Aging Maven

Rising again

2009-01-27T08:46:00.003-06:00

It's been a long time since I've visited here. The process of metamorphosis can wrestle your attention in different directions. This year, I've moved (or been moved) out of the roles of daughter, mother-with-kids-still-home, and employee.

So I'm shapshifting, and shifting this blog too.

I'll get less fuzzy later. But I'd like to talk about what provoked me to return: none other than the sort of appalling TV series True Beauty. In this Ashton Kucher/Tyra Banks creation, a group of stupendously vain and stupid beautiful people are subjected to various situations that give them ample opportunity to show their lack of "true," aka "inner," beauty. The gimmick is that they don't know they're being judged on kindness and decency as well as flesh tone and attitude.

One of the three judges who most of us recognize is Cheryl Tiegs. Still slender and pretty, if a little stiff, she stands a bit like a deer in headlights most of the time. But it's nice to have a clue about one of the characters.

No excuses for watching the show: let's just call it morbid fascination.

But last night (January 26) provoked my return here. The household of "beautiful" people were sent to pose with Old People. As they were shown their own faces aged by a computer program, they all expressed disgust. And when they saw their older model-partners, they howled with unkind laughter.

Sort of like people at a zoo watching the bonobos.

I'd never realized how shocking it is that there are still some groups people feel free to revile. Fat people, old people, homeless people, crazy people.

Until I became one of those, that is.

The format of the show is that some models, usually the last ones you'd expect, show better behavior than you'd predict. In this case, most were courteous to and became interested in the older people.

But how do we create a culture in which the faces of age don't shock and disgust us?

Redefining "senior moments:" Aha!

2008-07-29T07:46:00.004-06:00

According to Suzanne Stinnett, culture change student and author of Little Shifts, the healthy aging brain is a lot like new social media: "Adaptive, highly integrated, self-renewing, making use of accumulation of data."

Unfortunately, we tend to look at the older software of the mind the same way we look at older technology. "We view a tech tool that has been around for ten years as a dinosaur – and if it is still useful, smart, and engaging, we’re in awe."

Stinnett makes an argument for more awe, less ugh, and defines a senior moment as:

The moment of “aha” when yet another innovation comes together as a result of our activated brains. When a senior citizen provides an integration of concepts, a brilliant innovation, or makes some connection that no one else could think of. The product of an experienced brain which is functioning at a high level. Only people who have been around the sun fifty times or so are capable of these moments.

Aha!

So long

2008-07-21T12:02:00.003-06:00

This is the last entry for this blog as a vehicle of the Milwaukee Aging Consortium. We've had a great time exploring issues on aging in Milwaukee and in general here. We'd hoped that readers would become engaged in creating a discussion, but that didn't happen. So it's time to find a different way to get--and keep--the conversations going.

To those of you who read Aging Maven regularly, thanks so much. And keep the Maven bookmarked: she'll be resurrected as an independent blog.

Deep thanks to the Milwaukee Aging Consortium for trying this experiment. As always, the Consortium continues to find better ways to connect professionals so that together, we can make a real difference in aging.

Aging, changing American demographics: even on the political radar?

2008-07-06T12:51:00.010-06:00

Forget McCain's age for a moment. An aging America is nowhere to be seen in either presidential candidate's radar, says Newsweek and syndicated columnist Robert Samuelson (July 6, 2008).

John McCain and Barack Obama are against poverty and fiscal irresponsibility. . . (They) favor “reform.” But beyond these platitudes, they’re mostly mute.

That global aging is “a demographic shift with no parallel in human history” is not exactly a secret or even a disputed issue. So its absence from the discussion table seems curious. Then again, according to Samuelson,

It is one of our fondest political myths that elections allow us collectively to settle the "big issues." The truth is that there's often a bipartisan consensus to avoid the big issues, because they involve unpopular choices and conflicts. Elections become exercises in mass evasion; that certainly applies so far to the 2008 campaign. A case in point is America's population transformation. Few issues matter more for the country's future — and yet, it's mostly ignored.

Samuelson has visited the issue before, specifically focusing on developing bi-partisan think tanks to come up with data and policy solutions to the problems related to government spending on older Americans and immigration issues.

But that’s not enough, according to Encore, an organization devoted to revitalizing later life careers.

. . .Samuelson’s challenge is all to the good, but the framing is too narrow, too Beltway. Rather than merely craft a policy that averts the fiasco, we need a vision that fosters a renewal, both social and individual. Aging boomers are more than liabilities, after all, they are also assets. Changing the starting point of the discussion also changes the end result. Rather than muddle through, why not break through?

Certainly, longer working lives are likely to be a feature of boomers’ encores, but that reality will be much more appealing if work itself is reimagined: encore careers at the intersection of personal meaning, continued income and social impact.

How do we in the community of professionals and “experts” on aging find ways to bring constructive solutions to a table that’s not even set? It seems having faith that whichever candidate we prefer will “do the right thing” is a bit misplaced.

What’s your organization doing locally or nationally to “not muddle through, but break through”? Share your ideas and experiences with us!

Is age an issue in the presidential election?

2008-06-18T12:56:00.006-06:00

Last weekend, the New York Times suggested that age was the new "combustible" topic enflaming people's biases and prejudices in the presidential election. The others are race and gender, as we've seen.

Said author Adam Nagourney, the issue is not just candidate John McCain's age but the voters' age as well.

"Many boomers, as we all know, cherish and chase youth, and many of them, not surprisingly, could be found at Mr. Obama’s rallies this fall, the political equivalent of a 50-year-old man wearing a baseball cap backward. Yet, at a time when many Americans live into their 80s and beyond, those who are beginning to contemplate their first Social Security check can simultaneously embrace the belief that they will remain active members of society for years, even decades, to come. For these voters, Mr. McCain may seem as much a barrier-breaker as either Mr. Obama or Mrs. Clinton."

The same day, an article by geriatrician Greg Sachs, MD, professor and scientist for the University of Indiana Center for Aging Research, welcomed the controversy.

"I see this as an opportunity to help encourage greater education of the public about aging, health, and memory issues in particular." And those issues, he pointed out, don't just arise every four years but are with us always.

It's easy to merely dismiss concerns about age affecting performance as "ageist." But Dr. Sachs reminds us that, contrary to the beliefs of a youth-worshipping society, age brings with it greater diversity. It's not all old people who tend to be alike: young people are more similar in health and ability. With older people, you just can't generalize about anything. Especially not health.

Aging carries real concerns. Cancer, heart disease, stroke, diabetes, and kidney disease are found increasingly as people grow older. And so are alterations in brain and cognitive function. The latter is not an easy problem to address, as routine screening for cognitive impairment has yet to be found cost-effective.

Still, Dr. Sachs suggested, "perhaps older people who hold important positions affecting the lives of many others ought to have a more comprehensive evaluation on a regular basis."

Seems like a reasonable suggestion. For all of us, the ability to do the job should be the measure of suitablity, not age, race, gender or other factors.

What do you think about age and ability? Share your thoughts on this or other aging-related topics with us.

Doctor, care manager, gerontologist?

2008-06-11T15:08:00.004-06:00

Aging is an interesting field in which to work. But messages about training for professions in the field can be confusing.

An aging population assures a growing “market” for the services of knowledgeable providers of just about anything aging people need. In April the Institute of Medicine predicted an impending crisis and verified what many have already observed: a shortage of geriatricians (medical doctors specializing in aging patients), nurses, and frontline aides skilled in the concerns of aging patients. Meanwhile, the New York Times is touting geriatric care management as “one of the most important professional roles in the whole health services delivery system” over the next 10 years.

At the same time, the March-April 2008 issue of Aging Today raises thoughtful questions in two articles about whether gerontology can continue as an academic discipline. The problem, according to authors Anabel Pelham and Robert Binstock, has to do with lack of formal accreditation programs.

Perhaps the problem also has to do with lack of clarity. Neither article bothers to define gerontology. Wikipedia says it has to do with everything about aging except diseases, which are claimed by the field of geriatrics.

I guess if you’re in the field, you know gerontology “belongs” to the human services side. But it would be a mistake to assume that others share that understanding. Pelham says that “gerontology can synthesize the field’s many realms of knowledge;” it would help the rest of us to know toward what end.

No fewer than four different programs certify geriatric care managers, who don’t have to be social workers, and case managers, who do. And no one has any trouble figuring out what it is that those worthy professionals do: the name is self-explanatory.

Gerontologists, help us clear up some of the mystery that surrounds you. We’d love for you to tell us what you do and what is happening in your field in Milwaukee and beyond!

A jug of red wine and 90 becomes the new 50

2008-06-04T11:08:00.009-06:00

Eartha Kitt at 80 sets a tough standard. Image from Wikipedia

Is red wine the fountain of youth? I'm not suggesting that the divine Ms. Kitt relies on that elixer for her youthful appearance. But a handful of articles came across my desk today touting the potential of a resveratrol, a substance found in red wine, to keep people's hearts and bodies young.

All were based on two studies that found resveratrol kept aging mice healthy, middle aged, and slim in much the same way severe calorie restriction, a much less attractive way to maintain youthful vigor, does.

One of those studies came from Madison's LifeGen Technologies and the University of Wisconsin. (Barger JL, Kayo T, Vann JM, Arias EB, Wang J, et al. (2008) A Low Dose of Dietary Resveratrol Partially Mimics Caloric Restriction and Retards Aging Parameters in Mice.)

You'd have to drink a lot of wine to stay as young as the mice--the equivalent of 1,000 bottles a day. I'm thinking that after the first one, you might stop caring much.

The New York Times takes a balanced view, pointing out that the findings are interesting but there never is a panacea; that it's way too soon to understand what the research means for people; and that one reason for the interest is the enormous potential for a pharmaceutical company to clean up on this "longevity elixer."

The Reuters article focuses on potential protection to heart health.

The Atlanta Journal Constitution version homes in on the vanity angle, asking "is 90 the new 50?" and providing photos of well-aged celebrities such as Sean Connery, Kitt, and Sophia Loren. David Sinclair of Harvard Medical School, author of the second lab research report, admits to supplementing his diet with resveratrol. But he reminds readers that the most effective way to improve longevity is exercise.

I wonder what the desire for a magic fountain-of-youth pill that keeps us slim, healthy, and young without really trying does to the way we spend our healthcare dollars. And continuing to raise the bar for expectations of sustained youthfulness seems to serve product manufacturers more than it does the rest of us.

I don't know about you, but I'm having enough trouble keeping up with 50-something being the new 40-something!

Getting ready: continuing the conversation

2008-05-29T10:02:00.003-06:00

"Butting heads" by isadoreberg, flickr

A recent blog entry introduced the topic of talking to loved ones about difficult issues in aging. But it's a conversation that needs revisiting often.

One of the most thoughtful writers about Boomer children and their aging parents is David Solie, author of How To Say It to Seniors: Closing the Communication Gap with Our Elders. His most recent blog entry, How do we get them to move? answers bluntly the question so many of us have: we don’t.

“Older adults see where they live as the Alamo and will make their last stand defending it. We advance with logic, manipulations, and threats and they use any means at their disposal to repel us.”

The problem, he says, is that the children see themselves as managers of a situation, while their parents see themselves as preservers. We (the children) want to manage to avoid the inevitable disaster. They (our parents) want to preserve what they know far better than we do will soon enough be lost. Home, health, loved ones, mobility: “Having any of these another day is invaluable victory in the final phase of life.”

So we are left in a holding pattern. What do we do during that time? Put aside persuasion in favor of listening. Celebrate each good day as a gift. And help them—and ourselves—get ready to move when the time comes.

As mentioned in the earlier blog, My way: A workbook for planning and living life your way is an outstanding resource to aid in getting ready and shifting from conflict to partnership. It’s available from the Aging Resource Center of Milwaukee County and was presented at the May member meeting of the Milwaukee Aging Consortium. Another great resource is the 40/70 Rule Guide to Conversations brochure from Home Instead Senior Care.

Tell us your experiences with talking, listening, planning, and getting through the changes that come!

Something good about aging

2008-05-23T14:24:00.002-06:00

Blissed out in Natalie's Chicken Blog

Things change with aging, and even, sometimes, for the good.

University of Texas sociologists Catherine Ross and John Mirowsky found that around age 60, people begin to report "more feelings of ease and contentment than their younger counterparts." Their study "Age and the balance of emotions" appeared in Social Science and Medicine in May 2008. More about it here.

The researchers also found a shift from "active" emotions such as excitement to "passive ones" like serenity. Talking about that might be a little tricky, since it seems to require some adjusting of a cultural bias that active is good, passive is bad, and excitement trumps all. Adding to the complexity is the need to consider that positive and negative things can happen at the same time. Pub Med's abstract writer puts it this way: "In order to accurately portray the shifts in emotional tone, age may best be considered as simultaneously indicating maturity and decline."

It's not scientific, but I've found that getting older makes it a lot easier not to sweat the small stuff--and to know that most of it is indeed small stuff.

And serenity is definitely something to look forward to.

"We do our best and lean on each other"

2008-05-08T09:36:00.005-06:00

The popular press coverage of aging falls mainly into two camps: 1) fight it/beat it and 2) what to do when you can't anymore.

At the May 8 Milwaukee Aging Consortium member meeting, a panel of experts entered the important middle space between resistance and resignation. Critical conversations: helping families and elders get ready for transitions went beyond advance directives for the very end of life to address planning for a longer period of change. Panelists and audience considered the questions:

How do we think about the time of many transitions during the last developmental stages of life?

How do we talk to our older clients and relatives about making practical decisions that honor their desire for control?

On the same day as the meeting, Kathleen Merryman told a story in the Tacoma News Tribune that illustrates the problems of unanticipated change. The account of a recent shift in her family's universe begins, "Two months ago, in a Maverick gas station in Bridger, Montana, my dad backed into a post and shattered his sanity."

Merryman's 79-year-old father, who planned to live forever, was returning from a doctor's appointment with the news that he had not only an infection but an aortic aneurysm. The collision with a post marked what Merryman's mother described as "all the bonds of reason in his brain shred(ding) at once."

The collision was not caused by the aneurysm rupturing. The impact caused no physical damage to Merryman's father or mother who was also in the car. The cause of the sudden change was and remains a mystery.

But at least metaphorically, in losing his image of himself, he became someone else mentally and emotionally, someone living in a hell populated by delusions. His wife and children (one lawyer, two nurses, and others) were able to move swiftly through the maze of care options and changing housing and financial needs.

Even with the best of family support, the call for strength in the face of interpersonal friction and fatigue stunned the family. They now know "With aging, we do our best and lean on each other."

No matter how much planning has gone on, a sudden change for the worse is devastating. Unlike this story, the sudden changes in aging often follow a longer period of unrecognized decline. But having deep and honest conversations about what really matters and how to support basic values and desires can go a long way toward easing the pain.

It's probably a good idea to decide that "don't put me in a nursing home, ever" isn't the end of the conversation. It's just the beginning.

Some resources from the meeting to help in starting and sustaining the conversations include My Way, an in-depth planning tool from the Milwaukee County Department on Aging, and two documents developed by Home Instead Senior Care: 40-70 Rule 7 Tips (for conversations between Boomers and their parents), and the 40-70 Rule Guide booklet.

The Grandmother Hypothesis: Creating and saving civilization as we know it

2008-04-29T14:45:00.004-06:00

What are you supposed to do you do when you’re not raising kids anymore, anyway? The easy answers to that question aren't always very satisfying, as I was reminded today listening to a Wisconsin Public Radio call in show.

The topic was having children late in life. Author Elizabeth George had only positive things to say about the experience. The women she interviewed for her book, Why Women are Embracing the New Motherhood, didn't seem to be encountering any downsides, either.

One gentleman asked about children becoming caregivers at a younger age. Not a problem, George replied. People are healthier now. And they have better financial plans.

Well. Maybe. Let's hope.

Then caller Molly from Baraboo threw both George and host Joy Cardin off balance with a question about the developmental tasks of aging. The conversation, which I’m recreating loosely from memory, went something like this:

“I had my child at age 39 and then had an early menopause. We thought about having another child but by that time, I found I wasn’t really all that interested in children. I’d heard that you change after menopause, that you are ready start to begin a new life, and I felt like that was happening to me. I was ready to do that, but I couldn’t because I had a three year old. Do other people have that experience?”

You could hear the author frowning. “What do you mean about differences after menopause and being older? Do you mean retirement?”

Host Cardin jumped in and offered some other suggestions for what women do in that “next stage” of life: traveling around the world and self-improving. Lots and lots of self-improving. (Apparently she's not old enough yet to discover that sometimes that's an exercise in futility, not to mention boredom.)

“But with only one child, you can travel around the world easily enough anyway,” said George. The awkward conversation ended with an uneasy dismissal suggesting that Molly’s case might be interesting but didn’t really apply to others: “Early menopause is an anomaly,” George concluded.

Actually, it’s not. But besides that, I was stunned by the lack of vision of what it might mean to be in the world after menopause, after children.

As an older mom, I knew exactly what Molly was talking about. My friend Kathleen, also an older mom, used to say, “I’d be standing at the refrigerator, my mind drifting off on lofty and spiritual thoughts, thinking about God and peace and ways to save the world, and when that little hand tugged my shirt and asked where the juice was, it took me a few seconds to come back to earth.”

There’s a lot more out there than recreation and holding the line against a widening waistline. Apparently George and Cardin have never heard of the Grandmother Hypothesis. This intriguing idea says that postmenopausal grandmothers (and older men, too) created culture, if not the human race, by helping younger people nurture their children. This not only meant more calories in the family pot, which meant more children surviving, but it meant that everyone had more time to do interesting things like carve spoon handles, compose songs, and create political intrigue.

Time spent lingering in the sun at a table in Turino sounds lovely. But now that my babies are heading for college, I need to add calories in the form of money to both their pot and my own retirement one.

I’m also looking forward to writing books, getting a promotion, and saving some little corner of the world

There’s so much to do, and almost all of it interesting. Even necessary. . .

What are your thoughts about life between kids and the grave? How do you see changes in reproductive norms affecting aging and aging populations?

When things work right: housing and supportive services

2008-04-07T12:45:00.004-06:00

My mother died April 1. She was 86, in increasingly poor health, and had long been ready to go.

We encountered some troubling problems with the medical care system at the end. But I'm going to leave those behind and talk about what went right.

When Mom started having more trouble managing in the independent apartment in Oshkosh, Carmel Residence, where she'd lived since 2000, we moved her into the community's assisted living facility, Gabriel's Villa. There was an interlude of illness, skilled nursing, and rehab in between, but that's not really germane to this part of the story.

The apartment was lovely, and Mom quickly made friends with the residents and the aides. The food was superb, and she actually started eating three squares a day. She began walking around her apartment using only her cane, and generally was managing better than she'd been for the past two years.

But things got worse again. She developed pneumonia and digoxin toxicity, the congestive heart failure worsened, the implanted defibrillator started going off frequently despite an increase in potent drugs for arrhythmia. Her mental state became altered.

Gabriel's Villa operates under a residential care apartment complex (RCAC) license. As a result, the staff were able to be very flexible, providing more care as needed for an additional fee. They began administering her medications and checking her every two hours, later every hour.

After we decided to turn off Mom's defibrillator and let nature take its course, her plan all along, Gabriel's Villa agreed to let us bring home hospice into the apartment. No one wanted her to move her again.

Mom died a few hours after we'd returned there, before hospice care could begin. I stayed with her, with much loving attention and help from the aides who were with us, getting her ready for bed, when her big heart went into ventricular fibrillation. A few minutes later, she died, held by my sister and me.

It was as she wanted it-- a good death, I think. For that, we owe much to the dry sounding notion of "elder housing with supportive services."

Honors and awards

2008-03-17T10:22:00.004-06:00

Blog entry by Amy Ambrose, executive director, Milwaukee Aging Consortium.

I love a story about gut-intuition that turns out to be right. And I love a story about people investing in services for older people where they are needed most. Last week I had the pleasure of participating in the Milwaukee Awards for Neighborhood Development Innovation (MANDI Awards) celebration, hosted by Local Initiatives Support Corporation (LISC-Milwaukee).

The Milwaukee Aging Consortium sponsored a nomination for Community Care under the category of Building Blocks Award: Large Project. Last year's winner was the Dr. Wesley L. Scott Senior Living Community, developed by our friends (and a sponsor of our April 4 housing conference ) the Gorman and Company and the Milwaukee Urban League.

Community Care, a Milwaukee Aging Consortium member, is a private non-profit organization that provides health, home and community services to low-income frail elderly and adults with disabilities. The organization's mission is to provide the support people need to stay in their homes and communities, where they can continue to enjoy the fellowship of friends and family and play a vital role in their community.

Here's where the intuition gone right part comes in. In order to better meet the needs in Milwaukee, Community Care recently invested $5 million dollars in a property on Vliet Street in the Walnut Hill neighborhood. They turned an old factory building into a state-of-the-art adult day health center that includes examination rooms, a dental clinic, rehabilitation facilities, day center space for social activities and hot meals, and a full-sized commercial kitchen.

The Vliet Street Adult Day Health Center and clinics now serves about 200 participants. Physicians and nurses; physical, occupational and recreational therapists; dietitians, dentists and other health care providers all are part of the caring team.

According to Kirby Shoaf, Community Care founder and president, this choice of location was not met with great enthusiasm at first. Crime in the area is high, and the economy is poor. Security and staff satisfaction were concerns. But Kirby and others reasoned that the organization needed to be centered where the need was greatest.

They reasoned correctly. Now, they have created a gem in the heart of the city that not only serves the basic needs of elders and their families, but also conveys respect for them and their neighborhood. The Community Care Vliet Street location is now a favored place for staff members to work.

Community Care -- and the community -- "won" in our books, though they did not receive a MANDI award.

