Gray Matters
Mind the Gap 3 Grocery Delivery 4 Assistive Devices 6 Caregiver Training 7, 8
A quarterly publication of Area 1 Agency on Aging
Survey, Turnout Show Village-at-Home Appeal
T
he local effort to bring the “Village concept” to the North Coast is about to take flight. “There’s a real desire for it,” said JoAnn Schuch, the liaison between the Senior Action Coalition and Area 1 Agency on Aging in the joint effort to design and develop a local “village.” “More people are hearing about it and more people are coming. There’s a really strong movement to start one locally.” The most well-known village started in the Beacon Hill neighborhood of Boston, Massachusetts in 2000 to help people remain in their homes by accessing services that address the needs of aging. Villages are consumer- and community-driven models. Through some combination of membership, staff and volunteering, they usually offer basic core services covered by a membership fee in addition to concierge services, community-building
opportunities, and health and wellness services. Schuch was part of an effort that tried, but failed, to form a village in Arcata five years ago. She and Maggie Kraft, executive director of Area 1 Agency on Aging, spoke at a Dec. 3 OLLI Brown Bag luncheon that drew more than 80 people to the Humboldt Bay Aquatic Center to learn about the “Village movement.” “It seemed like a number of people there were ready to roll up their sleeves to help make this happen,” Kraft said. A1AA has secured funding and provided staffing to help jumpstart the village movement. Kraft released preliminary results from the Northcoast at Home survey. She said the survey attracted 1,380 responses from people aged 29 to 102. Almost 74 percent said they would join a local village in the next 10 years.
Forty-three percent of respondents were aged 60 to 69 and 25 percent were aged 70 to 79. Nearly 70 percent said they needed home maintenance professional services to continue living independently. Almost half identified computer help and more than a third described house or pet sitting and home modification as services of interest. One-third of respondents identified home organizing and laundry help as desired services. Cultural events topped the list of social, recreational and wellness activities with 56 percent citing an interest. Dance, exercise and weight training programs ranked second with 55 percent. Discounted gym memberships, book clubs, speakers, teas, walking and hiking groups drew interest from 50 to 51 percent of respondents. Additional analysis will be done this year to break down the data by county, region and demographics. Schuch presented an overview of three successful village models: Village Friends Village Values in Auburn, AL; Monadnock Village in Jaffrey, N.H., and Share Care in Leelanau County, MI.
WINTER 2015 All three are nonprofit models. The first two formed in 2010 and 2011 and charge $250 to $450 a year for individual memberships and $360 to $600 for dual memberships in a single household. Some need-based discounts are provided. The first two focused on core services such as technical support, home health, grocery shopping, transportation to appointments, vetted providers, and social visits. Share Care, which pre-dates the Beacon Hill village, attracted 400 enrollees in its first membership drive
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Services Desired for Independent Living Support From present up to 5 years
Computer Help House/Pet Sitting Home Modification Home Organizing Laundry Help
48% 38% 36% 35% 33%
Source: Northcoast at Home Survey
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and has been stable for 20 years. It offers a medical model that includes health care coordination and monitoring by registered nurses, access to services with a single call, and quality, pre-screened service providers. One-time enrollment fees went from $100 for those under 60 and $300 for those aged 60-75 to $1,400 for those aged 85+. Annual fees went from $100 to $300 and lump sum lifetime memberships were encouraged to create an endowed funding stream. The lunch presentation was part of a free event sponsored by Humboldt State’s Osher Lifelong Learning Institute. Free Brown Bag luncheon updates and discussions about the village will continue from 12 to 1:30 p.m. on the first Wed. of February, March, April and May and are open to non-OLLI members. “Not everyone can picture how a village would work,” Schuch said. “But there are many who feel as I do: if it saves me from even one month of assisted living at $5,000 a month, it’s worth the time and energy to build a model that suits Humboldt.” Thirteen of her Senior Action Coalition colleagues apparently feel the same way. What Schuch described
as a “group of heavy hitters” met on Dec. 4 as part of the SAC Village Support Group. That group will partner with A1AA and Redwood Community Action Agency to do the behind-the-scenes prep necessary for the first volunteer meeting sometime in February. The Feb. 4 OLLI luncheon will be the next opportunity for people to voice ideas, learn about other national templates for villages, and volunteer for work groups. OLLI membership is not required to attend as all Wednesday brown bag luncheons are free and open to the public.
