New Model of Care for the Elderly

Senior villages that help elderly stay at home come to West Coast
Robin Evans, Special to The Chronicle

The first "senior village" is open in the Bay Area, bringing to the West Coast a popular new model of care for the elderly. This village is not a place but a membership program that helps people stay in their own homes by providing support - everything from the medical to the mundane.

The concept was developed by a group of elderly neighbors in Boston trying to line up in-home services their insurance didn't cover.

"People end up moving because they can't change the lightbulbs or (they) get isolated when they get home from the hospital and can't coordinate everything," said Judy Willett, director of Beacon Hill Village in Boston, which opened five years ago. "The reason it's so popular is it's what everyone wants: to stay in their own homes. ... It's unbelievable the impact of such a brilliant and simple idea."

That simple idea is being developed in San Francisco by the Rev. Mary Moore Gaines, and is a reality at Avenidas Village in Palo Alto, which opened in October.

Mary Minkus, 74, a retired family law attorney in Palo Alto, was the force behind the village after she hurt her elbow five years ago and discovered what many seniors do: Her health insurance covered a nursing-home stay, but she didn't have coverage for the in-home help she'd need to stay at home during recovery.

For the first time in her adult life, the self-sufficient paraplegic couldn't lift herself from her wheelchair to her bed. She couldn't drive her specially equipped car and needed help dressing. What seemed at first like a nuisance had become a major obstacle, and she had a short stay in a nursing home.

"I was in the hospital for two weeks because I couldn't figure out how to do this," she said, referring to coordinating the cooking, cleaning, transportation and other daily tasks. "It changes your life."

The experience planted a seed. After hearing about the Boston village, she and some friends hooked up with Avenidas, a private nonprofit agency that has provided help and programs for seniors in the mid-Peninsula area for more than 35 years. It took almost two years, but the group developed the village program. In the past two months, it has signed up 187 members.

Here's how it works: Avenidas Village members pay an annual fee - singles pay $750, couples, $900. This buys them access to services that are often discounted for members: someone to cook, clean, do the laundry, fix the air conditioner, pick up groceries, make doctor's appointments, help them dress or get in and out of bed when they're laid up. It can even provide limited nursing care.

Members pay the providers, often from the community, but the village staff and volunteers select and screen them, and can help coordinate these appointments. Avenidas Village also provides a social outlet, linking people with similar interests. It's one phone call away.

Minkus, who still serves on the advisory committee, hasn't yet felt the need to take advantage of the village services - although she does occasionally volunteer to help others. She regards her membership as a safety net.

"Peace of mind is what goes with it, knowing someone is there to find answers for you at times you're not quite up to it or when it's faster and easier for someone to do it for you," she said.

In San Francisco, Moore Gaines, the pastor of St. James Episcopal Church, has spent the past year working with seniors and organizations to bring a village for people 50 and older to her Richmond District neighborhood. She hopes to develop programs to connect people with the help they need to stay in their homes as they encounter the physical limitations of growing older and the loss of family and friends. She expects the village to open by the middle of next year.

She also looked to Boston's Beacon Hill Village as a model and sees a silver lining for givers - from businesses to volunteers - as well as receivers: bringing back a sense of belonging.

"It creates community is what it does," Moore Gaines said. "We're talking friendship and an appropriate level of intimacy and trust, where you would be willing to ask someone for something and they would be delighted to be asked."
Retiring Boomers
As the huge Baby Boom generation begins to retire, more people will be coming face to face with the demands of aging. By the year 2030, people 65 and older will make up 20 percent of the population (a growth of 104 percent over 2000), according to Census Bureau projections. In San Francisco, and the Bay Area, that figure is put at roughly 23 percent.

"Every country is looking at large growth in the elder population and greater longevity," said Philip McCallion, director of the Center for Excellence in Aging Services at the State University of New York at Albany. "They're looking at quality of life and ways of prolonging the ability to live where we've always lived - and contain costs."

As employees care for their aging parents, business has a stake, too. Adult children still provide the majority of elder care, a value the National Institute on Aging puts at about $60 billion a year. The stresses and distractions of that extra, unpaid work can hurt on-the-job productivity.

"Everything in this country is already being affected by the growth in older adults," said Tom Miller, president of the National Research Center in Boulder, Colo. Its 2004 survey of Colorado seniors showed that those whose communities provided them social and practical support were less likely to be in a nursing home and happier with their quality of life.

"That's why aging well is going to benefit the entire community as well as the individual," he said.

"Successful aging means being able to do the things you want to do," McCallion said. "But it's also about being able to find support when changes happen. Many of these programs, their real intention is to delay that moment."
Most seniors want to stay in their homes as they age, studies show. But many find themselves alone and isolated as their spouses die or children move out of state for jobs or, in the case of the Bay Area, cheaper housing.
The Richmond Village program, she said, could help people avoid lurching from crisis to crisis until they're in even bigger trouble. "I'm really interested in how it plays out and if there is a role for us. This is so creative. It has a lot of possibilities."

One thing the city may be able to do, Hinton said, is help pay for individual village memberships through the $3 million Community Living Fund, created by the city last year to bring institutionalized people back into the community.

San Francisco Chronicle

Comments:

The idea of villages is great, and is a working model for communities where elders are living nearby one another already. The concept makes sense economically, just as "buying in bulk" does for any commodity. One of the most expensive components is physical care or assistance. If one worker can fill his/her day with visits to numerous homes, giving help with basic "activities of daily living", such as bathing, cooking, walking, etc., everyone is a winner. Connection to and access to qualified, licensed nursing help is crucial. Aging usually leads to decline in overall health, and the assessment of a licensed professional can go a long way to preventing disasters. Connection to community health agencies should be a part of any village plan.

Carolyn L. Rosenblatt, R.N., Attorney HelpWithElders.com