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Mayor John F. Street Transition Team
ELDERLY SERVICES
SUBCOMMITTEE
REPORT
February 2000
Mayor John F http:// www. phila. gov/ transition/ Elderly. htm (1 of 22) [2/ 7/ 2001 8: 57: 35 PM]
Table of Contents
Section A Executive
Summary...................................................................................................
4
Section B Full
Report................................................................................................................
7
(.... Subcommittee Process and
Activities...............................................................................
7
(.... Recommendations by Categories I.
Health
Care.........................................................................................................................
12
II. Mental
Health......................................................................................................................
13
III. Nutrition 13
IV. Safety
14
V. Housing 14
VI.
Transportation.....................................................................................................................
15
VII. Recreation 15
VIII. Licensing &
Inspection.........................................................................................................
15
IX.
Employment........................................................................................................................
15
(
Conclusion..........................................................................................................................
16
Section C
Appendices.............................................................................................................
17
Mayor John F. Street Transition Team
Mayor John F http:// www. phila. gov/ transition/ Elderly. htm (2 of 22) [2/ 7/ 2001 8: 57: 36 PM]
Elderly Services Subcommittee Report
The Elderly Services Subcommittee of the Social Services Committee is responsible for reviewing programs and services offered to the elderly in the City of Philadelphia and providing recommendations for their improvement.
SUBCOMMITTEE:
Co- Chair Co- Chair
Risa Lavizzo- Mourey, Director Rebecca Snyder Phillips, Director
Institute on Aging Gerontologic Nursing Consultation Service
University of Pennsylvania University of PennsylvaniaMembers:
Geneva Black, Executive Director Rennie Cohen, Executive Director
Haddington Multi Services for Center in the Park
Older Adults, IncHarold Goldman, President Anne Hagele, Executive Director
Jewish Family & Children’s Service of Philadelphia Senior Center
Greater PhiladelphiaHolly Lange, Senior Vice President Diane Menio, Executive Director
Philadelphia Corporation for Aging Center for Advocacy for the Rights and
Interests of the ElderlyMayor John F http:// www. phila. gov/ transition/ Elderly. htm (3 of 22) [2/ 7/ 2001 8: 57: 36 PM]
Alice Moy, Chairperson George Salloom, Administrator
On Lok House, Inc. Catholic Social ServicesTina Samakur, Student Nancy Smith, Deputy Director
University of Pennsylvania Institute on Aging,
University of PennsylvaniaVan Williams Dennis Wint, President and CEO
Transition Team Coordinator Franklin Institute
Elderly Services Subcommittee Executive Summary
To address the concerns of the elderly population in Philadelphia, the Elderly Services Subcommittee proposes the following list of recommendations in the areas of safety and nutrition, health care and prevention, mental health, housing, recreation and socialization, transportation and employment.
RECOMMENDATIONS:
The prosperity of Philadelphia is dependent upon the health of its citizens and their neighborhoods. Because the elderly compose a high percentage of all people who live and own homes in Philadelphia, the welfare of the elderly is important to the people and to the future of Philadelphia. An investment in the elderly has a direct relation to the growth and prosperity of Philadelphia.
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The recommendations of the Elderly Services Subcommittee include four major themes: 1. A prosperous Philadelphia needs healthy elderly citizens. Specific consideration should be given to areas of physical and mental health, nutrition, preventative health, and long- term care.
1.1 The City should encourage all district health centers to develop specialized programs for elderly, such as: ( the Star 65 Program, ( staff training regarding aging issues, ( geriatrics consultation for staff, ( programs based on risk factors for the elderly, such as immunizations for flu and pneumonia, ( creative and effective outreach programs, ( strong interfaces with community groups and senior centers.
1.2 The City should emphasize service to elderly with behavioral health needs by expanding the Mental Health Clinicians program to all areas of the city and expanding the training on aging issues for mental health workers.
1.3 The City should re- evaluate the long- term care services provided at the Philadelphia Nursing Home and Riverview. A feasibility plan should be developed to help the City identify ways to convert beds to a long- term care system reflective of the current needs of Philadelphians. Components of the plan must include the consideration of quality, consumer preference, access, a continuum of care, cost, and the use of state funds to convert long term care beds.