“This is your world. Shape it, or someone else will.”
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—Gary Lew
Funding from St. Joseph Care for the Poor helped A1AA conduct the Northcoast at Home survey last fall. The McLean Foundation is supporting the A1AA-SAC effort to form a village in 2015. Kraft said A1AA is applying for funds from other foundations to “put all the pieces together.” For more information, go to the Northcoast at Home link at a1aa.org or the Village-to-Village Network at vtvnetwork.org.
Mind the Gap in Choosing Residential Care Facilities
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esidential Care Facilities for the Elderly have come a long ways in the past 30 years, but the regulations that guide them haven’t changed since 1981. That’s created a gap between reality and expectations that may best be managed by informed residents and their families who do their homework ahead of time and understand the limitations of the facilities and the regulations that govern them. So say Suzi Fregeau, program manager of the Long-Term Care Ombudsman Program of Area 1 Agency on Aging, and Larona Farnum, coowner and manager of the Timber Ridge assisted living facilities in Eureka and McKinleyville. “Back in 1981, they were basically board and care homes, places to go for the safety of living with others, that included bridge, meals and outings,” Fregeau said. “Now, they have become one step below nursing homes, but the staffing regulations have not changed. That has created what should be important concerns for families.” “The whole medical component has increased dramatically in the last 10 years,” Farnum said. “And whether you are a facility of 500, or of four to six, you get the same license from the Department of Social Services.”
Residential Care Facilities for the Elderly – sometimes called assisted living or board and care homes – provide room, meals, housekeeping, supervision, storage and distribution of medication, and personal care assistance with basic activities of daily living such as hygiene, dressing, bathing and transferring. They are not skilled nursing facilities, which are regulated by the California Department of Health. RCFE staff is to be trained in first aid, but not all RCFEs have a registered nurse on duty. “Too many people have promised mom she’ll never end up in a nursing home, so if or when she needs help, they look to assisted living instead,” Fregeau said. “It makes them feel better, but do they realize the facility may not be medically qualified to take care of the needs she has?” Even evacuation plans can be challenging with non-ambulatory residents and low staff numbers. Humboldt County currently has 16 licensed residential care facilities, 12 of them in the Eureka area, three in the Fortuna area and one in McKinleyville. Capacity ranges from six residents to 108, for a countywide total of 423 spots. Del Norte has only one facility and 63 beds.
Costs range from $1,800 to $6,000 per month. The Community Care Licensing Division of the Department of Social Services visits and reviews RCFEs and investigates complaints. All RCFEs must have those reports on hand and make them available on request. To assist in assessing residential care facilities, A1AA provides a two-page checklist on its website (www.a1aa.org), available under the Programs & Services link to the Ombudsman Program. The list allows comparisons of two facilities with five to 14 questions in six categories that include quality of staff, quality of care, and facility policies, costs, attributes, location and surroundings. “Most people don’t think ahead about where mom or a spouse might have to go, so they are stressed out when something happens and they have to find a place,” Fregeau said. “The checklist will help.” Fregeau and Farnum’s top recommendation: visit a facility, and do it more than once. Make one of the visits in the evening. Observe resident and staff behavior. “Is there a good response to each other, and when staff is making a response, do they know the resident’s name and are they calling them by it?” asked Farnum. Facilities are also responsible for maintaining an active life for residents. Fregeau said that means
developing a customized care plan to meet each resident’s needs and keep him stimulated. “That’s more than Bingo one day of the week or every afternoon,” Fregeau said. Moving to a residential care facility does not preclude falls, they said. Also, staff numbers, turnover, and training requirements make it unlikely that care will be as intimate or attentive as the care provided by one long-time spouse for another. Fregeau also cautioned residents and families to consider each facility’s policy with regard to performing CPR or calling 9-1-1. “It is at the discretion of each facility to determine that policy,” Fregeau said. Fregeau said only trained medical personnel can legally give medications, but that line has become blurred. Family, the resident and assisted living personnel may jointly choose to fudge the line to avoid transferring a resident to a skilled nursing facility. “This is something we have to look at as a society because someone may not want to leave what has become home for five years, but to stay is asking a residential care facility to go beyond what they are currently licensed to do,” Fregeau said. For questions regarding resident rights and care in assisted living, contact the local Ombudsman program at 269-1330.
