August
Sub-archives
Aug 17, 2009
Interview with Diane M. Stobnicke, Volunteers of America Division Director
Interview with Diane M. Stobnicke, Volunteers of America Division Director, Northern Colorado Services for five years provides information on current volunteer services for Larimer County seniors, as well as future needs. Ms. Stobnicke has a Master of Public Administration degree and almost 40 years of experience in human services programs, nine of which are with Volunteers of America. She is responsible for the administration of the division, which includes seven different programs for seniors and 12 staff members.
Volunteers of America provides services to the most vulnerable individuals in the community. In Larimer County, services are focused on elderly adults to support them in remaining self-sufficient for as long as possible. Services include home-delivered meals, congregate meals, grocery-shopping services, commodities delivery, handyman services, respite services for family caregivers, and volunteer opportunities.
In terms of your area of service, what would you say are the most critical needs of seniors in our community?
Seniors need access to an array of affordable services that allow them to remain in their home. These services include food, housecleaning, building repairs, companionship, case management, etc. In addition, seniors need affordable public transportation.
Of those needs (or others), are there aging issues for which there is little (or no) adequate means of support?
Affordable case management would benefit many seniors by helping them navigate through all the support services opportunities. Often seniors do not access existing services because they either do not know about them or are unsure or unable to contact them.
There also seems to be very little support for "odd" jobs seniors need completed, such as moving appliances, painting, roof repair, and others.
What is your perception of how these needs now affect our community at large?
I am not sure the community at large is aware of the needs of our low-income elders.
What are your thoughts about the potential impact of seniors’ growing needs in five to ten years?
If we do not provide the simple services needed to keep our elders healthy and in their homes, then we will be paying the higher costs of institutionalization down the road.
What approaches/solutions have been tried in attempting to deal with these needs?
We do our best in assisting our Meals on Wheels clients to find necessary services, but we do not do full case management. We provide as much handyman support as we can afford, but it is limited to safety issues.
Which approaches/solutions have succeeded, and why?
We have found that the more one-on-one time we can give to an elder, the better the results.
Which approaches/solutions have failed, and why?
Just providing reading material does not change behavior. For example, we can provide information on how to prevent slips, trips, and falls, but unless we review it with the senior and help her or him address hazards, then very little change occurs.
What steps can community members take to help with solutions to current and potential unmet needs of the elderly?
Take an interest in seniors and value their contribution to the community.
Raise community awareness, so that when we fundraise we are likely to generate more donations.
Volunteer to provide some of these services.
What steps can community leaders/business leaders take to help?
Community and business leaders can take the same steps recommended for community members.
Interview with Valerie DiBenedetto, Fort Collins Meals on Wheels
In this interview, Valerie DiBenedetto, Fort Collins Meals on Wheels Executive Director for almost five years, discusses Larimer County seniors’ nutrition and social needs. Ms. DiBenedetto, who has a bachelor’s degree in human development and family studies and a master’s degree in gerontology, also addresses ways of meeting these needs—both now and in the future.
Fort Collins Meals on Wheels provides home-delivered meals, social contact, and a well-being check on each delivery day to homebound residents in the Fort Collins area; meals are delivered five days a week. Larimer County residents are eligible to receive the meals if they are homebound and unable to prepare nutritious meals for themselves, and therefore have a deficient diet.
In terms of your area of service, what would you say are the most critical needs of seniors in our community?
I believe that in the area of meeting nutritional needs of homebound seniors, there is possibly the need for seniors to have weekend home-delivered meal options. It is always a question we are asked, both by our recipients and the community at large. I also believe that a critical need is that a service, such as ours, must remain affordable to all who need it.
Of those needs (or others), are there aging issues for which there is little (or no) adequate means of support?
I truly believe that there is huge need in our community for more transportation options for our most frail elders. There are some of our elders who would still want to get out to activities if transportation could be more available and easier to use. It is difficult for an 85-year-old to be on Dial-A-Ride bus for two hours, as stops are made. I believe that more transportation, such as that offered by Senior Alternatives IN Transportation (SAINT), could help.
Do you have any examples of these "unmet needs" (e.g., a brief anecdote or story about an elderly person)?