2. A prosperous Philadelphia needs safe and stable neighborhoods for its elderly citizens.
2.1 The City should strive to support low and middle income elderly residents by assuring adequate funding of the Adaptive Modification Program to allow people with physical impairments to remain in their homes. Older Philadelphians need assistance with repairing deteriorating properties. The city can help by accessing resources such as the Community Development Block Grant and the National Affordable Housing Act, as well as exploring approaches to help subsidize home repair and home ownership programs such as HOME and SHARP. The city should examine the eligibility requirements for home repair programs and make them user- friendly. Mayor Street's efforts to provide real estate tax relief must also be continued and expanded. Finally, the city needs to improve access to existing services to aid in the preservation of neighborhoods.
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1. 3. A prosperous Philadelphia needs transportation services that are accessible and responsive to the mobility needs of its elderly citizens.
3.1 Through its representation on the SEPTA Board, and other available means, the City should help fill the gap and assure the provision of time- sensitive service by advocating for increased capacity for group shared- ride transportation.
3.2 Off- peak rides on SEPTA's fixed route system should be provided free to older adults given the significant benefit to this population. SEPTA is in the process of making bus routes fully accessible which will expand its utilization.
4. A prosperous Philadelphia needs to promote and provide social, recreational, employment and learning opportunities through its recreational facilities, local colleges and health department, to ensure healthy aging for its elderly citizens in such areas as:
- Nutrition - Inter- generational programs - Fitness - Preventative health - Creativity - Education - E- connection
4.1 The city should expand employment and volunteer opportunities for older adults as this demographic is an untapped resource.
4.2 Workforce development initiatives which encourage workers to enter elder caregiving vocations and professions should be undertaken by the City. Incentives might include decreased city wage tax, and community college tuition discounts.
4.3 The City should offer long term care insurance to all city employees.
CONCLUSIONS:
In order to effectively improve the lives of older Philadelphians it is imperative that the City immediately
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designate, empower and give sufficient resources to an Office which will serve as a strong internal voice for aging issues within the city, state and national government. The duties of this Office should, at the outset, include the development of a strategic plan for older citizens, which brings together city departments and appropriate non- governmental provider and consumer groups across the city.
1. Philadelphia needs an Advocate for the Elderly who will lead in planning all services and programs targeted to the elderly, including but not limited to: victim assistance, crime prevention, health, mental health, long term care, recreation, licensing and inspection, employment, transportation, and housing. The Advocate for the Elderly would also represent and advocate for Philadelphia's elderly citizens in Harrisburg and nationally. This could be accomplished by expanding the role of the Mayor's Commission on Aging, giving it the authority to coordinate services for the elderly across all city agencies and departments. This would require the provision of adequate funding and staff to meet its new responsibilities.
1. The Mayor's Commission on Aging should report to the Office of Social Services in order to improve accountability and facilitate increased coordination and integration of services to the elderly across city agencies such as Public Health, Recreation, Mayor's Office of Community Service, Philadelphia Nursing Home, Riverview, and Community Behavioral Health.
2.
3. The City should conduct a Mayor's Summit on Aging to hear the concerns of older Philadelphians and to launch the Office of the Advocate.
1. The City should redraw service areas so that Police, L& I, Streets, Recreation, Health, and other city agencies and departments have common service areas thereby facilitating collaboration to better serve neighborhoods and their ever- increasing numbers of elderly residents.
1.
FULL REPORT
SUBCOMMITTEE PROCESS AND ACTIVITIES
The elderly population is the fastest- growing sector in Philadelphia, the state and the nation. Twenty percent of the population in the City of Philadelphia is 60 years and older. Traditionally this has been a
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segment of the population whose interests and concerns have been underrepresented. Regardless of their need, elderly citizens have rights to and concerns about health care, mental health, nutrition, safety, housing, employment and recreation. Many services sponsored by organizations that advocate for the elderly exist but as the population changes, it is critical that the programs evolve to suit the needs of those who use them. Implicit in all of the programs and services is the ultimate goal of improving the quality of life for older Philadelphians. With this in mind, the Elderly Services Subcommittee took charge of addressing the concerns of the older population. By evaluating current services, the Subcommittee was able to make recommendations for their improvement or suggest an efficient alternative.
The Subcommittee held its start- up meeting on December 15, 1999, and subsequently met eight (8) times as a full Subcommittee between December 22, 1999, and February 9, 2000 (there was no meeting on January 26 due to a snowstorm). The full Subcommittee meetings were held on Wednesdays from 5: 30 p. m. to 7: 00 p. m. However, the last two meetings began a half- hour earlier to accommodate the discussions. In addition, the Co- Chairs attended two (2) meetings with the Social Services Oversight Chairs on December 9, 1999, and January 22, 2000.
