There is an overwhelming matrix of businesses, government agencies, offices, non-profits, support organizations, long-term care options, programs, and reports. This confusing matrix of resources, paired with employees so overwhelmed with their work load that they have difficulty returning calls, is one problem cited in the City of Denver’s Office on Aging Age Matters Report. This report was put together in 2015 with the local AARP office to investigate issues affecting Elderly in Denver County.
The Report calls this matrix “Coordinated Services” and identifies it as an area of concern. This means that, while there are many various services available to Seniors, some of these programs might be little-known and difficult to access. For some Seniors, every day can be a struggle to make sure they have food, transportation, medications, and even housing. Grappling with additional entities to keep the bare minimum needed for their benefit and welfare is more than many can deal with. Indeed, I began to wonder, because of the confusing resources available, if there were entities which are duplicating the work of others. I also wondered whether these entities reached out to one another for support.
This issue is made more difficult for Seniors because they often don’t use technology efficiently or at all. As an example, when I searched online for seniors to chat with for this series, I got very little response. My friend Iris, 72, says the technology on her phone and computer changes faster than she can re-learn it. Iris doesn’t understand why she always has to buy a new phone and why, on the new phone, her score on a game couldn’t be saved from her old phone. When seniors are struggling with how to use technology on their phone, how can we expect them to navigate the complex system of care and services available to them?
Some Seniors might be in denial about aging which would keep them from looking into needed services. Then there are those who get easily confused or misunderstand things they hear. As I spoke with Maia, 72, I wondered if she might be suffering in this way because of her absolute statements that they “closed Columbine High School” because of the shootings [only temporarily], that teachers are now carrying guns [extremely limited areas], and that there are frequent, drug-related shootings in the Denver Tech Center [did I miss something?]. Luckily Maia has a much-younger husband to watch out for her welfare.
There are, of course, Seniors in much worse situations, who might have dementia or Alzheimer’s. Those folks most certainly cannot navigate the programs available.
However, to help deal with this, there is a pilot program that can help Seniors navigate this matrix called “No Wrong Door.” Lara Martinez of Colorado Access is working with this pilot program. At a meeting on March 14, 2018 with Aurora Health Access Senior Circle, she spoke and said that as a Senior, if you don’t have a strong advocate you’re “screwed.” She repeated my thought when she said that in Denver there are so many confusing resources that Seniors get frustrated. “They can’t navigate it,” says Martinez. No Wrong Door has a referral network to accommodate smooth transitions between programs.
Lara Martinez explained what No Wrong Door does. She said having so many resources in the Denver region make it confusing. This tends to stress Seniors out which creates more problems like stress-related health issues or giving up on looking for the help they really need. No Wrong Door is a referral network that works not just with Medicare/Medicaid but anyone in any program. The goal of No Wrong Door is to help Seniors with smooth transitions between various programs as their needs change. No Wrong Door was probably the best program that I found during my research to help Seniors and their families navigate the system.
Other than No Wrong Door I found several publications that outline services available to Elders. There is the Senior Blue Book which is free and is available at Windsor Gardens (an active adult community) and other places with concentrations of Seniors. Not only is the Senior Blue Book loaded with advertisements for businesses aimed at Elders, it also lists programs, rec centers, senior centers, and informative articles about staying healthy.
Windsor Gardens also has their own newspaper publication with Senior-based advertisements. The newspaper also listed on-campus activities such as support groups, visiting performances, and various clubs as well as writing opportunities for Seniors who live on campus.
Despite publications like these, it is difficult to know which way to go. As with all advertisements, in general, the people placing them are looking at their bottom line. This can lead to Seniors being overcharged for a service that shouldn’t cost as much or might be provided for them for free through another entity. Again, this is where the No Wrong Door pilot can be helpful.
LONG-TERM CARE
While younger Seniors may enjoy the camaraderie of living in places like Windsor Gardens, sooner or later they are going to need additional care. Few people have saved enough for extended care in their Senior years. And with the age expectancy rising, this becomes more and more true.
I spoke with Anne Meier, Colorado State Long-Term Care Ombudsman at Disability Law Colorado which is a non-profit who helps give voice to Seniors (and others) who are suffering an issue related to their long-term care. She said the reality of it is that by the time any of us arrive at an extended care need, 60-65% of us will be on Medicaid. That is after all our other financial resources have been exhausted. Usually the Senior’s house and other assets will need to be sold to pay for the cost of care before they can be allowed to receive Medicaid to pay for long-term care.
Innovage (Program of All-Inclusive Care for Elderly ie PACE) is one program that helps care for elderly and keeps them in-place (at home) as long as possible. Meier says that because of programs like Innovage, seniors are spending less time and money in nursing homes before their passing. But, she adds that most of us will end up with Medicaid paying for our nursing care, once our estate has been depleted. This happened in my own family. My father’s care with dementia ate up all his assets including the farmland that my siblings and I grew up working.
More and more nursing facilities are not taking Medicaid. And some of them are taking Medicaid only if a resident had been a private-pay for two years previous to needing Medicaid. Often, when a Senior is placed in long-term care, family will feel that the facilities are inadequate, and that additional support is needed from them. “Caregivers need their voices to be heard as well,” Says Nancy, 65 who took care of her mother to the best of her ability as she bounced around between care facilities. Nancy did her best to “fill the gap” because she found that the care facilities did not provide adequate care.
My friend Oliva went through a similar situation. One day she called me to ask if I could sit with her father from time to time while he was in the nursing home for his final days. Oliva told me that the staff would not stay with him and that hospice and a social worker only visited once a day. While Oliva seemed happy enough with the other services provided by the nursing home that her father was in, Nancy’s story was different.
“They didn’t do laundry correctly, the care-givers are poorly paid and overworked, there was trash in the halls, and the place smelled. Every time they came to help Mom move, they pushed her to ‘hurry up!’
Nancy goes on to say that she feels as if her mother was neglected. “There was a traveling medical group included in the cost of the facility, but it wasn’t Mom’s regular doctor, so they missed stuff. So, Mom went into crisis and we had to take her to the regular doctor anyway.”
Nancy told about one facility that had two residents in one room, one with dementia, separated by a curtain. The carpet was dirty and matted with grime. People who worked there are not native English language speakers and so the elderly cannot understand what they are saying. She shared that this particular place cost $7,000 a month.
At one point, Nancy tried a group that provided visits to her mother. Nancy said that the people who worked for this organization seemed too young and untrained. She said she paid $75 for two hours of visits. She didn’t continue with the group because she was not satisfied with the service for what she was paying. And she could not pay more because her finances wouldn’t allow it. She said she felt as if she was at a dead end. “The nursing homes keep them fed and housed but that’s about it.”
“When you go ahead of time to tour the place, they paint a pretty picture. But those places don’t provide adequate care.” Nancy’s mother passed recently. Nancy carries guilt because she wishes she could have done better for her mother. She said she had considered the ombudsman but didn’t realize that ombudsmen were an entity outside the facility, paid for by donations, and that their focus is the best interest of the Senior. Had Nancy known these things she might have attempted to get help through them. Nancy says, “In the end, if you don’t have a million dollars, you’ll end up in a Medicaid home where you’re mandated to have a roommate.”
While conditions for Seniors can be disconcerting, having a home at all as a convalescing Senior, might be considered a luxury. Next time we examine what happens to Seniors with no place to go.
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