Providing For Parents

By Laura Koss-Feder

Bostonians Rachel and Tom Claflin wanted to go to California last Christmas to visit three of their children. But what about Tom's parents, who lived three blocks away and, at 86 and 89, couldn't manage on their own? No problem. Rachel and Tom were able to take their trip, secure in the knowledge that the elder Claflins had volunteers available to check on them daily, a round-the-clock emergency phone line and access to discounted nursing care, drivers and home repair, among other services.

Both generations of Claflins belong to a "virtual" community called Beacon Hill Village, which has arranged for residents 50 and over in the Beacon Hill, Back Bay and West End sections of Boston to pay a yearly fee to obtain discounts of 10% to 50% on a wide range of care and services. Members also attend regular lunches, classes, concerts and other events. The year-old nonprofit organization, run by a social worker who directs a staff and a network of volunteers, has 150 members. The annual fees are $500 for individuals and $600 for households (but $100 for households with an annual income of less than $45,000). "Even though my in-laws live three blocks away and we help them in a variety of ways, it alleviates some tension to know that they have someone in the neighborhood who can help them out if they need anything," says Rachel, an artist who helped found the organization and serves on its board. "Novel concepts like Beacon Hill Village can really help people take care of their aging parents."

Novel concepts are certainly needed, especially for baby boomers who, like Rachel, 60, and Tom, 61, are part of the "sandwich generation"--those with older, sometimes declining parents on one side and their own children and grandchildren on the other. "There is extraordinary stress in so many ways on today's baby boomers who are caught in the middle and have their own families, marriages and jobs to maintain," says Suzanne Mintz, president and co-founder of the National Family Caregivers Association, an educational and advocacy organization in Kensington, Md. Says Gary Barg, editor of the magazine Today's Caregiver and author of The Fearless Caregiver: "Boomers, who know that they will have their own elder-care needs down the road, are looking for new options and solutions right now for their parents."

Besides virtual communities, some of the new solutions being tried are:

--Statewide programs that allow family members of Medicaid recipients to receive stipends for caring for them.

--The growing use of geriatric-care managers to stand in for family members who live at a distance.

--An increase in the practice of home sharing among the elderly.

A handful of states have embraced the Medicaid idea. In New Mexico, for example, 6,238 Medicaid recipients have family members or friends providing basic, nonmedical care for them at a fee of $9 an hour, says Crystal Mata, manager of the program for the state's human-services department. Nearly 60% of those receiving care are 65 or older. Caregivers are required to take 12 hours of training each year, including CPR and first aid. The training is provided by 107 social-service agencies in the state, says Suzette Lindemuth, director of Senior Living Systems, a Los Lunas, N.M., personal-care agency that participates in the program. Agencies like Lindemuth's also arrange for monthly visits to check on the work of caregivers.

"Having this program makes Mom feel better, knowing that my husband and I are getting paid something," says Prescilia Burt, 57, a retired public relations executive in Albuquerque who takes care of her legally blind mother Terezina Valdez, 83. Burt quickly adds that "no family member does this for the money; it just provides a little bit of cushion." Her husband David, 59, a retired management consultant, also helps. They bought Valdez a house next door to them, pay for all her living expenses and spend about 80 to 100 hours a week maintaining her house, managing her medications, cooking her meals and taking her to doctor appointments. Together they are paid for 40 hours of care a week, totaling $360.

For the estimated 8 million Americans who live at least an hour away from older relatives who need attention, remote-control help can be provided by a growing group of professionals known as geriatric-care managers (GCMs). They assess an elderly person's health condition and living situation, arrange and monitor in-home help, aid with placements in nursing homes or assisted-living facilities and serve as a liaison to family members, says Erica Karp, secretary of the 1,600-member National Association of Professional Geriatric Care Managers and owner of an agency in this practice area. GCMs, who typically have backgrounds in social work, gerontology and nursing, charge $50 to $150 an hour.