A syllabus for the topics to be discussed was decided upon during the first meeting. The topics included health care and prevention, nutrition, mental health, safety, transportation, recreation, employment and housing. During each subsequent meeting, minutes from the previous meeting were discussed after which a city official with expertise on the topic( s) being discussed presented pertinent information and background. The weekly presentations were followed by a period for questions; concerns and suggestions regarding potential recommendations and/ or further research. The subsequent week's agenda was reviewed and specific requests for additional information and presenters were given to the Transition Subcommittee Coordinator for follow- up. Over the course of eight weeks, the Subcommittee identified the following recommendations and concerns.
CONTRIBUTING CITY OFFICIALS:
John Domzalski, Acting Commissioner, Department of Public Health Tom O'Hara, Administrator, Office of Mental Health Jackie Hood, Project Director, Mayor's Commission on Aging Ed McLaughlin, Commissioner, Licensing and Inspection Talmudge Rhodes, Program Director, Special Programs, Department of Recreation Lynn Spiro, Director of Older Adult Services, Department of Recreation Thomas Storey, MD, Ambulatory Medical Director, Department of Public Health Celeste Zappalla, Executive Director, Mayor's Commission on Aging
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CONTRIBUTING SERVICE PROVIDERS & ADVOCATES FOR THE ELDERLY:
Tom Volkert, Director, Aging Advocacy Project, Mental Health Association of Southeastern PA Philadelphia Health Management Corporation
HEALTH CARE
Health care was the focus of the discussion on January 19. John Domzalski, Acting Health Commissioner, presented on behalf of Estelle Richman. Tom Storey, MD, Ambulatory Medical Director of the department of Public Health, also presented information on city services available for the elderly. According to Dr. Storey, primary care services are provided for the elderly, regardless of insurance, in the eight (8) District Health Centers (DHC).
In 1999, 6000 older adults received care in a DHC. Each Health Center has a licensed pharmacy that provides prescription medication for those seniors using a Health Center physician as their primary care physician. In addition, each Health Care Center has a social worker who is available to provide referral services to the elderly, such as nursing home placement and PCA referrals. The social workers are also trained to advise seniors about their right to Medicare. Some centers have a pilot program of on- site benefits counselors who can evaluate eligibility for health insurance.
The Star 65 Program (which operates at three health care centers and plans to expand to five) was discussed at length. It is a program in which older adults schedule an appointment with a team of providers consisting of a doctor, nurse, and social worker and discuss problems ranging from illness to housing and heating bills. The advantage to this program is that there are experienced health care providers who develop close, stable, relationships with the clients. All appointments are fixed and there is no over- booking. Currently, there is a mental health pilot program, in collaboration with the Behavioral Health Services (BHS), attached to the existing Star 65 Program.
The Subcommittee expressed concerns that District Health Centers take steps to be better equipped to serve the elderly. For example, the centers could be staffed with medical and nursing personnel with expertise in geriatrics. Ambulatory Health Services (AHS) has education programs to emphasize issues relevant to the older population. The Subcommittee felt that there could be more education regarding elderly issues. A key concern was increasing outreach to elders with cultural and language needs. There are on- site formal interpreter services in: Spanish at DHC #6, Vietnamese at DHC #2, Cambodian at DHC #3, and Albanian at DHC #6. In addition, there are employees who speak French, Russian,
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Spanish, Indian, and Pakistani languages. With regard to the Star 65 program the Subcommittee felt the program does not have sufficient outreach which targets the elderly. The recommendation was to coordinate programs to focus on the older adult population. The Star 65 program operating at District Health Center #5 was cited as a good model for providing community services.
In terms of personal care homes and nursing homes, a concern was what plans the city has to improve their overall quality. A recommendation was that the city should have long- term care facilities that provide a continuum of care. Philadelphia Nursing Home and Riverview have been major resources in the Philadelphia area but were cited as facilities plagued by a myriad of issues including staffing. Mr. Domzalski cited that there are twelve personal care homes that are in violation. The Department has taken action against four.
The Subcommittee suggested that the city could help address the workforce shortage in long term care facilities by targeting training programs and incentives to attract individuals to these professions. Incentives could include decreased city wage tax or other tax incentives. The Subcommittee acknowledged that the DHC could have more preventative health services and programs like the successful flu and pneumonia immunization program. Preventative dental services are available at seven (7) of the DHCs. Ophthalmology screening is available at offices that cortex between the city and local hospitals.
