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  • Cathie Rowand | The Journal Gazette Sunny Helstrom, left, talks with in-home caregiver Jen Cleveland of Home Instead Senior Care. Efforts to keep older residents in their home are among the challenges of elderly-care policy.

Sunday, September 03, 2017 1:00 am

Long-term solution: Area workers face challenges of care for growing elderly population

TIM HARMON | The Journal Gazette

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Aging and In-Home Services of Northeast Indiana offers assistance in Allen, LaGrange, Steuben, Noble, DeKalb, Whitley, Huntington, Wells and Adams counties.

The agency can be reached at 260-745-1200 or 800-552-3662. Its website is www.agingihs.org.

Or call the United Way of Allen County's 211 hotline.

We are getting older, making long-term care an even bigger public-policy challenge for a state already way behind the curve.

“By 2040,” says Zach Benedict , Fort Wayne architect and Aging and In-Home Services of Northeast Indiana board member, “the state population grows by 15 percent (but) 65-and-over grows by 90 percent.” In rural communities, he said, that age group is likely to grow by 130 percent.

“About a third of our population is going to be 65 or older,” Benedict said. It's a national phenomenon, only partly explicable by baby boomers reaching retirement age. The challenge of providing for this rapidly expanding demographic may be particularly acute in Indiana. For one thing, there's the brain drain, which robs the state of many of its most promising residents at the same time the senior citizen population is booming.

Then, there's a recently released national scorecard on long-term services and support, a crucial aspect of senior life, in which Indiana ranked dead last – 51st among the states and the District of Columbia. The study, which measures state resources for the long-term care of older adults and people with disabilities and for their caregivers, has been issued every three years since 2011 by the AARP Foundation, the Commonwealth Fund and the SCAN Foundation.

Indiana's bottom-of-the-basement rating is unlikely a fluke. In the previous two AARP scorecards, Indiana ranked 47th. A state-by-state review of senior care and quality of life by healthcare.com this year ranked Indiana 49th.

Some say the AARP survey doesn't give enough weight to progress the state has made in recent years. And leaders of Aging and In-Home Services say those rankings apply more to funding of programs by the state than to the work local aging agencies do.

But if there is a revolution in long-term care at hand, the leaders of Aging and In-Home Services want to be on the front lines.

Decades of service

Based in Fort Wayne and serving nine counties, Aging and In-Home Services is part of a national network created in the 1970s as an outgrowth to the Older American Act, a piece of President Lyndon Johnson's “Great Society”  package in the 1960s. The law's purpose was to offer support services to help senior citizens stay in their homes and function in their communities.

The local agency also serves others with a long-term-related need, said Connie Benton Wolfe, Aging and In-Home Services' president and CEO. “Forty percent of our clients are people under 65 who have long-term services support needs,” she said – people with disabilities, family caregivers, veterans and others having trouble meeting their needs at home. 

That may involve delivering Meals on Wheels, helping with transportation to an appointment, facilitating medical or legal assistance, or seeing that hazards in homes are removed.

Benton Wolfe wants the state to work with in-home and institutional caregivers and health care institutions to further a more holistic approach to wellness and care for seniors. An integrated medical, behavioral and social care approach could help answer the growing concern about Medicaid costs as well as offering better outcomes for patients.

“The cost savings for this country that could be achieved by deploying the asset that is the area agency on aging network is huge,” she said. “They have nothing in their arsenal that would begin to drive down healthcare costs like ... letting us do what we have spent 40 years learning how to do.

“It's all of the things that are non-medical that make a difference in your healthcare,” Benton Wolfe argues.

“If you're worried about how you're going to pay your rent, or about where you're going to live, or if you have food insecurity, or if you can't afford your medications, or you don't understand how you're supposed to take them, or if you can't get in to see a primary-care doc or you don't have a primary care doc – all of those things, those are the drivers of health care costs.”

More can be done

During a discussion at the agency's headquarters on Lake Avenue recently, Benedict, Benton Wolfe, Senior Vice President, Resources & Advancement Mary Wiemann and board President Keith Huffman talked about some of the strategies that can make a positive difference in their clients' lives.

Huffman would like to see the state more effectively promote reimbursements to patients who hire non-professionals to care for them at home. “That's where you can choose who is going to provide services in your home,” Huffman said. In other states, he said, such self-directed attendant care programs are used by as many as 30,000 families. But only about 400 families take advantage of Indiana's plan.

Under the standard Medicaid waiver program, agencies hire people to come to clients' homes to help them with basic needs. “If you can hire a family member, or you can hire the neighbor, they're going to be like $9 or $10 an hour. An agency's like $20 an hour.” Huffman said. “So, for the same dollars you can get more care at home, and it's much more likely that somebody who's 85 would want to have a neighbor or child or grandchild help them out, instead of somebody you don't know.”

Benedict, of MKM architecture and design, said the local agency is good at envisioning “what things should change to engage people on their own terms.”

For instance, Aging and In-Home Services has a variation of Meals on Wheels. “We put food in a van and we drive it to people,” Benedict said. “Another way to go about that and get the same result is ... where you work with a local restaurateur and hand out vouchers. They, as independent, engaged, citizens, can go and get their nutrition on their own terms – and, I would argue, with a little more dignity and purpose in their lives – and while, at the same time, supporting local businesses.” That program won an award from the national organization for area agencies.

As an architect, Benedict has focused on creating livable communities. Most health problems, he said, are related to where and how we live. When people have less access to such basics as social interaction, nutritious food and regular health care, the result may be increases in chronic conditions and diseases: obesity, heart disease, depression, teen-age suicide, opioid addiction.

Of those 65 and older, Benedict says, fewer than 5 percent – most of them affluent – live in housing that fully meets the needs of their age group.

Using funds from the Indiana CHOICE program, Aging and In-Home Services can make simple and inexpensive adjustments to  homes that make them safe for seniors – such as adding safety railings in a bathroom or moving a washer and dryer from the basement to the first floor.

“A lot of these services are reaction to deficient community design,” Benedict said, and those must ultimately be addressed by city and town planners. But he sees Aging and In-Home Services' efforts as part of the effort “to engage people on their own terms.” He looks at Benton Wolfe. “She's trying to fix problems that we've created for ourselves, in the way we've built our communities.”

Benton Wolfe acknowledges the stigma AARP's 51st ranking places on the state, but seems confident agencies like hers can help the state catch up with and even surpass other states on long-term care.

“The scorecard paints this picture of Indiana,” she said. “It's not where any of us wants to be.”

Tim Harmon is an editorial writer at The Journal Gazette