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The Search for Meaning in Late-Life Entrepreneurship

Published: May 12, 2013 | No Comments

By Matt Perry
California Health Report

Mark Anderson had a lengthy resume as a successful project manager at the terminus of the Alaska Pipeline.

When he eventually relocated to California, he hired on with a major electrical contractor. Supervising the removal of hazardous materials, he accomplished in four months a clean-up job the company had struggled for years to complete.

His reward?

Anderson was fired, replaced by a subordinate earning half his salary.

After the initial shock, Anderson pulled up his entrepreneurial bootstraps and did what any savvy, young entrepreneur would do. He opened his own business – Geographica, an eclectic collection of international treasures – last December in a back alley two miles from the state Capitol.

“You get to be your own boss,” Anderson, who turns 60 in August, says with a smile. “I really enjoy the people who come through here.”

He is not alone. Older adults facing age discrimination or squeezed out by employers looking to cut costs are finding entrepreneurship a surprisingly realistic option in a rugged new economy.

For more than a decade, Pat Guerra has collaborated with the Global Social Benefit Incubator at Santa Clara University, helping hundreds of entrepreneurs start businesses targeting clean water, off-the-grid energy solutions, subsistence farming and similar ventures.

In January with a university colleague, Guerra launched the Encore Venture Accelerator Program, customized for older entrepreneurs.

“The program is specifically tailored to the needs of people over 50 in launching a venture,” he says of his first class of 10 students. “It greatly increases the probability of success.”

A whopping 25 million Americans between 44-70 hope to start their own businesses in the coming 5-10 years, according to a 2011 MetLife Foundation study. Half want to start what they consider a socially responsible enterprise.

Paul Tasner has already done just that. Tasner was a senior executive for Method cleaning supplies when he was downsized after the 2008 economic slump.

Two years ago at age 66, Tasner joined forces with his business partner – a recently laid-off architect – to start San Rafael-based PulpWorks, which designs and manufactures sustainable packaging for consumer products.

The two received intensive assistance from neighboring Venture Greenhouse, an incubator for green businesses. Venture Greenhouse helped them set priorities, create a business model, and find customers.

“We got so much great advice,” says Tasner. “And they really held our feet to the fire.”

Nancy Burkart worked at her family arts and crafts business for decades despite her frustration at its lack of toxin-free supplies. After a divorce, Burkart started Earth Safe Finishes online with her daughter in 2007.

“There’s no retirement now,” says Burkart. “You do what you need to do.”

Yet while pursuing lifelong dreams and serving a larger purpose are great motivators, they don’t always pay the bills.

“It’s all about financial literacy and risk management,” says Elizabeth Isele, co-founder of Senior Entrepreneurship Works, a Washington, DC-based non-profit started last year and has assisted 400 adults age 50 and over.

Isele says these entrepreneurs are part of an important economic shift in the United States. The title of her October Washington summit in the nation’s capital says it all: “New Engines for a New Economy.” (A Bay Area summit at Google headquarters in Mountain View is scheduled for July.)

In San Francisco, Encore.org (formerly Civic Ventures) helps job-seekers find encore careers and also encourages “encore entrepreneurs.”

Jim Emerman, Encore.org’s executive vice president, says along with green businesses, older entrepreneurs often target two areas: youth development and health improvement.

One San Francisco clinical therapist recognized how few children inside the foster care system received proper mental health care. Launched in 1994 as the Children’s Psychotherapy Project, the initiative pairs volunteer therapists one-on-one with foster youth. Now called A Home Within, the non-profit has 50 chapters in 22 states, winning Encore.org’s 2008 Purpose Prize for social entrepreneurship.

Isele says her organization targets unlikely entrepreneurs: low-income seniors.

“Sometimes they are greater risk-takers than the higher income makers because they know what’s at risk,” she says. “They’re investing in an idea, and they know they have to believe in it. And they are incredibly responsible.”

Isele ponts to Ireland – with its mandatory retirement age and stressed pension funds – as a model for older adults with its Senior Enterprise initiative.

“It is the program that is held up as the model program by the EU,” she says. “The EU commission is very interested in senior entrepreneurship.”

The key to success, says Emerman, is experience.

Older adult entrepreneurs target “all kinds of special needs that lend themselves to the kind of advice that someone with a lifetime of experience can bring to bear,” he says.

Lenders should take into account this very real “social capital,” says Isele.

“That should be considered equally with a credit report.”

Matt Perry wrote this article as part of the MetLife Foundation Journalists in Aging Fellows program, a collaboration of New America Media and the Gerontological Society of America.

 

‘Show Me The Money’

Published: April 28, 2013 | No Comments

Caring for Our Most Vulnerable Without a Budget

By Matt Perry
California Health Report

Imagine taking a job without knowing how much you’ll be paid. Or having your car fixed without knowing the cost.

That’s how state health insurers and our most vulnerable patients – the old, sick, and poor – feel about California’s latest plan to squeeze them into a new managed care program that may be woefully unprepared for a transition scheduled for the fall.

Officially announced in March and dubbed the Cal MediConnect program, the initiative targets patients who are eligible for both Medicare because they are either elderly or disabled and Medi-Cal because they are also low-income. The government calls these people “dual eligibles” because they qualify for both health programs.

The highly optimistic kickoff is slated for October 1st.

The goal? Give these patients better service, coordinated by the health plans to streamline fragmented medical care and social supports that historically have been managed separately by the two programs.