But I am proud to say that the winner in the large project category was another Milwaukee Aging Consortium member and sponsor: Manpower. The global headquarters of Manpower, located along the Milwaukee River in the Schlitz Park area, is another example of great investment in our town.

Dozens more innovative companies were honored as a part of the program. If your agency or your company is doing great things for older people, especially by reinvesting in senior services in the city, we’d love to hear about it.

Send your comments to this blog or to cmclaughlin@milwagingconsortium.org.

Did you hear the one about the woman, the black guy, and the Walmart greeter?

2008-03-13T09:19:00.007-06:00

Gloria Steinem is 73, Robert Redford and John McCain 71. McCain's mother Roberta, who just renewed her driver's license, is 96. Do they seem "out to pasture," doddering, or foolish to you?

In humor, you have to tread carefully. Unless you are going after "old folks," that is. Much has been said in this year's presidential campaign about sexism and racism. But there's another "ism" that seems to be taken for granted: ageism.

David Letterman calls presidential candidate John McCain a "Walmart greeter" and a "mall walker," according to Julie Bosman in the New York Times. She asks "Has ageism run rampant in mainstream discourse because America exalts youth?. . .is the oldster an archetype so ingrained in the American comic sensibility--a la 'Grumpy Old Men' and 'Golden Girls'--that it trumps identity in politics?"

Great question--although in fairness, ageist humor may be milder now than it used to be. When Bob Dole was running for office, Letterman said “Bob Dole is so old his Social Security number is 2. He’s so old that when he was a teenager, his cologne was New Spice. He’s so old, his Secret Service code name is The Clapper.”

Even McCain gets on board with 'the joke': "Usually, people watch my performance to see if I need a drool cup, or stumble around, or anything like that."

In Politico, Roger Simon points out that John F. Kennedy, for all his appearance of youthful vigor, was frail and ill much of his time in the office he entered at age 43. Youth alone is no guarantee of physical health, mental acuity, or fitness for office.

I'll admit that I'm not ready to give up jokes about old people myself. But I'm making a vow to find jokes where the older person comes out on top of the humor. Because what we say and how we say it makes a difference in how we see--and create--aging.

What do you think about old-age stereotypes? Age-related humor?

A place that makes you wish you were old

2008-03-03T17:08:00.004-06:00

"We know what helps people. What helps them age in place is not covered by insurers at this point," said Laura Gitlin, director of the Center for Applied Research on Aging and Health at Thomas Jefferson University in Philadelphia.

She was referring to healthcare and a study showing that periodic visits to independently living seniors by therapists can catch small difficulties before they turn into large ones.

But healthcare isn't all people need to age in place. To have a sense of wellness, we need purpose. Something to look forward to the next day. Ways to actively engage in the world.

Imagine if, instead of watching TV, you were broadcasting it. That was the idea behind the Burbank Senior Artists Colony. It's a 141-unit senior apartment community featuring 24-hour art studios, a film lab, performance space for its theater group, a resident-run internal cable TV station, and much more.

"You walk through this building and you never hear anybody talk about their aches and pains or how many medications they're on. They're just constantly talking about what they're going to do next," said Tim Carpenter of EngAge, a nonprofit organization that brings "whole person" creative programs to affordable senior housing.

The mission: "It's our vision to make aging a beginning. By providing life-enhancing programs to low-and moderate-income seniors living in affordable apartment communities, they will be given the opportunity to continue to grow intellectually, creatively, and emotionally. Programming will focus on the combination of mind, body and spirit to promote active engagement and independent living, and to provide seniors with a purpose."

Resident Suzanne Knode, who wrote her first screenplay after moving in, said "I never thought that I would be able to find something else that's new inside of me. You know that same feeling when you got out of school and the whole world was open for you? Now, all over again, the whole world is open to me and I have no idea what it's going to bring."

Everyone there is an artist, but many never called themselves that before entering a place where creativity is the air they breathe.

Six hundred people were on the waiting list before construction began, and 2,000 artistic souls are on the waiting list for the 43 affordable units that rent for $500 a month (market rate units start at $1400).

Burbank may be the home of Disney and Warner Brothers Studios. But you don't have to be in the entertainment industry to imagine creating senior communities as places anyone would want to live.

The question is, what would it take to do it here in Milwaukee? We'd love to hear your creative ideas.

Slow medicine for the old

2008-02-26T12:39:00.004-06:00

Time to "rescue the elderly from standard medical care"? Geriatrician Dennis McCullough says it is in his new book, My Mother, Your Mother. Embracing "Slow Medicine," the Compassionate Approach to Caring for Your Aging Loved Ones. I haven't read the book but the New York Times review makes me want to.

The book is aimed at children and relatives who, McCullough says, are the best medicine--along with a slower, simpler, less expensive, family based approach to medical care. In interacting with the medical system, frail older people need an advocacy team of friends and relatives for protection and moral support.

Among the changes to consider for people at advanced ages: manual breast exams instead of mammography, stool tests for blood instead of colonoscopy, revisiting hypertension medication that works differently in the very old, companionship instead of antidepressants.

Reviewer Abigail Zuger, also a physician, calls the book valuable, "chilling and comforting in equal measure."

The topic is especially timely as we think about our July member meeting. We'll be building on the dialog with discharge planners in January. This time, we'll be considering how family members can talk about "advance directives" that go beyond end of life hospitalization. As McCullough says, hard conversations about topics like when to stop driving and what to do when you can't manage at home anymore need to start early, while the parent is still vital and lively.

It's about anticipatory guidance. The Library Journal's review says that the book will help readers:

—form an early and strong partnership with your parents and siblings;
—strategize on connecting with doctors and other care providers;
—navigate medical crises;
—create a committed Advocacy Team;
—reach out with greater empathy and awareness; and
—face the end-of-life time with confidence and skill

Please let us know your experiences and thoughts about how professionals in aging might help families talk about and plan for all of the transitions from fully independent to needing a wide circle of concern and care!

Ageism and drug safety

2008-02-15T10:37:00.003-06:00

The Need for Drug Safety-the Older Person and Ageism grabbed me when it came across my desk through the Badgeraginglist. The listserv is a wonderful source of information for professionals in aging, and the source of many reports the Milwaukee Aging Consortium describes in our newsreel or information links.

Drug safety is not just an abstract good idea to me: it’s personal.

At Christmastime, my 87-year-old mother’s slow deterioration accelerated. It turns out that one of the prime causes was prescription medication toxicity. Another was electrolyte imbalance, a medication side-effect.

I haven’t looked at the bill yet to see what this episode cost in dollars. I won’t try to figure in the days lost from work and from our children for my sister and me. But I have a good sense of what it cost in pain and suffering, not just for my mother but for all of us.

The issue brief from the International Longevity Center-USA points to problems resulting from rapid approval of new medications and the lack of long-term “postmarketing surveillance”—research on what happens to 30,000 users, not just the 3,000 studied before release to the market. In 2007, the report says, the pharmaceutical industry “conducted only 7% of the studies they had promised.”

Drug problems affect older people disproportionately. Only 12% of the population, they use 40% of all prescription medicine. Physiologically, older people process drugs differently. They have the most problems with drug interactions. And yet there is no requirement that older people be included in clinical drug studies.

Report author Robert Butler, MD, uses some strong language: “Because medicines in the United States are disproportionately used by older persons, we must conclude that failures in drug safety are due in part to the belief that older persons, having lived their lives, are expendable. This is a manifestation of ageism.”

The brief calls for significantly increasing FDA funding and power to monitor drugs on the market and in older adults. The up-front cost, Butler says, “will likely save time, energy, and money, not to mention lengthening and improving the quality of lives.”

After a couple months of emergency rooms, hospitalization, skilled nursing facility stays, and rehabilitation, Mom's doing beautifully in an assisted living facility. In fact, she’s doing better than before. I wonder if, had her primary physician been monitoring her better, she could have stayed in independent living. But that’s a moot point now.

We’d love to hear your responses, ideas, experiences. Please comment here or send a message to cmclaughlin@milwagingconsortium.org.

Everybody's doing it: Caregiver help sites

2008-02-05T12:03:00.000-06:00

You may have noticed a proliferation of all kinds of websites for caregivers. According to Mass High Tech: The Journal of New England Technology, the surge is partly a response to need--and partly a response to commercial opportunity.

“All of a sudden, it’s like caregivers have money,” said Gail Hunt of the National Alliance for Caregiving. “The baby boomers have to care for their parents, and there’s money to be made.”

Some of the sites, in other words, are all about the advertising.

But folks who run “altruistic” sites with no profit motive can learn some lessons from the often young entrepreneurs who understand social networking. Chief among these: the term “caregiver” doesn’t resonate with Boomers. We don’t see ourselves as caregivers but as family members—or even “baby sitters.” Caregiving is a market with more than one niche.

Realizing that, some sites are including services for the other side of the Boomer sandwich: childcare and tutoring, for example.

One site is called Lotsa Helping Hands. Developed in cooperation with the National Alliance for Caregiving, it has “created 6,000 ‘communities’ for users, mostly networks focused on a specific patient’s circle of caregivers,” according to article author Christopher Calnan.

Sites that list providers often offer a free basic service and charge monthly rates for “premium” services as well as using advertising.

Hunt warns that most of these businesses will disappear like the dot.coms – unless they develop the “Holy Grail:” comprehensive information combined with a database of local resources for users.

In Milwaukee, the Family Caregiver Support Network offers diverse help and information and a social support network for caregivers--for free.

Other excellent noncommercial sites include the Family Caregiver Alliance, and Hunt's organization's website Caregiving.org.

Strength for Caring is a great site owned by a commercial enterprise, Johnson & Johnson.

We’d love to hear about the best websites for caregivers—and what’s needed but not there. Comments and guest blog entries are most welcome!

What's your priority for making communities elder-friendly?

2008-02-04T13:22:00.000-06:00

In the newsletter Connections, American Society on Aging (ASA) members identified as their top three policy priorities to make communities more elder friendly:

59% Public transportation improvements
25% Universal design requirements in building codes
10% Walkability mandates in urban planning

Public transportation improvement has been a chronic need for older people in this community since the days of the Older Adult Service Providers Consortium, the Milwaukee Aging Consortium's predecessor organization.

Are those the priorities you'd list, too? What could we do to fix the problems of getting around? We'd love to hear from you.

Some good news about aging societies

2008-01-28T16:00:00.000-06:00

There’s an upside to aging societies that most of us haven’t much thought about. According to new information from The Gerontological Society of America published January 25 in ScienceDaily, as a society ages, it loses the taste--and the opportunity--for political violence. (World's Aging Population to Defuse War on Terrorism)

If you look at the Mideast, Iraq, Pakistan, and Saudi Arabia, you’ll see what happens with “youth bulges” in which there are proportionately more young people than usual. The youth bulge creates lots of people with “strong grievances against current political conditions and little stake in society.”

Population age cycles. In about 20 years, an aging, invested population creates political stability and economic development. Think about the US during—and 20 years after—the Vietnam war. You get the picture.

When the population continues to age and stops working, the period of economic development can slow or stop. Then a developed country will likely have to choose between accepting a high level of poverty among the old—or diverting money from military spending to avoid that poverty.

I will leave you to draw your own inferences. But I for one prefer the second option.

Author Mark Haas of Duquesne University says that the aging trend is starting to affect all the most powerful nations. By 2050, Russia’s working age population will shrink by 34%, and China’s median age will be almost 45. Will they choose impoverished old people or reduced military spending?

Apparently, the US will be less affected than China, Russia, Britain, France, Germany, and Japan. “In 2050, this country’s median age will be the lowest of any of the great powers,” ScienceDaily reports. At the same time, “the working age population in the US is expected to increase by 31%.”

While the article doesn’t mention it, I bet that the “youthing” of the US depends partly on immigration.

Makes you look at politics, the future, the economy, and aging a little differently.

Can we please talk about this?

2008-01-23T15:05:00.000-06:00

If it’s sex or giving up driving, Mom doesn’t want the conversation.

Death, on the other hand, is okay to talk about, according to a recent Canadian study, The 40-70 Rule, by Home Instead Senior Care.

The title refers to the report’s suggestion that by the time you are 40 or your parents are 70 (whichever comes first), it’s time to start talking—and keep talking--about the hard subjects.

The 40-70 study found that the easiest topics to discuss were end-of-life wishes, living will, health concerns, and legacy. The hardest topics for Boomer children and their parents were independence (when Mom needs to move out of her home), personal hygiene, money, and when it’s time to quit – working, driving, and so forth.

Aside from parents refusing to talk, the main block to the conversation seems to be unprepared and fearful children.

Just how hard those conversations can be, and how little skilled most of us are in having them, is a message we keep hearing.

At our January Member Meeting, Dialog with Discharge Planners, it became clear that no matter how good a job we do at discussing options at the end of life for advance directives, we haven’t really begun to talk about the shifts before the end. “Don’t resuscitate me” might be a much easier decision than what to do when Mom needs more help. We’ll pursue this topic further at our July 10 Consortium member meeting on Advance Directives. Check the calendar at our website.

Yesterday (January 22), at WALA’s Aging In Place. . . Prepare for Evolution conference with Jim Moore, it was clear that senior housing operators also need to have clearer conversations with residents and family about changes in functioning that call for changes in housing or service.

David Solie’s blog entry, No Easy Way Out, has a wonderful discussion of the conversation problem. Solie is author of How To Say It to Seniors: Closing the Communication Gap with Our Elders.

As my mother approached 90 and despite increasing frailty and her super human responsibilities for my special needs brother, she simply refused any assistance. Every approach was rejected. The best we could do was build support scaffolding around both of them for when “the bottom fell out.”

This went on for years. Airline flights, phone conversations, involvement of other family members, protracted conversations with our family lawyer, meetings with my brother’s case worker, and endless strategy sessions with my wife all ended with the same outcome. It was my mother’s way or the highway.

So we shored up the situation the best we could. Despite my mother’s derogatory objections, we purchased long term care insurance when she was in her late seventies. We petitioned the court so she and I could have co-guardianship of my brother. We got her to sign a Medical Power of Attorney. Then we waited.

His recommendations?

1. Advance as far as you can go based on the personality and the nature of your relationship with the parent.

2. Retest the boundaries of that advance periodically even if they appear initally absolute. You never know when there is some give in the system.

3. Build the best scaffolding you can with what you have.

4. Keep asking yourself this question: What am I responsible for?

5. Draft a “When The Bottom Falls Out” list of the items that will require your management. Print it out and then start making weekly annotations. Your brain works better with a “starter” document. I think just “pre-thinking” about the house, the Medicare forms, the Power of Attorney steps, and so on will give you greater stability in the midst of the actual chaos.

6. Rethink what you know about the final mission of life. Most of what we are seeing in our aging parents is a need to maintain control in a world where all control is being taken away. Nothing is going to change that. It is not a rational need; it is simply a developmental task. We have all lived them in our own lives. The problem with the last one is how deeply it is connected to our family systems. However, knowing its true magnitude reduces the guilt over trying to craft a perfect ending or trying to control things that beyond our capabilities.

* * *

We'd love to hear your comments, as always.

Make sure you can get there from here

2008-01-17T11:53:00.001-06:00

A service and support program is only as good as the ability to access it. This concern was raised at the January 16 meeting of the Make It Work Milwaukee Coalition of health and human service providers. Cutting funding for intake and other staff—or not increase staff along with increasing caseloads—can put people in jeopardy. It also can waste the money poured into the program itself.

The Milwaukee County Department on Aging has built some economic support positions into its own budget to make sure that older adults get into and through “the system” without the delays and frustrations that others may encounter.

Milwaukee Journal Sentinel editorial cartoonist Stuart Carlson weighed in on the subject with this cartoon January 15. We’d love to hear from you about your solutions to intake and access problems you’ve encountered!

Beauty matters

2008-01-14T11:30:00.000-06:00

With more than half of the “aging alerts” that come across my desk dealing with physical appearance, it doesn’t seem right to overlook the important topic of beauty and aging.

Nearly everyone agrees that Boomers are driving the exploding beauty business. We were the generation that would never grow old, that would just “fix” whatever we didn't like, including aging. By 2001, more than half of all beauty products claimed to have anti-aging properties. Plastic surgery and injections promising rejuvenation have become ubiquitous, and eating disorders in older women are growing.

Care in appearance is part of feeling good. I knew that my mother, who’s now in a nursing home for rehabilitation, was doing better when she asked my daughter to pluck her eyebrows and complained that I’d brought her the wrong lipstick.

But those who are battling against aging instead of exploring a new territory of a different kind of beauty are sure to encounter despair.

A new website, Beauty Paradox, promises some interesting guidance for women who are growing older. Its authors, Vivian Diller, PhD, and Jill Muir-Kukenick, PhD, are both psychotherapists—and former models. They’ve written a book by the same name in which they propose to offer a “psychological map through which a woman can explore the role beauty plays in her life as she ages.”

The goal is to redefine beauty on our own terms, not the media’s.

There’s not much on the site yet, but what’s there is promising. The first entry is a keeper. If you pass these thoughts along to others, please remember to credit the authors for them!

10 Beauty Thoughts to Hold onto as Aging Takes Hold of Your Beauty,
by Vivian Diller and Jill Muir-Kukenick.

Beauty is not just a physical experience, but a psychological one as well. Although we can't stop the physical changes of aging, we can effect change psychologically.
While aging is unconquerable, inevitable and irreversible, self-image is not. Self-image can be fluid and timeless.
Aging is not a battle of time, but with one’s image of oneself.
Chronological age does note have to define you. You can define yourself at your chronological age.
Put your beauty in your identity, not your identity in your beauty.
Take an honest look at who you are, not what you look like.
Rob beauty of its power over you. Take back that power and you will feel more beautiful.
Learn about the psychological forces of beauty you can’t see and those you can’t hide from.
Fear of aging interferes with aging attractively. Fear is unattractive. Aging confidently is not.
Beauty matters to all women, but to women who age beautifully, beauty matters not too much nor too little.

A place to live—and a little bit of grace

2008-01-08T09:52:00.000-06:00

From Sarah Polley’s screenplay Away from Her:

Grant and Fiona are a comfortable, long-married couple who live in an old rambling house by a lake in Ontario. When Fiona’s memory begins to slip—“I seem to be disappearing bit by bit,” she says—they face a difficult decision.

(Fiona) picks up some forms from the dining room table.

Fiona What are these, Grant?

Grant They’re the. . . the forms to fill out. If you decide to go to Meadowlake

She looks frustrated.

Fiona But that is exactly what I have decided. You were to go and sign these forms. And leave them there.
. . .
Grant I don’t think I like the place.

Fiona I don’t think we should be looking for something we like here, Grant. I don’t think we’ll ever find that. I think all we can aspire to in this situation is a little bit of grace.

It seems like yesterday that I wrote about moving my mother into assisted living. But so much happened in the last week and a half. The Friday before the move, she became listless and delusional and was admitted to the hospital. A week later, after treating an infection and medication toxicity, straightening out her electrolytes, and getting the congestive heart failure under control, the hospitalist sent her off to a skilled nursing facility.

Like Grant, I don’t think I like the place. Not because there’s anything wrong with it: there isn’t. Because it doesn’t suit my image of how and where Mom should live.

But as Fiona said, in this situation, we’re aspiring to a little bit of grace. Here, she will be safer, and with grace, recover enough strength and independence to go to the original assisted living destination. If not, we’ll be grateful for the grace and care provided by a good skilled nursing facility.

Of course, we all want to be part of creating living and care situations people will like. I’m especially excited about a new event the Milwaukee Aging Consortium will present Friday, April 4, with the cooperation of LISC (Local Initiative Support Company) and hosted by Direct Supply. Linking Housing & Service Solutions for Bottom Line and Best Practice is a day-long seminar on bringing services to aging residents in Milwaukee area congregate living.

This seminar includes breakout sessions to stimulate working partnerships. Housing operators, developers and architects, home health and medical providers, and others won’t want to miss this! For more information and to learn about sponsorship opportunities, contact Tracy Straub, 414-289-0890.

More about this later!

New Year's resolutions: lessons from anti-aging marketing research

2007-12-31T14:18:00.000-06:00

What do you see when you look at this image? The young beauty--or the "feared self" of the future?

Afraid of aging? Most of us are, if we judge by the number of products and ads aimed at helping us avoid the “feared older self” the marketers keep holding before us. (Last week’s blog Princesses and hags addressed attitudes toward aging and how we train ourselves to fear and dislike it.)

Researchers Brett Martin from the University of Bath and Rana Sobh from Qatar University found that when beauty products, diets, Botox, and plastic surgery didn’t seem to be working, women were more likely to keep using them.

That’s right: failure to look younger kept aging anxiety high, and women continued doing more of the same to try to keep the wrinkled old woman at bay.

On the other hand, when the products and interventions seemed to work, women stopped using them. Their anxiety eased, they no longer worried so much about the face of the future.

This research finding in 297 women delivers an odd message to anti-aging manufacturers and providers: if you want people to continue using your product, market with fear (the wrinkled hag of Christmas Future)—and make sure your product doesn’t do the job it promises to do. Because if it works, they’ll stop being so afraid. And they’ll stop coming back to you.

In another study, Martin found a different result with men and women working out in gyms. As they became happier with their bodies, their frame of mind improved. Success—and a positive image of what they might become—were the motivators to keep on going.

When you’re making your New Year’s resolutions, keep these studies in mind. You’re much more likely to succeed—and stick with--changes that improve health, like working out. Even if the goal is cosmetic, the healthy body has a sneaky way of creating a healthy, positive mind.

Have a wonderful New Year! May you walk (run, skip, dance) toward the future in happiness and health.

Please share your New Year's resolutions about aging well in the comments section!

When the reality of aging loved ones hits home

2007-12-27T13:04:00.000-06:00

Labyrinth of Hope from Johns Hopkins University Interfaith Council

Almost daily for the past month or so, I’ve gotten an “aging alert” article about using the holidays to check on one’s aging parents. It’s the perfect time, the authors say, to evaluate how well older adults are doing in their current living situations.