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Pilot Grocery Delivery Program to Start Soon in Blue Lake
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n expansion of the Volunteer Driver Program to include a grocery delivery service in Blue Lake debuts this month. Blue Lake residents who are age 50 and older or disabled are eligible for the free Healthy Grocery Delivery Service. As of December 19, two Blue Lake residents are enrolled in the pilot effort and six locals have volunteered to drive. Participants can choose to have groceries delivered to their door if they are frail or homebound, or may schedule an appointment with a driver to pick them up and accompany them to the store and back. “I am currently in the process of recruiting, screening and training new volunteers in the Blue Lake area,” said Dan Birmingham, program coordinator for the Volunteer Driver Program run out of Area 1 Agency on
The production of this document was supported by a federal grant from the Administration for Community Living (ACL). Its contents are solely the responsibility of Area 1 Agency on Aging and do not necessarily represent the official views of ACL.
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Aging. “New clients can sign up at this time. We hope to have the service up and running by the end of January.” To volunteer or sign-up for grocery delivery, call the Volunteer Driver Program at 707-442-3763, ext. 217 or e-mail dbirmingham@a1aa.org. Birmingham said he needs at least a week of lead time to contact and schedule a driver for grocery delivery. “The volunteer will receive a grocery list from the client or shopper, and then the volunteer will submit the list to the store on the day of expected delivery,” he said. Murphy’s Market on Glendale Dr. will receive the order via e-mail, will pack up the desired groceries, and charge the client’s debit card. “The volunteer will come to pick up the groceries and deliver them at no cost to the client,” Birmingham said. That same Murphy’s Market will also be the host program for those
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who want to shop on their own but need a volunteer driver to get there. “There comes a time when seniors of all income levels are often no longer able to drive or shop because of the medical and physical challenges they face,” said Maggie Kraft, executive director of A1AA. “A volunteer driver program gives people a way to pay it forward by helping neighbors stay in their homes as long as possible.” Birmingham and Kraft said they plan to expand to other parts of the county in the future. Until July 2014, the Volunteer Driver Program provided free transportation to and from medical appointments for people aged 50 and older who reside between the Eel River Valley to the south, Trinidad to the north and Blue Lake and Hydesville to the east. Rides are now $3 to $9 round trip. In the year ending June 2014, the program’s 32 volunteer drivers collectively provided 1,872 one-way rides to medical appointments for 183 people. They rolled up 32,333 miles and 2,014 hours of service. A St. Joseph Care for the Poor grant to A1AA, which ended in November, helped to fund the work behind the expansion of service.
The grant originally focused on food security issues, but has expanded its focus to include support for A1AA as it works with the Senior Action Coalition and other community groups to determine the viability of a “Village project” on the North Coast. “The volunteer driver component is very critical to a successful ‘Village,’ Kraft said. “A village will need a strong volunteer base to get members to places like the doctor, the grocery store, and social events. St. Joseph stepped up to keep the Volunteer Driver program moving forward so that it can become a sustainable program and be there while the village takes shape.” Kraft said grants from the the McLean Foundation are now helping with the Volunteer Driver program and the “Village” movement. Volunteer drivers are eligible for 50 cents per mile reimbursement. The screening process includes a background check, interview, and ridealong training. Participants must abide by passenger guidelines covering courtesy and cancellation to participate. Currently, the program has 36 active drivers and 277 clients.
