Working with Seniors: Health, Financial, and Social Issues
Chapter 9: Home and Community-Based Services
In 1984 Dotty Strum, age 72, fell while getting out of the shower and broke her hip. The surgery to pin her hip back together went well, but her recovery was complicated by diabetes. After Dotty left the hospital, she moved to the home of her daughter, Brenda Jones, so Brenda and her own daughters could care for her full time. This meant that Brenda’s 26-year-old daughter had to give up her bedroom and move into her teenage sister’s room. After a couple of months, living in close quarters became unbearable for the Jones family, and with great reluctance, Brenda moved Dotty to a nursing home, where she died six months later.
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In 2003 Brenda, by then 73, fell while carrying groceries into the kitchen and shattered her hip. Her surgery went well, but, like her mother, her recovery was complicated by diabetes. Brenda’s rehabilitation, however, has been quite different than her mother’s was almost 20 years earlier.
Because she had access to services based in her community, Brenda was able to remain in her own home where an aide, Dana, came every day and helped her around the house, ran errands, and prepared meals. She also had help from a physical therapist who came twice a week for several weeks. When Brenda needed to visit her doctor, Linda, a person known as a friendly visitor, came and picked her up, accompanied her to the doctor’s office and the pharmacy to purchase prescriptions, and then drove her back home. And, because of the emergency response system that her daughters had installed in her home, she was comfortable staying alone at night.
Now recovered, Brenda still receives assistance from Dana and has become good friends with Linda, who stops in to see her regularly.
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Cheryl’s fiercely independent and elderly aunt, Jan Tompkins, is widowed and lives alone in a rural area in upper New York state, 350 miles away from Cheryl’s home in Virginia. Cheryl is the only family member Jan has. Jan was a lifetime smoker, and emphysema is now slowly robbing her of her ability to breathe. Cheryl does not know what type of care her aunt needs or where to look for help. She is afraid that she will have to arrange for her to go into a nursing home to be watched over 24 hours a day, seven days a week. Such a move would be very hard on Jan.
Luckily, one of Cheryl’s coworkers had a similar experience with her elderly mother, who lived several states away. She suggested she get in touch with the Area Agency on Aging closest to Jan’s home. Cheryl called the Tompkins County Office for the Aging, which put her in touch with a geriatric care manager.
The manager assessed Jan’s situation and arranged for the appropriate home health care services. He also calls Cheryl once a week and gives her an update on how her aunt is doing. For now, Jan can remain in her home, and Cheryl has the peace of mind of knowing that her aunt is being cared for and a professional is watching over her.
Introduction
In the 1970s and 1980s social policy makers in the United States became aware that the long-term care system needed far-reaching change to effectively serve the needs of the burgeoning senior population. The system was fragmented and limited. Often the only available option for seniors like Dotty Strum and Jan Tompkins was entering a nursing home. Since that time services that enable seniors to remain independent in the housing of their choice have flourished across the country.
Home and community-based services (HCBS) are popular in the field of aging because they exemplify a social policy away from nursing homes and toward independent living and consumer control. Many communities now have an impressive continuum of long-term supportive services available for seniors. The goal of these programs is to help people with physical limitations live outside of institutions and in their own homes. Some community programs have developed as the result of government funding. Many are run by not-for-profits, others are businesses. Some are free, others are available only to seniors who meet certain qualifications, and others require payment. Such programs fall under the umbrella terms of home and community-based services or long-term supportive services. This chapter will use the two terms interchangeably.
It is important for you to be aware of the long-term supportive services offered in your community so that you can refer your clients to them if and when the need arises. Armed with this knowledge, you can be instrumental in keeping your clients out of nursing homes.
Independent living is not doing things by yourself. It is being in control of how things are done.—Judith E. Heuman, as quoted in Beyond 50.03 (AARP, 2003, p. 6)