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Elder Care Sections
Mercy Life Aims to Keep Seniors in Their Homes

PACESenior citizens with health needs have plenty of options, running the gamut from home care to assisted living to nursing-home care.

But what about individuals who are struggling at home alone, but feel they’re not quite ready for residential care?

For such people, PACE — Medicaid’s Program of All-inclusive Care for the Elderly — could fill the gap.

“PACE is a program that’s designed for folks who would normally be living in a nursing home long-term, and provides everything they need to keep them at home,” said Joseph Larkin, executive director of Mercy Life, the PACE program recently established by the Sisters of Providence Health System (SPHS).

“The overall goal of PACE is to align the financial incentives of the PACE organization with the patient’s life goals — namely, to stay home and stay as independent as they possibly can be,” he explained, adding that the program relies on lower-cost preventive care to avoid higher-cost inpatient care. “The idea is to spend more money on preventive things and thereby avoid more expensive medication, hospital stays, and nursing-home placement.”

SPHS envisions Mercy Life — which will be housed, along with Mercy Home Care and Mercy Hospice, at the former Brightside for Children and Families campus in Holyoke — as a bustling facility, staffed by a host of medical professionals, where seniors can go to meet basic wellness needs. At the same time, PACE also provides in-home care when necessary.

Simply put, PACE programs serve individuals with long-term-care needs by providing access to the entire continuum of health services — preventive, primary, acute, long-term, and end-of-life care included. The model is centered around the concept that it’s better for the well-being of elders with chronic-care needs, and their families — to be served in the community whenever possible.

“PACE is a niche program,” Larkin said. “People who are doing well with home care or visiting nurses, or doing well with traditional adult day health programs, those aren’t necessarily good PACE enrollees.” On the other hand, people who find their needs aren’t fully met by such programs, yet don’t necessarily need to be in nursing-home care, are more likely to thrive in PACE.

Joe Larkin (right, with Chris McLaughlin)

Joe Larkin (right, with Chris McLaughlin) says Mercy Life will provide services both on site in Holyoke and in clients’ homes in an effort to keep them healthy and independent.

Christopher McLaughin, chief operating officer of the Mercy Continuing Care Network — which boasts a number of independent-living, assisted-living, and skilled-nursing facilities, as well as home-care, hospice, and adult day programs — says Mercy Life will fit well in that continuum when it opens later this year. “This gives seniors new options they have not previously had.”

 

Team Approach

Larkin noted that enrollment is open to anyone 55 or older who lives in the service area of a PACE organization, and who is also screened by Medicaid and determined to be eligible for nursing-home placement. An open house for Mercy Life coincided with a groundbreaking ceremony on June 17.

“People who enroll assign their Medicare and Medicaid benefits to PACE,” he said, “and the PACE organization provides everything they need, from hospitalizations to primary care to medications to help in the home — home modifications, pretty much anything the organization thinks makes sense to help people stay in their homes.”

Each client is typically served by an interdisciplinary team made up of a primary-care physician, the PACE center manager, a nurse, a social worker, a physical and/or occupational therapist, a home-care coordinator, a pharmacist, a dietitian, a transportation manager, a personal-care attendant, and other caregivers as appropriate.

If that sounds a lot like an accountable-care organization, it should, Larkin said, noting that PACE program fits well into the growing ACO movement in the healthcare industry, in which patient care is overseen by a similarly diverse group of providers.

The difference — and it’s a significant one — is who makes coverage decisions. While an ACO is still bound by payment limitations, PACE has none. In short, because the organization serves as both provider and insurer, the care team decides not only what services the patient needs, but which ones to pay for. There is no fee-for-service concept, as PACE takes on all the risk.

“That’s a huge difference from everything else; there’s not anything else I know of where that’s the case,” Larkin said, adding that PACE programs rely on a small-scale model of care, so enrollment is limited. “Once you get over 100, 120 patients, it’s harder. You need to know these people intimately to know what’s going to work for them. If you don’t, you underserve them, and they fail, or you overserve them, and PACE goes out of business. So it’s a real balancing act, and you have to know your patients well in order to strike that balance.”

But he emphasized that PACE does not scrimp on preventive services, which have been proven to save money over time. “Many times, the PACE organization pays for things that other insurance companies won’t pay for,” he noted, citing the example of a client whose dog’s flea dip was covered, because dealing with the health effects of fleas in the house would have been more expensive.

