Averting Disaster in Aging America
A Damariscotta doctor is using technology and volunteers to keep elders in their homes
Thursday, March 10, 2011 8:34 AM
Over the past 25 years Dr. Allan "Chip" Teel, a family physician in Damariscotta, has worked with thousands of older patients in the hospital, at nursing homes, in assisted living facilities and in their own homes. During those years, he's heard one refrain repeatedly from his patients: "Don't you ever think of putting me in a nursing home." Fifteen years ago he addressed their request by starting Lincoln County's ElderCare Network, a system of seven small group homes that provide a homelike care setting for 60 elders in need of daily services and support. But today Teel has taken an individualized approach, called the "Maine Approach," even further, using technology and a network of paid professionals and committed volunteers to help elders remain in their own homes, the familiar setting where plants, pets and memories give them daily pleasure and comfort.
The Grey Tsunami
By 2020 55 million Americans will be over age 65; by 2030, this figure will be 85 million.
The fastest growing segment of the population is those over 85.
Over 4 million are over 85 now; by 2050 an estimated 21 million will be over 85 and 1 million over age 100.
Current life expectancy for the average 65-year-old is 20 years.
Half of all Americans over 65 are admitted to a nursing home at least once.
Nursing homes currently serve 1.5 million.
22 percent of all Americans over 85 live in institutional settings.
40 percent of elderly women and 20 percent of elderly men currently live at home alone.
20 million American families have an individual older than 80 living with them.
6.9 million Americans are long-distance caregivers.
By 2030 one third of the adult population will be over 65.
The estimated caregiver shortage by 2030 will be 20 million.
In his early years of practice, Teel told a crowd attending a recent presentation at the Camden Public Library, "I was focused on pills, lab tests, fall risk, but not on a good enough reason to get up in the morning - family, friends, pets, personal interests...." He knew patients needed to be "living, not just surviving." At the same time, a family diaspora, with seniors often retiring to warmer climates, was taking place. Elders increasingly segregated in retirement or residential care communities, coupled with our increasingly youth-oriented culture, has meant there is less intergenerational connection. There is a need, Teel says, for a new elder paradigm, one engaging elders, caregivers and community in a different dynamic and utilizing the "hidden resource" of the cohort of retired people to solve problems.
Teel's research figures show that by 2030, 21 million Americans will be over 85 - a "grey tsunami." Even if many of these elders could afford $10,000 a month for nursing home care, there will not be enough facilities available to fill the demand for them nor will there be sufficient caregivers available to staff them. And, Teel reminded his audience, "We won't be talking about money for police, roads and schools." The costs of this care would be staggering.
By contrast, Teel's "Maine Approach" makes it possible for an elder to remain in the home for less than $700 a month. Over the past five years he's come up with a method of virtual assisted living he calls "Full Circle America" (FCA) that allows individuals, including those with significant memory impairment as well as those with advanced physical problems due to arthritis, stroke or heart disease, to be monitored by soft technology in the home. FCA has proved so successful in Damariscotta that last year Teel wrote and self-published a book about its methods, Alone and Invisible: Averting Disaster in Aging America. The book quickly sold out its first printing of 600 and has sold half of its second printing. He'd like to see it used to help reach his goal of having 10,000 affiliates across the country, with a national organization providing a turnkey operation for them. Not unlike a franchise, the national FCA group would provide manager training, a seed capital start-up loan, complete technology packages ready to install, bookkeeping and accounting software and more. Teel is already helping a group in Bangor start its own operation, and many of those at the Camden presentation, including representatives of community groups from St. George, Cushing and Waldoboro, were attending because there was interest in starting such a service in their area. As Teel says, "If Facebook can go from nothing to 500 million members in five years, we can do this. And the stakes are much higher."