The problem? Money.

A month after the announcment, public and private health insurers in eight California counties that will pilot the project are awaiting answers to this simple question: “How much are we getting paid?”

“That’s the million dollar question,” says Wendy Peterson, director of the Senior Services Coalition of Alameda County. “And we’re baffled by it. It seems a little bit backwards.”

Perhaps even more backwards than similar transitions.

In 2012, California went through a chaotic transition when it tried to slim down the state’s adult day health care program by converting it to managed care and shedding some clients. Overseen by the state’s Department of Health Care Serives (DHCS), that transition affected just 35,000 people – about 80% of whom survived the patient purge.

This year, the department is back with another conversion to managed care, yet the stakes are much higher.

There are a whopping 1.1 million “dual eligible” Californians, although the three-year project affects only about half that number in its eight pilot counties. A little more than 400,000 are expected to participate in the voluntary program.

The state eventually hopes to save a billion dollars annually when all dual eligibles participate.

Yet health insurers were burned badly over the last two years when forced to manage the state’s program known as Seniors and People with Disabilities.

“The plans lost their shirts,” says Peter Szutu, president and CEO of the Center for Elders’ Independence.

So why would the health plans take on yet another vulnerable population and lose even more money?

“We said essentially the same thing to the state,” says Howard Kahn, CEO for L.A. Care Health Plan. “You have to fix the SPD rate situation before we can start this dual demonstrations project.”

“The rates are key to the success of the demonstration,” agrees Abbie Totten, director of state progreams for the California Association of Health Planas.

Yet other questions remain. Lots of them.

When will the three-way contracts among the health plans, the state, and the federal government be inked? How can understaffed, financially battered counties prepare for the complex transition? What creative solutions can the plans invent without knowing their budget?

All that’s known today is that reimbursements decrease as the three-year pilot project continues – economic arm-twisting designed to force coordinated care and lower costs. Many patients fear that managed care is really code for cutting services to those who need them.

“It’s not about saying no to the right services,” counters Abbie Totten of the health plan trade group. “It’s about utilizing the right services at the right time and not overutilizing services.”

Still, many aging experts warn that coordinated care may actually be more expensive.

“Theoretically, this model will save money,” says Szutu. “But the rates that are being offered may not give the plans enough of a cushion so they can complete that learning cycle and get efficient and improve quality. They may still ration and cap benefits as they have throughout the years.”

Critical to the discussion are the two types of health plans in the counties: smaller, community-based plans that work almost solely with impoverished patients; and the much larger commercial plans that are typically for-profit enterprises and have less experience serving the poor.

“We have a greater amount of our existence at risk,” admits Kahn of his community-based operation. “Health Net’s a national corporation and we’re a local plan.”

Indeed, a look under the hood of the duals project reveals very different motivations. For humanists and optimists… coordinated care for the vulnerable. For the cynical… a loss leader that will help keep existing state contracts and lead to eventual growth in others.

“It’s really about capturing this revenue and this line of business,” said one observer close to the situtation. “The big private plans are confident they can make money.”

Revenue? Line of business? Indeed, last year, the global banking giant Barclays summarized the duals demonstration project this way: “We estimate the size of the overall opportunity in California to be approaching $17 billion in revenues in 2013, and more than $32 billion in revenue in 2015.”

Should California’s most vulnerable citizens – the old, disabled and poor – fear they’re being reduced to a medical spreadsheet?

“The state does have a bottom line they want to look at,” says Peterson.

“It’s a poker game between the providers and the state,” says Gary Passmore, vice president, Congress of California Seniors.

Despite the looming start date, some plans say they are standing firmly for quality over profits – and won’t be rushed into a haphazard launch.

“We’ve decided we have to do well by our members at the beginning of the program,” says Kahn. “If the rates come in and we can’t do a good job for our members, we won’t do the program.”

 

Older Californians Stand Tall, Avoid Falls

Published: May 28, 2012 | No Comments


By Matt Perry
California Health Report

“I’ve fallen and I can’t get up” has long been part of the American lexicon, a staple of late-night comedians for generations.

But for older adults – and California’s fragile healthcare system – falling is no laughing matter.

One in three adults 65 and older falls every year. Falls are the number one cause of injury – and death – for seniors in California and across the nation. They are also the largest single contributor to nursing home admissions – a staggering financial burden for both families and governments who shoulder the high costs of assisted living.

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This article is one in an occasional series on aging with dignity, independent living and public policy that affects both. For a complete archive of the articles, click here.

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Yet a number of experts and programs around the state are helping California become a leader in fall prevention awareness and training. In a state whose over-65 population is expected to be more than 10 million by 2040 – nearly one in five citizens – this is welcome news.

“Fall is a dirty word,” says Debra Rose, co-director of the Center for Successful Aging at California State University, Fullerton. “Nobody wants to address falls.”

Rose and her colleagues have trained more than 500 instructors under the center’s FallProof certification program using a wide-ranging curriculum that combats the common stereotype that falls are caused simply by physical frailty.

In truth, falls are caused by a combination of risk factors: medications, the surrounding physical environment, poor footwear and age-related decay – which includes vision and hearing.

“People want to find a quick fix for falling, and it’s just not that simple,” says Rose.

Many of Rose’s students are physical therapists or fitness instructors.

“This just adds one more element of expertise to their burgeoning bag of tricks,” she says.

