In the sunset years

JIM LOMAX, MD AND SKIP MENDLER
Posted 9/26/18

Growing old, as the saying goes, is not for sissies. Neither is caring for the elderly. When governmental organizations address the health care needs of older adults, they often concentrate on simple …

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In the sunset years

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Growing old, as the saying goes, is not for sissies.

Neither is caring for the elderly.

When governmental organizations address the health care needs of older adults, they often concentrate on simple mortality and morbidity statistics. These types of statistics, although important, do little to accurately describe the scope of medical and non-medical issues that confront seniors each day—issues that interfere with quality of life, exacerbate existing chronic conditions and limit the ability to remain independent in the home setting.

As we age, we face an ever-growing list of health concerns. For most people, the aging process naturally includes a gradual loss of function—generalized weakness, memory loss, inability to walk distances, difficulty climbing stairs, likelihood of falls, loss of hearing and vision, and so on. Add to this the increased risks of such conditions as arthritis, heart diseases, cancers, respiratory problems, Alzheimer’s and other forms of dementia, osteoporosis, obesity, substance abuse, depression — and the task of effectively managing care can become incredibly complex and challenging for patients and practitioners alike.

In rural settings such as the Upper Delaware region, transportation to and from doctors’ offices, hospitals, and availability of emergency services is difficult unless there are people available to drive the impaired older adult. Additionally, for the older adult who requires help with basic daily activities (bathing, toileting, dressing and food preparation), being left alone without assistance during the day while family members work can lead to many problems.

In the face of all this, older adults and their families must also contend with navigating a complicated and frequently confusing medical care system—finding ways to afford necessary medication, negotiating with insurance companies and locating needed services. Adult children of elderly patients may not know what their options are, or how to plan adequately for the future. Ever-shifting public policy makes funding for critical programs uncertain.

It’s these latter issues, rather than the medical conditions as such, that most concern Kathy Anderson. She’s a registered nurse, and director of the Adult Day Health Center (ADHC) at the Catskill Regional Medical Center in Harris, NY.

The concept behind the ADHC is simple enough: by providing adequate social and medical services during the daytime hours, the ADHC makes it possible for older adults to still live in home settings with their families. Such centers can also provide cost-effective alternatives to home-care services, nursing homes and alternative-care settings, while giving respite to family caregivers.

If the patients can learn about the program, get in and participate, that is.

The ADHC provides many useful medical, rehabilitative and social services. Adults over 50 can be provided transportation to and from the center (generally 8 a.m. to 4 p.m. Monday through Friday and 8 a.m. to 3 p.m. on Saturdays and Sundays), which is a secure unit within the hospital. A “wander guard” system is in place to protect patients with memory or orientation issues. The ADHC staff includes registered nurses, a dietician, a pharmacist and a social worker.

Complimentary activities are designed to promote physical, cognitive and social well-being, encourage independence, and boost self-esteem. The team also collaborates with physicians, caregivers and outside agencies to further enhance medical management, and can assist with such issues as Medicaid recertification, food stamps, SSI, personal-care services and housing.

Anderson sees patient education as one of the most important functions of the ADHC. “When people are at the center, not only can our Medication Management Program help them stay compliant with their meds, but we can teach them to deal better with their own self-care,” she says. “For instance, patients who can do their own blood-sugar tests can manage their diabetes more efficiently and can usually move from needing injections to oral administration of insulin.”

Because the center is hospital-based, the individual can receive the full range of diagnostic and treatment services available. “This is a big advantage for us,” says Anderson. “If we need to run blood work, or if someone needs an X-ray, everything we need is right down the hall.”

But there are many obstacles. Costs associated with the ADHC program can be covered by Medicaid, Medicaid Managed Care or Managed Long Term Care, but proper authorizations must be obtained first. Veterans may qualify for program coverage, but require approval from the VA. Recent changes in Medicare and Medicaid in New York State have reduced the number of individual referrals to the program. “Insurance companies prefer to send patients to less-expensive social programs, where their medical needs may not be adequately addressed,” says Anderson.

Used to a lifetime of relative independence and self-sufficiency, many individuals may put off dealing with questions of long-term care, and may be reluctant at first to leave the known security, routine and comforts of home even for a few hours each day. “Once they get here,” Anderson says, “patients enjoy themselves and respond very well to the program. But it can be difficult to change.”

Anderson encourages the public to learn more about elder care, including long-term care options, well in advance of the time when these services will actually be needed. “Those conversations have to happen,” she says, “between parents and adult children, even if they’re a little uncomfortable.”

We are living much longer than past generations. For babies born in 2016 in the U.S., the anticipated average life expectancy is now 78.6 years—76.1 for males and 81.1 for females. All age groups—not just our current elderly, or the huge wave of Baby Boomers who are now starting to enter old age—will become increasingly dependent on our healthcare system to address these needs going into the future.

For more information about enrollment in the ADHC program at Catskill Regional, call 845/794-3300, ext. 2781 or 2782. Also visit www.crmdny.org/adult dayhealthcare.

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