This year, the message became more than academic for me. My sister called the day before Christmas Eve to say that Mom, who lives in independent senior apartments, wasn’t doing well. Pain from arthritis in her spine was making it hard for her to walk, and her anxiety was soaring. With those triggers, she was becoming confused.

I drove up a day earlier than planned and stayed a day longer, feeling grateful that my kids were old enough to have their Christmas usurped without feeling resentment.

Trying to get information and make arrangements over the holidays is a nightmare. But because Mom lives in a retirement community with multiple levels of care, we were able to get an assessment for assisted living today. If all goes well, she will move to a place that’s familiar to her and where she’ll feel safer and get the help she needs on Monday.

We are all feeling a little stunned, apprehensive, and relieved right now. The pieces seem to be sliding into place as well as possible.

Some random thoughts:

We who live in Milwaukee are so fortunate to have sources of information and assistance that aren’t available in smaller communities.
I’m so grateful to the social workers and home care managers who return calls even on Christmas day. Your service in allaying anxiety and helping people think through next steps is incredibly valuable.
While many of us hope to see more “catered” home care delivered in people’s homes and independent apartments, the model of senior apartments-assisted living-skilled nursing on one campus still has a tremendous amount to offer.

To all of you who take care of our older adults, creating safe home for them wherever they are, deepest thanks. It truly takes a community to support us throughout our lives.

Princesses and hags: How we train ourselves to look at aging

2007-12-18T12:00:00.000-06:00

Images from Rich Gentleman Hide PhotoShop tutorial.Isn't the older woman beautiful before being transformed into America's Next Top Model?

Yesterday, Rush Limbaugh asked, “Does our looks-obsessed culture want to stare at an aging woman?” The woman in question was Hillary Clinton, of course.

“It's like almost an addiction that some people have to what I call the perfection that Hollywood presents of successful, beautiful, fun-loving people. So the question is this: Will this country want to actually watch a woman get older before their eyes on a daily basis?”

He illustrated his point with an exceptionally unflattering photo of the Democratic party presidential candidate next to an exceptionally presidential photo of Mitt Romney, courtesy the Drudge Report. The conclusion? The Republican is much prettier and therefore more electable. In other words, a better presidential candidate.

The same day, 24-year-old Amanda Hinsperger asked: “What is it about anti-aging?. . .Women in particular carry the anti-aging burden, since most anti-aging ads are marketed to women. Are we afraid of aging? Does the natural course of life disturb us? Nobody likes to admit their body is failing. With all the stress this worrying brings on, and with the aging impacts of stress, maybe we'd be doing ourselves a favour by embracing age.”

Offensive as Limbaugh’s screed is, his observations about our culture’s fear, even hatred, of aging, are sound.

I don’t know how to change that, but Gene D. Cohen, MD, PhD, Director of the Center on Aging, Health & Humanities at The George Washington University, believes the negative attitudes about aging get their start in childhood. Think of the fairy tales we read to our impressionable toddlers: they’re full of wicked witches, stepmothers who are ugly inside and out, old women who live in shoes and abuse their too-large broods.

The Center has compiled a list of stories for children of all ages that show older adults as kind, active, humorous, wise, creative, brave—all the rest of the admirable qualities we aspire to at any age.

That is, if we aren't aspiring only to looking good.

Seems we need to start at the beginning. Give a child you know a good book—and some real-life experiences with women--and men--who are older, but not worse for it.

Citizen philanthropy in the Internet age

2007-12-13T12:50:00.001-06:00

Image from the Plymouth Intergenerational Center

Milwaukee Aging Consortium member Marsha Vollbrecht, Director, Senior Services, Aurora Senior Health Services, is part of a brave new experiment in charitable giving.

Before I explain, a little background. Getting the margin to support even the most worthy mission is a challenge for nonprofits. Large and well-known organizations vie for big support dollars from big foundations. Meanwhile, small or newer organizations compete to gain enough support to build momentum through charitable donations.

But some believe the Internet might “democratize” charitable giving. Case Foundation co-founder Jean Case thinks that “philanthropy shouldn’t be defined as a bunch of rich people writing big checks. Small amounts of money given by large numbers of individuals can be combined to do great things.”

The more citizens are involved, the idea goes, the more the nonprofit activities can reflect the real needs and desires of the people.

So Case started the "Make It Your Own" grants program, inviting community-based organizations to submit their "citizen-centered civic engagement" programs. From a pool of more than 4,000 programs, a board selected the Top 100 Ideas. The programs are displayed at the website, along with space for comments by the "citizen philanthropists:" you and me.

You can even make a direct contribution to one of the programs from the site.

Vollbrecht’s " Top 100" project with the Plymouth Intergenerational Coalition involves Linking the Generations. It brings together volunteers from the school district, senior center, government, childcare center, finance, healthcare, and more.

Starting today, you and the rest of the world can read about and comment on the grants. A panel of judges will score the proposals, narrowing the field to 20. Each of those will receive a $10,000 grant toward “making their idea a reality.” And in February, we’ll be able vote to select the most worthy project. The top four vote-getters will receive additional $25,000 grants.

If you think Linking the Generations is a worthy idea, why not help make it happen?

And if you think the Milwaukee Aging Consortium is a worthy idea, we'd love to have your support, too, of course.

The Case Foundation site is full of interesting ideas about taking fund raising electronic. Take a little time to browse the ideas at the site. They are new, complex, and layered (and not always clearly described). But it's worth the effort to look around.

What might this brave new world of fund raising mean for your organization? Share your ideas with us here!

“A system begging for transformation” and other important reports

2007-12-11T09:55:00.000-06:00

Image from Tokyo Contemporary Art Gallery

From Isolation to Integration: Recommendations to Improve Quality in Long-term Care was released this month by the National Commission for Quality Long-term Care. The report says that “like the health care system, the long-term care system begs for transformation” and recommends bipartisan approaches for national reform.

New population health statistics and trends for older adults are now available through the Centers for Disease Control and Prevention website. The full report, "Health, United States, 2007, With Chart book on Trends in the Health of Americans, " was published by the National Center for Health Statistics Press (December 2007).

Finally, the Center for Retirement Research at Boston College has released a number of fascinating working papers on economic conditions and circumstances relevant to older people:

Capital income flows and the relative well-being of America’s aged population
Why are companies freezing their pensions?
The impact of late-career health and employment shocks on Social Security and other wealth
Health insurance and the labor supply decisions of older workers
The effect of economic conditions on the employment of workers nearing retirement age

Thanks to James Schmidlkoffer, Bureau of Aging and Disability Resources, Office on Aging, Wisconsin DHFS, for this information.

“Outliving their profit potential”: hospice patients

2007-11-27T12:03:00.000-06:00

Image by Ryan Stone, Flickr

“Hundreds of hospice providers across the country are facing the catastrophic financial consequence of what would otherwise seem a positive development: their patients are living longer than expected,” according to Kevin Sack in the New York Times.

The problem is the Medicare Hospice Cap, a law passed in 1982 to limit aggregate Medicare reimbursement to each hospice and assure that the average cost of caring for hospice patients was less than the cost of caring for them in acute care settings. The cap is determined by multiplying the number of patients by a per-patient allowance--$21,410 in 2007. When a hospice exceeds its cap, it must repay Medicare for services.

In the 25 years since the Hospice Cap was established, things have changed. Limitations on an individual’s length of stay have been removed, as long as a physician continues to recertify the patient as terminally ill. And those with non-cancer diagnoses became eligible. The two factors mean that the average hospice stay is considerably longer than in 1982: 86 days for people with Alzheimer’s disease versus 44 for those with lung cancer.

However, except for the yearly multiplier, no other changes have been made to the Hospice Cap.

In 1999, few hospices hit their cap. But estimates from the Medicare Payment Advisory Commission for 2005 project that 220 hospices in 25 states will be billed for repayment of $166 million. Most of these are independent hospices, and in some southern states, half of hospices will hit their cap.

In Wisconsin, 10-15 hospices hit their caps last year, according to notes from the May 2007 National Hospice-POE Advisory Meeting, Chicago CMS Regional Office.

Even with the increases in lengths of stay, hospice care saves Medicare money, according to Duke University professor Donald Taylor. And so the National Alliance for Hospice Access is calling for an immediate 3-year moratorium on calculating overpayments for 2005-2007, during which time Congress must develop a “fiscally sound, responsible, long-term solution.”

And if they don’t? To remain in business, some hospices have already begun to admit only cancer patients. Others, hoping to buy time, are “aggressively recruiting new patients in order to pay off last year’s cap charges.”

The next step may be to discharge patients who are medically eligible but just “live too long.” The Center for Medicare and Medicaid Services points out management issues behind that dramatic statement, especially doctors certifying patients too early.

Of course, you can’t tell the hospice story by numbers. Joan Rademacher’s end-of-life journey in the Wisconsin State Journal (May 2007) shows what hospice is all about.

Have you had an experience with the Medicare Hospice Cap? Care to comment on patients as “profit potential”—or anything else? Use the comment area or e-mail me at cmclaughlin(symbol for “at” here)milwagingconsortium.org.

Giving thanks: a work in progress

2007-11-20T11:52:00.000-06:00

Today's blog is from Tom Thoreson, program coordinator.

I’m thankful that I have a family and community(ies) that support me for who I am and graciously receive the gifts we all share.

I’m thankful for the good health I have and the gift I am developing to provide guidance, direction and health to others.

I am thankful for the times in which we live. In many ways these are challenging times and the future can look quite bleak. Nonetheless, I feel much hope for our children and their determination for growth and development of ecological systems that sustain our planet. These are the best of times for many peoples that would not have had a voice in the past.

I’m thankful that I have chosen a path (sometimes it feels as if the path has chosen me) that guides me towards heights and depths and with a breadth I could only dream of. I’m thankful for those dreams.

I’m thankful for all of the teachers and clients and elders and youth and colleagues that people my days and nights.

I’m thankful for the mindfulness to be still and silent and patient.

I’m thankful for my thirst and hunger and curiosity and playfulness.

I’m thankful for this opportunity.

First Lesson in Magic

Everything you need comes to you.
The gift you didn't expect
is the other half of memory.
Use it whenever you need it.
Don't worry about why
you're different. The truth is
expect it. You're alive!

-Ann Filemyr

Are you ready for the aging workforce?

2007-11-14T15:14:00.000-06:00

Looking around the room during meetings of professionals in aging, you’ll see many people, mainly women, of “a certain age.” People in their 20s, even 30s, are rare.

So when I read about the aging workforce, I think of us.

What, I wonder, are our own organizations doing to prepare for the future? For shortages and loss of skills and knowledge caused by our own retirements? What are we doing to attract and develop younger people?

Right now, I can't imagine not working--or not seeing the committed, still-passionate professionals I've come to admire in this field. But they tell me it can happen--will happen, one way or another.

The AARP’s Workforce Assessment Tool is a great way to take stock of the situation. It’s designed to help businesses “assess any potential impact the aging workforce will have on your organization.” It takes about half an hour to complete, and it generates a report of strengths and "opportunities." (That's "room for improvement" to those of us who predate the "no problem" era.)

It’s also a great way to look at the functions your organization performs, who performs them, what knowledge retention strategies you have, and more.

Some of the sections may lead to some corporate soul-searching. “Positive Work Environment” and “Workplace Accommodations” are two that might. So may “Training and Development Opportunities,” which inventories the types of training available to workers and whether the training is targeted to those over age 50.

Sometimes, we forget the need for lifelong learning in people who already have a lot of knowledge--or the desire for advancement even in people who may already seem advanced.

In looking at the “Flexible Work Arrangements” section, I was struck by how congruent the flexibility that appeals to older workers is to the flexibility younger workers—especially parents of young children—need.

Making a better workplace for older workers is making a better workplace for everyone.

Manpower, one of the Aging Consortium's member organiztions and sponsors, has some in-depth research on the aging workforce. You might want to look at New Agenda for the Older Workforce and Old Age Thinking, New Age Thinking.

Meanwhile, how’s your organization doing? Let us know your thoughts.

Time goes by

2007-11-08T12:11:00.000-06:00

It's been difficult writing lately. This has been one of those times when so many friends and coworkers are dealing with illness and death that I can't help but see mortality everywhere.

About half of the daily alerts on aging that come over my desk have to do with looking good. Creams and surgeries, excercises to make people look and, I suppose, feel younger.

Not so much about growing character and spirit or finding ways to deal with loss. The misproportion of information frustrates me.

Then I came across a blog, The Elder Storytelling Place. It's part of the Time Goes By: What It's Really Like to Grow Older weblog. I'm going to bookmark Time Goes By; it's wonderful.

Today's entry, A second chance at life, is by Georgie Bright Kunkel, who at 87 is still a freelance writer and stand-up comic.

Her story isn't a laughing matter, though she reminds us that at $10,000 or more a month for life in a skilled nursing center, we could all retire to the Ritz Hotel.

It's about considering that her life will soon likely be the life of a single woman. But now, though she and her husband spent their 59th anniversary in the emergency room and he is now being cared for at $10,000 a month, for the moment, they have some precious time together. And the grace to know how precious it is.

And so I cherish the time spent with my partner, as un-private as it may be in our present circumstance. Even if complete recovery may not be possible, we have been given a second chance at living and loving and we must make the most of it.

And so I bring the crossword puzzle to share with my husband every day. I play on the keyboard that our granddaughter loaned us so that my husband can enjoy all the songs we sang in the nineteen forties. I throw the beach ball to my husband so he can catch and throw in order to restore his waning coordination. We kiss each other and whisper sweet nothings into each other’s ears, even knowing the room is bugged for health monitoring purposes.

No way will I lose this opportunity to partner with my husband. . .We still have each other. I don’t want to consider the alternative just yet.

There is so much pain and loss. But there is so much more. Maybe age lets us see the two together, teaching us to love more what we have to love right now.

“To be a person is to have a story to tell.”

2007-11-01T14:13:00.000-06:00

Isak Dinesen said that.

And William Carlos Williams said, “Their story, yours and mine -- it’s what we all carry with us on this trip we take, and we owe it to each other to respect our stories and learn from them.”

Precious commodities, these stories.

You don’t have to be old to have a story. But being older means you’ve had a chance to accumulate a lot of chapters. You may have developed some insight into what the story means. And using experience or imagination or both, most people continue to work on that story until "the end."

If you know someone whose story you’d like to hear and preserve, there’s still a chance to become part of the StoryCorps project in Milwaukee.

Last January, the UWM Center on Age and Community partnered with the Milwaukee Public Library to make Milwaukee the first local “outpost” for this National Public Radio project in recording real people’s stories.

• StoryCorps will be recording in the Milwaukee Central Library Oriental Room until January 24, 2008. Log onto the site to register or call toll free 800-850-4406. You’ll get help—and a CD of the interview. With permission, a copy will also be sent to the American Folklore Center at the Library of Congress as well as the Milwaukee Public Library.

• On Tuesday, November 20, 7 pm, at the library’s Centennial Hall, you’ll be able to hear David Isay, founder of StoryCorps and author of a book about the project: Listening Is an Act of Love: A Celebration of American Life from the StoryCorps Project. The book contains some of the most compelling stories the project has collected. Call 414-286-3572 for reservations.

(Studs Terkel, who’s devoted a lifetime to telling the stories of real people, says the book "is history in the richest sense of the word, the kind that makes people feel like they count. . . This is what our country is all about." )

Spend $1 million, get $15 million back: Restoring the Milwaukee Housing Trust Fund

2007-10-25T10:03:00.000-06:00

This entry is from Tracy Straub, new Housing and Services Project Leader for the Milwaukee Aging Consortium. The Housing and Service Project is a multi-faceted effort to promote housing and service options that result in livable communities for older adults.

Today, Tracy shares information about the Milwaukee Housing Trust Fund, which was created but then only partially funded.

In November 2006, the Milwaukee Common Council created and Mayor Barrett signed legislation creating the Milwaukee Housing Trust Fund (HTF). Under the trust fund guidelines, 25% of the trust fund's dollars will be used to develop housing and provide services for people who are homeless, 35% will be used to develop or rehabilitate rental housing, 25% will be used to create and maintain home ownership, and the remaining 15% of the fund will be "flexible" and used for other housing needs.

For 2007, the city committed $2.5 million to the HTF to be raised by issuance of a general obligation bond. The response by housing developers has surpassed all expectations. The HTF has received 21 funding requests totaling more than $5.6 million. More importantly, the applicants would bring to the table $85 million dollars in matching funds.

In other words, for every $1 the city funds an additional $15 is invested from other sources.

As proposed in the original legislation, it was anticipated that the city would contribute an additional $1 million to the HTF in 2008. Unfortunately, the Mayor’s 2008 budget reduces funding for the HTF to $400,000. After making the bond payment, this will leave $160,000 available to fund projects in 2008. Clearly, the proposed funding is not anywhere near the originally anticipated amount and woefully inadequate to support affordable housing development in the city.

If you would like to weigh in on this issue, you can contact your alderman at 414-286-2221 or write to him/her at 200 E. Wells, Milwaukee WI 53202. If you are not sure who your alderman is, you can find out here.

Clarifying Quinn: women and Social Security benefits

2007-10-23T10:10:00.000-06:00

An article by Jane Bryant Quinn in the current AARP Bulletin is causing a bit of a buzz. Quinn wrote:

There's an exception for married people in good health when one of them has a small Social Security benefit. Typically, that's the wife. If she retires first, she should start her individual benefit at 62. When her husband retires, she'll switch to the spousal benefit. By using her own account first, she taps a benefit that otherwise would have gone to waste.

But Mary Jane Yarrington, senior policy analyst for the National Committee to Protect Social Security and Medicare, says that Quinn’s information is misleading.

. . .a wife cannot "switch." When a wage earner applies first for his or her own benefit, it stays in effect. A wife who takes her own benefit early does never receives the full 50 percent spouse benefit when the husband begins his benefit. The difference between her full-retirement-age benefit and 50 percent of his gets added on to her monthly benefit amount. This factors in the fact that she has been receiving months of early benefit. JBQ does not make that clear.

By taking the benefit early, does the wife "tap into a benefit that otherwise might go to waste?" Probably. Depends on how long the husband lives. When he dies, if she is full retirement age or more when widow benefits begin, she receives 100 percent of the benefit he would receive if still alive. Her own early retirement is ignored in determining her widow entitlement.

If you have questions about Social Security, you can “Ask Mary Jane.”

Thanks to Glenna Schumann, Coalition of Wisconsin Aging Groups, for passing this along.

Collaborative care for people with dementia

2007-10-21T10:07:00.000-06:00

According to blogger Jeff Muise (Caregiver Notes), it’s about time that the medical community is discovering what most people in the caregiving and service sectors have understood for a long time. An article in the November issue of the Journal of General Internal Medicine posits the need, Muise said, for “a system that fosters collaboaration among healthcare providers, community service organizations, and caregivers.”

To which Muise, a caregiver for his 90-year-old father, says, “well, duh.”

Again relying on Muise (I don’t have the journal), researchers at the Indiana University Center for Aging found that “most people with dementia only get care from their primary care doctor, and in the words of study co-author Malaz Boustani, MD, MPH, neither the primary care system nor primary physicians have the time or resources to meet the biopsychosocial needs of individuals with dementia.

In other words, it takes a village to support the whole lives of vulnerable people and those who care for them. But right now, that village doesn’t have enough money to sustain it.

Muise says the article’s vague endorsement of the right combination of critical components of dementia care to the right patient and the right caregiver at the right time really boils down to this: “each primary care practice should have a dedicated professional caseworker to follow up patient needs that extend beyond the practice walls.”

Muise lives in Woodstock, New York. I think things are a little better here in the Milwaukee area, in part because we have an amazing collaborative community, as we just witnessed at our Annual Networking Conference for Professionals in Aging last Friday. There, people not only collected business cards, pens, candy, and information; they discussed solutions to problems and shared dreams.

As Stephanie Sue Stein (director of the Milwaukee County Department on Aging) has said, what we have in Milwaukee is unique and advanced beyond the professional collaborations in aging services anywhere else.

But there’s still so very far to go. Please share your experiences in collaborative care. We’d be especially interested in hearing about successful collaborations with physicians.

Depression and stress: how can we help caregivers?

2007-10-15T10:56:00.000-06:00

The National Survey on Drug Use and Health includes some concerning evidence about depression among caregivers--and people in social services. One way to help caregivers: a local event for the mind, body, and spirit.

The Problem

People employed in personal care and service have the highest rate of major depression, with nearly 11% reporting episodes in the last year, according to a report released last week by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). (Depression among adults employed full-time, by occupational category)

A “major depressive episode” lasts two weeks or longer. The overall rate of worker depression is about 7%, and it leads to $30-40 billion in lost revenue. It’s a huge cause of absenteeism and low morale.

Other occupations that seem to put people at greater risk for depression are food preparation/serving, community and social services, and healthcare practitioners and technicians (all around 10%).

Women are at higher risk than men. The one good piece of news for people in the job market: those who work full time are significantly less likely to have had depressive episodes than people who are unemployed.

Caring for the Caregiver:
Not just a concept but an event

If you know caregivers, chances are you know people under stress. The Milwaukee Aging Consortium’s Caregiver Retention Project is one local effort to reduce caregiver stress by improving training, networking, and stress management among direct care providers.

An important free, day-long event for all types of caregivers is being offered by a number of concerned organizations including the Consortium. Please tell the caregivers you know about Caring for the Caregiver: an Event for the Mind, Body, and Spirit,Saturday, November 3, 2007, from 11 am to 5 pm, at Mount Mary College, 2900 N. Menomonee Parkway in Milwaukee.

Highlights include resources, networking, and a keynote address by Mary Marcdante (Author of My Mother, My Friend).