Acting Health Commissioner Domzalski concurred with the Subcommittee on the need for the city to be a catalyst in promoting public/ private sector partnerships to leverage resources for the provision of services to the elderly. It was reported that the city assumes this role currently and must continue to do so in the future. The Department of Public Health has been involved in an initiative entitled "Envisioning a Healthier Philadelphia" which allows representatives of different health and service organizations to work together for a healthier city. This is an excellent chance for public and private interests to advocate for older adults. The city should take a lead role in this envisioning exercise. It was also suggested that the city needs to develop a more structured and comprehensive approach to addressing priorities in health care issues for the elderly.
MENTAL HEALTH
John Domzalski, Acting Health Commissioner, and Tom O'Hara, Administrator of the Office of Mental Health, spoke to the Subcommittee about pressing mental health issues. One concern from the Subcommittee was how the City plans to provide leadership to educate on and advocate for the mental health needs of the elderly in Philadelphia. According to Mr. O'Hara, Behavioral Health Services (BHS) has a position whose sole function is to advocate for the mental health needs of the elderly. Tom Volkert, who chairs the Delaware Valley Mental Health Aging Advocacy Subcommittee (DVMHAAC), along with a number of other service providers, is responsible for addressing the mental health issues of
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elderly in Southeastern Pennsylvania. DVMHAAC has drafted a position paper, "Creating a Continuum of Care for Elderly Philadelphians with Mental Health Needs," and is pursuing funding for the new initiatives listed in the paper. One such initiative is the development of outpatient services at health center locations that will be staffed by individuals with expertise in serving the behavioral health needs of older persons. Another is a pilot program funding two mobile outreach evaluation and treatment services for mental health and substance abuse of older citizens.
The Joint Subcommittee on the Mental Health of Older Persons and the Deputy Secretary for Mental Health are working together to recommend pilot projects for the state to fund and to support increased services and integrated ventures. Another area of concern is what new partnerships are proposed to address the increase in elderly mental health needs. The DVMHAAC has proposed education of individuals on behavioral health care services and needs in the private sector. In addition, DVMHAAC also recommended training for all direct care non- behavioral health staff serving the elderly, and that mental health evaluations become part of the routine physical examination.
The BHS plans to work with the Personal Care Partnership program to identify the mental health needs of consumers. The other major concern was how to increase funding for mental health services. Thus far, DVMHAAC and the Secretary of Aging have discussed strategies for a PA Department of Public Welfare and PA Department of Aging collaboration to expand the effectiveness of mental health services for the elderly.
Partnerships between the city and faith communities to address mental health needs of the elderly were also a concern. The BHS has arranged for Reverend Thomas J. Ritter and Reverend George W. Anderson, Jr. to conduct site visits and interviews with nursing home administrators to assess the mental health of the residents. They are also completing a survey of 1000 elderly people to obtain a comprehensive needs assessment of mental health and primary care needs of the elderly. The BHS will initiate future partnerships with the faith community in serving the mental health needs of older persons.
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NUTRITION
Holly Lange, Senior Vice President of Philadelphia Corporation for Aging (PCA), gave a presentation to the Subcommittee on December 29. The nutritional health of the elderly is an increasingly pressing issue. PCA sponsors a meal delivery program as well as a nutritional supplement program for which there are no waiting lists for qualified individuals. Other meals on wheels programs are available through churches and non- profit organizations and are supported by fundraising efforts. A problem with meal delivery programs is that they provide only one meal per day. For many seniors this may be their only meal of the day. According to the Philadelphia Health Management Corporation, a majority of older Philadelphians have not utilized a meal program. There could be many reasons for this, but if the reason is insufficient outreach, then the city should support additional nutritional outreach. Another area of concern was cultural outreach for ethnic meal programs. PCA has kosher and diabetic meals but they only occasionally offer a non- traditional meal. Overall, outreach and in- home nutritional education programs were the most important recommendations in this area.