“The organization gets really creative in terms of what they do for people,” Larkin said. “They decide what is covered for each participant; there aren’t decision politics like you typically have with insurance. Decisions about what they pay for are made on a case-by-case, individual basis.”

To qualify, clients must dis-enroll from any managed-care programs and must meet Medicaid financial eligibility, or pay privately for that portion. They may also dis-enroll from PACE at any time, and PACE coordinates their insurance reinstatement.

 

Day and Night

During the day, Mercy Life will feature a host of wellness activities and morning and lunchtime meals, as well as offering treatments ranging from infusions to complex dressings, as well as routine medical appointments with doctors and nurses. “On average, people come to a PACE center 2.2 times per week — some every day, and some once a month,” Larkin said.

And sick people are welcome, he noted. “In adult day care, if you’re not feeling well, they tend to ask you to stay home. In PACE, if you’re not feeling well, that’s all the more reason to come in; they want to see you, to be able to help you.” In many cases, he added, “aides will go into the home, help people wash up, and bring them to the center.”

Indeed, “PACE also provides a lot of services in the home, as well as transportation,” Larkin said, adding that drivers often serve a critical role in observing and reporting clients’ unmet needs. And the level of services can change often; “there are no hard and fast rules, so it’s a negotiated process.”

PACE is not hospice care, he emphasized, but it’s a better fit for people who are focusing more on quality of life than for individuals who demand copious medical tests and workups for every physical symptom that arises. “It does tend to be people in the last four, five, six years of life who have made a decision to take this different approach. Having said that, there’s no limit to how long you can be with PACE.”

Clients are typically referred to PACE programs from a variety of sources, including healthcare providers, discharge materials, marketing materials, and word of mouth. “Some are people who have been calling their doctor with vague, non-specific complaints, and they’re lonely and scared,” Larkin said.

“Once people in a community get to know PACE, a lot of providers embrace it. It’s an opportunity to help those people providers know they’re not able to help anymore” in their current living situation, he added. “It’s an alternative to nursing-home placements for people who, if they just had a little more help, they could go on living in their own homes, where existing programs are not enough to fill that gap.”

Currently, Larkin said, there are 92 PACE organizations throughout the U.S., serving just over 200,000 people. “It actually started in the 1970s in San Francisco, where it was called On Lok,” he explained. “They did it as a charity, and then PACE regulations were developed, and by the ’90s, we started to see other PACE organizations. It’s really catch as catch can where you see PACE programs; there are six in Massachusetts, but none in Connecticut.”

McLaughlin said the Sisters of Providence — with its 140 years of local history — sees itself as a critical provider of senior care. Meanwhile, “our corporate parent, Catholic Health East, is the largest single provider of PACE programs in the country, so we had corporate support for this,” he added.

“When we think about this program, we think it complements other services we hold near and dear to us,” McLaughlin told BusinessWest, while also reflecting the Sisters’ philosophical emphasis on the dignity of the individual and the “spark of the divine” in each client.

“We feel this program does a really nice job providing services to people where they need it and respects their desire to live at home,” he said. “Basically, it allows them to live the fullest and most enriching type of life they can.”

 

Joseph Bednar can be reached at [email protected]

Elder Care Sections
Adult Day Health Spa Offers Elders, Caregivers a Healthy Option

Sheryl Fappiano

Sheryl Fappiano says Golden Moments provides social and wellness services seniors need while giving their caregivers a measure of freedom.

When Shelley Parker and her husband, Jonathan Gottsche, took Parker’s elderly father into their home in Northampton last summer, it was a life-altering experience for all three.

A World War II Air Force veteran, the elder Parker had a two-year wait for placement in the Soldiers Home in Holyoke, a facility where all felt he would be comfortable for his remaining days, surrounded by other veterans. So the decision was made to make Parker’s and Gottsche’s home a bridge to that institution.

Richard Parker was 87 at the time and showing many symptoms of dementia, the same signs that other members of the family had shown in the past.  Shelley already knew what to expect, which would be eventual 24/7 care for her father, and the loss of freedom for her and her retired husband.

“I’d always considered myself a planner, and I did plan; I prepared the healthcare proxy, the living will, the power of attorney,” said Parker. “But I didn’t plan for the time in which my father would be living.”

And that is the lesson that Parker and her husband learned in just a few short months by having her father with them.