Perhaps most intriguing are breakout sessions include financial and legal issues, caring for difficult people, stress management, grief, faith and inspiration, laughter therapy, dementia, and activities.

At the end, caregivers will receive a certificate of attendance. Call 414-220-8600 to register.

And please let us know about your ideas, events, and experiences with caregivers and caregiving!

Older workers and the law

2007-10-08T10:06:00.000-06:00

Is age discrimination a serious problem, and should protections be included in the Civil Rights Act?

According to the American Society on Aging July-August 2007 Aging Today (just received today), the answer to both questions is a strong yes. Stereotypes of older workers are used to discriminate in hiring. And even when people are happy with their older employees, it may not occur to them to offer them promotions or training.

The topic of age discrimination is much in the news.

Last week, an appeals court ruled that Brian Reid could proceed with his age discrimination suit against Google. Google fired the 54-year-old Stanford University professor after two years of coworkers' calling him “an 'old man,' an 'old guy,' an 'old fuddy-duddy.' They told him his knowledge was ancient, and joked that the CD jewel case office placard should be an 'LP' instead of a 'CD.'"

The same week, the Supreme Court agreed to revisit Gomez-Perez v. Potter to decide whether age discrimination provisions for federal employees include anti-retaliation protections for reporting such conduct.

Myrna Gomez filed an age discrimination suit against her employer, the US Postal Service, when she was 45. After that, she said, her employer and co-workers “retaliated” against her and cut her hours.

What’s the story in Wisconsin? I can’t say. But here’s some information about the state’s Fair Employment Law. And here’s where you go to start filing a federal complaint in Milwaukee.

It seems odd to be hearing about age discrimination while we’re also hearing about labor shortages. According to that other law, supply and demand, businesses would do well to cultivate their older workers.

Last spring, the Small Business Journal ran The Graying of Milwaukee, which reported that Wisconsin’s labor shortage will be particularly acute. It will accelerate after 2010, and “by 2015 all of the growth in the working age population will be generated by people age 55 and older.” (emphasis added)

That means finding new ways to do business and new ways to train and keep older workers.

What experiences and insights do you have about older workers -- and attitudes toward them? Should there “be a law”?

The Art of Aging (Gracefully)

2007-10-05T09:27:00.000-06:00

One of the Google Alerts I get daily on the subject “aging” offered this tasty tidbit: “The Art of Aging.”

Who could resist?

Click the link: the article was about cheese.

But might there be some lessons in aging cheese for aging people? After looking at The Nibble and Whey to Go! On The Art of Aging (Gracefully), I’m ready to say yes.

“When I mentioned to a friend that I was writing an article on aged cheeses, she shuddered, adding that she couldn’t stand 'strong, stinky, old cheeses.' Hold on, there! There are some very strong, sharp, er, particularly aromatic aged cheeses, but they’re not all like that, not by any means. . .”

“Cheeses are either fresh or aged. Fresh cheeses are generally mild and soft in texture. . . creamy and somewhat bland. . .Aged cheeses are. . . multi-textured. One of the great things about (them) is their range in flavors. . . some are sweeter. . . though beautifully complex.”

“The aging process is also known as ripening, maturing, or affinage.” (That’s French for “refining.”)

Here’s a point I can identify with:

“Without a good rind, a cheese will lose too much moisture during refining.” I don’t know about you, but my own refinement has involved a distinct loss of moisture.

The cheesemaker’s solution? Wash the exterior periodically with brine, oil, brand, whey, beer, cider, or wine. While the article didn't mention it, I've had some good cheeses that applied the wine internally as well.

The paths of people and cheese diverge when it comes to ripening, though. Cheeses do best in dark caves: people don’t.

One last lesson: You just can't judge a cheese by its appearance. Its beauty lies in its deeper essence.

Changing the ways we do business

2007-10-02T16:51:00.000-06:00

Nonprofits are businesses, and we have the responsibility to be financially successful so we can deliver on our missions. I believe strongly that too few nonprofits are thinking about services they need to change in response to the age wave. For me, my board members, and the people who work at Ecumen, the issue of providing services to the aging is very personal. At some point, we all will need these services — and there better be good choices.

So said Kathryn Roberts, president and CEO of Minnesota-based Ecumen, one of the country’s largest nonprofit senior housing and services companies.

In case you have any questions about why the Milwaukee Aging Consortium is growing to include housing and services, you’ll find some clues in a recent interview with Roberts in Boardmember. The article addressed how and why Roberts led her company’s way into the private sector market to create new ways to approach the organization’s mission, “to provide the poorest and the neediest with housing and nursing care.”

It’s all about imagination, partnerships, crossing boundaries, and creating new ideas in the spaces in between them.

An excerpt from the interview:

. . .In 2004, after I had been at Ecumen for about a year and was starting to put some strategies in place to ride the (aging) wave, the board went on a retreat. The members used that time to identify a vision for our future and a five-year plan. Since then, it’s been “Go, Kathryn, go. Go as fast as you can.”

I may be overstating this, but if this organization hadn’t changed, it would not be looking at its 200th anniversary. And the board knew it too. Five years ago, more than 80 percent of our revenue came from government reimbursement, primarily through our nursing home line. With set rates and declining Medicaid support, we were only going to lose money. Because the nursing home industry is so regulated, our expenses were completely out of our control as well. So our choice was to either change our product line or run through our cash and close up shop.

Facing this dilemma, we strategized with the board and came to the consensus that we would need to add services that are less regulated and generate private revenue to offset the inherent losses in the nursing home line. My leadership team and I recommended that these new services include independent housing, assisted living, and care for those with Alzheimer’s and other memory impairments. One of the goals we set in that first strategic plan was to reduce the percentage of our income that comes from our nursing home line from 82 percent to 52 percent — there is no question in my mind that we will achieve that goal and maybe exceed it.

You can read the rest of the article at Changing Aging.

Are you doing business in new ways to fulfill your mission? Share your stories and ideas with us!

Wisconsin: leader in long-term care, aging in community

2007-09-26T14:51:00.000-06:00

Wisconsin in the mid 1990s was the first to set up what it called Aging and Disability Resource Centers (ADRCs), well-advertised storefronts that provide information and advice on home care services, such as bathing and dressing, meal preparation, nursing, housekeeping and specialized transportation.

Now, 42 other states, with the help of federal grants, are following Wisconsin’s lead.

This from an article published earlier this month in Stateline.org.

Stateline.org has been a daily online public information service of The Pew Charitable Trusts since 1999. Professional journalists provide news to “help nourish public debate of important state-level issues such as healthcare, tax and budget policy, the environment, welfare reform and other issues that in recent years have not gotten the media attention they deserve.”

In-home services are important not only because they're what most people want, but because they save a lot of money. Home care costs about half of what nursing home care costs.

The article devotes much space to Wisconsin’s success and quotes Donna McDowell, director of the state Bureau of Aging and Disability Resources.

Wisconsin is now in the second tier of percentage of Medicare dollars spent on homecare services, devoting 42% to those services. Fourteen states now do better. The top five: Oregon, 70%; New Mexico, 67%; Alaska, 63%; Vermont, 60%, and Minnesota, 59%. So we have a way to go to get back to the front of the parade.

More from the article:

Since 2004, the U.S. Department of Health and Human Services (HHS) has given states more than $42 million in grants to create Wisconsin-style centers, which now serve about 22 percent of the population. Last month, 11 states – Alaska, Arkansas, California, Florida, Georgia, Illinois, Indiana, Iowa, New Mexico, North Carolina and Wisconsin – received additional money to make centers available statewide.

You thoughts? Comments? Stories? Please share them with us.

Communications robots gather dust in Japanese nursing homes

2007-09-24T10:32:00.000-06:00

When it comes to technology, genius inventors probably need to talk to seniors before trotting out high-concept, high-tech products for them. Or so the Japanese are finding out, according to a Reuters news release.

A pale green robot that talks, sings, and plays trivia to help seniors stay mentally agile is less popular than stuffed animals that do none of the above but offer some creature comfort.

It shouldn’t be a surprise. Harry Harlow, famed Wisconsin researcher, found out years ago that like people, Rhesus monkeys preferred to be “nurtured” by padded surrogates than wire ones.

What most seniors predictably want technology for is making their lives easier. That means big buttons, better audio, and physical adaptability: simpler phones and tools, adjustable countertops.

Two high-tech innovations that show promise are an electric tea kettle with a radio transmitter and a spoon with a built in stabilizer. The tea kettle sends e-mail to the family, letting them know whether Mom has made tea that day. The spoon compensates for shaking hands.

High tech is great, but it won’t ever replace the need for high touch--the voice and hands of real-life caregivers.

What technology do you know that improves the lives of seniors? What would you like to see?

A shortened life for caregivers?

2007-09-20T11:45:00.000-06:00

According to the September 20 ScienceDaily, there’s new “concrete evidence that the effects of chronic stress can be seen both at the genetic and molecular level in chronic caregivers' bodies.” (Accelerated Telomere Erosion Is Associated with a Declining Immune Function of Caregivers of Alzheimer’s Disease Patients. J Immunol 2007 179: 4249-4254.)

What that means for caregivers--spouses and children who care for loved ones with Alzheimer’s disease in this case—may be a shorter life expectancy by four to eight years.

The study, published in the Journal of Immunology, was done by a group from Ohio State University's Institute for Behavioral Medicine Research including director Ronald Glaser, professor of molecular virology, immunology and medical genetics; Jan Kiecolt-Glaser, professor of psychology and psychiatry; and Nan-ping Weng and other researchers from the National Institute of Aging.

The group has been looking at the effects of psychological stress on immune status in many different groups. In an earlier study, they showed chromosomal damage and premature aging in mothers of chronically ill children.

Interestingly, the Institute is also investigating whether yoga can reduce levels of stress hormones. While many people believe that to be true, there’s no scientific evidence—yet.

So there’s another good reason to help caregivers. This fall, watch for all the opportunities around Milwaukee. A few follow:

• On October 4, we’re sponsoring a caregiver training event in Milwaukee that talks about one source of stress--lack of health insurance--and one intervention that might help caregivers and the people they care for stay healthier—better nutrition.

• October 29-31 in Port Washington, the Wisconsin Alliance for Family Caregiving is offering a train-the-trainer session for people interested in using the curriculum Taking Care of You: Powerful Tools for Caregiving.

• And Saturday, November 3, there’s a free all day event for caregivers at Mount Mary College, Caring for the Caregiver: an Event for the Mind, Body, and Spirit. This event is sponsored by the Milwaukee Aging Consortium, Interfaith-Family Caregiver Support Network, Milwaukee Center for Independence, IndependenceFirst, Golden Living, New Health Service, Stowell Associates SelectStaff, and Interfaith Older Adult Programs, Inc. To register or for more information, call 414-220-8600.

Uninsured caregivers would benefit from Badgercare Plus

2007-09-14T13:40:00.000-06:00

One of the points that has the Wisconsin State Legislature stuck in budget morass is the governor’s plan for universal health insurance, Healthy Wisconsin.(Note: link changed 9-17-7.) The Republicans won’t budge on this radical innovation that would change the entire climate of health care reimbursement in the state.

But there’s one thing many of us, including the Wisconsin Long Term Care Workforce Alliance and the Wisconsin Direct Caregiver Alliance, can get behind, and that’s BadgerCare Plus. Healthy Wisconsin or no Healthy Wisconsin, this program is a must for many caregivers, whose average monthly income in Wisconsin is $1,700.

Many caregivers tell us that they must choose between having a car, increasingly a requirement for employment, and health insurance. It’s hard to imagine affording either on that income.

BadgerCare Plus is an expansion of the state’s existing healthcare program for families with children who are unable to afford health insurance. The expansion would include individuals and families with no children in the home who meet income requirements.

To help support direct care workers by seeing that they can have health insurance, contact your legislators. If you’re personally affected, tell you story.

There's a link on our website to a factsheet that should help you make your case about BadgerCare Plus and direct your message to the right person.

And please share your stories with us as well!

A tale of two agings. . .and another warning about the budget

2007-09-12T12:30:00.000-06:00

Two aging-related articles telling very different stories of the lives of aging people appeared in the Milwaukee Journal Sentinel September 12.

Front page (though below the fold) was Retiring an old notion. It’s about people staying employed into their 60s and 70s. And it confesses to an “idealized glimpse of the American way of working into the golden years. . .” The article featured Pat Benway, who works for Consortium member Stowell Associates SelectStaff, and who is at the top of her game at an age when many are retired.

It’s a story we all love to hear. People who are vital doing vital work as long as they feel like it, and shaping the job to suit their own changing desires.

Then there’s the other article, buried a little on page 3 of the Metro section: Study finds disparities in area nursing homes. Milwaukee holds the dubious claim to the largest gap in quality care between blacks and whites in nursing homes, according to a study in the journal Health Affairs.

According to the study, which was based on data from the year 2000, race, poverty, and segregation are intermingled in this sorry state of affairs. It's not that individuals of different races receive different care in the same nursing home.

Nursing homes in Milwaukee are largely segregated--by race and income. Mainly white nursing homes—not in the central city; mainly black nursing homes with high percentages of residents receiving Medicaid—in the central city.

The disparities include more significant inspection difficulties, staffing shortages, and financial problems in the inner city nursing homes.

In fact, the environment has changed greatly since 2000, if only because many nursing homes in the central city that served predominantly African-American clients have been closed down.

As Stephanie Sue Stein, director of the Milwaukee County Department on Aging, pointed out, in the few that still exist, “It is very difficult for a nursing home with 100% Medicaid recipients to provide a quality of care that we would expect to provide to older people.”

* * *

Another article appearing a day earlier suggested that the state may have to cut Medicaid payments to hospitals and doctors by 35% starting in January—if the legislators haven’t passed a budget.

Cuts for nursing homes and other home and community based waiver services would be at the rate of 15%, according to Secretary Kevin Hayden of the Wisconsin Department of Health and Family Services. That's because these long-term care providers "provide vital supports to highly vulnerable frail elders and individuals with disabilities.

Of course, if the legislature adopts a state budget, the whole thing becomes moot.

Maybe some of those Elder Boomers we talked about the other day and other vital working adults—including our elected officials--can put their heads together to improve an unacceptable situation.

Thoughts? Ideas? Stories?

Baby Boomers, grow up!

2007-09-11T12:59:00.000-06:00

And when you do, says Elders Guild founder Barry Barakan, you get to stop being babies and start being elders. And that’s a very good thing. But it’s full of responsibility, too.

Elders are the people with the experience, knowledge, and wisdom to rebalance a world gone far out of kilter.

Each of us needs to decide when to engage our aging with the intention to consciously prepare for the marathon of productive longevity. For each of us that moment is different, but as soon as we know that the second half of life is upon us, it is time to begin the process of reconceptualizing our reality. The process requires no less a level of dedication, effort, preparation, and continued learning than the work of establishing and growing a career and family.

Barkan has been a leader in elder-centered community action for thirty years. You can read more about his ideas at Tikkun. He was one of the founders of the Pioneer Network, in which the Milwaukee-based ActionPact change consulting group plays a large part.

The idea of the Elder Guild:

. . . to launch a new initiative that creates the organizational structure for a health-creating society for all. It will provide the antidote to the disconnection, impotence, and lack of meaning that contribute to our social malaise.

We need to learn to be effective, as we stand not just for ourselves, but also for the future generations to whom we have an ever-increasing debt. We call this initiative the Elders Guild.

The Elders Guild is truly radical, innovative, and based on proven experience. It is a new paradigm for regenerating community. And that is not just the community of the elders, but the whole multi-generational continuum.

It’s a tall order. But someone’s got to do it. What are your thoughts? Can elders, and especially Elder Boomers, lead the way? Does Elder Guild activity interest you? Share your ideas with us!

Who can’t afford what here?

2007-09-06T11:00:00.000-06:00

Here’s a personal story we just received from someone responding to Congress and caregivers: no overtime pay that appeared here June 15. The blog reported the Supreme Court decision that caregivers were not entitled to overtime pay under federal law.

The comment is edited a bit for typos and such. Other than that, I’ll let it stand on its own.

I personally work for one of these senior care companies. Unfortunately it is true, they do not pay overtime. I currently work on average 44 to 52 hours a week. I have four children to support. The excuse of the company was the elderly just cannot afford the care. Well, I believe not.

I work for not one person that is not living in a mansion compared to my shack. These people pay for home care because they want to stay in there home. A residential facility costs about $3000.00 a month. That is a fraction of what I pay to live. I make $1500.00 a month on average working over 40 hours a week. I have to support 4 children on this pitiful wage.

Who can’t afford what here?

Anyone have any answers or fixes for this very real–and very uncomfortable—problem?

“Expand this program.” Family Care expansion not in the budget yet

2007-09-05T10:01:00.000-06:00

Last year, the Legislature overwhelmingly voted to support Gov. Jim Doyle's proposal to expand the program statewide. On the heels of that strong bipartisan support, Doyle put $20 million in his budget in February to expand the program over the next two years. The Senate kept the money in its budget, and the bipartisan Joint Finance Committee voted to include the money in a 15-1 vote. Journal Sentinel, September 2, 2007.

Unfortunately, the Wisconsin Legislature hasn’t allocated funds for the program, and the Conference Committee hasn’t put funding into the budget as they continue to dither about it.

The editorial writers concluded:

Time's running out. If the legislators don't act soon, they're going to be bumping up against federal deadlines and state and local timelines that could delay or even jeopardize the expansion, Doyle spokesman Matt Canter says.

Kudos to Aging Consortium and Make It Work Milwaukee Coalition members Tom Hlavacek, Altzheimer’s Association, and Barbara Beckert, Milwaukee Jewish Council for Community Relations, for persisting in getting the story in front of the public.

And kudos to Consortium member Gwen Jackson, who wrote that it’s time to set politics aside. Scroll down in the article a bit to read her letter to the editor:

Nearly 2,500 people with disabilities in Milwaukee County are waiting; many are adult children whose aging parents are desperate to have community supports in place for their children. Many have no choice but to leave their own homes and enter nursing homes, which are far more costly than community services.

There are all sorts of good reasons to favor expanding Family Care, one of Wisconsin’s successful pilot programs for keeping low-income seniors out of nursing homes, to people with disabilities. Chief among them are the 11,000 people waiting for help the program can provide. Nearly as important is the $60 million in federal funds Wisconsin’s $20 million investment will draw.

Please write your legislators now!

Talks with communities: senior housing

2007-08-31T13:13:00.000-06:00

We just held two neighborhood meetings to discuss innovative ideas in senior housing that came out of the UWM School of Architecture and Urban Planning’s Senior Housing Ideas Competition earlier this year. You can see the competition designs and download the report here.

6th and Walnut

The first meeting on August 30 looked at ideas for the site of the former Plymouth Manor nursing home in Bronzeville. While most of the sites selected for the competition were “wouldn’t it be nice if” sites, this one is well along the way to actual development. Prince Hall Masonic Foundation, along with ELL Development, LLC, is building the Prince Hall Campus there. Plans aren’t set, but the entire continuum from independent living to skilled nursing is in the works.

Competition architectural firm Plunkett Raysich is developing the plans, which probably won’t look much like the ones you see at the UWM website.

Lots of movers and shakers attended the meeting at the United Way. The development group is working on funding, including the possibility of bonds; completing studies; issuing an RFP for service and management; and developing an advisory board to help in the process. If you’d like to be involved, contact Georgia Cameron, gcameron@pobox.com.

At the end of the presentation, Stephanie Stein, director of the Milwaukee County Department on Aging, challenged everyone to find ways around barriers to create a better model, one that doesn’t have separate areas and ideas for different levels of care.

People don’t want to move from place to place to place, and they shouldn’t have to. Seniors in independent living will hide problems because they want to stay where they are, not be moved, she pointed out.

Bringing services to the people and community whenever possible rather than sending people to the services is the bottom line for all the sites, not just this one.

Sherman Park

The evening meeting for the Sherman Park neighborhood was a different ballgame. That site, the location of the no-longer-used Jackie Robinson Middle School, is for sale. But nobody’s been talking about new ways to develop it, and no buyers seem to be looking at the site.

A smaller group, mainly neighborhood residents, attended. They looked and listened with open minds, and maybe the “hmmmm” of new possibilities opening. The idea of a large scale senior living center hadn’t been raised before.

However, the attending neighbors said that as they thought about it, there was indeed a need for congregate senior living places in their neighborhood of single-family homes. They also wanted to pay attention to this site as a focus for strengthening the neighborhood. And the plans, they said, showed places they might like to live themselves.

Another bottom line: build the place you'd want to grow old in yourself!

Stay tuned to hear about future meetings. And please share your thoughts with us.

The great diaspora: moving seniors

2007-08-29T11:20:00.000-06:00

How—and where—seniors will live is a lively discussion topic for communities with aging populations. And that would be almost all of them.

“Housing for elderly sparks protest” was a front page headline in the August 27 Milwaukee Journal Sentinel, as one Mequon neighborhood digs in to oppose an 8-person assisted living group home among their half-million dollar homes.

Just a day earlier, however, the same paper proclaimed: “Condos find niche in Grafton: new projects helping attract seniors to walkable downtown.” The article profiles a Mequon couple who wanted to avoid the traffic congestion in their neighborhood, so they moved into Grafton’s “rural-urban downtown, where you can walk to get some coffee or walk to the river or walk to a restaurant. You don’t always need your car anymore.”

What’s going on here?

On one hand, we see smart developers going after the affluent “young” senior population. On the other hand, we see communities objecting to assisted living "homes" in suburban neighborhoods.

It looks like the idea of moving seniors “out” of where they now live is strong, whether it’s to chic and pricey housing in revitalized downtown areas or to larger community-based residential facilities in more commercial parts of town.