SAFETY
Diane Menio, Executive Director of CARIE, discussed safety issues with the Subcommittee. Safety is important for all Philadelphians and it is of special significance for the elderly population. Each year nearly 2 million seniors become crime victims. Older citizens are more likely to be attacked by strangers at or near their homes. Neighborhood safety is of great importance and consequence. Access to information and statistics on crime from the police department, the District Attorney, and the Victims Services Unit is needed. More information is also needed about the availability of safety services for senior citizens in the city. The more important safety issue is crime prevention in neighborhoods. Currently, there are dedicated crime prevention officers who visit neighborhoods to do outreach. One concern is that there is no longer a community relations officer to assist the elderly. Another area to be addressed is the need to initiate community models that make neighborhoods a safe place for the elderly to live. A suggestion was that there be a representative on the neighborhood revitalization committee. The issue the Subcommittee most supported is that there should be neighborhood representatives familiar with elderly issues and an enhanced neighborhood watch system.
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LICENSING AND INSPECTION
Ed McLaughlin, Commissioner of L& I, spoke to the Subcommittee on January 12 about L& I's primary roles. According to Commissioner McLaughlin, the L& I plays a limited role in quality of care issues for the elderly. The Department administers Philadelphia's land use and life- safety code requirements including building, fire, health, housing, and business codes. L& I oversees the annual certification requirement of fire alarms in personal care facilities and nursing homes. They also perform annual inspections of sprinkler and fire alarm systems by scheduling inspection appointments with operators of facilities. Subcommittee members raised the issue of facilities that still operate in spite of violations or revoked licenses. According to the Commissioner, the L& I has the authority to cease business operation if life and safety issues are a factor. The Commissioner also commented that L& I must be computerized to keep track of the facilities in violation of codes and to make the certification and code approval processes more efficient and accessible to new operators. Other concerns from the Subcommittee were that there needs to be more effective communication between L& I and other city agencies. Communication to the Mayor's Commission on Aging on public safety issues is critical. The Recommendations which resulted from the discussion are the need for an elderly advocate in the Department and training programs for L& I inspectors on elderly health care issues and services.
RECREATION
Two Department of Recreation representatives spoke to the Subcommittee on February 2. Lynn Spiro, Director of Older Adult Services and Talmudge Rhodes, Program Director of Special Programs, informed the Subcommittee about recreational activities offered to senior citizens at the five older adult centers operated by the Department of Recreation. The thrust of the older adult centers is to promote a healthy lifestyle through nutrition, exercise, and education. Some activities offered include: dance classes, yoga, arts and crafts, and computer classes. PCA funds 53% of the salaries and supplies for three of the five Older Adult Centers. The remaining two are owned by the city and are the largest facilities. The centers have served 6000 seniors in departmental programs. In addition, the centers provide 133,500 meals and 22,650 van rides for seniors, although only three of the five centers own vans which were donated from corporate sponsors. The Department owns and operates a school bus used to transport seniors on cultural and recreational excursions. Amenities in selected centers include a computer lab equipped with ten donated computers with internet and networking capabilities, and a fitness room with weight machines, treadmills, and exercise bikes. The Department is currently looking for an exercise physiologist. The Department has collaborated with Tenet Health System to provide an on- site physician at one of the centers. The three citywide events which the Department sponsors are the Holiday Party, Rally in the Park (which is a citywide picnic at Strawberry Mansion) and the Philadelphia Senior Games (in which bowling, swimming, golf, and tennis are some of the featured events).
The Department representatives commented that the two older adult centers owned by the city could use social workers. They also mentioned that the Department would like to expand services to evenings and
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Saturdays in order to reach a broader base of seniors, recruit active seniors to volunteer with the frail elderly at the centers and increase public relations and marketing in order to attract younger seniors. The Department began the planning process to address these issues in July 1999. Ms. Spiro mentioned that it would be extremely useful to have a Development Office/ Grants Writer for the three citywide events to increase funding support for these programs. It was proposed that the city needs to play a strategic role in corporate sponsorship for the senior events. The question of in- home outreach for homebound seniors was also addressed. Currently, senior centers do not offer this service although one older adult center has a visitors program. The Subcommittee contemplated increasing the capacity to provide computer training and internet access to seniors to help combat isolation from society. It was suggested that the Department collaborate with the Franklin Institute and other organizations to seek funding for this initiative.