Jack Mendelsohn, 68, a retired State Department official living in Washington, obtained home care for his mother in Chicago by working with Karp's Evanston, Ill., agency. His mother, who was frail and becoming forgetful, was receiving care she was dissatisfied with. Karp found a more suitable attendant and supervised her with regular home visits. Karp's fee was $90 an hour, and home care cost $125 a day--all paid for by Mendelsohn. His mother died last year, at 91. "You need a professional on-site to supervise this kind of continuous care, check in with the doctors and keep everything going smoothly," Mendelsohn says. "If not, we would have wound up moving my mother near us, and she didn't want to leave her home."

Worries from afar can also be alleviated when doctors are willing to make house calls, a retro trend that is spreading among some geriatricians. The American Academy of Home Care Physicians has 700 members, and the number is growing at a rate of 10% a year, says president-elect Dr. Gresham Bayne, who belongs to a San Diego practice of 12 doctors who only make home visits. "This kind of option allows more critically ill senior citizens to remain at home and gives great peace of mind to their family members," Bayne says. "Baby boomers don't necessarily have to get on a plane and check up on Mom every time there is a medical issue."

A Boston organization is trying to come up with other techniques to address the needs of elderly parents living far from their baby-boomer offspring. Caring from a Distance, which started a year ago, is putting together a database that could potentially match elderly family members with volunteer caregivers, says president Ted Patton. "Let's say one adult child is living in New York and has a mother in California, and another baby boomer is in California and has a father in New York. The two could offer to be the eyes and ears for each other's family member, checking in with them on a regular basis and giving each other updates," says Patton, who hopes to have the program running by next year. "In a sense, we would be building our own senior-care community."

For boomers who are concerned about an elderly parent living alone, solace may come in the form of another kind of community-based initiative: home sharing. The Chicago Department of Aging last month launched a program to screen and match people 60 and older with compatible individuals in the same age range who are interested in sharing a home. Working with four social-service agencies, the program aims in its first year to match 30 seniors with 30 others who are willing to share their homes, says spokeswoman Tanya Mitchell. "Particularly for the older segment of this population, this will be a way to have companionship and save on household costs at the same time," says Carla Windhorst, director of community initiatives for Mather LifeWays, a not-for-profit organization that is assisting with the program.

Evanston resident Dan Brush, 74, a semiretired investment broker, is a firm believer in home sharing. For three years he has been sharing his 12-room house with another divorced man, introduced to him by a mutual friend. Although Brush is healthy and active, he appreciates having someone else around. He also saves about $3,000 a year on utility expenses. "This man had just got divorced and was looking for a new place to live, and I have a big home with a lot of space, so it seemed to make sense that we share this place and the expenses of running it," Brush says. "My three kids especially like the idea that there is another person in the house with me; it gives them--and me--a feeling of comfort."

Corporate America is beginning to get more involved in elder care too. U.S. companies lose $11 billion a year in reduced productivity, absenteeism and turnover from employees who have responsibilities with aging parents, according to the MetLife Mature Market Institute, which studies issues related to the senior market. In response, a growing number of employers are providing their workers with elder-care referrals through employee-assistance programs. One such program, ComPsych, began a service three years ago called Elder Outreach, through which it provides in-home assessments for employees' elderly family members, says chairman and CEO Richard Chaifetz. Often these two-to-four-hour assessments are free to employees.

More relief from the corporate sector could be on the way. The Alzheimer's Foundation of America is in conversation with several companies that are considering providing on-site day care for the older parents of employees. This is at least two to three years away from becoming a reality, says foundation CEO Eric Hall. "We have seen on-site child care in the workplace," he says. "I don't see why this wouldn't be workable for our aging parents, who have given so much of themselves to society. They deserve at least that much."

Meanwhile, the search continues for still other innovations. Some 22 million American households are already providing help in some form to older people, and the number will only increase. According to the latest U.S. Census, the fastest-growing segment of society is people 85 and older. Clearly, creating imaginative and flexible new forms of elder care is more crucial than ever before. As Suzanne Mintz of the National Family Caregivers Association puts it, "We have never experienced a time like this, where people are living so much longer and needing more care."