Move them, but don’t put ‘em in my back yard is the message in Mequon. “I think it’s a great thing. I just don’t think they should be in the middle of a neighborhood with 30 kids around,” a woman said.

You’d think we were talking about sex offenders.

Of course the story’s more complicated than that. It seems that the Mequon CBRF owner neglected to talk to the neighbors about her plans, and that’s always a huge mistake. The first principle of creating a great community place is “the community is the expert,” the place where you start the planning.

Still, it seems there's a huge disconnect between what people in the aging field and those in the rest of the community are thinking. Staying in your home or at least your community and non-institutional group living is the direction we're headed. But the trends don't seem to have filtered into the way the community at large sees aging.

For many seniors, the best place to live is home, or a place like home. And some of those places should be in the neighborhoods in which people raised their families.

No better place to explore the “do unto others as you would have them do unto you” rule.

Employers rediscovering the value of experience

2007-08-23T10:12:00.000-06:00

Is age 74 the new 47 for job hunters? According to an article in the August 23 Milwaukee Journal Sentinel, it may well be.

According to manager Greg Gardetto, 43, who hired 74-year-old Ron Mulvaney to sell mattresses for Verlo Mattress Factory, “I hardly look at this as charity work to bring someone in who’s older. . .He already knows how to interact with people.”

To those of us who are over 40—the age at which some begin to tag us as “older workers”—that seems to state the obvious.

But obvious or not, scarcity of good employees and increased need or desire of “mature” people to contribute their gifts in the workplace seem bound for what could be a happy collision.

Interfaith Older Adult Programs is an important player in helping older workers find jobs. Writer Joel Dresang says that employment services director Pat Delmenhorst is noticing that employers seem more willing to consider mature workers.

After all, who would prefer immature workers?

The secret to a long life. . .

2007-08-21T16:13:00.000-06:00

. . . is not just how you live but where you live. Walk fast and live in a big city. Or so says Clive Thompson in New York Magazine.

Oh, Wisconsinites still live longer than New York city residents by about six-tenths of a year (79.2 vs 78.6). But they’re moving up faster: we only gained about 2 months from 2002-4 to 2003-5 to their 5 months.

Read the article: it’s fascinating. But here’s a brief synopsis of why New Yorkers (and Chicagoans and Bostonians) are living longer.

• They walk a lot, and they walk fast. Research says the fast walking is key. (They also do a lot of climbing: the city is “built like one big jungle gym for pedestrians,” someone said.) The built environment makes it hard to drive and forces people to be active.

• They weigh less—10 pounds less. That’s partly because they walk a lot. “The more you drive, the more you weigh,” said professor Lawrence Frank.

• Because it’s crowded and people are out walking a lot, they bump into each other and have extensive social networks. Which means, I guess, they walk a lot with each other.

• The city is aesthetically pleasing and charming. Which makes people want to get out and. . . walk a lot.

• New York cleaned up its environmental and criminal acts, making it possible to . . . walk a lot.

• Proximity matters. People visit parks more because they are closer, and they. . . walk around them a lot.

• The city is rich and prospering. Gentrification leads to better housing, better food, better hospitals, better health care. The rich always live longer. And ambitious, driven cities attract ambitious, driven people, who. . .

walk a lot.

Steal this idea!

2007-08-20T15:33:00.000-06:00

According to Changing Aging, the Ecumen blog, “Parmly LifePointes, an Ecumen community in Chisago City, Minnesota, is embarking on a very cool new journey built upon successful aging.” Ecumen, affiliated with the Evangelical Lutheran Church in America, is one of the nation's largest nonprofit providers of housing-and-services to seniors.

Once you get past that pesky extra “e” in LifePointes, you’ll probably agree that the Vitalize! Wellness Centre (don’t get me going about the ! or the other oddly placed “e”) is indeed a very cool venture.

It’s an up-to-the-minute gym with “TechnoGym weights and TechnoGym aerobic fitness equipment that digitally measure one’s personal progress, a warm-water lap pool, a warm water pool with a treadmill, herbal teas and great food, exercise rooms, massage, plus classrooms for lifelong learning that helps people explore, personalize and enhance dimensions of successful aging."

There’s also a feng shui garden.

One of the coolest things about it is that it’s multigenerational and open to community members. According to the blog, “Vitalize! will be the place where a 25-year-old certified nursing assistant (what a great asset this will be for Parmly employees) and an 85-year-old who might have a chronic condition and lives in assisted living or the nursing home, go to take greater control of their life and how they travel through it.”

Cool indeed!

Keeping good things going

2007-08-17T15:27:00.000-06:00

The Milwaukee Aging Consortium is no longer a direct advocacy organization, but some things have clear benefits for seniors, and it’s worth getting behind them. Make it Work Milwaukee! (MIWM) Coalition offers some alerts for immediate action. On the state level, Family Care expansion funding is threatened. On the Milwaukee County level, transit costs threaten to soar as access is reduced.

Family Care
One hundred and thirty people showed up for our meeting on Family Care Thursday, August 16. Also present were representatives from iCare and Community Care Inc., two other care management organizations serving both older adults and people with disabilities. We hope this was only the first meeting of senior and disability service providers we'll host.

Family Care is an innovative Wisconsin program that helps low income seniors and people with disabilities continue living in the community. It has a track record in nine counties, and expanding the program has bipartisan approval and was supported by the Governor, the Joint Finance Committee, and the state senate in the current budget cycle. Yet the Assembly eliminated Family Care expansion from the budget.

Family care is cost effective, keeps people out of nursing homes, and gives consumers choices about services, among other qualities.

Negotiations are going on right now, so it’s important for Family Care supporters to let elected officials and the media know why this is important.

More information in this Action Alert.

Transportation

Transit is a persistent problem for seniors. And it doesn’t look like it’s going to get better with the current county budget. Rising fares, fewer routes, and reductions in Transit Plus services hurt seniors and others who must rely on public transportation the most.

Like the state budget, the county budget is currently being hashed out. If transit is important to you and your clients, see MIWM budget highlights , including phone numbers of key people to call.

If you’d like more information on either issue or to become involved with the MIWM! Coalition, contact Barbara Beckert, Milwaukee Jewish Council, 414-390-5718, or Tom Hlavacek, Alzheimer’s Association, 414-479-8800.

Milwaukee, best city for boomers—because of you!

2007-08-06T10:55:00.000-06:00

Atlanta; Portland (Oregon); Chandler, AZ; Boston; Milwaukee. . .to people who don’t live here, there’s one surprise in AARP’s list of best cities for Boomers to live—and retire-- published this week.

Milwaukee’s “vibe” is listed as “urban renewal at its best.” Director of the Department of City Development Rocky Marcoux said the city is making sure it stays appealing. “We think sustainability has a lot to do with accessibility. It’s what will make it possible for future generations to age in place. People shouldn’t have to leave their home because it’s badly designed.”

If that all sounds like a page from the Expanding Housing Options Summit we held in January, there’s a reason.

Members of the Milwaukee Aging Consortium have a lot to do with the quality of life for seniors cited in the article. The five free “fitness centers” mentioned are really Milwaukee’s acclaimed Senior Centers,managed by Interfaith Older Adult Programs and funded by the Milwaukee County Department on Aging (Clinton Rose; Kelly; and in the parks, McGovern, Washington, and Wilson).

And as an example of what can be done for lower income seniors, the article cites Lapham Park—a partnership venture that includes Community Care, Inc. and SET Ministry, along with the Department and our friends at the Housing Authority City of Milwaukee and others.

But there’s much work left to be done in neighborhoods that aren’t part of the waterfront boom. There’s much work to be done for housing-and-services for those who are frail or the “older old,” people in their 80s and beyond. And we’re going to be an important part of that.

On Thursday, August 30, the Consortium and the UWM School of Architecture and Urban Planning, along with Connecting Caring Communities, will host two neighborhood meetings presenting exciting ideas from the school’s senior housing ideas competition last winter. The plans we’ll showcase focus on creating senior housing and communities that keep older adults vital in those neighborhoods. While the ideas developed for the sites in the competition may not be the plans that will eventually be developed there, they present a great starting point for thinking and future planning.

The Walnut Street neighborhood meeting will be held 11:30-2:00, United Way, 225 W. Vine Street. The Sherman Park meeting will be held 6:30 – 8 pm, Wheaton Franciscan Healthcare-St. Joseph’s Hospital, Klieger Auditorium (M1010 in the Marquette Building) 5000 W. Chambers Street. While meetings are geared to neighborhood members, if you serve people in the area or have a special interest, call 414-289-0890 to register.

Stay tuned for more about the Consortium’s housing interest groups and carrying on the work of designing Milwaukee for aging in community.

"Don't call me 'elder'!"

2007-08-02T14:19:00.000-06:00

Baby boomers are “the pig in the python” that moves through time in America, changing the shape of everything they pass through. And many are trying to predict how they—we—will change the end of life.

Ecumen, Minnesota’s largest non-profit senior housing company and affiliated with the Evengelical Lutheran Church in America, studied a cohort of Minnesota boomers to find out what they thought. Age Wave findings make interesting reading. Among other things, I now know that “80 is the new 60.” Which must mean that 60 is the new 40: what a relief!

What’s in a name?
“Senior” and “older adult” are okay; “elder” and “third-ager” aren’t.

Call them “people,” not “residents.”

They want to live in “homes,” not “units.”

“Community” is the term of choice for where they live: forget “facility” and “campus.”

“Community with services” is good, but not “assisted living.”

“Life care community” is the term of choice, not “nursing home.”

And they don’t like the term “long-term care;” it had negative connotations for nearly half of those studied.

Care options—and how to pay for them
They may not like the term “long-term care” but they know they are going to need it.

89% support using Medicaid dollars to pay family members to provide care for a senior in the home, a model being tried in Vermont (and Wisconsin's Family Care).

86% would pay a payroll tax of up to $12/month to provide funding for a year of guaranteed long-term care.

80% support a lifecare annuity: a single payment that would yield an ongoing income stream to pay for long-term care costs.

Most important characteristics
Between 90-100% of boomers say these will matter as they age:

1. Independence
2. Nearby friends and family
3. Privacy
4. Easy access to health care
5. Safety
6. Easy access to shopping
7. Spiritual opportunities
8. Easy access to transportation

The next most frequently named list (64-81%)

9. Meaningful volunteer opportunites
10. Welcomed community involvement
11. Easy access to fitness opportunities
12. Multi-generational community

Is this our future?

2007-07-30T16:12:00.000-06:00

Welcome to Elliot Lake, Canada's most elderly community. Upsides: Bungalows under $100K, wheelchair accessibility, carpet bowling. Downsides: Doctor shortage, dwindling tax base, con artists. This is our future.

- Patrick White, July 30, Globe and Mail, Ontario, Canada

Elliot Lake is the oldest town in Canada. By that, I mean the town with the highest average age: 55. One in three people is over age 65. And it got that way on purpose.

After the mines that employed most of the citizens closed in 1990, the city council decided to pursue a new industry: senior citizens. They invested millions in making the town physically accessible—and senior friendly. Golf courses and condos proliferated. And mobility vehicles whir down the streets, defying laws that no one has the heart to enforce.

If this is the future, we might take heed of some lessons to see what it really means to age in community.

For one thing, we need to look beyond real estate. Planners failed to take services into consideration, and services cost money. The town is running out of doctors. At the same time, the hospital is now the biggest employer in town.

“There will come a point when the tax base on a municipal basis can’t take it any more,” said the town’s mayor, Rick Hamilton.

Elliot Lake is also overrun with scam artists selling unneeded or non-existent products and services to people.

Might be a good idea to make the elderly everybody’s concern, not just their “business.” At the same time, this in vivo "laboratory" suggests that a community needs balance in everything, including age.

On their shoulders

2007-07-25T12:11:00.000-06:00

This Thursday, July 26, is the Milwaukee Aging Consortium’s annual Excellence Awards and recognition event at the Italian Community Center. It’s also our fifth anniversary. The governor will be there, along with the mayor. We hope to see you, too!

This year, so we can reflect on all the people and organizations that went before us—and in so many cases, are still part of our Consortium—we have fewer award categories than usual.

We’ll be giving Starr Krause the Distinguished Caregiver award. She’s been employed as a caregiver for about 30 years and is about to retire from her formal caregiving job at Aurora Day Care Center.

We’ll also be giving Daniel Bader and the Helen Bader Foundation the Leadership award for their role in helping start and sustaining the Milwaukee Aging Consortium. We are privileged to be one among many of the programs for aging and Alzheimer’s disease benefiting from that organization’s stewardship.

But first, we’ll recognize the members of the Older Adult Service Providers Consortium that went before us, our first board members, and the original founding members of the Milwaukee Aging Consortium. What an impressive group they are!

In getting ready for this event, I got to learn more about the history of not only the Consortium but aging professionals in this area. Not only are they a wonderful bunch, but they are still out there, in the work world or in private life, making life better for older people.

Thanks seems like such a small word to express our gratitude.

1. Sites for affordable housing; 2. The Wisconsin Quality Home Care Commission

2007-07-20T17:54:00.000-06:00

Today's Milwaukee County issues day!

Affordable Housing

On Wednesday, July 18, the Committee on Health and Human Needs of the Milwaukee County Board of Supervisors passed a resolution to “create a work group of County officials. . . to survey all county-owned land that potentially could be utilized for affordable, accessible, and supportive housing benefits for seniors and disabled citizens” and to prepare a list of appropriate sites.

The list will be sent to appropriate County Board committees and the Committee on Economic and Community Development. Authors of the resolution were Supervisors Holloway and DeBruin.

This may be an important step in locating affordable service-and-housing for those who need it most where they need it most—throughout the county.

* * *
Wisconsin Quality Home Care Commission

The second agenda item, a discussion of a report about the benefits and potential problems that might result from instituting the Wisconsin Quality Home Care Commission resolution (QHCC), was more controversial.

And trying to figure out what it all means has been an education! This is really long, but I wanted to share the fruits of my sometimes frustrating search for information. I'm counting on you to help me out if I'm off-base!

The Wisconsin Quality Home Care Commission is an intergovernmental entity, separate from the state or county, established in 2006 to provide services to consumers and providers of home care and personal care services. It promises to develop a provider registry, offer assistance for consumers in selecting providers from the registry, and serve in some capacities as the employer of record for private providers (those who aren’t affiliated with an agency) who want to be in the registry. Dane was the first county to sign the agreement, and the Commission is looking to Milwaukee County to sign on.

The Milwaukee County committee voted 5-1 endorsing the principle of the Commission. That’s different from actually signing an intergovernmental cooperation agreement, as Dane County and the Wisconsin Department of Health and Family Services (DHFS) have.

Presently, the Commission is only in the developmental stage. It has no continuing funding source, and it’s intended to “improve the quality and accessibility of supportive home care and personal care services” for clients with disabilities who receive medical assistance waiver services, not elderly people.

So why write about it here?
One of the reasons for looking at this proposal, according to Paper #436 (May 2, 2007), Health and Family Service—Disability and Elder Services, is the need to grow the pool of personal care workers in light of the expansion of Family Care, the nursing home diversion initiative, and other long-term care community program options. So it seems reasonable to follow carefully what unfolds here. It may be something in the future for home care providers for the elderly, too.

Who’s your boss?
If you are an independent personal care worker in a participating county, the Wisconsin QHCC could be a sort of Professional Employer Organization (PEO) for you.

With a PEO, you really have two employers--the person or organization that hires you and supervises you, and another entity that “assumes much of the responsibility and liability for the business of employment, such as risk management, human resource management, payroll, and employee tax compliance.” Training and orientation can also be PEO roles.

Because of the role of the Service Employees International Union (SEIU) in establishing the Commission, it would be a very new thing indeed—a union PEO. Traditionally, PEOs are “white collar” entities.

About the registry
A prototype registry already exists, and it’s expected that the provider registry of the Wisconsin Regional Training Partnership and the Service Employees International Union (SEIU) will be folded or developed into the QHCC registry.

Here’s what the provider registry form for Dane County looks like. Presently, it seems to be a list of skills and preferences, without a way to evaluate quality.

Back to the meeting
Corey Hoze, director of the Milwaukee County Department of Administrative Services, expressed reservations related to potential costs and limitations on consumer choice. Apparently, he’d expressed support for the objectives of the Commission but the same reservations at the previous meeting.

But the room was packed to overflowing with supporters, mainly from the Wisconsin Home Caregivers United for Quality Care, who spoke eloquently to the pressing need for quality home care--and support for the people who provide it.

I spoke to an organizer for Local 150 of the SEIU, who confirmed that the Wisconsin United people were from his organization.

Wherever you sit on the question of unions, there’s no question about the value of some of the points made by the supporters, especially about the need for better training and quality of care.

Ann Kruschke spoke to the lack of any but basic training for home care workers, compared with hospital employees who can upgrade their skills. “People are coming home in much more serious condition, with tracheostomies for example, and there’s no training for the people who take care of them. There should be at least one place they can go to learn more.”

Another woman, new to home care, talked about a gap she found in caring for older people. Formerly a childcare worker, she pointed out that part of the caring job with children was to provide cognitive, emotional, physical, and social stimulation. But there is nothing like that in the task list she receives from the agencies for which she works. “I’m afraid if I start a puzzle, sit down for coffee with my client, or take them for a walk, I’m stealing from the agency’s time. But I know how important those things are.”

A place for training for some
Important points, and we’d love to hear your comments on them. But there’s one place direct care workers who work with the elderly can go for free education and professional development.

The Milwaukee Aging Consortium's Caregiver Retention Project has been providing ongoing caregiver enrichment education since 2004. The next resource event, Thursday August 9, 5-7 pm at the Milwaukee Center for Independence, is providing skills and knowledge in dealing with people with disabilities and seated exercises home care workers can use with their clients.

Just what the Wisconsin United folks are looking for. Is this another place to develop partnerships?

Medicare: Universal health care for everyone?

2007-07-03T07:32:00.000-06:00

With a genuine universal health care plan headed for the state assembly, Wisconsin’s abuzz with debate over the best ways to improve health care access and cut costs.

Some see salvation in the plan, which opens to all the system state employees use. Others see socialism and disaster. Business groups are divided, with many trade groups opposing the plan but some independent operators supporting it. Republicans have vowed to administer a swift death to the plan.

Wisconsin Democrats aren’t the only supporters of universal health insurance. The National Older Women’s League, OWL, is, too. In their Mother’s Day report for 2007, Give ‘em Health Revisited: Medicare for All, authors Joan Brodshaug Bernstein and Merton C. Bernstein say we’ve already got a system that works, so why not use it for everyone?

The Oregon Alliance for Retired Americans writes of the report:

Give 'Em Health, Revisited: Medicare-for-All illustrates the ways midlife and older women are especially at risk for lack of health care coverage. The report provides a scathing overview of what is wrong with the current health system including the one-third of total health care expenditures that go to pay for administration, the tripling of profits over five years of the top seven U.S. health care insurers, and the exorbitant salaries of pharmaceutical company CEOs. Yet 47 million Americans have no health insurance, including 15 percent of women age 60-64. OWL concludes the report by endorsing a Medicare-for-All plan that would provide health care insurance coverage to all Americans without requiring new taxes or fees.

Here’s one Tennessee woman’s response:

I am a registered nurse and health care administrator (recently retired). I spent a huge part of my 37-year career finding ways to get coverage for the medical needs of patients. If health care providers were freed from this laborious concern, there is no telling how much talent and skill would be freed up to care for patients—the impact would be wonderful and dramatic!

What do you think? Does dealing with insurance take your time away from more important tasks? Is universal health care important? Viable? Could Medicare be a good system for all? Who would benefit--and who would not?

USA Today series plunges into caregiving

2007-06-27T14:30:00.000-06:00

USA Today is doing a great job helping people understand what’s involved in caregiving and longterm care for our elders.

If you’re a professional in aging, it may seem like an old story well told. But if you’re just starting to get an inkling, the series of articles Role Reversal: Your Aging Parents and You is an eye opener. You may want to share these articles with friends and clients.

To give an idea just how big the issue of caregiving is, not only personally but as a factor in the economy, consider these "average caregiver" facts from the AARP:

• The “typical” caregiver in the U.S. is a
46 year old female who works outside
of home and spends more than 20
hours per week providing unpaid care.
Caregivers often experience serious
economic losses due to changes in
work patterns, including lost wages,
loss of health insurance and other job
benefits, and lower retirement savings
and Social Security benefits.

• Almost one fifth of workers (19%) are
informal caregivers. Productivity
losses to U.S. businesses related to
informal caregiving are estimated to be
as high as $33.6 billion per year, more
than half the value of all productivity
losses due to common pain conditions,
such as arthritis, headache, and back
conditions.

In the USA Today series, “Becoming ‘parent” of your parent an emotionally wrenching process” is an especially eloquent account of the emotional aspects of the caregiving relationship.

Here’s the list of series articles that have appeared or will appear in the journal and its online counterpart. ABC news is running stories on the subject as well.

Monday
The burden of caring for elderly parents
A shift away from nursing homes
Valuable resources for caregivers

Tuesday
Coping with an aging parent: The emotional toll
Balancing work and caregiving
Claiming your parent as a dependent

Wednesday
Navigating sibling relationships
Re-emergence of multigenerational households
Avoiding scams that target your parents

Thursday
Long-term care insurance has its own risks
When a parent has Alzheimer's or dementia

Friday
Planning for retirement and elder care
How to spend down assets to pay for care

Tell your elder care story to ABC

2007-06-23T15:51:00.000-06:00

ABC television news is planning a series on "the challenges of elder care." And they're looking for brief audio or video story clips from people who do the work.

Glenna Schumann, CWAG, who passed this information along, said the ABC folks are looking for "children caring for parents, role reversal and sandwich generation issues. . .They would like highlights of 1-2 things they experienced or challenges."

The deadline for uploading your video to their site is Friday, June 29--or sooner!