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Devices for Better Nutrition
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hree months remain to take advantage of a free program that provides assistive devices to improve the health and nutrition of Humboldt County residents. “It’s not just about access to better nutrition, but access to food, period,” said Ali Lee, services specialist for Area 1 Agency on Aging. The program makes cutting, opening and preparing food easier by providing such tools as adaptive cutting boards, blenders, electric jar openers, and adaptive kitchen stools to qualified people. Items such as food processors, microwaves, electric skittles and toaster ovens have also been dispersed – rarely – to those who meet the criteria. Can openers and adaptive grips are the most common items granted. “Most people can be helped with very basic, simple tools,” Lee said. One example: an adjustable plastic stand, shaped like a “V,” with clips at the top and a suction cup on the bottom. It can hold open a plastic zip bag while it is being filled, enabling clients to pour with both hands, cutting down on the spills that require them to bend over and clean.
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“Spills are associated with falls,” Lee said, “And fall prevention is a key to keeping people out of the hospital and living independently.” One of this year’s recipients received a fluorescent, reflective rain jacket and reflective cane to become more visible while walking and taking the bus to Humboldt Senior Resource Center’s congregate meal program. Another received a solar shower to make hot water for cooking and cleaning in an outdoor kitchen that had no plumbing. Thirty-eight people participated in the program last year. Three-quarters had arthritis in the hands, 63 percent had a weak grip and 21 percent had difficulty maintaining balance while standing. “Some had stopped eating or cooking in certain ways,” Lee said. “The devices gave them more choices in preparing healthy meals.” A1AA staff is two-thirds of the way toward its goal of reaching 75 people by the time the grant ends on March 31. From now through March, Lee said A1AA will continue to work with Food for People’s pantries to reach out to people in pockets of poverty in geographically isolated areas like Hoopa and Orick. Those seeking assistance should call A1AA at 442-3763. An A1AA staffer will provide CalFresh application assistance, a food security assessment and an assistive device assessment “to start figuring out how to reduce or remove barriers to good nutrition,” Lee said. A1AA and the Humboldt County Department of Health and Human Services partnered in 2012 to raise awareness, improve access and alter attitudes around CalFresh, the state name for the federally funded Supplemental Nutrition Assistance Program (SNAP). The assistive device grant is funded by DHHS through CalFresh.
Free Stanford Course For Caregivers
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f there’s one New Year’s resolution caregivers should make, it’s to take better care of themselves. To make that resolution a reality, consider enrolling in the free Building Better Caregivers workshop and research study designed by Stanford University. “It’s very empowering for caregivers,” said Frae Wittwer, a Loleta resident who enrolled in the fall BBC course. “We all know we need to exercise, stretch, watch our diet and do all sorts of simple things to say healthy. But when we are pushed for time, stressed and tired, they become impossible to do.” The course changed that for Wittwer, who has finally carved out time to pursue the guitar lessons she’s always wanted. Small steps, reasonable goals, and group support helped her broaden her focus beyond her husband. “If I don’t take care of myself, then he’s up a creek, too,” she said. By the end of March, she will be one of 250 volunteers from Los Angeles, San Jose, Sacramento and Humboldt County helping chronic disease self-management expert Dr. Kate Lorig fine-tune the 15.5 hour, six-week workshop
she developed at Stanford. Three more North Coast workshops of 10 to 15 people begin this month, starting with a Jan. 10-Feb. 14 program set for 1:30 to 4 p.m. on Saturdays in Fortuna. A McKinleyville workshop runs on Tuesdays, from 1 to 3:30 p.m., Jan. 27 through March 3. A Eureka workshop is slated for Thursdays from 1 to 3:30 p.m., Jan. 29 through March 5. Anyone 18 years and older who is a caregiver for a family member or friend with cognitive impairment such as Alzheimer’s or other dementia, traumatic brain injury, Parkinson’s, post-traumatic stress disorder, stroke, or other diagnosed memory impairment may participate in the workshop. To learn more and register for one of the Building Better Caregiver workshops, call Aligning Forces Humboldt at 707-445-2806, ext. 4.
