The Commission on Affordable Housing and Health Facility
Needs for Seniors in the 21st Century
September 24, 2001
M. Christiane Pepe, MGS, MSW
Elder Services Network of Central Ohio
Thank you for the opportunity to testify before the Commission today. My name is Christiane Pepe, and I currently serve as Executive Director of Elder Services Network of Central Ohio (ESN).
The Elder Services Network of Central Ohio (ESN) is a collaborative effort of eight not-for-profit community health and social service organizations that provide services to older adults and families. The ESN's goal is to provide centralized or "one-stop" access to comprehensive, coordinated health and social services for older persons and families who are not eligible for similar publicly funded programs. ESN of Central Ohio is one of eight developing public-private partnerships across the country, sponsored by the AT&T Family Care Development Fund. ESN coordinates services for older disabled individuals and their families regardless of the type of housing in which they live.
From now until 2020, the United States will see or experience the largest increase ever in the number of older adults living with chronic illnesses and some level of functional disability. Central Ohio is no exception. As the fastest growing part of our state, we have undergone a transition in population age structure and in the leading causes of death from acute, short-term illnesses to chronic and degenerative diseases. Franklin County is home to nearly 103,000 older adults, 62% of whom are women (U.S. Census Bureau, 2000). Nearly 40,000 Franklin County older adults are disabled and live outside of institutions, and 38,000 of these individuals live alone (U.S. Census Bureau, 2000).
Although the U.S spends a significant amount of money on nursing home care for older adults, most older persons in need of long-term care continue to live in the community and receive most of their care informally from family and friends. It is clear that our existing government-sponsored programs are not providing the care needed for our oldest members. As the population shifts, we must change these programs in order to meet this growing need.
Although federally funded services for older adults have been available in Franklin County for over thirty years, a 1998 survey performed by the Central Ohio Area Agency on Aging (COAAA) found that older adults still identified home repair, transportation, housework and health issues among their primary needs and concerns (Franklin County Profile of the Aging Population, 1999). Most public funds are targeted specifically to low-income older adults. The Medicaid community-based service program, called PASSPORT, provides an alternative to nursing facility for just over 1,000 poor and disabled older persons in the county. Franklin County is advantaged by the availability of the Franklin County Senior Options tax levy. Last year, the Franklin County Office on Aging provided centralized, care-managed services on a sliding fee scale to nearly 5000 older disabled persons living in the community. Because this program operates at capacity, it does not serve persons with over $24,000 in annual income or those with over $68,000 in assets.
During the planning period for our Elder Services Network, the Ohio office of the American Association of Retired Persons (AARP) sponsored a survey of 5000 central Ohio adults to test the ESN concept. Thirty-eight percent (38%) responded that they were likely to purchase assistance from adults who specialize in the needs of older adults. The AT&T Family Care Development Fund did a similar survey in 1999 that determined that among the concerns of adult children is the availability of a single phone number when help is needed. The tasks most frequently performed for an older parent in this survey included shopping and driving, managing finances and everyday household chores. When seeking assistance, families often use the yellow pages, rely on word-of-mouth or senior center referrals to service agencies. Yet no single agency offers all of the services a family might need, particularly as the older person's health status or other circumstances change.
The ESN of Central Ohio responds to the need for centralized information, consultation, coordination and supportive services that are not currently available to older adults and families who are ineligible for existing Franklin County programs. Its member 501c(3) agencies together have hundreds of years of experience and success serving Franklin County's older population. Collectively, they offer hospital and rehabilitative health services, skilled home care and equipment, homemaking, personal care and meal preparation, adult day health services, and transportation. Home and yard repair and maintenance by trusted professionals keeps older families safely at home. Skilled nursing facilities and assisted living environments are available when caregivers need relief, or for rehabilitation after a fall or hospital stay. Professional consultation, assessment and service oversight help families evaluate their older member's needs, identify service preferences and assure quality arrangements for care. Professional staff can also help find a nursing home or assisted living setting that best meets the family's needs and preferences.
Prior to the development of the ESN, individuals and families who were not eligible for public programs were referred to multiple independent agencies to purchase care and services. No professional was assigned to help find the best solution to the family's problem. Since the development of the ESN, public program staffs, hospital discharge planners, and other professionals have referred ineligible families to the ESN because it includes the service, coordination and quality oversight functions that families want and need.
- Our current government programs are designed to serve low-income people and don't support the needs of all older individuals and families.
- The baby boomers will swamp the existing system in the coming 20 years. We need to do something to prepare.
- Although some older people may have money and concerned family caregivers, they can't necessarily get the services they need because government services and programs are a maze of confusing agencies and billing systems. Comprehensive, care managed programs like ESN are needed to assist families determine what kinds of services they need, and then to provide good quality service and oversight for their loved ones.
- Most care for our oldest members is provided outside government systems and programs - by informal caregivers. It is the smartest thing that government can do to invest in supporting informal caregivers because once families can't provide any more, government - the stopgap or safety net for our society - will have to step in. If government will support the development of private care-managed service delivery networks like ESN, informal caregivers in middle and upper income families will receive the support they need and ensure that good quality services are delivered to their elderly loved ones.
- Finally, if you provide people with support and appropriate home-based services, they can stay where they are happiest and alternative housing may not be needed. Home revision, home maintenance and repair are vital network services in addition to traditional skilled and non-skilled services.