“Planning ahead is really key,” Parker went on, “because we learned very quickly that there was only so much we could do to keep him busy every day that first four months.

“And with the winter coming, we said, ‘OK, this isn’t going to work for very long; ‘somebody’ isn’t going to make it for these two years,’” Parker continued with a laugh, referring to the buildup of stress and anger among husbands and wives that is common when taking on an elder parent full-time.

What changed the equation for the caregivers and the elder Parker is an option that is becoming increasingly popular due to the growing numbers of family members caring for elderly parents.

It’s called ‘adult day care,’ and BusinessWest spoke with one such company that is adding some new and effective wrinkles to that concept.

The venture is called Golden Moments Adult Day Health Spa, which offers structured programs featuring more attentive and customized services than the typical senior center for those who are frail or suffering from dementia, and some unique offerings as well, from massage to Reiki, that explain the word ‘spa’ in the company’s name.

In doing so, it has given new meaning to the elder Parker’s life, and new freedom to his his younger caregivers.

Golden Moments is the creation of Sheryl Fappiano, a licensed social worker and care-management-certified geriatric-care manager, whose mission is to see elders remain safe in their homes — or their adult children’s homes — for as long as possible. She puts her skills to work to fashion a unique environment where seniors can socialize and remain active, physically and mentally.

Her parent company, a geriatric-care management and consulting firm, Elder Care Access LLC, just celebrated 10 years in business, providing alternatives for working families with elders that need to be safe, and feel safe, wherever home may be.

Over the years, Fappiano saw a need to go a step further than consulting through Elder Care Access and provide a physical place that would allow elders with a range of physical, mental, and social needs to go to during the day, which would in turn give caregivers their own freedom. And she also knew that a social fix for an elder would also be more desirable than living alone or with family, which could become unsafe at any point, or incurring the exorbitant costs of home care or an elder facility.

For this issue and its focus on senior living, BusinessWest visited Golden Moments to learn more about this emerging concept in elder care, and how Fappiano and her staff are adding new dimensions in service to seniors.

 

Home Away From Home

During the time that Elder Care Access has grown and evolved, Fappiano, who has been in the geriatric-care industry for two decades, has witnessed a somewhat disturbing trend involving caregivers and the frustration and burnout experienced by that constituency.

“I started doing a lot of work with protective services with Highland Valley Elder Services [a Northampton-area agency on aging], and its department is just swamped with people [seniors] who are being abused, neglected, and sometimes financially exploited for one reason or another, and need oversight,” Fappiano told BusinessWest, adding that it was her job to go into such situations, provide support, offer solutions and resources for both the senior and the caregiver, and monitor the situation.

And it was while doing so that she determined that a cutting-edge form of adult day care could be an effective answer for those on both sides of this equation. So she went about making this latest entrepreneurial urge a reality.

Just over a year ago, she and her husband acquired space in the Florence Medical Center building and opened Golden Moments Adult Day Health Spa, a rather long name, chosen because it accurately conveys all that goes on there.

The facility now boasts more than 20 clients, who attend anywhere from three to nine hours, one to five days a week. The service, which ranges in cost from $45 to $85 per day, is paid for by the client or family, or may be covered by long-term-care insurance. In any case, the cost is significantly less than for other elder alternatives, such as assisted living or home care.

“Not only do both parties do better on every level, but the cost is less than half what it would be to live in an assisted-living or nursing home,” said Fappiano, noting that 24/7 care at home with an agency costs more than $500 dollars per day, even more than a nursing home, which runs about $300 a day, or $9,000 to $10,000 a month.

Parker began her research online for a solution to her father’s care needs, but found Golden Moments through word-of-mouth referrals first.

She and her husband visited several adult day-care facilities in the Pioneer Valley, but determined that Golden Moments offered the best overall fit for all those concerned, especially her father.

While the Florence Medical Center building itself is fairly sterile in appearance, with its concrete walls, Golden Moments projects a warm, inviting look and feel.

The main room, with its flickering fireplace, multiple plush couches, and numerous interactive games like bowling, beanbag toss, and board games, resembles a typical American living room. Meanwhile, the open back room has large sunny windows, and is a gathering place for lunches, card games, storytelling, and interactive word trivia that Fappiano and her six employees say helps clients with memory retention.

But aside from all the fun and games, there is the primary prescription for elder depression that is the key to the adult day-care concept.

