The Living Model for Comprehensive Elderly Care

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If we don't create and support environments that foster dignity and connection -- where even the most vulnerable among us can participate in opportunities for service and recreation that honor our intrinsic worth at every age -- shame on us.

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In a previous piece, "Casinos as the Bleak New Senior Citizen Center," I ventured into the heart of a riverboat casino to talk with seniors taking advantage of the $2.99 discount lunch buffet. I was spurred by the realization that more than half of all adult visitors to casinos last year were 50 and older, and many of them (as is echoed in the slim body of research on the subject) come to play slots -- a game that I surmised can make a luckless zombie out of any of us. I closed the piece by asking:

Now that government is the biggest sponsor of casino gaming, all of us--even those who never visit casinos -- have to ask, are we turning a blind eye to a government-sponsored predator that creates false community, drains money and undermines dignity for those most vulnerable among us? Are casinos really the most responsible form of recreation we can offer our seniors?

I couldn't end on that bleak note without offering more in the realm of alternatives. I decided to visit a proper senior center, of the sort that's recently been making some headway. I chose PACE (Program for the All-Inclusive Care for the Elderly), which is among the new-model interdisciplinary care centers -- incorporating teams of doctors, recreational managers, dieticians, pharmacists, physical and occupational therapists, and home care coordinators in an integrated approach. The idea is that the team effectively assesses medical needs and support systems to create unique, comprehensive care/life plans.

Arriving at the sun-lit PACE building in Baton Rouge, I watched as wheelchairs and walkers glided smoothly across the wood floor as people left in vans for home or the grocery store, and new people arrived for the day's activities. Everyone who entered was greeted warmly by name while the receptionists retrieved their name tag. 

In the lobby, I read the PACE Bill of Rights (posted in conspicuously large font) that reminded everyone not only of their entitlement to high-quality care and attention,  but that they had the right to complain and leave the program should they choose. I overheard a nurse leading a seminar in their main gathering room on "The Good Life," offering reminders such as: "Get out and exercise, say thank you like you mean it, smile, connect to your family, give your clutter away to someone who needs it, and be a friend to have a friend." I looked over the month's newsletter, which highlighted trips to a local outdoor shopping area, a swamp tour, a saxophone concert, a Wii bowling tournament, a springtime fashion show, and a "Top Chef" of the Month class.

"Oh, everybody loves Charlene!"

The Executive Director, Sharon Thoms, RN, described to me how the PACE model of care won her over. "I saw how our participants flourished here. We were able to interact with their families in a proactive and positive way. They could come from home and go back. It wasn't a dreaded place to come. Here they receive all their healthcare, opportunities for fun, and nourishment... I stay because I see that it works." 

Two of their original four patients from 2008 were still with the program. Though their health had declined and they'd grown increasingly frail, the team had adjusted to those changes and strategized for how to keep them safe and out of the hospital. "One woman broke her hip, and we got her out of the hospital and back home in two days. We made sure she was comfortable, that she had no infections, and she was back walking in no time." 

The PACE model of care strives to be best practice for the patient and family as well as cost-effective for the community at large.

The only downside -- and one that is not insignificant -- is financial. You must be Medicaid-eligible to enroll in PACE at no personal cost. The middle class seems to fall through the cracks. It was humbling and eye-opening to hear this professional, hard-working woman admit, "If I have a stroke tomorrow, I couldn't afford a nursing home. And I don't qualify for Medicaid. What happens to me?" The faces of my parents, aunts and uncles, and countless church parishioners ran through my mind as she spoke.

We made our way to the main gathering area, where I spoke with one of the residents, Ms. Audrey. Her granddaughter had encouraged her to enroll with PACE about 6 months ago. Her biggest stress before PACE was keeping all her appointments and medications straight, and because PACE coordinates everything at the center, even allowing her to pick up her medications there, she felt that much of the burden had been lifted.

I concluded my trip with two PACE team members who serve in the clinic. Sharon ran the administration of the clinic, and as the first person to meet with new PACE enrollees at each clinic visit, she took on the mantle of hospitality. "People here are not patients, they're people." Charlene, who served as a pharmacy technician and managed medication distribution, smiled at Sharon's observation, "Oh, everybody loves Charlene!" 

Charlene went on to speak of some of the enrollees who had especially touched her. One enrollee had recently passed away, and as she spoke she became a bit teary. I thought to myself, "I hope that a pharmacy tech cries over my grandma someday."

As I drove away from the PACE program I thought about where I would want the senior members of my family spending their time. PACE may not be perfect for them, but the philosophy of the system intrinsically honors that each person enrolled is unique and deserves genuine opportunities for engagement, growth, and fullness of life. Each of us should be able to live in our communities of choice and live well.

Currently there almost 1500 casinos in the United States, and that doesn't count the recent onslaught of "sweepstakes" businesses." But there are only 82 operational PACE sites, and these sites only truly benefit the indigent. As our senior population soon explodes, we have an opportunity to be inspired by the PACE model of care and disgusted by the sham of casinos that draw on senior citizens. Be it a slot machine, a movie, a conversation at a clinic, or even indirectly through our tax dollars -- when we give the gift of our time, money, and attention, we breathe into a world that either facilitates life or death. In my experience with hospice care, our mission aimed to serve those facing death, but our every move focused on how even the inevitability and immanence of death cannot deter us from facilitating life. 

If a person can no longer drive or work a traditional job or even complete tasks of daily living, we, with the privilege of relative health, must adjust our definitions of life. We must learn what individuality and community means at every stage of existence. As I thought of those seniors I met in the casino, I felt the onus on me and my generation: If we don't create and support environments that foster dignity and connection -- where the most vulnerable among us can participate in opportunities for service and recreation that honor our intrinsic worth at every age -- shame on us.

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Amy Ziettlow is an affiliate scholar with the Institute for American Values where she currently studies Gen X caregiving and grieving. She is ordained in the mainline Evangelical Lutheran Church of America and most recently served as Chief Operating Officer of Hospice of Baton Rouge.

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