FallProof graduate Kelly Ward, who has trademarked the name “The Fall Prevention Lady,” was once a personal trainer to high-tech firms like Intel. Over six feet tall, lean and muscular, Ward is a striking contrast to seniors nearly a foot shorter in her elder mobility class at a Sacramento Presbyterian church.

Ward steps the 60 and 70 year-olds through a rigorous series of toe lifts, marches, step-ups, and heel-to-toe walks to improve balance and strength. Students use resistance bands for upper body strength, then face a challenging obstacle course.

“They’re not going to get this at senior centers,” jokes Ward, who typically sees improvements in the third week of her six-week program. “The choices you make in your 60’s will determine your vitality and independence of your 70’s.”

Aileen Nitta has taken Ward’s beginner class, and is now in the intermediate course.

“I went hiking in Sedona and hiked two times a day and am glad I had that prep,” she says. “My legs didn’t buckle. And I watched where I was going.”

Low-risk seniors who’ve never fallen can pursue several health-promoting physical activities: walking, biking, tennis, yoga, pilates, and tai chi.

But adults who have already taken a tumble “need a program that specifically targets balance and strength,” says Rose. “You can’t refer them to an aerobics or yoga class.”

In 2009, there were 1,851 deaths and more than 81,000 California seniors over 60 hospitalized due to falls, says Barbara Alberson, chief of the State and Local Injury Control Section. About one-quarter of seniors who suffer hip fractures die in the year following a fall.

The nation’s pioneer in fall prevention is Mary Tinetti, director of the Program on Aging at Yale University, whose early work paved the way for California’s two-day “Targeting Falls in Older Californians” conference nearly a decade ago.

That event spawned creation of the Fall Prevention Center of Excellence, a comprehensive resource both nationally and internationally headquartered at the University of Southern California’s Andrus Gerontology Center.

Center co-director Jon Pynoos says that that physical environments – both indoors and out – are implicated in nearly 40% of falls.

Pynoos describes most contemporary homes as “Peter Pan housing” – built for families who never grow old.

“What I really hate are the modern houses in Architectural Digest with floating staircases, and no hand rails,” says Pynoos. “They’re beautiful designs but disastrous for anybody with disabilities.”

Many falls occur on stairways, which often suffer from dim lighting, worn carpets and single-side hand rails. Pynoos says the best indoor improvements include bathrooms located in the ground floor, walk-in bathtubs, grab bars, non-slip tiles, raised toilet seats, and glare reduction. Older adults need up to three times as much lighting as their counterparts.

Outdoors, Pynoos says cities can do plenty: fix uneven sidewalks, add hand rails, or improve lighting by replacing bulbs or adding new LED or halogen lights. Timed walkways also help seniors cross safely.

Falls can also result from the dizziness and confusion produced by medications – prescribed or over-the-counter.

Dr. Laurence Rubenstein fingers plenty of chemical culprits: anti-depressants, anti-psychotics, blood thinners, or any drugs that modify behavior.

“Drug side effects are a big risk factor in old people.” says Rubenstein, chairman of the Department of Geriatric Medicine at the University of Oklahoma College of Medicine.

Seniors taking six or more medications are at higher risk for falls “even if they don’t include the culprit meds,” he adds.

The drug store can be just as dangerous: sleeping pills, sedatives, Tylenol PM, and antihistamines such as Benadryl or Chlor-Trimeton can all increase the risk of falls.

Experts say proper footwear is also crucial. Seniors should wear non-stick shoes and avoid thick soles.

Around the state, several counties are leading the effort against falls with unique initiatives.

“Tai Chi: Moving for Better Balance” is a streamlined set of eight tai chi forms (simplified from 108) taught for a San Diego County pilot program to more than 60 seniors over six months.

“It’s not as overwhelming to learn but it has all the essential elements for improving balance and reducing the risk of falls,” says Kristen Smith, health promotion manager for San Diego County’s Aging & Independence Services.

Developed for older adults by the federal Centers for Disease Control and Prevention, the program is now being adopted by the San Diego Community College school district.

“Stepping On” is a seven-week fall prevention workshop for 12 seniors covering the full range of fall prevention topics: medical conditions, drug interactions, physical health, and the environment.

“The program is really instilling long-term behaviors,” says Smith.

Though both programs have lost their federal funding, the county says seeds have been planted for future growth.

At Stanford University Medical Center, the Farewell to Falls Program began in 2005 to assess patients who had suffered a recent fall.

Conceived by Ellen Corman, supervisor for injury prevention, the program significantly reduced repeat falls and helped combat the number one cause of hospital admission at its level one trauma unit. It now extends to any at-risk older senior.

StopFalls Napa Valley has sent an occupational therapist into more than 300 homes to conduct a full-scale home assessment spanning physical hazards and health. Fall prevention coordinator Naomi Dreskin-Anderson follows up to ensure social services or materials, such as hand rails, are provided.

“The vast majority of these clients have not had another fall,” says Dreskin-Anderson.

Silverado Senior Living, headquartered in Irvine, houses older adults with dementia and Alzheimer’s disease in six states.

Each of its 23 communities offers mobility training to improve range of motion and gait. Residents are also assessed for medications, dehydration, or infections of the ear or urinary tract – all of which can cause falls.

Rather than confining residents, Silverado has instituted a “dignity in risk” policy that allows residents to roam freely despite potential hazards.

“We allow them to do a lot of wandering inside and out,” says Joann Fetgatter, vice president of quality care.

