HealthyCal.org

By Nicole Jones
California Health Report

The Great Recession hit black workers the hardest, according to a recent report by The Urban Institute, a nonprofit, nonpartisan policy research organization.

“Many low-wage unemployed African-American workers are likely suffering more economic hardship than their white counterparts,” the report said, on top of the statistics that African-Americans likely have fewer assets to fall back on.

Although the unemployment rate is higher for blacks than for white or Hispanic workers, the report found that black workers were less likely to receive benefits than whites, 23.8 percent compared to 32.2 percent respectively. This is even after considering other factors that might explain differences like education, the type of job they held and length of employment.

Some of the difference could be attributed to workers’ choice or preferences, the report said, but it could also reflect discrimination in hiring and reported reasons for separation from those jobs, both of which can affect eligibility.

Previous similar studies have shown that unemployment benefits help to keep families out of poverty when a breadwinner loses a job, said Margaret Simms, one of the report’s authors. Having access to these benefits helps families reduce the need to deplete their assets and draw funds from retirement accounts.

The unemployment insurance system is designed to assist workers who lose their jobs through no fault of their own. A number of factors are considered that might be related to “fault,” Simms said. For example, “they were not fired for cause or quit the job voluntarily,” she said, or “they worked long enough in the job to show a commitment to the employer. They aren’t job ‘hoppers.’”

The measures used to determine fault may work against some types of workers seeking benefits. For example, people who leave a job for family reasons are not eligible in for unemployment in all states. People who don’t hold a job for at least a year are typically not eligible for benefits. In some states, people who are only looking for part-time work also may not eligible. Workers in certain industries might not get unemployment because their employers do not pay into the system.

California’s unemployment insurance system is fairly inclusive, allowing workers to leave a job and collect benefits for family reasons, and even if they are only looking for part-time work. Although there is currently no data specific to race and unemployment insurance benefits in California, the state saw fewer workers filing for benefits over the last year. The California Employment Development Department reported that there were 518,605 Californians receiving regular unemployment insurance benefits during July, compared to 566,380 last year. At the same time, new claims for unemployment insurance were 52,336 in July 2012, compared with 57,897 in July of last year.

But as the Urban Institute study reports, these numbers are not a true indicator of how many people are actually unemployed. There could be many more people who simply haven’t applied for benefits or have been denied for various reasons.

The current unemployment insurance benefit system is a combination federal-state system, with the states making up most of the rules on who is eligible and setting the tax rates for employers who contribute to the system.

Simms says eliminating the racial gap in benefit receipt work require greater information dissemination about who qualifies, as well as some changes in state and federal policy.

“The federal government could make it attractive for states to institute reforms that make the program more inclusive,” Simms said. This tactic was tested under the 2009 Unemployment Insurance Modernization Act, which was part of the stimulus package, and was only partially successful in encouraging reforms.

“The federal government could also assume a greater share of the costs on an on-going basis, basically federalizing the system,” Simms said. That might not be very likely, she added, given the current concerns about the federal budget deficit.

Larry Gray on his second day at Pine Grove Youth Conservation Camp. Photo: Callie Shanafelt/California Health Report

By Callie Shanafelt
California Health Report

Driving into the wooded campus of Pine Grove Youth Conservation Camp feels like arriving at a summer camp – until you see the road signs warning that you are entering a correctional facility.

The mint green office, school, kitchen and dorm buildings are relics from their Civilian Conservation Corps days. The only hint that something unique is happening here is the large garage with red and white ambulance-looking vehicles marked CAL FIRE parked inside.

At this camp, about 60 young men aged 18-25 serve the last year of their sentence with the California Division of Juvenile Justice (DJJ) fighting wild land fires and responding to other emergencies on a CAL FIRE crew. There are no fences, the doors are unlocked and wards are regularly left unsupervised.

“We give them opportunities to screw up,” says Camp Superintendent Mike Roots. “We hope they don’t—but sometimes it takes a while.”

The main goal of the camp is to prepare wards to return to their communities with a work ethic and job skills that will help them be productive members of society. But after a decade of juvenile realignment, Roots says that goal is getting harder to achieve.

