Seniors on the Edge Watch Safety Net Unravel

Suzy Hopkins
By Suzy Hopkins March 15, 2011 09:07

AJ Holmes of Sonora and Dorothy Bates of San Andreas have never met, but the two women have much in common.

Both live in tiny, cheerfully decorated homes that reflect warmth and creativity. AJ is a former singer and actress, and Dorothy, a retired nurse’s aide who plays harmonica and pens country songs.

AJ Holmes, 69, doesn't look like a senior at risk, but severe pain makes life a daily struggle

Both are on the far side of 60, suffered serious falls that left them disabled, and live alone on less than $900 a month. Neither thought they’d need outside help in their later years, and neither wants to end up in a long-term care facility.

They are able to remain at home thanks in part to help provided by the Area 12 Agency on Aging’s Multipurpose Senior Services Program (MSSP). The program is one of several senior safety-net services threatened by pending state budget cuts. The endangered list includes Adult Day Health Care and in-home supportive services, which like MSSP, provide help aimed at staving off costly long-term care placement.

It is a significant issue in Area 12’s five-county region, where more than 25 percent of the population is 60 or older (nearly 30 percent in Tuolumne and Calaveras counties) and the state Department of Aging projects sharp increases, particularly in the 80-plus demographic.

One of the most vulnerable groups is perhaps best illustrated by MSSP, which helps low-income people 65 and older at risk of institutionalization – “the frailest of the frail,” as one social worker described it.

“As our population is aging, the need is growing,” said MSSP Manager Michael Mitchell. “Our program is a great savings to the state, because people can be cared for at home at a much greater savings than being placed in a facility.”

With an annual budget of $385,000, a mix of state and federal funds, MSSP serves about 100 foothills clients at any given time, mostly women in their 80s. Its staff of three full-time and two-part time workers takes referrals from physicians, agencies and individuals, assesses each client’s needs, then develops a plan to provide care. Those services are a diverse mix – from meals and  in-home help to safety repairs, transportation, respite care and more – to help that person live safely at home for as long as possible.

If MSSP is eliminated, Mitchell estimates that a third of its 100 clients would be at immediate risk of long-term-care placement, costs that would fall to taxpayers at the rate of about $5,000 a month.

At 69, AJ Holmes is far younger than the average MSSP client, but she too is at risk of being placed in skilled-nursing care if her health further declines. She has heart and lung problems, and chronic back and neck pain. The program’s support allows her to continue living independently in a tiny mobile home in a Tuolumne County park.

The program has paid for in-home safety improvements, an occasional gas card to help her get to Modesto medical appointments, and recently replaced carpet damaged by a sewage overflow for which the park owner refused responsibility. Largely homebound, she reads avidly, tends her cats, Shanee and Sam, and talks by phone with friends around the country.

“I’ve been on the phone calling Governor Brown’s office and begging them not to take away this program,” said Holmes, ever the activist since moving from Brooklyn to San Francisco “on a dream” in 1964. She sang, modeled and acted for 30 years, marched for civil rights and other causes, and in her 40s earned a graduate degree to become a psychotherapist for children and the elderly. A fall on a slippery floor at work in 1995 “was the end of life as I knew it.”

She thought her move to Tuolumne County in 1999 to a friend’s home would be temporary. It wasn’t. Life now is a daily struggle in which pain often wins. Without outside help and her faith, she said, she couldn’t go on.

Dorothy Bates at home

“I’d rather die in my own bed in my own home, as humble as it is, than in a convalescent home,” she said. “You lose your freedom. That’s the most important thing to me – freedom and justice for all. I’m just an old hippie.”

Dorothy Bates is older, but has been dealing with health crises since suffering a stroke at age 38 that permanently weakened her left leg. The 60-year Calaveras County resident was dumping an ash bucket two years ago when she fell over, landed on hot coals and was unconscious for a time. She awoke to searing pain in her right leg. A neighbor heard her cries and rescued her, but not in time to prevent serious burns.

She recovered and went on, but continues to fall in part due to advancing scoliosis. The Area 12 program has provided a life-alert device, a new mattress to reduce back pain, and nutritional drinks – none of which she could otherwise afford. Her children help as they can, but none has much money to spare.

“I didn’t really think I needed any help,” said Bates, who now views the program as “a godsend.”

“I’ve always been a go-getter, and if you didn’t feel good, you did it anyway.”

Jean Jones, a social worker with MSSP, said most clients “are by themselves and need somebody to advocate for them.”

That advocacy is happening in state corridors, where the debate over how to spend taxpayer dollars continues. But the reality is, the needs far outstrip funding on every front, and in every demographic. Education, law enforcement, parks, prisons and dozens of other programs fight for scarce financing.

For Michael Mitchell, seniors served by safety-net programs are a largely silent constituency with virtually no means and little voice.

“So many other programs have been cut – in-home services, mental health services – that we’re one of the last safety net programs,” Mitchell said. “How sad is that? These people are not throwaway people, and we can’t just walk away. That’s not okay.”

Ann Connolly, Tuolumne County’s human services director, said some of the proposed cuts to safety net programs will likely face court challenges. The underlying issue, she said, “is that as we see increased needs, what are people going to be willing to support?”

Her biggest concern, though, is what lies ahead.

“We’re going to have many more individuals living to older ages, who suffer from more chronic diseases,” she said. “How can we best prepare ourselves, as a county, a state and a nation, to really manage those needs? It’s here and it’s coming.”


Multipurpose Senior Services Program

The program continues to accept referrals of low-income residents 65 and older in Amador, Calaveras, Tuolumne, Mariposa and Alpine counties. Services include respite care, transportation, safety repairs, counseling, home medical equipment, nutritional supplements, legal help and more. Call 532-6272, or l (800) 510-2020.

© 2011 Friends and Neighbors

Suzy Hopkins
By Suzy Hopkins March 15, 2011 09:07