I am very concerned that in the area of nutrition (i.e., daily delivered meals) that my clients may decrease the number of deliveries/a week to limit the cost—but they really need them all five days of the week. They will often not admit that decreasing their meals and/or completely stopping them is due to cost—they are too proud to tell us that.
What is your perception of how these needs now affect our community at large?
I hate to start off with “in these difficult economic times,” but the truth is that everyone is impacted when elders need more assistance to live independently. I believe that, on the whole, families are there to support their elders and will do whatever they can to help. But I recently had a family member who was paying for her father’s meals and had to stop because of her change in employment status; now her father struggles with the cost. We still have him on meals, but he struggles. We will do our best to continue meals, but that translates into our finding more funds to subsidize more than usual. Again, the need for weekend meals could become more important if the working adults caring for elders need to work additional jobs to make ends meet. We shall see.
What are your thoughts about the potential impact of seniors’ growing needs in five to ten years?
We all know about the “tsunami” of the baby boomers becoming elderly. When the largest number of baby boomers are between 75 and 85, I believe a service like ours will be most impacted. The first baby boomers will reach 75 in 2021. I hope the prediction that many baby boomers are healthier will translate into a later date that the number we will be serving will really “boom.” Right now, we serve about 150 meals a day—I expect that number will start increasing slowly over the next five to ten years but will approach 200 during that time period—at least.
What approaches/solutions have been tried in attempting to deal with these needs?
If/when the demands on our service increase, we will have to work closely with our partner, Poudre Valley Hospital (PVH), to see what their maximum will be for the number of meals they can prepare. If we reach their maximum, another vendor would need to be found. If the demand for weekend meals increases, and we, as an agency, decide to try to meet that need, we would have to look at PVH to provide these or another vendor, plus we would be looking at recruiting a whole new volunteer base for weekend volunteering.
Which approaches/solutions have succeeded, and why?
I do know that other Meals on Wheels programs have added frozen meals to their Friday deliveries or an additional “lunch.” I have also found some programs that provide breakfasts, delivered at the same time as the lunch meal—to be eaten the next morning.
Which approaches/solutions have failed, and why?
I have no knowledge of failed approaches. I hope to gain more information in this area in the future—if/when I start looking at different ideas.
What steps can the community take to help with solutions to current and potential unmet needs of the elderly?
I do believe that in working with seniors, the challenge is not in reaching the active, younger seniors, but in reaching the homebound, most elderly, most frail community members. We need to find a way to reach them, talk to them, find out their needs.
What steps can business leaders take to help?
Reaching these frail, very elderly people is something that needs to happen, and maybe the business community can be a “pipeline” of information giving and gathering, both to and from the older seniors they serve.
Do you have any other comments, observations, or key messages you wish to communicate to members of the public, government representatives and employees, and business leaders of Larimer County?
My heart is in making sure that the most elderly residents of our communities are able to live out their lives with dignity in the living situation that ensures their safety and optimal health. This living situation also has to ensure their quality of life. Preventing the isolation that causes depression is key. If our elders want to “age in place,” I want them to be able to do that. I believe that our community has what it takes to make this happen, now and into the future. Most important is the fact that we can’t do it without talking to those we are trying to help.
Aug 02, 2009
More health care providers needed for the elderly
The good news is that Americans in general are living longer—there are eight times as many people over age 65 and 21 times as many over age 85 as there were in 19001—and various surveys indicate that, overall, disability declined in the elderly from 1982 to 1996.2 The bad news is that a potential health care shortage could leave millions of seniors without health care in the coming three decades, just as the number of elderly baby boomers swells.3
Robert F. Schoeni et al. reported their findings on declining disability in The Journals of Gerontology. The findings were based on data from 124,949 participants aged 70 or older in the 1982-1996 National Health Interview Surveys. The researchers pointed out that the prevalence of disability declined over that time. However, gains did not persist over the whole period or accelerate with time. In addition, only “routine care” disability, not more severe disability, decreased. They also point out that gains were among seniors with higher levels of education. They reported that exploring causes for improvements should be a priority in other research into seniors’ disability.2
This does seem an important first step in determining how to ensure optimal health for the growing population of elderly people: the number of people over 65 is projected to almost double in the United States by 2030. At the same time, too few physicians, nurses, nurses’ aides, and home health care workers are being trained; in fact, a recent Institute of Medicine report states there are only about 7,000 physicians specializing in geriatrics in the country. The report recommends tripling the number of health care workers capable of caring for the elderly by 2030—a challenge as the average internist with specialized training in caring for the elderly earns less than the average general internist.3
Home health care workers are also a key group, according to Larimer county residents who participated in a recent survey on aging needs by the Foundation on Aging for Larimer County. Although health professionals’ acceptance of Medicare coverage was seniors’ top concern (cited by 26%), home health care came a close second (25%).