Silverado’s policy addresses a key irony of elder falls: seniors who are afraid of falling restrict their activities – leading to eventual falls.

Many Silverado residents also wear “hip protector” underwear with additional padding that can reduce fall injuries by 50%. At night, many sleep in low beds above cushioned “landing pads.”

For Silverado, these policies pay off. Fetgatter claims only 4% of residents who fall are injured, and less than 1% of falls result in fractures.

While plenty of fall detectors and alarm systems exist on the market – 43% of California’s in-home caregivers use fall detection technology – prevention experts say they don’t solve the root problem of falls.

“The real thing is to prevent them in the first place,” says Pynoos.

 

The Health Perils of Aging: Lonely and Sick

Published: May 13, 2012 | Comments (3)

By Matt Perry

The grim effects of smoking, drinking, and poor eating are commonly cited by doctors as appalling and expensive health scourges. Yet for aging Californians, an often hidden health plague can be just as deadly: loneliness.

Social isolation and its common offspring – loneliness – became a political hot potato when California recently cut back on its adult day health care program, disqualifying 20% of the state’s older and disabled citizens from its attendance rolls. Families who depended on the centers for medical supervision and social interaction suddenly had to scramble to find new programs to care for these relatives.

For seniors with or without families, this often meant more time home alone.

“They’re just going to go home, watch TV and decline,” predicted Katya Hope, acting director of the Golden State Adult Day Health Care Center in San Francisco’s Tenderloin district, of the approximately 7,000 clients cut from the state program.

Research linking social isolation to poor health is abundant.

“It’s as large a risk factor for mortality as cigarette smoking,” says Laura Carstensen, director of the Stanford Center on Longevity.

Loneliness can increase depression, neuroses, pessimism, alcoholism, and suicidal thoughts. It can also disrupt sleep and reduce self-esteem.

Its physical effects are equally disastrous. It can increase blood pressure, limit the body’s ability to fight off illness, and has been linked to higher death rates. Social isolation can increase obesity and speed the progression of Alzheimer’s disease.

From a public health perspective, the most damning effects of social isolation are that it prevents older adults from living independently and exercising.

Long-term, all of these factors can cost the state money in chronic disease management and skilled nursing dollars.

Because funding for programs – like adult day health care – can end abruptly, creative local initiatives to address social isolation dot the state.

Some of these programs use the phone to reach seniors who are shut-ins or lack mobility.

The Senior Center Without Walls, based in Oakland, holds nearly 70 free classes a week for isolated seniors who call a central number to join a telephone classroom.

Classes include health information, poetry readings, brain games, cooking, gardening, and a popular travel club.

Director Terry Englehart, who started the program in 2004 with six women to tell jokes, said last fiscal year the center had 667 participants.

Many have lost their spouses or confidantes.

“They have found a community they belong to,” she says. “They have something to look forward to. They have friends.”

Every day of the year, the center hosts a 9 a.m. “Gratitude” call.

On one day, there are 15 older adults on the long-distance teleconference. Some are chronically ill. Although they have never met in person, the sense of community, friendship – even love – is palpable.

They give thanks for phone calls from children, medicine reminders, electricity, reality TV, museums, casinos, dogs, cats, fog, sleep, and blooming spring flowers.

“I’m just very grateful that I went for a walk this morning and they weren’t narrow hallways,” said one man recently discharged from the hospital.

In Northern California, volunteers at the Eskaton senior living community’s Telephone Reassurance call 550 older adults in a three-county area in and around Sacramento.

Callers socialize with clients, check on their health, or remind them to take medicines – even to eat and drink. They can also set up home visits or suggest social services, including financial advice.

“A lot of the folks we call live totally on their own,” says Terri Becker, director of the telephone reassurance program, which is one of many around the state. Becker says many are women who have outlived their husbands. Others live in poor neighborhoods, are financially destitute, or suffer from dementia. All crave personal contact.

Becker says the phone calls provide a sense of security in a confused world.

“Their anxiety goes way down,” she says. “Medicines can only help so much.”

Indeed, some experts decry the modern medical model that depends so heavily on pharmaceutical drugs.

Walking outside with a neighbor does “more good than all the friggin’ pills in the pharmacy,” says Dr. Walter Bortz, a “robust aging” expert and author of the book “We Live Too Short and Die Too Long.” Bortz currently teaches the Stanford course “Exploring the Human Potential.”

Former Harvard University president Derek Bok in his book “The Politics of Happiness” writes that good health and happiness are clearly intertwined. Yet Bok says that a clean bill of health from a physician is only “roughly correlated” with happiness.

The leading factor in being healthy and happy according to Bok: social connections.

A 2010 study by AARP of 3,000 people 45 and over found a whopping 35% “chronically lonely” – up significantly from 20% a decade earlier. Surprisingly, the loneliest age groups were in their 40s and 50s.

Peter Szutu, CEO of the Oakland’s Center for Elders’ Independence, says that older adults bounce back from sickness and stress with four factors: a community they belong to, meaningful activity, hope, and a confidante.

Yet in aging California, social isolation is expected to grow right with its population.

By 2030, an estimated one in five Californians will be 60 and over, says Mariko Yamada, chair of the state Assembly’s Aging and Long Term Care committee.

Yamada says a revolution in aging services is needed to survive a future often termed “the silver tsunami.”

By contrast, she says fellow legislators have oversimplified a complex issue.

‘There’s a fundamental flaw in the way we look at services in general,” says Yamada, who has worked in social services for 38 years. “We try to define them as either social or medical… It’s really both.”

