Alexian Brothers Live At Home and Alexian Brothers Choices Programs Featured Catholic Health World Magazine

"Seniors want to live at home," said Linda Paulson, director of business development and interim director for Live at Home and Choices at Home in Chattanooga, Tenn., for Alexian Brothers Senior Ministries. Both programs are part of a continuum of Alexian services that help older people to remain independent.

The aging-in-place service market is expected to grow about 50 percent over the next 10 years, said Richard Williams, a program coordinator with Alexian's Choices at Home program. "This is a burgeoning industry, with more agencies opening every year," he said.

There are virtually as many approaches to helping seniors age in place as there are providers entering the space.

Cafeteria-style service offerings
With Alexian's Live at Home program, seniors can prepay out of pocket for the bundle of services that they want. Alexian staff assists elders with grooming, dressing, bathing, meal preparation and household chores, for instance. Staff also provides companionship. Live at Home's three pricing tiers cover most or all of these types of services. The two higher-priced tiers also cover all or part of adult day services, and provide assisted living and skilled nursing care discounts, if those placements become necessary.

"The glue that kind of binds (the services) together is to have an effective care management program — care managers who understand the needs of the older adult population," said Paulson.

Cutting through the clutter
Senior Promise, a nonprofit program at St. Francis Hospital and Health Centers in Beech Grove, Ind., charges members $15 per person, per year, or a lifetime membership cost of up to $100 to get assistance with figuring out hospital bills, insurance options, prescription drug discount programs and service discounts.

"We are an information source for seniors in our local community," explained Jim Poole, director of Senior Promise and of St. Francis Insurance Services. "When a person becomes eligible for Medicare, he or she is bombarded with offers for products and services, and this can cause much anxiety."

St. Francis helps the seniors to understand the offerings. The team members also point seniors in the right direction for assistance with financial planning, meals, home maintenance and the like.

St. Francis Healthcare System of Hawaii in Honolulu charges individuals $600 and couples $900 annually for its "Stay Healthy at Home" service. A participant receives a medication review, home safety evaluation and financial counseling, among other benefits. The service also provides referrals for help with tasks including housework, yard work, meal planning and errands.

Stay Healthy at Home administrators said that with support people can avoid premature or unnecessary moves into institutional care settings.

Home maintenance simplified
Provena Health facilities in Vermilion County, Ill. and in Danville, Ill., dispatch volunteers from a group called Faith in Action to assist seniors in declining health. The volunteers are trained by Faith in Action. They do household and yard chores, build wheelchair ramps, provide transportation, and the like.

Currently, the Vermilion county contingent of 90 volunteers serves 110 seniors, while 140 volunteers in Danville assist 115 people.

SMDC Health System of Duluth, Minn., got buy-in from three health maintenance organizations on Minnesota Senior Health Options. Through the program, SMDC staff performs an extensive evaluation of a senior in his or her home to determine what mix of services might enable the person to remain safely at home.

What services are offered? "You name it," said Dr. Michael Van Scoy, the medical director of SMDC's Elder Care program. There is nutrition support, transportation, appointment scheduling and coordination, help with eyewear, home safety evaluations — "whatever we feel would help the patient to live independently," he said.

Van Scoy said the program addresses a problem that is endemic to today's senior care system. "Fee-for-service sort of promotes a passive neglect of elders, meaning that the payment comes when something bad happens with elders, and that really works to the disadvantage of the elder."

In the past, SMDC clinicians burned time and money when they would help coordinate such services without reimbursement. But when the three major health maintenance organizations recognized the value of care coordination and the resultant cost savings, they got behind the approach by reimbursing for the services.

SMDC also offers memory assessment and a program that helps appropriate hospital patients to transition to home so that they do not have to go to nursing homes.

Countering isolation
Recognizing that the social needs of elders are part of the aging-in-place picture, St. Joseph Hospital in Bellingham, Wash., established a day center at its campus in 1978. The program enables seniors to interact with their peers while enjoying meals together, exercising, stretching, doing crafts, playing bingo and taking field trips.

Not all seniors immediately warm to the prospect of adult day care. "Engaging with seniors initially can be challenging," noted the program's manager Erika Stanley. "If somebody has started to have a physical health issue that makes it harder for them to get around, or if they're starting to have memory issues that make it harder for them to feel like they can connect with people, often they will tend to try to isolate."

While it may be difficult to break through the resistance of some elders, once they experience the program about 90 percent come back, said Stanley.

Santiago Anglada Palleja, an 83-year-old with dementia, has been in the day program for about two years. His wife, Susan Radonski-Anglada, said, "He has a lot of social interaction, he began painting again — he is an artist — and he is able to remain living at home."

Radonski-Anglada works full-time. She said that without the day program, her husband would not be able to live at home.

Riverview Place in Fargo, N.D., adapted the aging-in-place concept to its continuum of care campus. Seniors can purchase "a la carte" supportive services that include massage therapy, exercise programs and transportation.

The campus offers some services so seniors can remain in their apartments even as their needs escalate. In the past, "when we moved residents within our complex, they left their neighbors, they left their apartment that was chosen when they were independent, and it took a negative toll on their body, mind and spirit," explained Bonnie Peters, a marketing and resident relations representative with Riverview Place. "Everyone that left was distraught by the move.

"Keeping residents in their homes … gives our seniors something to look forward to each day," said Peters. "There is less time to concentrate on illness and a better part of the day is filled with a community spirit."

Julie Minda, Catholic Health World, Nov. 15, 2009, Volume 25, Number 20