Participate in the discussion about Health Care in Larimer County.
References
1. Smith GP II. Allocating health care resources to the elderly. I. Limitations on elderly access to medical care. Elder Law Review, Annual; 2002 [cited 2009 Jul 27]. Available from: http://findarticles.com/p/articles_6995/is_1/ai_n28132649/
2. Schoeni RF, Freedman VA, Wallace RB. Persistent, consistent, widespread, and robust? Another look at recent trends in old-age disability. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 2001;56:S206-18.
3. Zwilich T. Crisis ahead for elderly health care? Seniors could be strapped for health care as demand increases and workforce dwindles, experts warn. Medicare Health Center. WebMD 2008 Apr 14 [cited 2009 Jul 27]. Available from: http://www.webmd.com/medicare/news/20080414/crisis-ahead-for-elderly-health-care
Universal design and more accessible housing for seniors
As the population ages, a lack of accessible housing could become an increasing problem. In a study of accessible housing design published in the journal Housing and Society, researchers Jean Memken and Nichole Earley point out that the growing elderly population means more adaptable, accessible, and safe family housing is needed in all parts of the country. The authors point out that this approach would permit people to age in place, because houses would have features such as accessible entrances and ramps, grab bars and walk-in showers in bathrooms, and a single-level design.1
Unfortunately, in more than 75% of cities examined, less than 1% of accessible single-family housing was available for sale. The shortage existed across the nation, although slightly more (2%) accessible housing was available in the Northeast. The authors suggest evaluating the role that advocacy groups can play in increasing accessible housing options.1
Another research group’s work highlights the importance of universal design and accessibility for seniors’ homes. Frank Oswald and colleagues examined ENABLE-AGE Project home interview data from 1,918 people who were between the ages of 75 and 89 and lived alone in their own homes in Sweden, Germany, the United Kingdom, Hungary, or Latvia. The researchers report in The Gerontologist that these people had a greater sense of well-being and were more independent in their daily activities if they lived in more accessible homes, perceived their homes as useful and meaningful, and did not believe that external influences were responsible for their housing situation. The authors therefore recommend that seniors be consulted to determine their personal preferences for home modification or relocation.2
Similarly, in a cross-sectional study of elderly people reported in The Journals of Gerontology, Gary W. Evans and colleagues found that housing quality is associated with psychological well-being in elderly people living independently in the community. Higher-quality homes led to greater feelings of attachment to home.3
Finally, any options selected to ensure accessible, high-quality housing for seniors must also be affordable. The recent Foundation on Aging for Larimer County Aging Needs Survey revealed that Larimer county seniors’ largest housing concern is affordable services enabling them to continue living at home. Fifty-one percent of those who completed the survey indicated that this was a concern for them.
Participate in the discussion about Housing in Larimer County.
References
1. Memken J, Earley N. Accessible housing availability for the growing U.S. elderly population. Housing and Society 2007;34(1):101-15.
2. Oswald F, Wahl H-W, Schilling O, Nygren C, Fänge A, Sixsmith A, et al. Relationships between housing and healthy aging in very old age. The Gerontologist 2007;47:96-107.
3. Evans GW, Kantrowitz E, Eshelman P. Housing quality and psychological well-being among the elderly population. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 2002;57:P381-3.