HOUSING
Alice Moy, Executive Director of On Lok House, Inc., and Holly Lange, Senior Vice- President of Philadelphia Corporation on Aging, gave presentations to the Subcommittee on February 2. According to a HUD study, the elderly population is decreasing but the number of elderly over 85 is increasing. There are approximately 60,000 low- income elderly homeowners. The housing problems that affect this population also affect the entire city. The major housing problem is the need for home repairs and maintenance to make homes safe for senior citizens. It was suggested that increased funding from the Community Development Block Grant and the National Affordable Housing Act be spent for housing programs such as Home Owners Maintenance Emergency Program (HOME) and the Senior Housing Assistance Repair Program (SHARP). PCA produces a housing guide for seniors, listing assisted- living homes, nursing homes, independent retirement communities, etc. The city should continue looking at the impact of estate recovery on properties in Philadelphia neighborhoods. All housing rehabilitation and new construction paid with city dollars should be energy- efficient and well equipped for heating and cooling. These homes must be designed to allow independence as the occupant ages.
TRANSPORTATION
Holly Lange, Senior Vice- President of Philadelphia Corporation for Aging, presented information on transportation on February 2. As our population ages, more people will be relying on public transportation. SEPTA is the main transportation provider for the city and offers various services. One service is the off- peak free ride for seniors, which is in effect from 9: 30 a. m. to 3: 30 p. m. SEPTA is in the process of making bus routes fully accessible to the elderly. SEPTA also operates state and consumer- funded CCT Connect which is a shared- ride service that picks up seniors and transports them to senior centers, doctors appointments, adult day care, dialysis appointments, etc. Although this service has been useful, extremely early and late vans pose a major problem, often forcing seniors to wait for long periods for their rides. This causes significant problems for older adults and the health and social service providers who serve them.
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Given the increasing demand for this shared- ride system, the city should focus on making this system more efficient as it is becoming more popular as the elderly age and are unable to use the fixed route bus system. It was also suggested that training on sensitivity and other issues related to the elderly be provided to the drivers. Overall, the elderly population would benefit from being able to easily access information on transportation services offered in the city. The city should continue to advocate for transportation services to be accessible to the growing needs of the elderly, through its representation on the SEPTA board. SEPTA also needs to increase capacity for its Shared- Ride Program.
RECOMMENDATIONS
The Subcommittee believes that in order to improve the lives of older citizens it is imperative that the City immediately designate, empower and give sufficient resources to an Office which will serve as a strong internal voice for aging issues city wide and with state and national government. The duties of this Office should, at the outset, include the development of a strategic plan for aging citizens that brings together all affected city departments and involves non- governmental provider and consumer groups across the city.
1. Philadelphia needs an Advocate for the Elderly who will lead in planning all services and programs targeted to the elderly, including but not limited to: victim assistance, crime prevention, health, mental health, long term care, recreation, licensing and inspections, employment, transportation, and housing. The "Advocate for the Elderly" should also represent and advocate for Philadelphia's elderly citizens at the state and national levels. This could be accomplished by expanding the role of the Mayor's Commission on Aging, giving it the authority to coordinate services for the elderly across all city agencies and departments and providing it with adequate funding and staff to meet its new responsibilities.
1. The Mayor's Commission on Aging should report to the Office of Social Services in order to improve accountability and facilitate increased coordination and integration of services to the elderly across city agencies such as: Public Health, Recreation, Mayor's Office of Community Service, Philadelphia Nursing Home, Riverview, and Community Behavioral Health.
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1. The City should conduct a Mayor's Summit on Aging to hear the concerns of older Philadelphians and to launch this Office.
1. The City should redraw service areas so that Police, L& I, Streets, Recreation, Health, and other City agencies and departments have common service areas thereby facilitating collaboration to better serve neighborhoods with ever- increasing numbers of elderly residents..
1. In addition the Subcommittee has the following specific recommendations by content area:
HEALTH CARE
Health care is one of the most serious concerns for the elderly population. Although many seniors remain independent, others have difficulty with everyday activities like walking, cooking, shopping, and bathing. The degree of assistance needed differs from person to person, but there are choices available in long- term care to suit individual needs. These include home health care, adult day care, assisted living, and traditional nursing homes. It is not adequate, however, to just have the options available. It is imperative that standards are reevaluated and adjustments made, as conditions in some nursing homes are unacceptable.
1. The City should advocate for intergovernmental funding of assisted long- term care. 2. The City must appreciate the services of the Philadelphia Nursing Home and provide financial and technical support to significantly improve the quality of long- term care provided by the institution.
3. Information on programs available for the elderly at city health centers, e. g., the Star 65 Program, should be widely disseminated to the elderly, their families, caregivers, neighbors and other agencies and institutions serving the elderly. The City should also consider the creation of a gerontologic resource team (GRT) e. g., physician, advanced practice nurse and social worker trained in geriatrics to provide in- house consultation and training on geriatric care and aging issues to staff in the city health centers, Philadelphia Nursing Home, Riverview and the Prison Health System. The latest cost- effective interactive technologies, e. g., videoconference, satellite teleconference, phone conference, and web- based programs should be utilized to access training and consultation. (Refer to GRT- DVGEC model).