In the past ten years, the DJJ has gone from more than ten thousand wards to under one thousand. Most low-level offenders are now serving their time in county facilities and those left in state institutions are the highest-level offenders.

In order to qualify to finish their sentences at Pine Grove wards must show signs of rehabilitation, not be a flight risk or have violent tendencies. The number of wards who qualify is getting less and less.

Ten years ago there were six fire camps for juveniles throughout the state. Pine Grove is now the last camp in operation. But Pine Grove is a crucial program for preparing these young men to go back out into the world. Most of them are serving sentences of less than three years.

“A program like Pine Grove is great because it teaches you to practice [life skills] in a pretty safe setting,” says juvenile justice expert Barry Krisberg of the Earl Warren Institute on Law and Social Policy at UC Berkeley.

“If they’re all coming home what’s the process you’d like to see them go through before they come home?” asks Krisberg. “Lock up 21 hours a day is not a good public safety strategy.”

Eighteen-year-old Manuel Lujan has served two years for assault, the result of a fight back in his hometown of Bakersfield. Before coming to Pine Grove, he was incarcerated in the Preston and O.H. Close Youth Correctional Facilities.

“Over there it’s just to do your time—over here it’s to get your mind right.” Lujan said.

In the other institutions he was associated with the Sureños gang. In Pine Grove he’s on a work crew with people from rival Norteños gangs. One day while they were out hiking, he was surprised when he slipped and a Norteño helped him back up.

“I thanked him,” said Lujan.

“Here, a lot of people basically put their gang stuff behind them,” said 21-year-old Jose Nunez “because it’s your life or another person’s life and you got to be able to help them out.”

Roots says wards with gang backgrounds often catch on to the firefighting chain of command quicker than others.

“They have a value system – it’s a messed up one, but they have one,” Roots said. “If their allegiance goes to their crew instead of their gang, they end up doing a great job.”

Many of the wards at Pine Grove are reevaluating their relationships on the outside.

“All this gang banging that’s old news—that was fun when I was young,” said 19-year-old Larry Gray of Inglewood. “Everybody in my hood, they’re my associates—my one true homie understands.”

Many of the wards never worked before they were incarcerated. Now they all have to get up and work every morning whether there is a fire or not. Every night from 6-10 the ones without a high school diploma have to go to school.

“The pace here is ten times what it is in a facility, yet when they leave here it is one hundred times what it is in here,” Superintendent Mike Roots said.

And he points out that at Pine Grove they are provided with a place to live, food to eat and access to a doctor and nurse 24 hours a day, something that is harder to come by on the outside.

Twenty-two-year-old Bryan Griffith of Oakland has been at Pine Grove for about a year. Before that he served four years of his sentence for second degree homicide at the Preston facility. Over the first two months of his time at Pine Grove, his CAL FIRE captains promoted him through fifteen crew positions to first man because he demonstrated strong leadership qualities and work ethic.

That position comes with privileges. The base pay for any ward is one dollar an hour. As first man, Griffith is paid two dollars an hour with an additional dollar added when he is out responding to an emergency. He also eats first and sits at the head of the table in the mess hall.

But even though he’s learned to shoulder extra responsibility, Griffith says sometimes he’s embarrassed to think about how unprepared he is for the outside world. “I don’t know nothing about no ATM machine,” Griffith said. “I never got a chance to drive myself back and forth to work.”

But he says Pine Grove has helped him to take one step closer to his freedom. He’s decided he would rather go home and get a living wage job than make quick money selling drugs.

“Just learning to accept you can’t get everything you want in life,” Griffith said, “and it actually feels good to do the right thing.” When he gets out in December he hopes a family friend will be able to help him enroll in a pipe trades apprenticeship in San Francisco.

When asked if he wants to be a firefighter the answer is a simple “No.” He hopes to start a family and he doesn’t want to spend 2-3 days at work.

Superintendent Mike Roots says about 10 percent of their wards have been determined to keep fighting wild land fires and got work with the forest service.

The CALFire Division Chief Brian Estes says since most of the wards at Pine Grove and adult fire camps have felonies they are disqualified from working for CAL FIRE or local fire departments. The work crews at Pine Grove basically contain wild land fires by using hand tools to clear fire lines around the fire. Currently only inmates are doing this work.