Press release with more information follows.

ABC News wants to know about your family, friends & loved ones. We want to hear your care giving stories-- from the difficulties and challenges you face caring for your elderly loved ones--to ways you've managed to make it all work.

Get your videos in by June 29th and you may have your story shown on ABC's special series "Role Reversal: Your Aging Parents and You!"

It's easy! Here's HOW:

Click here to directly send a VIDEO:
http://abcnews.go.com/US/BeSeenBeHeard/story?id=3279347

ABC News is specifically requesting 15-45 second video comments or photos highlighting one aspect of your story.

HOW TO SUBMIT VIDEOS:

1) Via cell phone
Record a 15-45 second clip and email it to: seenandheard@abcnews.go.com

2) Via the web:
http://abcnews.go.com/US/BeSeenBeHeard/story?id=3279347

NOTE: Deadline for submissions is Friday June 29th @ noon EDT.

We look forward to hearing from you & Thanks again for your participation!
- The "Talk Back" Team

Importing caregivers to look after the oldest old?

2007-06-20T08:58:00.000-06:00

“Listening to the current bitter debates over immigration, I wonder whether those so eager to rid our nation of these immigrants have thought about what that will mean for the growing number of elderly in our nation.

"As one of four siblings who shared the burden of looking after my mother when she became too weak to care for herself in her late 80s, I worry about the heavier burden I will put on my two children, and panic at the thought of what the future may hold for them when they are very old, for neither of them has children. What makes their future care so problematic is that they are part of a growing trend—people who will live much longer and who are likely to have no or few children to care for them. “

This thought-provoking comment comes from Beverly Goldberg, a scholar with the Century Foundation and author of the new report Facing the Problems of Providing Long-Term Care for the Oldest Old.

The report “examines the demographic realities facing our nation as the boomers continue to age, the special needs of the oldest old, the costs of the long-term care necessary to meet those needs, and the challenge of developing a large enough cadre of health care workers who are trained in gerontology.”

Policy recommendations to “improve the care of the elderly while
containing costs for government and families include some creative and controversial workforce recommendations, including issuing visas for caregivers.

Among the recommendation are:

• establishing programs to train primary-care doctors, nurse practitioners, and others who provide nursing care in geriatrics;

• ensuring that drug trials include the elderly; that possible interactions between drugs used by the elderly are reported, studied, and information about them made available;

• covering long-term care through a social insurance mechanism like Medicare;

• encouraging the use of, and payments for, alternatives to nursing home placement;

• expanding the available tax credit for family caregivers or passing legislation providing direct cash payments to family members who provide such care;

• creating a civilian health service corps that will train people to provide basic home health care in return for funds for vocational training or community college education after a given term of service is completed;

• providing forgiveness for loans taken out to cover college tuition for nurses who work for a certain mandated time in nursing homes;

• increasing the pool of available home health care workers by increasing the number of visas for low-skilled workers; and

• encouraging businesses to provide programs aimed at easing the care-giving problem for workers, which would aid in retention, decrease absenteeism, and improve the
productivity of workers carrying such burdens.

Which recommendations strike you as most intriguing?

Congress and the caregivers: No overtime pay

2007-06-15T08:27:00.000-06:00

On June 11, the Supreme Court ruled unanimously that home care workers are not entitled to overtime pay under federal law. This decision affects more than a million people in the United States.

From an editorial in the June 15 New York Times:

A retired home health aide who sued her employer for unpaid overtime lost big this week in the Supreme Court — and so did fairness and the health care system. A regulation that was ill-conceived and is cruelly applied is depriving an increasingly important group of health care providers of a decent living.

The story: for 20 years health aide Evelyn Coke, now 73, worked long hours and lots of overtime—sometimes, 24 hour days—for the people her home care agency assigned her to.
The Supreme Court upheld a law dating to 1975 excludes home health aides from overtime and other basic protections, including minimum wage.

More from the editorial:

But the justices were completely silent on the question of whether denying overtime to home health employees is good policy, let alone morally justifiable. Clearly it is neither. As the population ages, home health care has become one of the nation’s fastest growing occupations, with an estimated 650,000 aides currently employed — most of them by for-profit agencies. Most of them are low income, female and minority, a recipe for exploitation. The support of federal labor laws is crucial to ensure that the aides, entrusted with the care of the most vulnerable Americans, are treated with professionalism, fairness and dignity.

The editorial writers point out that “refusing to pay employees fairly for the work they do is not an acceptable way to keep costs down."

Congress has to reform the law to include home health employees. If that intensifies the pressure to find suitable ways to pay for the health needs of an aging population, fine.

Speaking on the other side of the story is Paul Hogan, founder of Home Instead Senior Care, which has 540 franchises in the United States with 41,000 full- and part-time caregivers.

Many seniors need long hours of companionship, even overnights. If the exemption is eliminated the cost of service would go so high it would drive many seniors into the gray market where they would be hiring home care workers directly. There would be no screening, no training, no supervision and no backup.

Your thoughts?

Won't you be my neighbor?

2007-06-04T15:16:00.000-06:00

This weekend my neighborhood in Wauwatosa was shaken by a terrible event. A house exploded, probably owing to gas buildup, killing its owner and damaging other buildings nearby. I was walking my dog about a mile away when it happened, and a postcard from the woman I later learned had died fell out of the sky in front of me. It included a hand-written list of things she wanted to remember to discuss with her doctor.

I don’t know whether her age, 80, played any role in what happened. But I can’t help wondering whether she was doing well enough at home, whether she had the kind of long-term care help she might have needed from time to time to remain healthy and safe.

The day before I had attended “Won’t you be my neighbor,” a wonderful presentation on the Connecting Caring Communities (CCC) pilot program in helping Milwaukee County communities become “elder friendly.”

To make the communities more livable, the program connects older adults with people, organizations, and businesses in the area. And that’s an important part of what long-term care is about.

CCC is supported by the Robert Wood Johnson Foundation Community Partnerships for Older Adults Initiative, along with local support from the Helen Bader, Faye McBeath, and Greater Milwaukee foundations. The Milwaukee Aging Consortium is a CCC partner, and our Caregiver Retention Project is also part of the grant.

The program, organized by project director Stephanie Sue Stein, presented the first two Milwaukee neighborhoods, Layton Boulevard and Sherman Park, in which unique connections have been made, and introduced the next ones underway: Prospect/Farwell Corridor and West Allis-West Milwaukee.

But Connecting Caring Communities isn’t stopping there: everyone attending was asked to get involved in continuing the momentum in our own neighborhoods.

Milwaukee CCC has developed a guide to elder-friendly community development. It's called, of course, Won't You Be My Neighbor? A Guide to Connecting Caring Communities. If you’re interested in getting copies—or helping your own neighborhood become “connected”--contact Alice Kowalski, Milwaukee County Department on Aging, 414/289-5973.

Act now for more funding

2007-05-30T14:51:00.000-06:00

Now’s the time for state budget advocacy on a 6% increase in transportation aids for older and disabled people -- and federal advocacy in support of a 10% increase in Older Americans Act (OAA) funding.

This Thursday morning, May 31, is the deadline for asking state legislators to support the 6% increase, according to Gail Sumi of AARP. The Joint Finance Committee is scheduled to vote on transportation aids that morning.

“Call the Legislative Hotline at 1-800-362-9472 during business hours to leave a message or email them – email addresses available at http://www.legis.state.wi.us/.

“This program is a vital service for the people who would otherwise be stranded in their homes.”

Glenna Schumann of CWAG writes to urge calls to our congressmen to increase Older Americans Act (OAA) funding by 10%.

This act, signed into law by Lyndon Johnson, remains the critical source of funding for aging programs to keep people in their homes and save money through prevention and using the lowest appropriate level of service.

The act created the Administration on Aging, authorized grants to States for community planning and services programs, as well as for research, demonstration and training projects in the field of aging. Later amendments to the Act added grants to Area Agencies on Aging for local needs identification, planning, and funding of services, including but not limited to nutrition programs in the community as well as for those who are homebound; programs which serve Native American elders; services targeted at low-income minority elders; health promotion and disease prevention activities; in-home services for frail elders, and those services which protect the rights of older persons such as the long term care ombudsman program.

Funding has been frozen since 2002, despite increasing costs and needs.

The National Council on Aging (NCOA) writes:

Congress now can fund human service needs that have been sorely underfunded in recent years. . .Chairman David Obey (D-WI) plans to move the Labor-HHS-Education bill--which includes Older Americans Act funding--through his subcommittee in early June. The Senate subcommittee likely will act in late June.

NCOA is providing “a toll-free number for grassroots advocates to use next week to urge Congress to (1) increase funding for all existing OAA programs by at least 10 percent and (2) provide sufficient start-up funding for new program initiatives in the 2006 OAA reauthorization.

“Please urge your members to call 866-OAA-2184 (866-622-2184) next Tuesday, Wednesday and Thursday (June 5, 6, and 7). They will be connected to the Capital Switchboard, where they can then be forwarded to the offices of their Representatives and Senator."

Good news on SeniorCare, Family Care

2007-05-25T11:33:00.000-06:00

Great news:

SeniorCare to run through 2009 (JSOnline, May 24, 2007)

Washington - Wisconsin's SeniorCare prescription drug program, set to
expire this year, will get a sudden two-year lease on life under a
provision tucked into the emergency war spending package that Congress
passed Thursday night.

”The program will continue on," Sen. Herb Kohl (D-Wis.) said.
He and the House Appropriations Committee chairman, Rep. Dave Obey
(D-Wis.), inserted the language into the hotly debated spending bill
that President Bush has said he will sign.

However, as James Schmidlkofer, Bureau of Aging and Disability Resources
Office on Aging, reminds us, until the spending bill is passed, nothing is final. Stay tuned!

In the meantime, what do we tell seniors? Schmidlkoffer thinks it’s safe to say that:

1. All current SeniorCare participants should remain in SeniorCare.
2. Seniors who get a SeniorCare renewal form in the mail should
complete the renewal.

Family Care expansion approved by a vote of 15 to 1

Also on May 24, the Joint Finance Committee (JFC) approved a modified version of Governor Doyle's proposed expansion of Family Care. According to a briefing circulated to members of the Make It Work Milwaukee Coalition, “The motion approves the Governor's proposal on funding, retains legislative oversight of expansion, requires consent by a county to participate in Family Care, spells out specifics and decreases the county share of costs, provides ombudsman advocacy services for participants under the age of 60, and increases the funding available for the children's long-term support program.”

Joint Finance also funded Independent Advocates (Yr 1 = 4 FTE and Yr 2 = 6 FTE,) to assist consumers in the Family Care expansion.

Read the approved version of the bill here.

Democracy in action

2007-05-23T08:06:00.000-06:00

Monday May 21, Executive Director Amy Ambrose and I had coffee and sweet rolls with some 300 “ordinary people” from Milwaukee County plus a dozen or so of their Wisconsin state legislators.

We were talking about doing good work with limited resources, and the woman sitting next to me said, “the non-profits are doing a great job of holding things together with duct tape and paper clips. But we can’t afford the paper clips anymore.”

The legislative breakfast at State Fair Park Expo Center was sponsored by two “groups of groups.” The People Can’t Wait Coalition includes agencies devoted to “Improving the quality of life for people with disabilities,” while the Make It Work Milwaukee! (MIWM) Coalition works at “Strengthening Milwaukee County through better health and human services.” MIWM includes the disability community as well as groups for the aging, mental health, and children and families.

Constituents and professionals took half a day to come out for the chance to tell their stories about important issues to the people who will vote for the final state budget.

Areas that are being discussed in state budget that affect these populations, and all of us, include:

• Community Aids to fund safety net programs for people with disabilities
• Income Maintenance to eliminate backlogs
• Support for WisconsinCare, BadgerCare Plus, and Family Care expansion
• Transportation, transportation, transportation
• Mental health parity, matching funds for community mental health services
• State funding for Wisconsin Supports Everyone, Recovery Choice
• Emergency assistance and transitional jobs pilot to reform W2
• Wage increase for providers of community-based longterm care
• Affordable housing (support for Housing Trust Fund)
• Increased reimbursement to increase access to dental care

Attitudes, beliefs about race affect us all

2007-05-14T11:01:00.000-06:00

One of the interesting “factoids” Jeff Browne of the Public Policy Forum presented at the Milwaukee Aging Consortium member meeting on race relations May 10 was the reluctance of people of color to drive into the more distant—and more white—suburbs. For caregivers, those who place them, and those who need them, that can present big problems.

That reluctance comes from perceptions about dealings with the police and from fear. You can read the report here, but two excerpts follow:

• Police dealings – The biggest single racial gap found on the survey related to dealings with police. Just 1% of whites feel they have ever been stopped by
police because of their race, while half of blacks (including the vast majority of
black males) and a third of Hispanics feel they have.

• Common sense or prejudice? – There is a racial gap in what constitutes prejudice. Most whites view racial profiling by police and avoidance of driving through nonwhite neighborhoods as common sense. Most people of color perceive those decisions as prejudice.

To put some flesh on the bones of the statistics,
consider this story from last week’s Journal Sentinel online:

County park worker sues Tosa
Police seeking black robbery suspect had bias, she says

Dressed in office attire, Alfrieda Durrah was leaving work at a Milwaukee County parks building when she was ordered to the ground at gunpoint by Wauwatosa police, handcuffed and forced to lie face-down on the ground. . .

The lawsuit says that the robber had been described as in her 40s, between 5 feet 8 inches and 5 feet10 inches tall, 180 to 200 pounds with short, straight black hair, brown eyes, medium skin tone, wearing a short-sleeved gray top and blue shorts or pants. . .

Durrah is approximately four to six inches shorter, weighed 20 to 40 pounds less and was six years older than the described assailant, and was wearing completely different clothing, the suit says.

Ms. Durrah’s coworkers were just 3 blocks away, ready to vouch for where she was that day, had anyone asked.

Do you have any experiences in which race played into caregiver relationships? How did the people involved talk about and resolve the problems? If they didn't, what prevented them from doing so? How can we make things better?

It’s not your mother’s retirement. . .

2007-05-11T15:14:00.000-06:00

Happy Mother’s Day to those of you who are mothers or who have had mothers! And to anyone who values the nurturing "mother" roles people play throughout their lives.

This is the time of month community newspapers sponsor mother-daughter look-alike contests and publish the winners' photos, and everyone publishes essays on motherhood.

But mothers and daughters aren’t necessarily alike. And neither are their retirements.

According to a InsuranceNet, "Mothers advise their daughters to save more money and not to 'live beyond your means'. . .Daughters, when asked how they would have advised their mothers, say, 'don't forget your dreams' and be 'willing to spend money if it will make you happy.' It will be interesting to see if daughters, as they approach traditional retirement age and are faced with the financial realities of a long life, are more open to their mothers' advice."

The author was referring to a phone survey of some 1,200 mothers and daughters, It’s Not Your Mother’s Retirement: Generational Differences in Retirement Expectations for Women, which found that:

• Daughters will work longer. . . or forever.
• Still, they believe their retirement will be better, more active, and more interesting,
• But they also are more likely to face “financial adjustments."
• Both expect to be able to rely on family and friends to provide support when they need it.
• Married women expect to retire earlier than single women.
• Daughters expect different sources of retirement income than their mothers' sources of income.
• Daughters have more debt and may be derailed by it.
• Home equity will play a role in the retirement of both generations.
• Married women in both groups feel well prepared to take over financial management should they need to.
• Mothers and daughters have different perceptions about how much they talk about anything, including retirement.

The study was undertaken by MetLife Mature Market Institute; WISER, the Women’s Institute for a Secure Retirement; and Mathew Greenwald & Associates.

WisconsinCare prescription drug help--not just for folks with SeniorCare

2007-05-10T08:30:00.000-06:00

I'm not sure whether the state's new prescription drug program for seniors and people with disabilities, WisconsinCare, is the SeniorCare "wrap around" program everyone's been talking about.

But it looks like a boon to Wisconsin seniors struggling to pay for medications--or to get insurance that does a good job of it! Thanks for Glenna Schumann of the Coalition of Wisconsin Aging Groups for passing the information along.

“WisconsinCare will provide seniors and people with disabilities access to life-saving prescription drugs at a price they can afford,” Governor Doyle said. “By filling donut holes, using one-page applications,and providing access to affordable prescription drugs, WisconsinCare will protect our seniors – our greatest generation, who ask very little of their government and deserve so much in return.” Governor's office press release, May 9, 2007.

WisconsinCare will begin January 1, 2008. While rolled out to help seniors who must leave the the state's SeniorCare program, it will also be available to all Wisconsin seniors who are on Medicare but not on Medicaid and whose incomes are less than $24,504 (singles)/ $32,856 married couples.

Also eligible for WisconsinCare are:

• All other Wisconsin residents under the age of 65 who are: 1) enrolled in Medicare; 2) have an income of less than $16,336 ($21,904 for a married couple); and 3) are not getting Medicaid.

More information about specific benefits, signing up, and more in the WisconsinCare Fact Sheet.

According to the press release:

WisconsinCare uses a one-page application form similar to the current SeniorCare application; provides seniors with co-payments as low as $2 a prescription drug without any annual enrollment fee; and, by leveraging more federal dollars, serves more people and provides more benefits at a cost that is equal to what the state invests in SeniorCare and without additional state bureaucracy.

Toward fewer surprises in Medicaid estate recovery

2007-05-07T09:48:00.000-06:00

Since 1993, every state except Michigan has been legally entitled to recover the costs of long-term care and related Medicaid expenses from the estates of people who received those services. Merely by enrolling, the 55 million low-income Americans presently receiving Medicaid “agreed” that their estates would pay the money back to the extent funds are available.

But they and their families may not realize it, especially as few other federal programs require repayment. According to a recently released AARP report, “Requiring low-income Medicaid beneficiaries to reimburse the government for services received often stuns surviving spouses and family members of deceased Medicaid recipients.”

Protections in Medicaid Estate Recovery: Findings, Promising Practices, and Model Notices, was developed in response to another report in 2005 by the American Bar Association’s Commission on Law and Aging study. The earlier study called for “more rigorous and uniform notice and other procedural protections. . .(to) check misperceptions about estate recovery and ensure the effectiveness of hardship waiver requirements.”

The new 75 page report concentrates on current state practices for clarifying protections, showing “promising practices and model notifications that can be replicated throughout the country for the benefit of both estate recovery programs and the people affected by them.”

SeniorCare saga continues

2007-05-04T14:06:00.000-06:00

Added later in the day: It was announced today that Wisconsin has been granted an extension of SeniorCare to December 31, allowing officials to craft a wraparound program for a smooth transition.

The Wisconsin Board on Aging and Long Term Care, issued a news release, SeniorCare, What’s Next?

Some points from the release to keep in mind:

• It’s okay to wait: you don’t need to take action now. SeniorCare and state health officials are working on an alternative program.

• By staying in SeniorCare as long as it lasts, you may continue to save money. You’ll have two months to change after the actual loss of service.

• Call Medigap Helpline if you have problems with health insurance (1-800-242-1060).

For a very different perspective, read Medicare Part D insurers may reap $100 million in revenue in the April 28 Journal Sentinel.

“One of the by-products of providing limited prescription drug coverage for people in the Medicare program, what is known as Medicare Part D, was the creation of a multibillion-dollar business,” Guy Boulton writes.

Twenty-three companies stand to gain the additional revenue from 102,000 customers who, while fighting, will have to switch.

We’re all in this together: health care reform survey

2007-05-02T09:36:00.000-06:00

May 1, 2007, the first day of Older American’s Month, seems like an appropriate day for the AARP to release their national healthcare reform survey results.

(Have you noticed that AARP never uses the spelled-out form of its name? My guess is that the "retired persons" part doesn't market test well.)

The report for Wisconsin is here. Consortium member Gail Sumi, AARP State Issues Advocacy Director, helped prepare the report.

In the telephone survey exploring the medical experiences and opinions about health care reform of people ages 18 to 64, Wisconsinites reported believing that “they’re in good health, but that the health care system isn't.”

Even though only those under age 65 were surveyed, their responses show that people in Wisconsin are looking at the bigger picture, not just the one they are in now. And many are ready to support elected officials who will reform the system.

The report concludes that “Clearly, concern over the increasing costs of healthcare and support for universal healthcare are top issues for all Wisconsinites. While exploring ways to ensure that all residents have access to healthcare, Wisconsin should also address the concern residents have over increased healthcare costs.”

Statistical highlights

• 80% of respondents have health care coverage, and 27% say they are in excellent health.

• Almost half of respondents say Wisconsin’s healthcare system has major problems, and 13% say it’s in crisis.

• 76 % say it’s important to reduce the number of residents without healthcare coverage.

• 84% say that it’s important for Wisconsin to make healthcare more affordable for all residents.

• 82 % agree that all Wisconsinites should have access to the same basic healthcare coverage.

• 76% agree that everyone should contribute to the healthcare system to enable all residents access to healthcare.

• 56% would be more likely to vote for a candidate who supported healthcare coverage for all Wisconsin residents.

Budget Matters: changes in the state budget

2007-05-01T13:58:00.000-06:00

A couple weeks ago the Joint Finance Committee held meetings around the state to gather input on the governor’s proposed budget. If you want to know what came of those meetings and other deliberations, please read the following message passed along by Barbara Beckert, Milwaukee Jewish Council for Community Relations. It’s long but full of useful information.

(The report was sent to members of the Make It Work Milwaukee! Coalition in which the Milwaukee Aging Consortium participates. The group includes organizations serving older adults, people with disabilities, children and families who want to “strengthen Milwaukee County through better health and human services.”)

From: Michael Blumenfeld

The Co-Chairs of the Joint Finance Committee (Representative Rhoades and Senator Decker) sent the following memo on Friday to committee members. Here is a link to it.