One program that blends good health and social interaction is offered in San Diego county, where the Sharp Rees-Stealy Medical Group conducts six-week chronic disease management classes for patients.

A hallmark of the group’s Healthier Living program: the buddy system.

“Everybody gets a buddy,” says Kelly Dutcher, a wellness education specialist and class supervisor. At the end of each session, patients create an action plan for the following week.

“When they call their buddy mid-week it’s really to check in on those action plans,” says Dutcher. “So much of why people are successful is accountability.”

“I liked exchanging phone numbers and have (sic) a partner,” wrote one participant. “It motivated me.”

Dutcher says the program indirectly addresses social isolation: “Coming to this class may be the only time they get out of the house that week.”

Statewide, the PEARLS program treats older adults at home who are suffering from mild depression. Developed by Dr. Ed Wagner, who has developed models to treat chronic disease, PEARLS emphasizes an increase in physical and social activities. There are five programs in California, with two more in development.

Older adults who maintain or increase their social connections can slow both physical and cognitive decline, according to a study last year by the Population Research Center at the University of Texas in Austin.

In Fremont, two ethnic groups wracked by social isolation are Pakistanis and Afghanis – the latter suffering high rates of PTSD.

The city’s Pathways to Positive Aging – Fremont’s collaboration with the Tri-City Elder Coaltion – has built bridges to seniors in both ethnic communities. After creating the Afghan Elder Association and the Muslim Support Group, health programs were then introduced to address obesity, diabetes, and other health concerns.

Older adults in these communities were heavily isolated and not getting proper healthcare, says Ray Grimm, project coordinator for Pathways to Positive Aging. Creating these social organizations played a major role in improving health outcomes.

“Once you get them linked you keep them out of the emergency rooms, and hopefully out of the hospitals,” says Grimm.

In the city famously called “The Happiest Place in the USA” – San Luis Obispo – Wilshire Community Services offers both “senior peer counseling” (peer advice for those 55 and older) and Caring Callers (all-ages volunteers who make free weekly in-home visits to older adults).

Heartened by such community programs around the state, Yamada nevertheless anticipates a bleak future unless radical service improvements are made for aging Californians.

“It’s kind of like watching the Titanic approach the iceberg, and knowing that a lot of people are going to die or be hurt.”

First of two parts. In Part 2, Matt Perry will profile the Senior Center Without Walls, which connects older adults with new friends via telephone conference calls.

 

“Meet the pharmacist” event helps seniors manage medications

Published: November 2, 2011 | 1 Comment

Letty Santos Bustria, 72, of National City, meets with pharmacist Stephanie Mastorakos of Crocker Drugs, also in National City.

By Michele Clock

Some fill up Ziploc bags, others stuff carryall bags. Still others use big plastic boxes.

For years, California seniors have been toting their pharmaceuticals into “Meet the Pharmacist” events for one-on-one help with their daily medicine regimens. The events offer seniors a chance to sit down with a pharmacist and get free advice outside the sometimes busy, sterile pharmacy setting.

Demand for the events is on the rise, organizers say, as the state continues to struggle with a sluggish economy, high unemployment rate and budget cuts. Nearly $2 billion in pending slashes to Medi-Cal could put low income residents, including seniors, at further risk. The cuts call for increases in patient co-payments for doctors’ visits and caps on doctors’ visits each year.


This article is one in an occasional series on aging with dignity, independent living and public policy that affects both. For a complete archive of the articles, click here.

These cuts could put patients with complicated medical issues and medication regimens “in a bind,” said Maxine Fischer, manager of state operations for AARP, which helps organize the events.

As people are living longer, the number of chronic illnesses such as asthma, depression and congestive heart failure, have increased, said Stephen Shortell, Dean of the School of Public Health at UC Berkeley. What’s also risen is the number of daily medications people are taking.

“Many have 10, 15, 20 medications they take at different times of day,” he said. “It’s become a huge new public health challenge.”

As a result, pharmacists have taken on a more important role in people’s lives, Shortell said.

Concerned about unsafe prescription drug and drug-food interactions, the county of San Diego’s Aging & Independence Service agency created the “Meet the Pharmacist” events about seven years ago, said agency spokeswoman Denise Nelesen.

Too often, people decide to not take their prescribed medications after learning the cost or after becoming sick, Fischer said. Some don’t take their medications at all. Language barriers can also add to the confusion. A quarter of adults aged 65 and older skip doses of medication or don’t fill prescriptions because of the costs, Fischer said.

The events, which are organized by a network of groups focused on senior-related issues, offer participants a chance to ask vital questions and review their medicines in familiar, neighborhood settings. Over the years, the events have caught on and been repeated around the state, including in Los Angeles, San Francisco and Fresno, Fischer said.

At a Meet the Pharmacist event in south San Diego County late last month, in walked Letty Santos Bustria, 72, pushing a walker and clutching a plastic bag full of prescriptions.

Bustria, a spunky, outgoing Filipino-American who wears pink rhinestone studded eyeglasses, said she suffers from diabetes, hypertension and gout. She survived a heart attack and triple bypass surgery six years ago and now lives in a National City senior housing facility near where the event was held.

“I’m still alive,” Bustria said, smiling. “I like to live.”

Bustria is enrolled in both Medi-Cal and Medicare. She said she came to the event, held at National City’s Kimball Senior Center, to talk with a pharmacist and make sure her seven daily medications were “OK.” Sometimes she goes to pick up her refills. Other times, she has her son or a friend get them.