“It’s totally the socialization — it helps with depression, anxiety … it’s huge,” said Fappiano, adding that this element to elder care is often missing in the traditional caregiver situation.

Elaborating, she said that when she consults in clients’ homes for her Elder Care Access company, she will often find caregivers leaving the elder client to eat alone in their dining room or kitchen, while the caregiver busies themselves with some other chore.

“I would tell them they have to sit, eat with them, talk with the elder client,” said Fappiano. “But it is hard being with the same person for hour after hour, and they do run out of things to say and do.”

This problem doesn’t generally exist at Golden Moments, she went on, because clients have many comtemporaries with whom to talk and interact, and there are different faces on most days.

As if on cue, another client arrived at Golden Moments, dropped off by an adult child who offered an obvious smile of relief.

“Top of the morning to you,” Fappiano cheerily said to her client, who genuinely broke out into a wide smile and returned the greeting in an Irish brogue. As the client, who is near 90, passed by slowly leaning on his cane, he joined his friends in the back room, much as a young boy would join his friends in school.

In fact, Fappiano said the first time a caregiver, which is usually the adult child, drops off an elder client, it’s like dropping off a child at their first day of kindergarten.

“We give everybody a free, three-hour trial, and in the beginning, when the caregiver drops them off, they have that look in their eye, and I tell them, ‘a quick exit is better; trust me when I say they’ll be OK. Give me your cell number, and I’ll call if I have to.’”

The feeling for the elder client can be similar to a small child in kindergarten as well, but they soon adjust to a new way of life. In fact, Fappiano has never had a potential client not return for weekly visits.

Vicky Applebee, office manager at Golden Moments, is not one of the direct-care staff members, but from her point of view, the atmosphere exudes family, for both clients and employees.

“Sometimes, when people first walk in the door, they are lost, unsure, even worried,” she said. “But after a few visits, I see this stress on their faces go away after getting into a new routine; that’s the biggest joy for me.”

 

Alternative Options

Fappiano said one of the keys to success at Golden Moments is knowing and fully understanding each client’s needs, capabilities, limits, and expectations, and then personalizing care to reflect all this data.

A comparatively low client-to-staff ratio (5 to 1 is generally the norm) enables the facility to tailor exercises and programs to suit each individual’s needs, rather than implement something approximating one size fits all. This is one operating philosophy that appealed to Parker as she sought a solution to her father’s needs, and one that differentiates the facility from others she visited.

“If they were taking a walk outside and one of the people could only walk a few feet, then that’s all everyone would walk that day,” she said, referring to one facility she toured. “I said, ‘no, that doesn’t work for me; if my father wants to walk a mile, he should be able to walk a mile.’”

Golden Moments has an LPN or RN on duty a few times a week to take vitals, work with stroke patients and other clients with specific needs, and administer medications, injections, and wound care as ordered by a primary-care physician.

In addition to regular activities involving socialization, such as memory word games, singing, special outings, and physical exercises, Fappiano is integrating more spiritual and “energy-related” alternative treatments that are more commonly found in the typical health spa.

Some alternative treatments and healing modalities include massage (also available for caregivers), Reiki, foot care by a holistic foot nurse, weekly pet therapy, sound and aromatherapy, and meditation.

But she’s finding some generational kickback.

“Those in their 90s, they don’t tolerate it so much; they just don’t understand the whole pampering thing,” Fappiano explained. “The younger ones … they get it, and we do meditation together.”

But Fappiano knows that a very open-minded group of aging Baby Boomers is headed her way, and Golden Moments is prepared to accept them when they’re ready.

The overall feeling in Golden Moments, she noted, is one of family from the minute a client or staff member walks into the room.

“Everyone is smiling around here … not sometimes, but every day,” said Applebee. “It’s a happy place, even with the struggles some might have at home, because caregivers get a much-needed break, and their loved ones are safe, staying active, and socializing.”

For Parker and her husband, the decision to bring her father into their home is, by all accounts, working, but basically because this unique adult day-care facility provides both client and caregiver what they need most — socialization and room to breathe, respectively.

“People [caregivers] say they have no time for themselves; they’re too busy,” she noted. “And I just see that, if they don’t figure out how to make things work, these situations could destroy relationships and families. My father is here, and this is allowing me to have my life, too.”

 

Elizabeth Taras can be reached at [email protected]