4. The STAR 65 Program should have an outreach program that targets the elderly. 5. Health Department services should be expanded to include increased public/ private partnerships to advocate on behalf of the senior population and their caregivers.
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6. The City should take a lead role in the "Envisioning of a Healthier Philadelphia," and further ensure that elderly issues and concerns are given focus and addressed as an important priority.
7. The elderly and their families should have access to long- term care insurance. 8. The City should adopt a “continuum of care” model to effectively address the need for quality long- term care and ensure that it is easily accessible to low- income and impoverished elderly citizens.
Refer to selected best practice models, articles and papers:
"GERONTOLOGIC RESOURCE TEAMS (GRTs)", Delaware Valley Geriatric Education Center (DVGEC), University of Pennsylvania, 1995- 2000. This research- supported innovation was based on the concept of the Geriatric Resource Nurse, first developed and tested at Yale- New Haven Medical Center. Imported from the acute care setting, the DVGEC model was expanded to include an “interdisciplinary” Gerontologic Resource Team (GRT). Each long term care facility registered for the DVGEC training, identified a two member team comprised of nurse, physician, social worker, nutritionist, or other health professional to participate in train the trainer programs on geriatric care and related aging issues. Once trained, the teams served as consultants and resource authorities to staff within their respective facilities. The DVGEC provided follow- up training and consultation to the team members for a 2 year period.
"ENVISIONING A HEALTHIER PHILADELPHIA", 1999. "SELECTED HEALTH AND SOCIAL INFORMATION ABOUT OLDER ADULTS (65+) IN SOUTHEASTERN PENNSYLVANIA (SEPA)", Philadelphia Health Management Corporation, Community Health Data Base 1998/ 1999, Household Health Survey.
MENTAL HEALTH Approximately 20% of all Americans suffer from some form of mental illness and fewer than half receive the appropriate treatment. This is especially true for the older population. Although mental disorders are not a normal product of aging, mental illness, unfortunately, is prevalent with increasing age. With the fastest growing age group over age 85 and the ability to live independently directly affected by mental well- being, meeting the mental health needs of the elderly is critically important.
Refer to selected best practice models, articles and papers:
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"CREATING A CONTINUUM OF CARE FOR ELDERLY PENNSYLVANIANS WITH MENTAL HEALTH NEEDS", discussion paper (mental health presentation by Tom O'Hara- 1/ 12/ 00).
"MEMPHIS POLICE CRISIS INTERVENTION TEAM, CIT – MORE THAT JUST TRAINING , BEYOND THE BADGE –ALLIANCE FOR THE MENTALLY ILL ", 1995.
NUTRITION
With an increasing elderly population more attention has been focused on good nutrition, the goal being to improve the quality of life as one ages. Nutrition is particularly important for this age group as appetites tend to be smaller and many elderly do not have the means to prepare or access a nutritious meal.
1. Cultural outreach is necessary to integrate minorities' communities into the elderly population. A culturally diverse meal program could serve as an integrative outreach.
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2. An up- to- date informative guide to nutrition services offered by PCA and other agencies providing meals and food shopping services could be a very useful source of information for the elderly and referring agencies and institutions. This should be an exhaustive list of programs including those which provide free meals, as well as those which charge for the service. The guide should be accessible in print, on the Internet and featured on television and radio programs. 3. Nutrition assessment, education and outreach programs should be targeted to the homebound elderly who are at the greatest risk of malnutrition. Telephone consultation, home visits to high risk elderly, printed materials, public television, radio and internet programming, and access to nutrition assessment and counseling at district health centers for dietary and nutritional information could be infinitely useful to the elderly. |
Refer to selected best practice models, articles and papers:
"WIDER HORIZONS - Region In Transition", WHYY- TV Channel 12, Philadelphia. Given new technology, i. e. wide band digital TV, WHYY will have 4 channels available in Year 2000 which will include: website, internet, radio and TV. The aging network of organizations have already begun to collaborate with WHYY in planning kickoff programming for older adults, to be launched during a week in May (Older American's Month). Participation in the ongoing planning is an opportunity for the City to gain visibility in its new role in coordination and advocacy.