Volunteer Michelle Bautista, who works as pharmacy manager at a Walgreens in Chula Vista, said that at busier pharmacies patients may feel “like they don’t want to take a pharmacists’ time.”

“A lot of the patients are intimidated,” she said.

In addition to the sit-downs with pharmacists, the event offered presentations on fall prevention and wise use of medications. Vision, depression and blood pressure screenings were also available. Participants got free food and reusable shopping bags full of fliers and other goodies.

“We spoil them rotten,” joked Anabel Kuykendall, a county of San Diego Aging & Independence Services employee who helped organize the event.

Last month alone, the San Diego region hosted four of the events—in National City, Santee, San Diego and Escondido.

National City’s senior services coordinator Maria Wright said she’s seen an overall jump in demand for free services for seniors. Attendance at the Meet the Pharmacist events in her city rose from 100 to about 300 people over the past three years, she said. This year, about 160 participants attended the event, but Wright and others attribute the lower number to less publicity. If more knew about it, more would have been there, she said.

National City’s commodity food distribution program aids nearly 400 seniors a month, up from 75 last year, she said.

And while seniors like Bustria got the all clear on her medicines, Judy Gunn, of Bonita, got some tips on her daily medicine regimen.

Gunn, who declined to give her age, said she takes 12 daily medications for three chronic conditions. A pharmacist suggested that she take one of her over-the-counter medicines—Citracal—both in the morning and at night. He also recommended that she speak with her doctor about reducing a cholesterol medication.

“I’d been having sore muscles but I thought it was a side thing from the condition,” she said. The advice “will be helpful.”

 

Minority nursing home residents increase, whites decline

Published: October 13, 2011 | Comments (2)

By Jessica Portner

As the nation’s elderly population balloons, nursing homes across the country have seen a demographic shift in their residents. More Hispanic, black and Asian elders are moving into nursing homes while white residents choose other options.

A recent study by Brown University researchers published in the journal Health Affairs found that this nationwide trend is driven in part by changing demographics, such as the rapid growth of elderly minority populations.

But the study, released in July, also found that the increase in the proportion of minority nursing homes residents indicates a lack of access to home and community-based alternatives, which are generally preferred for long-term care. Whites, who have greater economic resources on average, are finding better housing alternatives as they reach old age.


This article is one in an occasional series on aging with dignity, independent living and public policy that affects both. For a complete archive of the articles, click here.

“We know those alternatives are not equally available, accessible, or affordable to everybody, certainly not to many minority elders,” said Zhanlian Feng, assistant professor of community health at Brown University’s medical school and the study’s lead author. “Most elders would rather stay in their homes, or some place like home, but not a nursing home unless they have to.”

The researchers found that between 1999 and 2008, the number of elderly Hispanics living in U.S. nursing homes climbed by 54.9 percent while the number of Asians increased by 54.1 percent. The number of black residents rose 10.8 percent. During the same 10-year period, the number of white nursing home residents in the U.S. dropped by 10.2 percent.

In the Los Angeles/Long Beach region, the residency increases were also significant with a 56 percent increase in the Asian population and 41 percent rise among Hispanics. The increase for blacks was slight, only 1 percent.

Patricia McGinnis, the executive director of California Advocates for Nursing Home Reform, agreed that minorities as a group tend to be less able to afford Residential Care Facilities or home care aides who charge about $15 to $20 an hour.

California currently has more than 7,600 residential care facilities, up from about 5,500 a decade ago, she said. The average rate for those facilities, which generally offer more freedom and personal attention to residents, can cost $5,000 a month.

“Lets face it — money issues and a disparity in income and assets in minority communities is still there,” said McGinnis. “Unless you have savings, people are priced out of the market.”

To conduct the study, Brown researchers used data from a federal survey, which collects periodic information on nursing home residents, their race, ethnicity, the size of their population, and where in the U.S. they live. They used information from the Census Bureau’s Metropolitan Statistical Areas to gather information on the racial and ethnic mix of nursing home residents and the demographic shifts in urban areas.

These demographic shifts in the composition of nursing home populations are taking place within a rapidly shifting long-term care landscape. There are currently 76 million baby boomers in the nation; the oldest of them will turn 65 years old in 2011. The Census Bureau projects by 2030, 20 percent of the U.S. population will be sixty-five or older. Today that figure is 13 percent.

The population of older racial and ethnic minorities is slated to grow particularly swiftly. The number of older Hispanics, for instance, is projected to jump from under 1.8 million in 2000 to over 8.6 million by 2030. The number of elderly Asians is expected to balloon from 0.8 million to 3.8 million.

At the same time, elderly people don’t have the support at home or the social structures of previous generations. People don’t live as close to their relatives as they did in the past. Couples are having fewer children and often both have to work outside the home and are unable to provide full time care to their elderly or ill parents.

These dramatic societal changes have prompted the government to alter certain policies and priorities. There has been a shift in support from nursing home care to favoring home-and community-based services, the study said, which cost significantly less than institutional care. A significant change was the passage of the Medicaid “waivers” authorized in 1981 in the Social Security Act. It allows recipients to use their Medicaid dollars to pay for personal care and other supportive services, enabling more beneficiaries to live at home or in a residential setting.