Estes says it is getting harder and harder to build crews of the highest-level firefighters at the fire camps. “I’m concerned for the program and the future in general because of realignment and DJJ in general,” Estes said. “If you look at the history, I’d be crazy to say I’m not concerned.”

Until recently, the camp had four crews of 13-17 young men. They require two crews in order to assemble a strike-team to go to another part of the state for a fire. They recently had to send an entire crew back to institutional facilities because they robbed a house when they were out on a fire.

Superintendent Mike Roots says nothing like that has happened during the seven years he’s been there.

He thinks some aspects of realignment such as the increased rehabilitation programs have been positive, but he’s finding it challenging to cope with others.

Before realignment, wards were paroled to state parole officers with whom Pine Grove caseworkers worked closely to find placements. Sometimes that meant finding them a place to live away from negative associations back home. Now wards are released into the supervision of county probation departments. Roots worries that rehabilitation will be more difficult after realignment because there is no longer the same emphasis on getting wards away from the negative peer influences they had before detention.

Barry Krisberg believes that probation officers are in a better position than parole to integrate these guys back into their communities. But he says the transition from parole to probation was made too quickly and with little planning.

Krisberg is more concerned that no one is tracking the 500 youth who’ve been released from DJJ since the switch. “Why isn’t the legislature demanding to know what is happening to these youth?” asks Krisberg. “Public safety demands we should be doing it.”

Roots will continue to follow-up with his wards twelve months after they’re released and try to adjust his program to set his wards up for success.

Wards like 19-year-old Nathaniel Hawkins will be returning to Los Angeles in nine months. He’s working on his AA through correspondence courses at Coastline Community College and hopes to eventually study business and acting. He returns to a supportive mother who was devastated by his past behavior.

“She’s proud of me now,” Hawkins said. I’m proud of myself, I never thought I’d be here to the point I’m a man like this—but I am.”

By Robert Fulton
California Health Report

When considering the world of affordable health care clinics, certain images may come to mind.

Some patients, such as Nicole Webb, would go so far as to say there’s a stigma.

“I think that there’s the stigma of economic status,” said Webb, 43, of South Los Angeles. “You’re just a poor person. People are just unattracted to poor people and they say ‘you’re poor, I don’t want to hang out with you,’ like it’s going to rub off on them, you know what I mean?”

Webb doesn’t have that impression at the To Help Everyone Clinic, located in South Los Angeles on Western Avenue a block south of Exposition Boulevard. Webb has been coming to T.H.E. since she was a teenager, receiving general care as well as prenatal, gynecological and mental health services. Webb is currently unemployed, but utilized T.H.E. even when she did work because of her long-established relationship with the clinic, its proximity to her community and its quality of care. More recently, Webb’s mother started visiting T.H.E. after she was laid off.

“Here you don’t feel like you’re waiting in some kind of a soup kitchen line or whatever,” Webb added.

Founded in 1974, T.H.E. provides general, high-quality health care to the uninsured and under insured population in South Los Angeles on a low-cost and ability-to-pay basis. Patients can access a range of services, a one-stop shop, with an emphasis on preventative medicine.

The recipe for growth, and subsequently the ability to serve a growing segment of the population in need at T.H.E is simple. More exam rooms, additional locations and longer hours will result in greater access for an ever-increasing population that requires the clinic’s services.

Within the past two years, the T.H.E. Clinic has received funds made available through the Affordable Care Act to increase access to and serve more patients.

In June, the U.S. Department of Health and Human Services announced $6.8 million in grants for 12 community clinics in Los Angeles County. T.H.E. received $483,333 to open up an additional location a few blocks north on Western Avenue.

In October 2010, T.H.E. received nearly $1.6 million in a federal Health Resources and Services Administration Capital Development Program grant. The clinic has used the funds to make repairs to its headquarters, a building it leases from the Los Angeles County Department of Health. The capital improvements will include between eight and ten additional exam rooms to the already established 17 rooms. T.H.E. has also been able to expand its hours, add Saturday services and launch a mobile clinic to increase its geographic outreach. T.H.E. has also secured funds to implement an electronic medical records system. Using T.H.E.’s Patient Portal, patients can access records, talk with doctors, receive lab results and make appointments on line.