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SAFETY
Safety is important for all Philadelphians and it is of special significance for the elderly population. Each year nearly 2 million seniors become crime victims. Older citizens are more likely to be attacked by strangers at or near their homes. Suggestions for safer neighborhoods include:
1. Access to information on the safety of neighborhoods, crime- prevention programs and services available for seniors is needed by the elderly.
2. Although safety outreach exists in neighborhoods , designation of a community relations officer to work with the elderly population would provide greater benefit to this population.
3. Community structures, which make neighborhoods safer should be initiated, e. g. other city district models have neighborhood representatives for immediate assistance. Police training on elderly services is necessary. Bike and walking patrols can make a neighborhood watch a beneficial service for seniors.
HOUSING
The need for suitable housing for older persons continues to grow. According to a study by the Department of Housing and Urban Development, the high cost of housing is the most pressing problem for senior citizens. Significant percentages of elderly live in housing that is in dire need of repair and rehabilitation and is considered sub- standard. In addition, many seniors have requested housing modifications that remain unmet and as such pose a threat to their well being.
1. The City should assure adequate funding for the Adaptive Modification Program to allow people with disabilities to remain in their homes.
2. The City should assist by accessing resources such as the Community Development Block Grant and the National Affordable Housing Act, as well as exploring approaches to help subsidize home repair and home ownership programs such as HOME and SHARP.
3. City- funded housing rehabilitation and construction should be energy- efficient, well equipped for
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cooling and heating, and aging- friendly. 4. The City should continue to explore estate recovery for the Medicaid Program. 5. The City should work on vacancy prevention for properties in Philadelphia.
TRANSPORTATION
According to the American Association of Retired Persons (AARP) one quarter of the 75+ age group does not drive. Mobility is a critical issue for the elderly in general but for those who do not drive, alternate modes of transportation, i. e., public transportation are used. As the elderly population continues to grow, reliance on public transportation services will increase.
1. SEPTA should arrange to give senior citizens full accessibility to fixed bus routes. (in progress) 2. Increased accessibility to Shared- Ride services is critical. 3. Elderly representation is necessary for transportation services to be responsive to the needs of the elderly.
4. Free, off- peak rides to older adults on SEPTA's fixed route system is a benefit to this population. SEPTA is in the process of making bus routes fully accessible which will expand its utilization.
5. Through its representation on the SEPTA Board, and other available means, the City should help fill the gap and assure the provision of time- sensitive service capacity for group Shared- Ride transportation.
RECREATION AND SOCIALIZATION
A part of aging that cuts across all socio- economic groups of older people living in the city of Philadelphia is the issue of isolation. Due to deaths of spouses, friends and other family members; the scattering of family and friends created by a mobile society; retirement from the workforce; and the extension of the life span there is a need for older people to develop new roots in order to stay connected to a community (church, senior center, club, etc.). It is important to feel one's life purpose so that there are reasons to greet each new day. Socialization and recreation offer essential and inexpensive interventions to assuring optimal mental and physical wellness, management of chronic illness, and
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prevention or delay of increasing frailty among older adults. 1. Corporate sponsorship and city support for "Senior Games" should be increased in order to extend the event to other areas in and around Philadelphia.
LICENSING & INSPECTION
1. Training programs on elderly issues and information about citywide services for the elderly should be made available to License and Inspection personnel.
2. An Advocate for the Elderly position should be created within License &Inspection to ensure that expertise on elderly issues is available and sensitivity to elders needs is given.
EMPLOYMENT
1. Advocacy for older- workers must take place with the Workforce Investment Board. 2. Programs need to be developed which encourage people of all ages to work in the caregiving vocations/ professions so desperately needed by the agencies and institutions providing services to the elderly.
3. The city should expand employment and volunteer opportunities for older adults as the demographic is an untapped resource.
4. Workforce development initiatives are needed which encourage workers to enter elder caregiving professions/ vocations. Incentives might include decreased city wage tax, and Community College tuition discounts.
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CONCLUSION
The elderly are a large and critical part of Philadelphia's richly diverse population. They provide stability to neighborhoods, families and society as a whole. Yet all too often their needs go unmet. Philadelphia has a particularly large older population who has contributed greatly to the fabric of the City for decades. The City is fortunate that so many of its elders are homeowners and therefore are the mainstay in many neighborhoods. Therefore, as Philadelphia looks forward to an even more prosperous future, meeting the needs of older Philadelphians must be a significant part of that future.
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