The memo basically does two things:

1) It outlines 48 non-fiscal policy items that will be removed from the budget and considered as separate legislation. These items reference the Legislative Reference Bureau's summary of the Governor's budget proposal that can be found here.

Some items of interest are:

BOARD ON AGING AND LONG-TERM CARE

* CBRF Requirement to Post Contact Information on the Ombudsman Program (Page 63, #9)

EMPLOYMENT RELATIONS COMMISSION

Repeal QEO Provisions (Page 137, #3; Page 138, #4; Page 464, #9)

HEALTH AND FAMILY SERVICES
Medical Assistance - Long-Term Care
* Statewide Licensed Nursing Home Bed Cap and Bed Transfers (Page 290, #7)
* Repeal Nursing Home Bed Bank (Page 291, #8)
* Nursing Home and CBRFs -- Contesting Actions and Receiverships (Page 291, #10)
* Community Relocation Initiative -- Authority to Provide Services to Additional Clients (Page 292, #13)

HEALTH INSURANCE RISK-SHARING PLAN AUTHORITY
* Authority to Designate Insurance Types for Eligibility Purposes (Page 343, #4)
* Eligibility for Premium Subsidies (Page 343, #5)
* Pharmacy and Pharmacist Participation (Page 343, #6)
* Provider Rates (Page 343, #7)
* Fiscal Agent Responsibilities (Page 344, #8)

INSURANCE
* Minimum Coverage Requirements for Treatment of Mental Health and Alcohol and
Other Drug Abuse Problems (Page 362, #16)
* Required Health Insurance Coverage for Autism Spectrum Disorders (Page 363, #17)
* Health Insurance -- Insurer Disclosure of Current Procedural Terminology Code Changes and Explanation of Restriction or Termination of Policy Coverage (Page 363, #18)

2) It also lists what parts of the budget will be using the 2006-07 (current fiscal year) adjusted base as a starting point and what parts will use the Governor's proposal as a starting point.

This is a very important distinction. For items that use the current base as a starting point, the Committee will entertain motions to amend current law or the adjusted base rather than the recommendations of the Governor. Although the Governor's recommendations will be before the Committee, it will take a majority vote for them (or any other proposal) to be adopted.

For items using the Governor's proposal as a starting point, the opposite is the case; it will take a majority vote to remove the Governor's proposal from the
budget. Remember that the Joint Finance Committee is evenly split, 8-8, for
this budget deliberation. The bottom line: base budget items-majority vote
needed to add anything to the base; Governor's proposal items-majority vote
needed to remove a proposal contained in the Governor's budget.

Almost all of the DHFS budget, including Family Care, BadgerCare and other Medical Assistance expansions, will be "Governor's proposal" items, which will require a majority committee vote to remove. Among the "base budget" items is the "Health" section of DHFS. This can be found on pages 304-314 of the Fiscal Bureau summary.

The entire list of base budget items is on page 2 of the memo. For all other agencies, the Governor's budget (known as SB 40) will be the starting point.

In addition, the memo makes these points:

Children and Families. SB 40 recommends that portions of the Departments of Health and Family Services and Workforce Development be transferred to a newly-created Department of Children and Families. The Committee will consider the programs to be transferred within their respective agencies and will separately determine whether the new Department should be created.

Programs Funded with New Revenue Sources. There are a number of programs in a variety of agencies that are funded under SB 40 from new or expanded revenue sources. They include: (1) programs funded from recycling fees; (2) the county aid fund (real estate transfer fee); (3) provisions funded from increased vital records fees; and (4) the health care quality fund (cigarette tax, tobacco products tax, hospital assessment, and injured patients compensation fund). Rather than consider these items under each affected agency, executive sessions will be scheduled for each of these four funding sources. At those meetings, all items related to the use of those funding sources will be considered.

Action begins on SB 40 Thursday, April 26. For agendas and information go here.

The latest on SeniorCare

2007-04-26T09:12:00.000-06:00

Yesterday (April 25), state Senator Jim Sullivan held a town hall meeting to discuss SeniorCare at the West Milwaukee "Senior Center" at 47th and Greenfield. The room was packed with seniors eager to hear what the panel had to say--and to let panelists know what they thought!

Two of the three state representatives from Sullivan’s Fifth District, David Cullen and Tony Staskunas, were there, along with representatives for Jim Sensenbrenner, Herb Kohl, Russ Feingold, and Jim Doyle. Elder advocates Gail MacInnes from the Coalition of Wisconsin Aging Groups and Matt Hayes from SeniorLaw completed the panel. (Apologies to any panelists I may have missed.)

Advice to seniors
• If you have SeniorCare, hold tight for a few weeks to see what happens. Even if there’s no extension (the worst-case scenario), you’ll have 60 days after the end date, June 30, to choose a new plan.

• At the same time, it would be a good idea to start examining Part D plans now so you have time to process information and choose.

• SeniorLaw advocates are available at no charge to Milwaukee County seniors to help evaluate which of the 50+ Part D plans might work best for them, as everyone’s situation is different. Remember that how well the plan will work for you depends on your other coverage as well, so all of it needs to be considered together.

Other take away points from panelists and audience members
State support for SeniorCare is bipartisan and nearly universal, and everyone has been lobbying hard for its continuation. But the power to extend the program lies with the Bush administration, which does not want the program to go forward for reasons that appear to have more to do with serving pharmaceutical companies than serving seniors.

Senators Feingold and Kohl placed a 2.5 year extension for SeniorCare into an Iraq study bill. President Bush will veto the bill, however. They are exploring other legislation.

While getting the several year extension is unlikely, it’s very likely that SeniorCare will be extended six months to give people time to change and the state time to develop a “wrap-around” program for a smooth transition to Medicare Part D.

Wisconsin elected officials and senior advocacy groups continue to fight for SeniorCare and explore all possible approaches to saving it.

The lack of reimbursement for preventive care is a serious flaw in our healthcare system that creates greater costs during the senior years. Reform of the whole system is imperative.

The governor and others made promises that SeniorCare would continue. They need to honor those promises, whatever it takes to do it.

The federal government has called for state innovations and models as a way of finding out what works and what doesn't. But for that to work, they have to be willing to adopt the best practices, not pass them over for programs that are more expensive and less effective.

Links
Medicare information
Centers for Medicare and Medicaid Services (CMS)
SeniorLaw
Coalition of Wisconsin Aging Groups

Your chance to go to Harvard!

2007-04-24T12:19:00.000-06:00

by Amy Ambrose, Executive Director, Milwaukee Aging Consortium

A year ago, I attended an executive education program at the Harvard Business School. The program is called Strategic Perspectives in Nonprofit Management (SPNM), and it’s a weeklong intensive just for executive directors.

This was an incredibly valuable experience, and I recommend it for anyone who is interested in advancing their leadership skills, refining the strategic vision of their organization or learning from other nonprofit leaders from around the world.

The program this year will be held July 15-21, 2007 in Boston. The fee for the course, which includes meals and housing for the week, is $4,500.

Don’t let the cost stop you if you feel this is what you really need. I was fortunate to receive a scholarship from the Hansjoerg Wyss Fund for Social Enterprise at Harvard which covered my entire fee. Applications for SPNM are requested four weeks before the program start date, but if you are interested in scholarship funding, apply early. Call 1-800-HBS-5577 for more information, or visit the Harvard Business School Executive Development website.

A local Harvard Business School Club in Milwaukee also has invited nonprofit leaders to apply for scholarships to attend the program. The club typically gives two or three scholarships. This year's deadline (in February) has passed.

To be eligible for this scholarship, applicants must be "head of a Wisconsin nonprofit organization serving the public in arts, education, environment, health care, human services, community development or related areas." Scholarships cover tuition, books, room and board, and all institutional materials, with agencies responsible for travel and personal expenses.

When is SeniorCare ending?

2007-04-23T12:16:00.002-06:00

A reader asked for SeniorCare's end date. That information might be available this week, according to a radio interview with Governor Doyle last week.

More information from an article in the April 18 Milwaukee Journal Sentinel, "After a meeting Wednesday with U.S. Health and Human Services Secretary Mike Leavitt, Gov. Jim Doyle and U.S. Sen. Herb Kohl (D-Wis.) said they were hopeful that Leavitt would grant Wisconsin a six-month extension for the SeniorCare prescription drug program."

They're asking for a December 31 date, giving the state time to craft a plan that "matches or exceeds any wraparound program in the United States," according to Governor Doyle.

What the new plan won't have is the ability to negotiate with drug companies for discount rates. This substantial limitation appears to be non-negotiable.

I'll be attending a SeniorCare Town Hall Meeting Wednesday, April 25, with 5th District state senator Jim Sullivan and will let you know what I learn.

If you live in the 5th district and want to attend, the meeting is at 3 pm, West Milwaukee Community Centre, 1345 S. 47th St., West Milwaukee.

Flat funding and growing demands: a nursing home administrator's dilemma

2007-04-17T10:27:00.000-06:00

Five percent can make the difference between staying in a job—or in business—or not.

I’m reproducing here with permission the complete letter of testimony one nursing home administrator, Bonnie Zabel, gave to the state Joint Finance Committee during its budget hearings around the state last month. The letter came across my desk in The Wisconsin Longterm Care Workforce Alliance newsletter April 15.

It speaks eloquently for itself, and I suspect for many.

Joint Finance Committee

My name is Bonnie Zabel and I am the administrator at Marquardt Memorial Manor in Watertown, Wisconsin. We are a not for profit organization affiliated with the Moravian Church. I’ve been employed at Marquardt for almost 20 years, as Director of Nursing and now Administrator for 13 years.

Marquardt is a 140 bed skilled nursing facility, which is part of a retirement community of approximately 600 seniors. We also have independent senior apartments, assisted living, home health, supportive home care and hospice.

Twenty years ago our private pay rates and our T-19 rates were equal. Our T-19 reimbursement has doubled over that time and our private pay rate has tripled to cover our T-19 deficits.

We are currently 66% T-19. Our actual costs are $185 per day and T-19 pays us $125 per day. We lose $2,000,000 per year by serving Medicaid seniors.

Watertown is a blue collar farming community. Our seniors are not wealthy. People are moving into our apartments @ age 85. They utilize our support services and enter the skilled facility at 90+. Their retirement savings have typically been exhausted after 20+ years of retirement. At this point they require excessive skilled services.

Our 140 residents:
3 can dress independently
25 can feed themselves independently
15 can toilet independently
21 can transfer independently
98.5 % have unstable medical conditions
83.8 % have no discharge potential

This population is very labor intensive. Besides their physical and medical needs, dementia is a factor for most. Staff endure wandering, hitting, kicking spitting, biting on a daily basis- in addition to the physically demanding work. These are not sought after jobs. They deserve a living wage and benefits.

Our health insurance rose 17% this month. Routine costs are up 6%. Utilities are through the roof.

Federal legislation created Medicaid. The Federal government pays 60% of the costs. The state of Wisconsin has increased GPR spending on Medicaid only 1 time since 1993. What other cost center has to fund their own increases? $13.8 million dollars of that self funding has been diverted to other state budget needs. The governor is proposing 3-5% increases to care management organizations, Family Care etc., but 2% for skilled nursing facilities. How can you justify that? Do our seniors have no value at the end of life? We need 5% just to stay in business.

Legislation is in place requiring that you provide Medicaid. Without adequate reimbursement, more and more facilities are limiting or eliminating entirely T-19 services. The choice is yours. If you can’t fund it, eliminate the legislation that created it. We could return to the poor farms of the 50’s.

I invite any of you to visit my facility to see your constituents whom we serve. We have a mission and so do you.

Thank you.

What’s the value of unpaid work?

2007-04-16T08:22:00.000-06:00

In the field of aging, an enormous amount of valuable work is not paid for by wages. But if it were, what would it cost? And who would pay it?

We can answer at least the first question.

According to Independent Sector (IS), the value of a volunteer hour in 2006 was $18.77, up from $18.04 per hour in 2005. That’s a national average: in Wisconsin, where pay rates are lower, the value of an hour is listed as $15.63.
The figure is calculated using the average hourly wage for all non-management, nonagriculture workers from tables compiled by the Bureau of Labor Statistics. Twelve percent is added for fringe benefits.

If your organization uses volunteers, the figure can help you give a better picture of the value you receive or give—or in many of our cases, both. The site also links to Financial Accounting Board Standards for determining the value of volunteer services for financial statements. Generally, only special skills work your organization would have to purchase if it were not donated is covered.

IS is a "nonpartisan coalition of approximately 575 organizations leads, strengthens, and mobilizes the charitable community in order to fulfill our vision of a just and inclusive society and a healthy democracy of active citizens, effective institutions, and vibrant communities.”

A lot of food for thought here. What do you think about unpaid work in your field or other parts of your life?

The crystal ball: Centers for Medicare & Medicaid Services (CMS) look to the future

2007-04-12T09:56:00.000-06:00

For a glimpse into the "mind" of CMS, look at the online speaker presentations from the 7th New Freedom Initiative Conference “Access to Community Living: Promoting Independence and Choice” in March.

According to the program, “Choice and Independence is a key pillar of the CMS vision for a person-centered long term services and supports system for the future. The 2007 conference focused on the policies, programs, and tools – including opportunities authorized by the Deficit Reduction Act of 2005 – available to shape and carry out the vision.”

Presentations are provided in both PDF and accessible text format by the National Academy for State Health Policy, which conducts policy analysis; provides training and technical assistance to states; produces informational resources; and convenes state, regional, and national forums.

The complete list of sessions, descriptions, and speakers also is available at the site.

There's a wealth of interesting information here. Available topics include:

Creating Flexible Funding Streams: What Does It Mean?
Transparency: 20/20 Traversing of the System
Developing a Mental Health System that Maximizes Recovery
Quality Assurance in HCBS: Federal Vision, Approaches and Resource
Consumer Control and Systems Change: The Positive Impact on State and Federal Policy
Supportive Housing Strategies: HUD and State Perspectives
Application of CMS Quality Management Strategy: Self-Direction and Risk
The 36 Hour Day: The Overlooked Workforce
Coordinating Institutional Transitions and Diversions: Changing the Direction of LTC System Pathways
Driving Toward a More Balanced LTC System: The Important Role of Transportation Services
Expanding Options for Home and Community Based Services
Self-Direction: Functions in Support of Self-Direction
Benefit Flexibility through Benchmark Plans: Rightsizing It for Consumers
Benefits Counseling: A Proven Strategy for Promoting Independence and Self-Sufficiency for Individuals with Disabilities
Building Natural Supports by Connecting Individuals with Disabilities and Community Members
Promoting Choice and Independence through Employment
Rebalancing Long Term Supports: Measuring Your Progress

What to tell seniors about SeniorCare

2007-04-11T09:46:00.000-06:00

The denial by the Centers for Medicare & Medicaid Services (CMS) of an extension for SeniorCare is a disappointment, though not a surprise. The feds had made it pretty clear that they weren’t really going to consider extending Wisconsin’s Pharmacy Plus Demonstration for reducing drug costs to seniors.

The state has requested extending the program until the end of the year to allow for a better transition. Likely, that extension will be granted.

Tom Frazier of the Coalition of Wisconsin Aging Groups (CWAG) suggests:

As you talk with seniors about the news . . ., please tell them that there is more than enough time to decide what they need to do. CMS has offered to tend the waiver until the end of the year so, until you hear differently, I would assume that this will happen. . .

In addition, several Wisconsin Members of Congress are exploring legislative possibilities for extending SeniorCare, and I am working with the Governor’s office and DHFS on efforts to develop an alternative that I hope will be better than existing Part D plans.

Frazier also urges SeniorCare enrollees to be aware of insurance sales people saying that you will need to enroll in a Part D plan right away. "This is not true and you should remain on the SeniorCare program as long as possible," adds Frazier. "SeniorCare enrollees will hear officially from the Gov. Doyle or the department of Health and Family Services (OHFS) regarding their options."

CWAG offices are a reliable source of information, so check there if you wish to verify any rumors you might hear.

(608) 224-0606
(800) 366-2990
(888) 758-6047 TTY/Texnet
(608) 224-0607 fax
Email: cwag@cwag.org

Major changes needed in Medicaid, says Center for Retirement Research

2007-04-03T14:14:00.000-06:00

Here’s a thought-provoking new report: Medicaid and Long-Term Care: How Will Rising Costs Affect Services for an Aging Population?, Howard Gleckman, Center for Retirement Research at Boston College, April, 2007.

From the conclusion:

The goal of government long-term care policy should be to provide the best possible quality of life for the elderly and disabled in the most cost-effective way. It should not merely become an exercise in saving money. However, unless policymakers are willing to make major changes, Medicaid will threaten to crowd out spending for other services citizens have come to expect from government, force substantial tax increases, or both.

This brief described the existing Medicaid system, its cost pressures, and experiments aimed at reducing cost growth. Subsequent briefs will look at the role of private long-term care insurance, describe how other developed nations provide such care, and explore ideas for fundamental change in the way long-term care is financed and delivered in the United States. The fundamental question that reformers must answer is whether this care should be provided as part of the nation’s structure of social insurance, whether it should be an individual responsibility, or some combination of the two.

A Boomer reflects on senior “engagement.”

2007-04-03T10:50:00.000-06:00

No, I’m not talking about late-life romance, although someday I’d like to experience it!

I’m talking about what we are going to do with the rest of our lives.

As a person over 50 who is still “growing” her career, I’m keenly interested in senior workforce issues.The big question seems to be not whether we can work (we can) or if we want to work (many of us do—or must), but who will hire us.

Especially for jobs that don’t involve wearing red vests and shopping carts.

The other buzz word for seniors is “civic engagement.” Why not, the thinking goes, harness all that wisdom and time to do the really important work of the world that’s so often unpaid?

I’ve been impatient with my Boomer generation for a long time because it seems so many of us are working mainly on our flesh tone and our golf swings. We seem to have forgotten that we were going to transform the world.

Of course, the senior as full-time player is a media image, so it’s not really “true.” Besides working, plenty of Boomers are volunteering in schools, driving more senior seniors to appointments, serving in city governments, setting up angel funds to help seed important social causes, building houses in inner cities and Costa Rica.

Now it seems like everyone wants to harness our energy. Here’s what Civic Ventures has to say:

Now arriving: the experience generation

The first of 77 million baby boomers turn 60 in 2006. They are on the front edge of the largest, healthiest, best educated population of Americans ever to move through and beyond their fifties.

They are pioneers in a new stage spanning the decades between middle and late life. Neither young nor old, they represent an extraordinary pool of social and human capital. And, in large numbers, they want to do work that serves a greater good. . .

But too often, their individual enthusiasm is stymied by perceptions, policies, and practices that discourage the sharing of experience. As a result, this growing number of Americans represents a largely untapped resource in a nation with many unmet needs.

Imagine unleashing their potential.

It’s that last line that gets me: just who is going to unleash our potential? Shouldn’t we be doing that ourselves?

It would be great to present a better picture of what’s actually going on already, formally and informally. Please share your stories of civic engagement by seniors in the Milwaukee area, whether “young” or old seniors. You can write them in the comments section and I’ll transfer them to the blog body.

Snapshot: householders over age 50 in Wisconsin and the nation

2007-03-30T09:58:00.000-06:00

Here’s a new report on housing in various states from the AARP Public Policy Institute, State Housing Profiles: A Special Analysis of the Census Bureau's American Community Survey, by Andrew Kochera.

A few details about householders (heads of households) over age 50 from the report:

• Wisconsin ranks 18 among states with number of households headed by those over age 50.

• Twenty percent rent, 38% own with mortgages, and 43% own without mortgages (over 100% because of rounding.)

• Nationally, the number of households headed by someone age 50 or older increased by about 25% between 1990 and 2004.

• Of those, 16% were racial minorities in 2004, compared with 5% in Wisconsin.

• About 4% of householders over age 50 have a grandchild living in their households. In Wisconsin, it’s 2%.

• Nearly 40% of households with heads over age 50 have at least one person with a disability, most commonly physical limits related to walking, climbing, reaching, lifting, or carrying. In Wisconsin, it’s 35% (but 51% for renters).

• A few more 50+ Wisconsinites own their homes free and clear than the nation as a whole,(43% vs. 40%,) but that’s down from 53% in 1990.

• Only 5% live in condos in Wisconsin, compared with 7% in the US, but we’re catching up: in 1990, only 2% did.

Medicare prescription drug coverage: Wisconsin’s news

2007-03-27T15:46:00.000-06:00

Prescription drug coverage for seniors has been in the news a long time. And it’ll be in the news for a long time to come. Wisconsin plays a big role in developing better ideas and new initiatives—and fighting to keep them afloat.

Earlier this month, the Coalition of Wisconsin Aging Groups (CWAG) learned it was one of nine organizations to share a $900,000 grant to “help fund initiatives designed to identify, educate and help eligible beneficiaries in their communities to apply for the Low-Income Subsidy (LIS) and other prescription savings programs.”

The grants were awarded by My Medicare Matters, a community-based education initiative sponsored by the National Council on Aging and the Access to Benefits Coalition, with support from AstraZeneca Pharmaceuticals LP.

This is especially important because, as CWAG director Tom Frazier will testify before the Senate Committee on Aging tomorrow (March 28), “. . .in Wisconsin. . .we have the second worst record in the country in terms of applications for extra help being approved—just over one-third (35.4%) of applications are approved by the Social Security Administration. This means that the vast majority of the lowest income seniors would not be eligible for extra help under Part D and, therefore, would face significantly higher out-of-pocket costs. As you have also heard, many SeniorCare enrollees with incomes over 160% FPL also would face much higher costs.”

SeniorCare is Wisconsin’s model drug reimbursement program that is scheduled to end unless the state receives a waiver to continue it. The federal government has been clear that it is not inclined to offer the waiver, despite much good evidence of the lower cost and greater satisfaction with SeniorCare than Part D programs.