Older adults and those with disabilities prefer living independently at home or in community-based alternatives, according to a related study published in Health Affairs that examined what people want from long-term care. Assisted living allows people to have more freedom; a skilled nursing facility is more confined and has more supervision.

The Brown University study cites earlier research, which shows that minorities, even if they had the means, have other disadvantages when it comes to finding quality care. Nursing homes in largely minority areas are often of lesser quality and are more likely to close, while assisted living facilities are more likely to proliferate in high-income areas.

Eli Quinones, President and CEO of Alliance Nursing Centers, Inc., operates three nursing homes in El Monte. But he said the residents of his nursing homes, 90 percent of whom are Chinese, tell him they feel safer and more comfortable in his facilities. But Quinones said that in his industry in general, he sees how the cost of care can be a factor in the demographic makeup of a nursing home population.

“Assisted living has become quite popular and it’s also very expensive,” he said. “When it comes to economics, white folks are able to afford a different level of care.”

 

Home help affected by cuts to Medi-Cal and Medicare

Published: October 6, 2011 | No Comments

Programs for supportive services, in-home healthcare impacted by state, federal changes

By Melissa Flores

Low-income families in the Salinas area who are in need of home healthcare or support with daily activities due to a disability may have a harder time getting that help as state budget cuts and cuts to Medi-Cal and Medicare reimbursements continue.

“It would really be a disaster,” said Fe Stallworth, the director of business development and patient care planning of the Central Coast Visiting Nurses’ Association and Hospice, if reimbursements continue to be cut for home healthcare.

CCVNA is one of two agencies that offer help to those who have limited functionality – CCVNA through skilled medical professionals who can help people recover from surgery or illnesses at home rather than in a hospital and In-Home Supportive Services, which provides help for residents with limited functionality on day-to-day chores.

The main concerns for CCVNA are that it has become harder for clients to qualify for home healthcare and the reimbursements have gone down. The nonprofit agency is funded through grants, bequests, individuals and organizations, and government contracts.

In the 2010 annual report, Steven A. Johnson, the president and CEO, noted “There have been many challenges during 2010 including severe economic downturn, reduced government reimbursement and increasing governmental regulations.”

Changes in Medicare requirements include the new Health Care Affordability Act, which requires patients to have a face-to-face meeting with a home care certifying physician within nine months prior to starting services or within 30 days of starting services.

Stallworth touted the benefits of using home healthcare instead of staying in a hospital or skilled nursing facility.

“The cost of outpatient is probably half the cost of in the hospital,” she said. “It improves your well being.”

She said that patients can have medication administered, receive physical therapy or other medical services at home.

“They don’t have to drive to outpatient (clinics) every day,” she said.

CCVNA accepts patients with private insurance, but they also work with Medi-Cal and Medicare patients.

The services include skilled nursing services, rehabilitation services, certified diabetic educator, cardiac program, a wound care program, enterostomal and wound care, medical social workers, dietary and nutritional counseling and palliative care.

In-Home Supportive Services provides longer-term help to people with a functional impairment who need help with day-to-day activities. Services include assistance with light house keeping, cooking, laundry, medical transportation, and personal care such as dressing, bathing, and grooming.

In-Home Supportive Services received a 3.8 percent cut in the state budget, according to Sam Trevino, the public information officer for Monterey County’s Aging and Adult Services, which services Salinas clients. He said that an additional 20 percent cut is still a possibility.

Trevino explained that the types of activities that are allowed through IHSS have remained the same, but the number of hours available to each patient has been cut by 3.8 percent.

“The scope of the activities covered include daily living – chores and housekeeping,” he said. “There was some reduction of hours, but the initial 3.8 percent was absorbed (by the clients and homecare providers.) We didn’t get much in the way of calls coming in. I think they are doing their best to accommodate it.”

To qualify for the program, a resident must be low-income and have some kind of functional impairment. The impairments can be physical or developmental, and clients of all ages are eligible for the program. Through an interview with a social worker, the staff determines how many hours a client needs, from 20 hours a month up to 9 hours a day of care.

“We are concerned about the trigger cuts of 20 percent,” Trevino said. “It would be a challenge to respond to that if that were to occur.”

He said that he expects to know if the additional cut will come through in mid-December when the state completes its second-quarter reports. The “trigger cuts” refer to possible $601 million in cuts that will be implemented if state tax receipts come in lower than anticipated. If projections fall below estimates by more than $1 billion, the cuts will be enacted, including an additional $100 million to IHSS.

“It’s a threat that is actually looming on worker’s minds and recipients who rely on this service,” he said.

In Monterey County, about 4,000 employees are working with 4,000 recipients. The rate of pay is the same for all IHSS employees, though the number of hours they work varies by the clients’ needs. In 2010-11, employees made $12.10 an hour.

Statewide, 438,000 residents are expected to use IHSS services for the 2011-12 fiscal year, according to The SCAN Foundation, a nonprofit group that focuses on issues affecting seniors.

In March, state officials adopted several measures to save money that impacted IHSS. They included eliminating hours for recipients who do not have a physician certification that personal care services are necessary, for a savings of $67.4 million. They also eliminated an advisory committee that county boards of supervisors were mandated to establish. Counties can still continue with the advisory committee with $3,000 provided from the state.

The legislature is also banking on keeping some services through the federal Community First Choice State Plan Option, which provides community-based attendant services and IHSS for consumers who meet nursing facility eligibility.

Trevino said the IHSS program is funded through state, federal and local funding. A large amount of the money comes from Medicaid and Medical reimbursements.