Risё K. Phillips, To Help Everyone Clinic’s CEO, said that the clinic has seen a 56 percent growth since 2008, and 26 percent growth in the last year. The clinic serves 12,000 patients a year, and the added exam rooms will increase capacity by 5,000 patients.

“We were able to justify the need,” Phillips said. “The mission is to provide low-cost, high-quality health care to all that come to us.”

Coinciding with the impact of the recent recession and her start at T.H.E. in 2009, Phillips set upon a program of expansion to better meet the increasing needs of the under served in Los Angeles. In addition to the current renovations and expanded hours at its main location, T.H.E. has established a part-time clinic in the community of Lennox, southwest of South L.A.; a weekly clinic at  the Homeless Outreach Program Integrated Care System in South Los Angeles; and the mobile clinic.

“As a primary care clinic like ours, our major focus is to keep people healthy so they don’t show up in the emergency room,” Phillips said, adding she believes the clinic saves the local health care system $15 million a year by keeping folks out of the emergency room. “We are the safety net providers for the health care system throughout the nation.”

Natalie Goff, 44, has been coming to T.H.E. for 20 years. She first visited the clinic for prenatal needs, has had two children with T.H.E. as her primary care provider, been treated for cancer of her small intestine and for high blood pressure.

“They’ve been so good, why would you leave?” asked the Crenshaw District resident. “Everything is perfect.”

Goff, who does not have health insurance, said that her alternative was a hospital an hour away by bus.

“I don’t know what would happen,” Goff said. “I’d probably be dead somewhere because the blood pressure was a big problem.”

Dr. Tracy Robinson, T.H.E.’s Chief Medical Officer,  stressed the preventative care mission of the clinic.

“Any primary clinic, the goal would be to prevent a problem before it starts,” Dr. Robinson, who has worked at T.H.E. for more than six years. “That comes with education, that comes with access, that comes with affordability. Is there a place that you can go that will see you? Yes, we are that place. Is there a place you can go and you can afford to be seen? Yes, we are that place, because we’ll see you not based on your ability to pay.”

Dr. Robinson has seen a direct impact from the Affordable Care Act, particularly with the facilities improvement and coming increase in exam rooms.

“It has been a tremendous benefit to us in regards to facility improvement, which allows us to provide better access,” Robinson said. “It’s not just nice little brown tile floors. It’s being open prolonged hours, being able to have more exam rooms so you can meet the need and the demands of patients coming through the door.”

“Community health clinics have a stigma attached to them,” Dr. Robinson continued, echoing Webb’s comments. “Many people think, oh, you’ll have to wait for four hours. They think community private clinics are the same as county clinics and you’ll hear that’s the county way where you may have to wait several hours. Now that sounds a little bit pejorative, but the benefit of during that four hour period, you’re seeing the nutritionist, you’re seeing the behavioral health  person, you’re getting your labs drawn, you’re getting your medications dispensed to you on site, you’re seeing your provider, you’re being able to have dialogue with those people that can help you with linkage to other resources.”

Phillips finds it a challenge to attract talent to work at T.H.E.

“One of the gaps that’s going to occur for everybody is a shortage of medical providers that are willing to come in with community clinics and willing to come and work with patients that we serve,” Phillips said. “There’s a lot of heavy competition from private providers who can pay a lot more and will look more attractive.” She added that quality time with patients is one draw for T.H.E. doctors.

While T.H.E. is currently benefiting from Affordable Care Act funding, Phillips warns of the impact of any possible future budget cuts.

“We’re the safety net for the health care system,” Phillips said. “Should we get a Congress that is unfriendly to community clinics, it’s going to set the movement back, and it will be very hurtful to all of the patients that are coming to us for care. We’ll have to cut back on hours, we’ll have to cut back on a  number of things should they decided to start reducing funding as they have promise they might potentially do.”