Warm and Fuzzy Technology
For many people, the idea of using a Web cam to monitor the daily living situation of an at-home elder smacks of Big Brother. But, as Teel points out in his book, a basic kit with one or two cameras, wireless motion sensors, a wireless event alarm signal and other monitoring devices allows video checking from anywhere in the world via cell phone or computer, allowing family members to have more control and input into their elder's care. Monitoring is primarily focused on the kitchen - dishes in the sink or not, mail on the kitchen table or not, the elder getting something out of the kitchen or not - with all shots time stamped, providing a body of work that can often exceed the information provided by in-home caregivers. Such surveillance is much less intrusive for the elders than agency caregivers being in their homes many hours a day, and users of the system say they find great comfort in knowing someone is looking out for them. As Teel says, "Compare this inconvenience to the far larger loss of privacy which results from moving into a double bedroom in a residential care facility, sharing a bathroom, bureau and closet with a complete stranger."
The technology aspects of FCA are combined with home visits, from a nurse, a personal advocate such as a family member, or a volunteer. They can provide a friendly visit and, together with errand and transportation services, can reduce the loneliness and isolation of members.
Volunteers are Key
The use of volunteers in FCA's plan is as integral as that of technology. "If just 10 to 15 percent of the over-65 population will contribute four hours a week to a meaningful activity, the resultant labor force would meet all the needs of every elder," Teel says. To illustrate how much seniors desire to make meaningful contributions to their community, Teel tells of speaking to the Pemaquid Cooperative Ministry's Community Outreach Forum in March 2010. After the presentation more than a dozen 90-plus-year-olds signed up to volunteer to help their neighbors as described in the approach he outlined. In any of the FCA affiliates, volunteers in the community work with paid staff so that paid staff goes further.
A Tale of Two Options
At his presentation and in his book, Teel presents multiple cases of elders who use the Maine Approach to stay in their homes. One story is that of a 98-year-old "pleasantly forgetful" Alna woman, Elizabeth, whose concerned neighbors "arm-twisted" her into accepting a video-monitoring and elder-support package that included a Web cam in the living room with intermittent remote monitoring. After one frigid January night, the Saturday-morning spot Web cam check showed Elizabeth sitting on her couch, bundled in her winter coat and blankets. The team went into action, calling her personal advocate, Amy, who was serving breakfast at the Alna Store across the street. Scooping up Elizabeth, Amy set her up in front of a space heater at the store and warmed her with rotating hot blankets and sweetened hot tea. Other team members arranged for her to spend the afternoon at the nearby home of Al, another Maine Approach client, where the two of them were monitored with the Web cam almost continuously as they enjoyed an afternoon together of reading, conversation, television and a family visit. Both benefitted from the additional company and hustle and bustle, and Al felt good about being needed and useful - elder care volunteerism at its best. Other team members had discovered that Elizabeth had inadvertently shut off the furnace switch rather than the cellar light switch, so the furnace switch was duct-taped tightly in the "on" position and Elizabeth was back in her home for the night. No emergency room, no paramedics, no hospital bills were involved.
The alternative scenario would have been a frightened woman taken to the emergency room with a whole team of professional strangers asking her many confusing questions. After many invasive procedures she would have been admitted to a cardiac-monitored hospital bed to meet another team of caregivers with more confusing questions. A couple of days later the hospital would have deemed her too weak and fragile to go home, and, having met the requisite three-hospital-night provision of Medicare to qualify for a rehab stay, she would have been moved by ambulance to a skilled nursing facility, with yet another team of caregivers in a different room with a different routine. A few weeks later the skilled nursing social service and physical therapy teams would have recommended to her out-of-state distant relatives that she needed to reside in a long-term care facility for the rest of her life.
The aging of our population, Teel says, requires a new approach, not only because the cost of elder care will bankrupt all our public and private assets, but also because "the currently available elder care options are often undesirable and deprive us of one of our richest resources: the wisdom, experience and friendship of our elders." The new model of care he suggests in Full Circle America, one that is "dramatically decentralized with a digital spine holding it together," will enable community-based affiliates to involve, coordinate and serve the elders in their areas.