Residents don’t have to come into an office, as social workers can visit them to determine their needs, with input from a physician. Residents can select their own IHSS worker, if they have a family member, friend or neighbor who wants to assist them. But Trevino said the staff can also pair residents with a provider through the IHSS Public Authority.

“The majority of recipients, about 80 percent, have one already,” Trevino said. “Having a family member can be good because they know the person intimately.”

Trevino noted that the program does help family members who are struggling, who have lost a job or have limited time to work due to caring for a loved one.

“If they have disabled family or aging parents, they might be struggling to stay employed,” he said. “This is trying to maintain the family, financially and be independent.”

 

Homeless for Years, Older Women in Los Angeles Find a Good Home

Published: September 26, 2011 | Comments (4)

Francine Andrade in her room at the Downtown Women's Center in Los Angeles.

By Jessica Portner

On Skid Row, the downtown hub of the homeless population in Los Angeles, transients ask passersby for change, slump against concrete buildings, and mumble obscenities at bus stops. The Downtown Women’s Center’s beautiful new building, sitting in the middle of the mayhem, is a standout. The DWC’s Day Center serves hundreds of homeless women in its facilities every day and 71 lucky ones live in permanent residences, or efficiency apartments.

The Center is a particular refuge for older homeless women who have lived in shelters, with family or on the streets for longer stretches of time. Of the 50,000 homeless people in LA County, 30 percent are women, and that number is increasing. About 47 percent of the women at the DWC are 51 years or older, the age that the AARP designates as senior citizen.

Women like Francine Andrade have struggled for years to find a home.

“To me, this is paradise,” said Andrade, 61, a teen runaway and abuse victim who slept on the cement sidewalk in Hollywood for two years. “Finally, at last, I don’t have to keep moving, not knowing where I am going to be.”


This article is one in an occasional series on aging with dignity, independent living and public policy that affects both. For a complete archive of the articles, click here.


Women often become vulnerable to homelessness if they have lost a spouse who was primary source of income for the family. They may not be easily employable because they have little experience in the workforce. Some older women, however, chose to be homeless and give up rent so their child could finish college or they could help support their grandchildren with their Social Security check.

“The philosophy is to create a sense of home,” said Patrick Shandrick, the Center’s Director of Communications and Public Education. “The first thing when you become homeless is you lose your dignity and sense of self worth, so we really try to provide comfort.”

The Center was the first organization in the nation to provide permanent supportive housing for women. Founder Jill Halverson started a center in 1978 following the closure of psychiatric hospitals statewide in the early 1970s, which led to a ballooning of the homeless populations. At the time, homeless women in the city had few options because shelters were only accessible to men. Halverson withdrew her life savings, bought the furniture and opened the center that served hot, healthy meals to women and offered a respite from a life on the streets.

The Center’s newly renovated facility was funded by a variety of public and private sources, including $8 million from the California Department of Community Development, $3.5 million from the city’s Community Redevelopment Agency and $7 million from foundations.

Stepping from the grimy street on Skid Row into the Center’s clean, airy space is a dramatic shift in ambiance. There’s a nicely decorated reception area, an open cafeteria, and couches in a flower-filled waiting area as quaint as a nice hotel’s. Design firms have decorated the spaces for free in the building, which is split between the quiet residential apartments and the bustling day center. There’s a Women’s Health Center that offers medical treatment, mental health and case management services for residents. Women receive gynecological health care, family planning and mammograms. The Center paired up with a clinic to provide physicians and nurse practitioners that conduct blood pressure monitoring, STD and HIV testing, cancer screenings, and diabetes tests.

There’s an impressive roster of physical and mental wellness activities that would rival some holistic health clinic. The women can take exercise stress reduction workshops and meditation. A nutritional specialist conducts cooking classes and prepares well-balanced meals for about 150 women who eat in the cheery cafeteria daily. They are introduced to healthy foods not generally served in shelters or soup kitchens, like quinoa, kale and couscous.

A team of mental health specialists at the Center offers psychological and psychiatric services for the women in the center, most of whom have experienced abuse, been victimized, or have a mental illness.

Jennifer Ma-Pham, the Director of Clinical Health Services, said the staff is attentive to how complicated diagnoses can be for older patients. Older residents go through the same issues any older person living in independently or in a nursing home might experience. They may need assistance with more intensive things like personal hygiene and dressing. Because the older residents are often less mobile, the staff always bring a plate of food at mealtime to women who can’t easily leave their room.

“People brush off that an older client forgets things and might not screen for dementia or Alzheimer’s disease,” she said. “They also might brush off the fact that they might be going though depression.”

Julia Perry, 65, a resident of the center, feels very well taken care of and keeps up with all her various annual screenings. For years, Perry supported herself and her sons by working as a maid, for All State Insurance Company, and as a nurse’s assistant. She traveled back and forth from Mississippi and California living with family, friends, and sometimes in rescue missions and hotels.

“This is wonderful,” Perry said. “I love the fact that it’s affordable and safe.” In the single room occupancy hotel, she said, “you never knew who could be entering the building while you are sleeping.” To stay at the Center, residents contribute 30 percent of the income they receive from Social Security. The average length of stay at the center is 13 years, but they can live there as long as they like.

Andrade, sitting on her cozy quilt in her own efficiency apartment, said it’s definitely worth it. “I got my kitchen and got my microwave and I got a real bed,” she said. “I never I had a place I could call home.”

 
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