Nurse practitioner Patricia Dennehy is a warrior for the uninsured

Patricia Dennehy in Glide's wellness center. Photo: Heather Tirado Gilligan

By Rosa Ramirez
California Health Report

Glide, situated in the heart of San Francisco’s gritty Tenderloin neighborhood, is a haven for the homeless. Outside the shelter’s door, though it is just before noon, a group of men and women line up to wait for a bed for the night or a hot meal. Some push shopping carts packed with their belongings and hold tattered blankets, neatly rolled up. They press their backs against the wall as they try to shield themselves from the gushing rain shower soaking the street.

Hints of the state-of-the-art health center on the top floors of the onetime hotel start inside the lobby, in the form of posters and flyers announcing services ranging from free HIV testing to tai chi classes.

Patricia Dennehy, the director of Glide Health Services, has learned that low- income patients make better health decisions when providers focus on the entire person, not just the illness that landed them in the examining room. Challenges such as poverty, inadequate housing and unemployment can eventually wreak havoc on people’s health.

“We can’t take care of a complex person, who has had very little care for their whole lives, in a 10-minute visit,” says Dennehy.

Instead, Dennehy likes to say, the Glide clinic meets patients exactly where they are in life. With the right kind of support, she says, even the longest-suffering clients can make positive changes to improve their health.

And that’s something that nurse practitioners like Dennehy are uniquely positioned to do. Dennehy’s career has taken her from working as a hospital nurse to managing Glide, the largest nurse-practitioner health center on the West Coast, and one that’s considered a model for serving the poor.

“We see this nurse-practitioner model not as being the only solution,” she says, “but as being a great part of what we can do to answer the fact that the uninsured don’t have primary-care access.”

Nurse practitioners have advanced academic degrees, such as a masters or doctorate, as well as additional training, and are held to the same ethical standards as physicians. There are nearly 11,000 nurse practitioners in California, and 6,877 nurse practitioners licensed to prescribe medications, according to the California Association for Nurse Practitioners. Ninety percent of them already provide primary care.

“We know we do not have enough primary-care physicians, and training programs can’t fit the need,” says Dennehy. Nurses, she thinks, can help fill that void.

Studies have shown that nurse-run clinics reduce the cost of providing preventive health care. That’s mainly because of salary differences. Patients have the same health outcomes when they’re treated by nurse practitioners as when they’re treated by physicians, according to a 2007 study titled Substitution of Doctors by Nurses in Primary Care. What’s more, patient satisfaction was higher when nurses provided the first contact during urgent care. One likely reason for this finding is that nurses tend to give more information to patients and spend more time with them during visits.

Clinics reduce the cost of providing preventive health care. That’s mainly because of salary differences. Patients have the same health outcomes when they’re treated by nurse practitioners as when they’re treated by physicians, according to a 2007 study titled Substitution of Doctors by Nurses in Primary Care. What’s more, patient satisfaction was higher when nurses provided the first contact during urgent care. One likely reason for this finding is that nurses tend to give more information to patients and spend more time with them during visits.

Glide, a federally qualified health center, is one of 250 nurse-managed health clinics in the country. They integrate primary care, such as immunizations and health screenings, with services like psychotherapy, medication management for chronic pain and urgent care.

“Community health is the most exciting place to be, because this is where you can make your greatest impact,” Dennehy says, “working with families and communities to improve health and to feel cared for and empowered.”

Dennehy says she hopes California puts more emphasis on preventive care and extends medical benefits to include adults who can’t afford individual health insurance.

“There are very exciting opportunities for people to work together with hospitals and other institutions of care to make sure we just do what we do better,” she says.
Glide clients are screened for depression and substance abuse, and are asked if they smoke—all during a regular visit—so the conversations become part of a long-term dialogue that nurses have with their patients. Health issues aren’t compartmentalized.

“Our nursing model is one that puts the person at the center,” Dennehy says. “It’s not the person with hypertension or diabetes. It’s not the diabetic in room seven. It’s Mary who’s in room seven. Mary may have diabetes and hypertension. She may also be a smoker. She may need assistance with housing. She may have relapsed in her alcohol use.”

“We treat the whole person,” Dennehy emphasizes.

