assistance. Howard County's initiative was one of the few in the nation that functioned in concert with multiple critical components, all working together to provide a seamless web of appropriate services.

Interestingly enough, it was the home modification component of the program that brought about the initiative's most cost-effective results. The success stories were both touching and instructive. They suggested that, in many cases, it takes little more than appropriate (and inexpensive) changes in the physical environment to forestall more expensive facility placement. Mrs. W., for example, continued to live in the home where her husband had died from a fall down the stairs. Despite severe arthritis, hypertension, osteoporosis, nerve damage, a history of falls, and macular degeneration to the point of legal blindness, she was still able to handle most of her activities of daily living. The initiative provided her with assistive devices to help sort out her many medications, use the telephone, do her laundry, and generally navigate throughout her home. It prescribed behavioral and environmental modifications and installed new handrails, lighting fixtures, grab bars, and stairway modifications. Mrs. W.'s enthusiastic acceptance of the initiative's help and the resulting success became the subject of a feature article in the Washington Post, and Our House, the organization providing the home modifications, was prominently featured on Oprah Winfrey's TV talk show.

But Howard County wasn't through. While the aging in place initiative was a demonstration, a demonstration that worked and for the most part continues to work, it pointed to the need for even greater attention to more overarching issues that prevent seniors from continuing to age in place. Perhaps the most critical of these was the absence of information and referral sources for those eager to productively age, regardless of the setting. So Howard County applied for and received a grant from the federal government enabling it to become one of only 12 "aging resource centers" across the country. These centers are designed to serve as single points of reference for seniors and others looking for information they might need in planning for a productive retirement. Maryland Access Point offers information regarding an entire array of support services and information, from financial planning to housing, from healthcare to transportation.

So, there you have it-a small success story, perhaps, but one that reflects a growing need for similar initiatives. Aging in place is not, after all, a denial of the critical need for facility-based long-term care services. Congregate care, assisted living, nursing facilities-all are important to the continuum of long-term care. But all of them share one characteristic: a perception by most potential residents that they reflect an option less desirable than remaining in one's own home. That is not an indictment of facility-based long-term care. It is simply a reflection of customer preferences.

You, readers of Nursing Homes/Long Term Care Management, can look at Howard County as a precursor of trends that will become ever more prevalent across the entire country. You can look at those trends as having serious implications for market share-and you would be right. As such, you might be inclined to oppose them-and you would be wrong.