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Free Caregiver Training Series Starts Jan. 8
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at Dillman was a nurse’s aide some 35 years ago, but that didn’t prepare her for the caregiving demands she faced last year. For that, she turned to the free Caregiver Training Series offered by Area 1 Agency on Aging. “I was tickled to go and couldn’t learn enough,” the Bayside resident said. “Even when my husband started doing better and could take care of himself, I kept going. What if it happens again?” It wasn’t supposed to happen the first time. Her husband entered the hospital for a “simple” procedure, she said. After 7.5 hours in surgery and another week in the ICU, he came home to recover. She was the one-woman recovery crew. “All of a sudden, there were all these things to know,” she said “Some of it I had learned before as a nurse’s aide, but it wasn’t what they are doing now. They have better ways, and new tools to help. Who knew there were tools to put on socks if you can’t bend over, or compression socks with zippers?” Dillman said the class not only gave her the “big picture, but all the details, right down to how to fold sheets so it would be easier to make a bed with someone in it.” She’s taken three parts of the four-part series and is committed to finishing the final segment this year. “I want this information, just in case,” she said. “It’s like buying insurance. If you don’t have it, you sure are going to need it one day.” Area 1 Agency on Aging introduced the Caregiver Training Series in fall 2013 to improve the quality of care and family caregiver competency while at the same time reducing the level of stress among caregivers. “The constant responsibility, the lack of knowledge regarding community resources and the lack
of adequate training all contribute to frustration and stress among family caregivers, many of whom are often unprepared for what is being asked of them,” said Jeanie Ren, Manager of Information and Assistance and Caregiver Services at A1AA. “Stress threatens the health of the caregiver and, when mixed with other family dynamics, can sometimes lead to unintended abuse or neglect of the person who needs the care.” Dillman is one of 32 people to have taken the course at some point in its first 16 months of availability. She began the 32-hour, four series course last summer. Each part of the series consists of four, two-hour classes, which are offered on consecutive Thursdays. A one- to two-week break separates most of the series parts. The next full series starts Jan. 8 in Fortuna from 6 to 8 p.m. Space is limited and pre-registration required at 442-3763. Respite assistance is available to help participants attend the class. The class is taught by professionals to adult family and unpaid caregivers living in Humboldt or Del Norte counties. Participants must be caring for a person who is 60 years of age or older or has a neurological brain dysfunction such as dementia. Ren said caregiver support and stress management are a part of every series, but each series also has different focus areas. Series 1 will cover family caregiver support and stress management; communication skills and community resources; basic safety issues; and special challenges in family and informal caregiving. Course dates for parts two through four in the upcoming Fortuna Caregiver Training Series are: February 19 - March 12, April 2-23, and May 14 June 4.
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Series 2 covers normal aging, vital signs, chronic illness, dementia, changing habits, infection control, public health issues, mobility safety, ambulation, transfers and falls. Series 3 covers personal care and mobility with an emphasis on skin care; bathing techniques; bowel, bladder and wound care; dressing and undressing, bed mobility and making an occupied bed. Series 4 focuses on nutrition, medications and resources for getting affairs in order, emergency preparedness, abuse and neglect. Classes include presentations, educational videos, discussion and hands-on skill-building for performing transfers, caring for someone on bed rest and more.
Gray Matters is a quarterly publication of the Area 1 Agency on Aging. Maggie Kraft, Executive Director • mkraft@a1aa.org Carol Harrison, Editor • cah5@humboldt.edu A1AA is located at 434 Seventh Street in Eureka, 95501, across the street from Eureka Inn. Phone: 707-442-3763 Gray Matters is designed by graphic artist Amy Barnes of the NCJ and is posted on the NCJ website at www.northcoastjournal.com
The next edition of Gray Matters is Thursday, April 2, 2015.
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