Elderly people’s risk for poverty and economic vulnerability
Millions of elderly people live below or barely above the poverty line. About 3.4 million of those over age 65 live in poverty (considered to be below an income of $9,669 for one person and $12,186 for a couple in 2006). Meanwhile, 22.4% have a family income below 150% of the poverty line. In an article for the Center for American Progress, Alexandra Cawthorne stresses that seniors’ economic security (or lack of it) will become increasingly important as growing numbers of the 75 million baby boomers enter the senior years.1
Cawthorne adds that the elderly poverty rate would be higher if the measure of poverty were more precise. The burden of rising health care costs with age, for instance, is not taken into consideration in defining poverty. Such costs are worrisome to seniors: in the recent Foundation on Aging for Larimer County Aging Needs Survey, 52% of participants cited health care costs as a concern. This is hardly surprising, as these costs can reduce seniors’ disposable income for other expenses, such as energy and food bills.1 In addition, some groups of elderly people are at greater risk than others: seniors from ethnic minorities represent 70% of the poor economically vulnerable (those with limited incomes that are not low enough for means-tested assistance programs).2 Likewise, women who are 75 or older are three times more likely to be poor than are men of the same age (1.3 million women compared with 416,000 men).1
Finding solutions to assist the poor and economically vulnerable elderly is crucial for a variety of reasons, including evidence of a strong association between illness, death, and income. Studies reveal that people with lower incomes die earlier, have more mental health conditions, more chronic health problems, more functional limitations, and worse health overall. In a National Poverty Center paper, authors Pamela Herd, James House, and Robert F. Schoeni conclude that difficulty meeting needs such as adequate nutrition and a healthy environment, an inability to afford basic requirements such as housing and food, and a lack of health insurance and health care all contribute to worse health in poor people.3
Participate in the discussion about Economic Security in Larimer County.
References
1. Cawthorne A. Elderly poverty: the challenge before us. Center for American Progress; 2008 Jul 30 [cited 2009 Jul 28]. Available from: http://www.americanprogress.org/issues/2008/07/elderly_poverty.html
2. Faruque CJ. The economically vulnerable elderly American. Selfhelp Magazine; 2009 [cited 2009 Jul 28]. Available from: http://www.selfhelpmagazine.com/article/elderly-poor
3. Herd P, House J, Schoeni RF. Income support policies and health among the elderly. Conference on Health Effects of Nonhealth Policies. Washington: National Poverty Center; 2006. National Poverty Center Working Paper Series #06-27.
Ensuring that supportive services meet seniors’ needs
According to a recent Foundation on Aging for Larimer County survey, home care services are an important concern for seniors. In the category of support services, the largest percentage of respondents (29%) stated that home care services were a concern for them.
However, careful, individualized assessment of elderly people’s needs is required before home care services or assistive devices can be provided effectively. Authors William Weissert and colleagues explain in a Journal of Aging and Health article that currently there are several potential problems with home care services, including unclear goals and a lack of information about their effectiveness. The authors recommend clarifying goals and improved selection of clients who can benefit from such care.1
In addition, addressing a shortage of home care workers is necessary, say Clinics in Geriatric Medicine authors Robyn Stone and Robert Newcomer. They recommend the involvement of the private sector, federal government, and state governments in meeting current and future needs for a larger and stronger workforce of paid personal assistant service workers in the community.2
Assistive technology is another area of support for which an elderly person’s specific needs must be assessed appropriately, according to another Clinics in Geriatric Medicine article. Physicians Kenneth Brummel-Smith and Mariana Dangiolo believe effective assessment focuses on a senior’s specific requirements and motivation for using assistive technologies, including personal computers for information and support, devices for activities of daily living and mobility, and tools for managing the home and ensuring personal safety.3
Participate in the discussion about Support Services in Larimer County.
References
1. Weissert W, Chernew M, Hirth R. Titrating versus targeting home care services to frail elderly clients. Journal of Aging and Health 2003;15(1):99-123.
2. Stone R, Newcomer R. Advances and issues in personal care. Clinics in Geriatric Medicine 2009;25(1):35-45.
3. Brummel-Smith K, Dangiolo M. Assistive technologies in the home. Clinics in Geriatric Medicine 2009;25(1):61-77.