Some data from a SeniorCare factsheet dated March 12 from the state DHHS office:

 An AARP study found that 94 percent of SeniorCare recipients are better served under SeniorCare than they would be under Medicare Part D

 The average annual federal subsidy for a SeniorCare waiver participant is $617, about half as much as the $1,174 the federal government spends to subsidize a Part D participant

 We estimate that SeniorCare will save Medicaid roughly $697 million between 2008 to 2010. This includes $404 million in reduced federal expenditures

 SeniorCare has already saved Wisconsin seniors and taxpayers hundreds of millions of dollars since its inception. In State Fiscal Year 2006 alone, SeniorCare reduced drug costs to Wisconsin seniors by almost $200 million

CWAG’s Glenna Schuman has asked people to:

• Call the Whitehouse leaving a message for the President: (these are all long distance calls, but worth it to make your voice heard. Thank the President and leave your name and address or at least the city and state.

202-456-1111 is the comment line
202-456-1414 is a live voice that will direct you to the comment line
202-456-2461 is a fax line if you would like to write a note and fax it.

• Call Secretary Mike Leavitt’s office at 1-877-696-6775, tell the recording that this is about Senior Care, your city and state, and that you are for it.

• Or write the President (The Whitehouse, Washington DC, 20500) and Secretary Leavitt (200 Independence Ave. S.W. Washington, D.C. 20201). The message can be as simple as, “Please SAVE Wisconsin’s SeniorCare prescription drug program.” If you have a story, briefly tell that.

Angel to Milwaukee’s older and vulnerable people: Gwen Jackson

2007-03-26T09:44:00.000-06:00

“She walks on non-profit water,” said Peter Goldberg (president and CEO of the Alliance for Children and Families) of Consortium member Gwen Jackson in a Journal Sentinel article by Felicia Thomas-Lynn.

Ms. Jackson is an indefatigable volunteer and champion of the disadvantaged and the vulnerable. She was one of the first people I met at a Consortium event when I started work here in October, and she’s been an important presence at most events since.

As Goldberg said, “When Gwen Jackson speaks, people think.” There’s not much higher praise for an elder (or anyone) than that.

A member of the Senior Citizen Hall of Fame and Milwaukee County Commission on Aging, she serves organizations ranging from the American Red Cross to Early Music Now. There’s even a building named after her.

A fund to help elderly people and others who live in group homes throughout the state, the Gwen T. Jackson Angel Fund, was created through Volunteers of America of Wisconsin.

I don’t know anyone who doesn’t think the fund is most appropriately named!

Aging in community: housing, services-- the whole enchilada

2007-03-23T13:44:00.000-06:00

Yesterday, some 30 people gathered over cheese enchiladas at the United Community Center to discuss ways to "get it right" with senior housing. And that includes making sure the services are there to support a great life into and through old age.

The Next Steps meeting was a follow-up of our earlier Housing Options Summit and, informally, of the UWM Senior Housing Ideas Competition.

Around the table were developers, case managers, architects, mortgage lenders, senior advocates, landscape architects, county department directors, grad students, consultants who put together deals, program developers, senior citizens, and more. Most were concerned mainly with older adults, but some represented the community of disabled people, whose needs are very similar.

They came because they know about the gaps in housing and supportive services that make it hard to age in place—or live at home with disabilities. And they brought with them ideas, hopes, frustrations, and most of all, a desire to make a real difference now.

What’s needed is affordable, appropriate, accessible housing. Right now, the supply of housing that meets all three of those criteria is small. Services and the stuff to maintain a life need to be incorporated into the residence or the nearby community. Safety, beauty, respect, and community life matter. So does transportation. And so does variety: no one size fits all.

No surprises there. But what’s missing is coordination to fit all the parts together, resources and a plan. Political scientist Norton Long said forty years ago that people building economically viable cities are coming to realize that the vision they are seek is not just bigger roads and more tax base but “the possibility of attaining a shared common goal of a better life.” Plans come and go, and we keep trying to figure out how to do it better.

The next step in the process will be engaging in strategic planning, looking at models that work and can be replicated (or improved upon), like Lapham Park. We’re looking for ways to bring all our knowledge and wisdom to existing and new planning and decision-making processes.

We are also looking at what we need to build in terms of better coordination between the range of services and housing options. Stay tuned for more information or forward your name if you are interested in being a part of these exciting developments.

The passing of a friend: Eldon E. Murray

2007-03-23T13:27:00.000-06:00

This message from William "Bill" Serpe, Executive Director, Senior Action in a Gay Environment (SAGE)/Milwaukee:

The final details have been made for the Memorial Service for Eldon E. Murray, founder of SAGE/Milwaukee. Eldon passed away on March 5th.

The Memorial will be held on March 31st at the Washington Park Senior Center, 4420 W. Vliet Street in Milwaukee. The service will begin at 1:30 p.m.

I am hoping that as many SAGE/Milwaukee members current and past as well as SAGE/Milwaukee friends can attend. Without Eldon Murray there would be no SAGE/Milwaukee.

Thank you all. See you at the Memorial.

Resources, we’ve got resources

2007-03-21T09:24:00.000-06:00

So much information, so little time! Here’s a list of resources that have come across our desks recently. Most are new; one isn’t, but the issue of paying caregivers is before us always, and especially as government budgets are being tweaked.

Aging workforce
“The National Association of Professional Employer Organizations wanted to know what the small businesses its members serve are doing about their aging work forces.” Don’t be put off by the authorship: Older and Wiser: As the Work Force Ages, Small Businesses Change, Too is a fascinating and useful report.

Alzheimer’s disease
Alzheimer’s Association report on prevalence, March 2007.
“There are now more than 5 million people in the United States living with Alzheimer’s disease. This number includes 4.9 million people over the age of 65 and between 200,000 and 500,000 people under age 65 with early onset Alzheimer’s disease and other dementias. This is a 10 percent increase from the previous prevalence nationwide estimate of 4.5 million.”

According to Senator Barbara Mikulski (D-MD), “Now we need an All-American effort to not only find breakthroughs, but to make sure we are giving patients and their families the support they need.”

Medicare and Medicaid primers
New Medicare primer
New Medicaid primer

“Together, Medicare and Medicaid provide health coverage to about 90 million Americans. To help explain the two programs, the Kaiser Family Foundation has issued a new primer on the Medicare program and an updated version of its primer on the Medicaid program. Prepared by Foundation staff, the primers provide an overview of the programs, who they serve, how the programs work, and how they are financed.”

Paying for quality care
Paying For Quality Care: State and Local Strategies for Improving Wages and Benefits for Personal Care Assistants “was written by Dorie Seavey and Vera Salter in October 2006 and published by the AARP Public Policy Institute. This report examines state and local initiatives to improve wages and benefits for direct-care workers delivering Medicaid personal care services. The authors outline seven strategies -- wage pass-through legislation, rate enhancements linked to provider performance goals, updated reimbursement rates, litigation against state Medicaid agencies, collective bargaining, living wage ordinances and minimum wage improvements, and health insurance initiatives -- discussing the advantages and disadvantages of each.”

Rethinking: aging and more

2007-03-16T16:31:00.000-06:00

“In order to survive, mankind needs a different way of thinking.” Albert Einstein

I’m a big believer in attending conferences. Maybe that’s because I always get salted with fire by new ideas and new people.

And sometimes, you have to go out of town to meet the people back home, as I learned when running into Pat from Interfaith Older Adult Programs and Jeannine, who’s in the UWM Center on Age and Community certificate program in applied gerontology, at the Annual ASA-NCOA Joint Conference in Chicago earlier this month.

Rethinking aging, being leaders, and seizing the chance to do something amazing to improve the lives of older adults was the theme of the conference. I’ll be using this blog as a place to share some of the ideas gleaned there. Please share yours here, too—whether you attended the conference or not.

(You can also explore some of the conference best ideas at the Milwaukee Aging Consortium’s Best Ideas Breakfast March 27.)

Something concrete for you: the Blue Moon Fund has made available for free download a wonderful document: Toolkit for Viable Futures. From the intro:

“If you are an administrator, advocate, or practitioner in
aging, you are on the front lines of planning and providing
services for a society that is aging. How you make your
decisions and use your resources will go a long way to
determine the quality of later life for today’s older adults,
and the legacy that elders will leave for generations to
come. You need strategies that connect the generations.”

Overheard at the conference:

Boomers are just not prepared adequately for aging.

“We need more vaccines, not more Viagra.”

Because the business of healthcare is failing, we need to find ways to promote wellness—and develop structures that make best use of available wisdom.

“We have research that shows if you live in a community where you can get out and go where you want to go, you are doing better than people who can’t do that.”

Perhaps we need to play to find serious answers: “Genius is childhood recalled at will.” (Pierre Charles Baudelaire)

Your thoughts?

What about becoming old at heart?

2007-02-23T14:30:00.000-06:00

From Amy Ambrose, Executive Director, Milwaukee Aging Consortium.

The Old Lady in My Head

I shared this story at the National Grantmakers in Aging Conference, during a luncheon at the Pfister Hotel featuring Dr. George E. Vaillant, author of Aging Well. A Consortium Board member asked me to repeat it for this blog.

Over a year ago, I participated in a guided imagery exercise that was a tour of people and events I had known at different stages in my 35 years of life. I knew nothing about guided imagery before this experience, and you are free to think that it's a bit flaky. It can be. But read on.

Before it was over, I wound up face-to-face with a woman I didn’t know. She was 105 years old, hunched over a cane, and smiling. She seemed to have a very generous spirit, to be the kind who loves without thought of return.

She offered me a cup of tea. There were other parts of this guided tour that were not so pleasant, but the presence of the old woman was a comfort. I felt safe with her, safe from judgment. She offered me a gift to guide my way home. It was a candle.

At that point, the woman leading the guiding imagery exercise made an announcement to our group. She said "The woman you have just met is you."

Me? You must be mistaken. I felt overwhelmed by the idea at first, and then had the good sense to ask my 105-year-old self what she knew.

Her message was simple. She said: “Give up the worry. It all turns out alright.”

Much has been said in popular culture, literature and lore about the benefits of staying "young at heart," of aging well by basically refusing to age. But being young at heart is a mixed bag. Most of us during our youth are so busy trying to earn the respect and love of others, or looking for them to earn it from us, that we waste years on anxiety and hustle and judgment. Have I accomplished enough yet? Have you?

Instead, I think it might be helpful to embrace what it means to be "old at heart." For me, this means being fearless because you have moved past the need to prove your worth. To love completely, because today is all you have and because that’s what life is really all about. And to keep giving, whatever little thing you have to offer the world.

That’s just my own little perspective. I am eager to invite yours, whatever age you are.

If you could close your eyes and come face to face with yourself at 105 years old, what would this person have to say about your life?

What can we learn by connecting with the part of us that is "old at heart"?

Retirement: it doesn’t have to be “either-or”

2007-02-22T09:55:00.000-06:00

When we try to gaze into the future of the workplace, the crystal ball is hazy.

On the one hand, we hear about worker shortages. On the other hand, we hear that workers will have to—or want to—work past age 65 or any other arbitrary retirement age. We hear that older workers are great assets. Then we hear how difficult it is for many people to find work even in their 40s and 50s.

There are some huge disconnects between the prognostications and the realities people find in their own lives.

Fortunately, those gaps are fertile ground for new ideas. The Boston College Center for Retirement Research recently published a brief on phased retirement. This concept opens possibilities for older workers continuing to work with their current employers while reducing hours or eliminating certain aspects of the job they are now doing.

Phased retirement has already made headway in many universities and businesses that use knowledge workers. Still, the concept has lots of rough spots. For one thing, phased retirement seems to be more appealing in white collar jobs. There’s always the problem of health insurance and pensions. It might be hard to apply phased retirement uniformly, as some workers are perceived as more valuable than others.

But none of those problems is insurmountable.

It seems fair to say that a better future for older workers (as well as younger ones) is a more flexible one.

More on phased retirement:
Workforce Management

National Older Worker Career Center

Rand Corporation, Elder Workforce

AARP Phased Retirement: Who Opts for It and toward What End?

Comcast Finance

House considers bill to change union organization, negotiation procedures

2007-02-20T16:23:00.000-06:00

An important piece of legislation is moving forward in the 110th US Congress. HR 800, the Employee Free Choice Act, was placed on the Union Calendar, Calendar #8, on February 16.

The purpose of the bill is: “To amend the National Labor Relations Act to establish an efficient system to enable employees to form, join, or assist labor organizations, to provide for mandatory injunctions for unfair labor practices during organizing efforts, and for other purposes.”

It was introduced by Representative George Miller of California with 233 supporters, among them 4th District Congresswoman Gwen Moore of Milwaukee.

According to Michael Sandler in the Congressional Quarterly, the legislation that “would make it easier for unions to woo workers to their cause could be the first real test of organized labor’s clout in the Democratic-controlled Congress.”

Currently, employers can call for a vote by secret ballot after a majority of employees have signed union cards, a step which the AFL-CIO has called coercive. The bill would eliminate that option, a step that business groups say allows union organizers to be coercive.

The bill also provides the option of unions and employers moving into mediation after talks have been stalled for 90 days, with binding arbitration to follow if no agreement is reached 30 days after mediation began. Current law calls for good faith bargaining only.

To read opposing viewpoints on this issue, look at Helping Workers Secure the American Dream and The Coalition for a Democratic Workplace. The latter coalition includes the Assisted Living Federation of America, the national organization for the Wisconsin Assisted Living Association.

More innovative senior housing ideas: co-ops

2007-02-19T12:48:00.000-06:00

Earlier I wrote about co-housing because a half dozen or so people who attended the Expanding Housing Options Summit have expressed interest in that idea for senior housing.

Housing co-operatives are another idea that’s popping in senior housing. People sometimes confuse co-ops with co-housing. Basically, co-operative housing refers to a specific form of financial structure and group decision-making. However, co-ops don’t usually form around a specific central idea such as environmental sensitivity and deep community the way co-housing does.

The biggest argument for co-ops is affordability: ”Lower down payment, much lower closing costs, economies of scale, longer mortgage term all make co-ops more affordable than other ownership housing.”

Wisconsin has two senior co-ops Wisconsin has two senior co-ops listed in the Cooperative Development Foundation.

For seniors, a notable benefit of co-ops is the ability to purchase extended services as a group—housekeeping, transportation, other long term care needs.

Wisconsin has two senior co-ops listed in the Senior Cooperative Foundation website: Realife Cooperative of Eau Claire and Homestead Cooperative of Mount Horeb. I know that a group in Waukesha has been looking into developing a “55 and better” co-op with the Realife group.

You’ll find some invaluable reports at the Cooperative Development Services Senior Co-op Housing site and the Cooperative Development Foundation.

Here’s a nice table that compares co-ops to rentals, condos, and home ownership.

The co-op model has been big in New York city for a long time. There, it’s for the rich and famous (John Lennon and Yoko Ono lived in a co-op) as well as the not so rich and sort of obscure. I’m not sure why there’s not more of it around here, but it seems that the financial structuring is a little tricky. I’m hoping one of you who knows more about co-ops will write back.

In any event, it’s exciting to have so many more ideas on the table!

Medicare Advantage plans: ongoing problems

2007-02-16T09:48:00.000-06:00

This information comes from Vicki Baker.

The State of Wisconsin has a Medigap Helpline (800-242-1060) to help people with questions about Medicare Advantage plans. The helpline also fielded questions about the meetings that were held "touting the value of enrolling" in the plans.

Some of the problem areas frequently reported to the Helpline or the Ombudsman Program (800-242-1060):

A given plan is not suitable, especially for people with complex health needs
People on Medicaid find themselves paying premiums that they did not have to pay in the original federal Medicare A and B plans.
People who want to enroll only in a Part D prescription plan are being enrolled by agents into the Advantage Plan.
Some agents use high-pressure, intimidating sales tactics.
Trial period and open enrollment rights are being denied.

What's more, the Medicare Rights Center says that Advantage plans cost about 12% more per enrollee than the original Medicare, and the total excess payments to Advantage plans exceeded $5.2 billion in 2005.

Make sure your clients and loved ones know that they shouldn't sign anything they're not comfortable with. They can check with the hotline. If they've already signed and have problems, they can file a complaint with the State of Wisconsin Office of the Commissioner of Insurance, 800-236-8517.

More information in this press release from the State of Wisconsin Board on Aging and Long Term Care.

How do I want to live as I age?

2007-02-14T10:27:00.000-06:00

I asked Jeri McClenaghan-Ihde, a member of our Board of Directors, who works with Direct Supply but participated in the Senior Housing Ideas Competition with AG Architecture, about her participation.

Aging in Community was a wonderful opportunity to take time to consider what we do as architects and how it can affect the world around us. Here are my thoughts...

Architects provide environments which support strong care models. Having and understanding the philosophy or motivation of our client's thinking allows an architect to produce a customized answer to the question, "How do I want to live as I age?"

I would like to have as many answers to that as possible. It is a very personal question, intimate in fact. Does your spouse know your true answer? How about your kids? You may even be afraid to write the answer down.

I challenge all who read this to consider answering the question and sharing it your readers.

AG's motto, by the way, is "We create community in every sense of the word." They've identified community as the key to living and working, and not just for the elderly.

How do you want to live as you age? It's easy to say "not in a nursing home." But what are the qualities of "the good life" as you grow older? Are they the same when you are 65 and when you are 85?

What's senior cohousing? Plus an invitation from Milwaukee's DCD

2007-02-13T10:08:00.000-06:00

On a day like today, when the weather is rude and the streets and sidewalks treacherous, you don't have to be "55 or better"to want an easier way to live your life.

By the way, "55 or better" is the new way we talk about those of us who are past the speed limit age. I wonder if they keep raising the speed limit to make us feel younger!

Co-housing is about creating intentional communities, which are like neighborhoods the way we think they used to be. The movement started in Denmark around 1985. A group of people who shared some common goals and are committed to living and working together would buy a piece of land, cluster individual housing densely and hold the rest of the land for common use.

The housing is built around a narrow walkway or commons area instead of a dividing street to encourage people to walk, meet and interact. While each unit is a private, a common building serves as a place to share meals, movies, woodworking tools, whatever suits the people who live there. Generally you own your own place plus a non-dividable chunk of the common property, and the community makes decisions cooperatively.

I've been following cohousing for more than a decade because I want to live in such a community. For many of us, from the first moment we learn about co-housing, we know it's for us. And it's readily apparent why people "55 and better" would find co-housing a great way to age in community. It's a time to develop and use social capital, not just money. No one wants to be Howard Hughes, isolated with his fortune and cared for only by those who never knew him.

If you want to read more about senior co-housing, there's a rather random but intriguing list of links on our resources page and more to come!

There's not much cohousing around this area, but there will be. The Milwaukee Aging Consortium will be facilitating exploratory meetings for this and other housing-related needs around Milwaukee. We invite you to join in! Call me at 414-289-0890.

Finally, an invitation from Vanessa Koster, Assistant Planning Director, City of MilwaukeeDepartment of City Development:

Thanks so much for contacting me last week and your eagerness to participate in the planning process. We're very excited about the Citywide comprehensive policy plan that is underway. We will be asking the Milwaukee Aging Consortium to join our technical advisory group for the housing chapter. . .

In the mean time, (you and your members) could get involved in the neighborhood plans that are currently underway (Northeast, Southeast, Near North and Near South) and consider serving on the housing focus group to help identify where housing should be developed: http://www.mkedcd.org/planning/plans/CompPlan/Area/index.html.

Or, members could join the Plan Advisory Groups (PAG) for the area plans. The PAG comprises approximately 50-100 individuals with first-hand knowledge of the area and representing various interests. The Plan Advisory Group meets approximately 4-6 times over the planning process to review the work of the hired consultants at all major milestones. The Plan Advisory Group is instrumental in making recommendations for public participation, plan development and plan implementation. Most importantly, members will help inform the general public of opportunities for input.

Vanessa's e-mail: vkoste@mkedcd.org

Senior housing potpourri-links and more links

2007-02-12T10:56:00.000-06:00

This will be a link-heavy post for people who just want the facts, Ma'am.

First, thanks to Journal Sentinel reporter Michele Derus who brought to the front page of the real estate section the problem of failure to understand seniors' needs when developing housing.

And although the Milwaukee Aging Consortium is a membership organization, not an advocacy organization, it's fair to say that we are advocates for anything that will improve the lives of seniors!

Let's start with what aging looks like in Milwaukee County: this wonderful report, Now at 60 What I See.

Looking for new ideas about redeveloping sites as communities in which to live, work, and age? The results of the UWM School of Architecture and Urban Planning Aging in Community Senior Housing Ideas Competition will be displayed on their website by the end of February. And a white paper covering the week of events begining with Eden Alternative guru William Thomas will be developed and posted at the UWM Center on Age and Community.

In Milwaukee County, the mecca for all information about health services for older people is the County Department on Aging's Elderlink.

Interested in resources for housing and health care for older adults in Milwaukee, Ozaukee, Washington, and Waukesha counties? Try Senior Resources Online for 2006/2007.

Worried about older people not being able to afford housing? Steve Falek of the Milwaukee Housing Authority says call and write your senators and representatives to support Senate bill 427 (thanks to Brian Peters for the correction), the Affordable Housing Expansion and Public Safety Act. This bill makes available new home production and older home rehab as well as Section 8 vouchers and re-institutes the currently unfunded program to fight crime and drugs in low-income housing. It also calls for creation of a National Affordable Housing Trust Fund.

Why is affordable senior housing so important? See what the Retirement Housing Fund has to say: "It is illusionary to believe that we can have good healthcare in this nation unless persons have decent, safe, and secure affordable housing because affordable housing is the base which makes good health a possibility."

And that's just a start! If you're interested in doing something creative to advance aging in community here, call me (414-289-0890) to be put on the e-mail list for our project exploration group!