Dennehy makes this approach clear as she walks through the clinic, a soothing space of light colors and blond wood. In the waiting room, a man who appears to be around 50 years old has his eyes glued on the large flat-screen television. Flashing across the screen isn’t a movie, Dennehy notes, but a PBS video about health disparities, just one way the clinic integrates education, compassion and patient empowerment into the work it does.

Dennehy stops frequently to point out the accomplishments of other nurses at Glide, as well as mention student nurses who have moved on to work in other clinics. Elizabeth Goldstein is part of the clinic’s residency program, which started this year and gives additional training and mentorship to nurse practitioners (NPs) who work with high-risk populations.

As nurse-led clinics catch on, residency programs like this one will help clear any doubts people may have about the level of training that NPs receive. Dennehy was instrumental in bringing the residency program to Glide.

Goldstein, who had done six volunteer rotations at Glide, says her work at the clinic inspired her to change her career from architecture to health care. “I have so much to learn from the nurse practitioners here,” she says. “There’s an unbeliev- able amount of mentorship here.”

In the center of it is Dennehy’s vision, Goldstein adds. “She doesn’t say much, but when she opens her mouth, every- body listens. I just admire Patty tremendously. She’s a great role model for me.”

For the past two months, the health center has accepted only new patients coming from emergency care at Saint Francis Memorial Hospital and Dignity Health to receive follow-up primary care. The clinic’s needs are greater than its resources. The lines for the food kitchen and the beds wrap around the block.

“We can’t see everyone who comes,” Dennehy says.

Still, Dennehy says, Glide’s social justice mission continues. “What we do is continue to advocate, to have a voice in many circles about the needs and about the need to expand care,” she says with a measured acceptance of the limits of what one nurse’s clinic can accomplish. “That’s part of our work.”

By Matt Perry
California Health Report

Sister Roseanne Murphy basks in the sun of the peaceful courtyard of the Mercy Retirement & Care Centeer, content after finishing off a lunch of barbecued chicken alongside 100 fellow residents.

“You can tell the spirit of a place, can’t you?” smiles Murphy, a former college department chair. “You can tell whether it’s dead, or whether it’s welcoming and alive.”

Although Murphy is at the Oakland facility only temporarily for rehabilitation after a knee replacement, she’s visited many senior care facilities, and contrasts this one with others where the favored activities are often sleeping and watching television with “no real sense of joy and peace.”

Over a decade ago, Mercy adopted principles of the Eden Alternative, an international organization based in Rochester, NY, committed to humanizing the aging process. It’s one of many progressive new alternatives for engaging older adults inside long-term care facilities using various pathways: art, nature, music, animals, dance, literature and friendship.

Adopted in California – and around the country – this groundswell of adventurous programming is riding the wave of America’s “silver tsunami,” changing the way older adults are perceived and cared for.

“The old model was doing things ‘for’ the patient who is inert,” says Anne Davis Basting, one of the nation’s leaders in older adult care and the developer of a unique storytelling forum for seniors with dementia. “The shift here is from entertainment to engagement. (Today) you’re doing ‘with’ them. Co-creating and co-learning.”

Sister Mary Creedon admits that 20 years ago Mercy was more concerned with operational efficiency than people: if you slept through breakfast, you missed a meal.

“Oh, we were very good at it,” cringes Creedon, Mercy’s enthusisastic executive director, who has worked at the facility since 1979.

By adopting the ten guiding Eden principles – intended to eliminate “the plagues of loneliness, helplessness and bordedom that make life intolerable in most of today’s long-term care facilities,” according to the Eden Alternative – a new patient-centered approach brought meaningful care for mind, body and spirit.

First, Mercy introduced the canine companion Captain, a dog so intuitive he would visit the rooms of sick residents and sleep under their beds. Mercy’s Eden program expanded with the addition of birds, cats, even lizards.

“Some (residents) who can’t relate to people can relate to animals,” says Creedon.

Life Enrichment Director Jana Gesinger then started a gardening program, which produced tomatoes, onions, garlic, strawberries, bell peppers and herbs. Gesinger says the gardening makes closer friendships.

“It’s a good reminiscing time,” she says.

Mercy has also added cooking classes, drum circles, and a daily exercise program with curriculum provided by the Arthritis Foundation. Gesinger will be trained in Tai Chi this summer, and she’s also exploring “Conductorcise” – “a sound workout for body and soul” – which blends exercise with orchestral conducting.

“We moved from an institutional environment to a home,” says Creedon.

She cites writer Maya Angelou in her facility’s evolution: “When you know better, you do better.”

Mercy is one of ten California facilities to adopt the Eden Alternative – the second of six Elder Care Alliance members in the Bay Area to do so.

Basting, as director of the Center on Age & Community at the University of Wisconsin-Milwaukee, has pioneered the popular TimeSlips Creative Storytelling to engage patients with dementia in an artistic process without the burdens of technique or memory.

During her research, Basting found that the ancient art of storytelling helped residents at long-term care facilities become more alert and engaged. Caregivers also reported happier staff.

TimeSlips facilitators use photographs or other prompts to start the group storytelling process.

“It’s an invitation to expression and an affirmation of whatever omes out,” says Basting. “These tools are what enable you to bridge and reach each other again.”

Although centered at two Milwaukee-area facilities, last year teachers nationwide started becoming certified in the TimeSlips technique.

Basting is also one of many collaborators with Wisdem – wordplay combining “wisdom” and “dementia” – an international organization of eductors, neurologists and artists dedicated to changing society’s perception of dementia.

Basting says she no longer separates the aging process from a clinical diagnosis of dementia.

“When I talk about aging, I talk about people with dementia,” says Basting. “I don’t separate them out in a special category anymore.”

Older adults with dementia – Alzheimer’s Disease being just one form – often spiral into a cocoon of loneliness and despair as their cognitive functions and verbal skills decline.

While working together at a Kentucky Alzheimer’s research center, David Troxel and Virginia Bell in the early 1990’s watched families and friends abandon these patients, and came to a simple yet powerful conclusion: the best therapy for patients with dementia is a best friend.

The duo pioneered the “Best Friends” approach to treating dementia patients, and now train national organizations and local caregivers how to engage with dementia patients by learning everything possible about them – and sharing their interests.

“If you do repetitive work, if you study Emily Dickinson’s poetry, or read from an upbeat publication like USA today, you can get to them,” says Troxel, a Sacramento resident. (Bell, who is 90, still lives in Lexington, Kentucky.)

Sacramento is just the second city in the nation to introduce the arts appreciation program “ARTZ: Artists for Alzheimer’s.” Coordinator Tiffany Paige has made alliances with several local museums to offer tours for Alzheimer’s sufferers in an effort to connect with them outside the traditional – and limiting – world of conversation.

Paige recounts a moving story from the daughter of an Alzheimer’s mother after a recent museum visit.

“She was almost in tears. She hadn’t seen her mother so engaged in months,” says Paige. “There was so much happening inside, but she just wasn’t able to articulate it.”

On a June day at the Crocker Art Museum in Sacramento, six older adult women wander the halls in walkers and wheelchairs, perusing works from the museum’s permanent collection. Paige peppers them with quertions about the art, color choices, subject matter, characters, even theme.

The women comment and joke, clearly more engaged in the museum’s larger paintings, like the western-themed “The Patriotic Race.”

Paige asks them if the painting was made at sunset.

“Looks like a bonfire,” says one woman.

“Will you bring the smores?” asks another, evoking laughs.

For children of Alzheimer’s patients, ARTZ is a welcome antidote to the frustrations of cognitive and verbal decline.

“I see hope in the families,” says Paige. “They’re learning this communication technique they may not have known before.”

Across the nation, there are dozens of other new programs, conferences, and workshops transforming the aging process: Songwriting Works in Washington state; the Alzheimer’s Poetry Project in Brooklyn; Opening Minds Through Art from Ohio’s Miami University; and San Francisco’s annual “Poetics of Aging” conference.

In Oakland, Creedon is thrilled that Mercy adopted the Eden principles to help ride the crest of the silver tsunami.

“We liked it beause we are part of something larger,” says Creedon. “It’s not just us doing this, but it’s part of a whole movement dedicated to moving patient-centered care forward.”