PACE program’s outreach director on elder care options

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There are many things to be considered when loved ones can no longer care for themselves alone. However, nursing homes and long-term care can be expensive and being in an unfamiliar place can be frightening. Michelle Rincon, community outreach director for Senior CommUnity Care of Michigan PACE, talks about the alternatives for elderly people wanting to spend their last years with family members who still want to be involved in their loved ones’ lives.

Q: What are the origins of the PACE program?
A: So, it started out in California, in San Francisco, in a Filipino community where they realized that there wasn’t enough alternatives for aging adults. In the Filipino community or in the Cantonese community, they don’t typically put their family members in long-term care. They usually will keep aging adults with the family members. And so, this provider got with some other medical people and came up with this model of care because obviously people in the United States and people around the world work and they still want to be able to take care of their family. So that was in the ’70s, and then through legislation and some pilot programs— there were like six different pilot programs that started — they approved, and then the Affordable Care Act and that legislation helped pass it so that PACE providers could be considered another alternative to long-term care.

Q: In what ways is this an alternative to a nursing home?
A: With a long-term care nursing home, you have to leave your home. You have to live someplace you’re not familiar with. So, aging adults, especially those with Alzheimer’s or dementia and memory deficits, … their life expectancy and their longevity declines, because then they’re even more confused or depressed because you’ve taken them away from everything that made them feel like they still had some say in their life.

Q: What reasons may people want this program as opposed to a nursing home?
A: Traditionally speaking, you have families. If we’re talking about ethnicity a little bit, like for me and my family we’re a very large family so we don’t believe in putting anyone in a nursing home when we have enough people in our family that could care for somebody that is aging ourselves, you know and we don’t want them to feel like we’re abandoning them. Also. some people just work really, really hard their entire lives. They save their money to purchase the home they have, it’s where they love, they don’t want to have to die someplace they haven’t called home and don’t have memories. Some people are scared to death to leave their home, especially now because of COVID, to be enrolled in a long-term care facility because they feel like they’re going to get their and going to get sick and they’re going to be a lockdown again and they’re not going to be able to see their loved ones and they’re going to die alone. Other people would much rather live on the streets than be in a long-term care facility. Some older generations have some very bad memories of things they have seen that have happened throughout history with long-term care facilities. There’s a whole caveat of reasons why people wouldn’t want to leave their home. If you think about an aging adult it’s kind of like the great circle of life. When you’re an infant there are other people telling you what to do and how to do it and teaching you all of these things, and as you age, you get all of this autonomy. And you want to keep that as you’re aging because it’s one of the very few things that you think you can hold on to.

Q: Can you elaborate on the history and problems with elder care?
A: There have been sexual assaults that have happened in long-term care facilities— not that it doesn’t happen anywhere else — but there’s that. There’s neglect and abuse that have been reported at some long-term care facilities where either a single member or multiple members of the staff were abusing the elderly; over-medicating, not giving them proper activities for daily living, or personal hygiene. If you open up that can of worms, I’m pretty sure you can find about everything. And so, people just have it in their minds that their family can take care of them,. (They think) they’re not going to get good quality care because the people in these long-term care facilities might not care for them. I mean, I work with a lot of long-term care facilities that are amazing, they have a great staff and great people who care, but people can’t forget about the things they hear on the news or on television.

Q: Do families have any hesitation in putting their loved ones in this program?
A: Yes, because sometimes when families reach out to us, they’re already at kind of caregiver burnout point, or they aren’t really sure what all comes with keeping someone at home. So, I like to say that we’re a nursing home without walls, so people can come to the day center to get socialization so the family has peace of mind during the day. We help coordinate all the care, but even though we have all of these different safety measures and we are all inclusive and touch every health and safety aspect, we still expect the family to be involved in the care plan. So we want the family to be available or involved, where maybe something happens, maybe the family members are out of town, they know that we’re there to cover while they’re out of town.

Q: How do you determine how long a person will be under your care?
A: When somebody comes in, obviously they were having some sort of deficit. And most of the time if an aging adult is deemed eligible for our program … those people are typically in our program until they pass away. And the longevity of our participants is usually 3-5 years, you’re lucky if you get 5 years.

Q: What kind of benefits does socialization activities have?
A: Think about COVID. Think about the isolation that happens as a young adult, how awful it felt to not be able to interact with other people and how it affects your mental health. And if your mental health is affected and you’re depressed and you’re just not getting that stimulation, what can you imagine happens to our aging adults that are already feeling a little isolated because of their aging process. We saw the biggest declines in our participants during COVID when we had the mandate for quarantine. It was awful. Our participants declined so quickly because they weren’t getting that everyday interaction, they weren’t getting up in the morning, having something to look forward to … If you’re already having all these medical issues, it’s just going to exacerbate those.

Q: How does this benefit the Lansing area?
A: Healthcare is very expensive. And especially now that we have COVID, and ther a shortage of healthcare providers, right— so if you have an elderly person who’s living at home, who maybe is just lonely, or they just don’t have a great support system, they have a support system but it’s just not a great support system. They sometimes will call the emergency room or call the police department or call an ambulance for something that is very, very simple. (They could call) a friend or a family member or the PACE program and ask the question. It saves on costs for the medical institutions, the health care providers and professionals, because we are providing those services, those reassurances. We’re teaching the family those coping mechanisms, also. So, the costs are reduced when it comes to care. And the same thing with hospitalizations. We have a lower re-hospitalization rate, meaning that when someone’s in our program, if they do get hospitalized, we address what the issues are in the hospital and we make sure we change and adjust their care plan to the needs to keep them out. So, we do a lot of preventative care, which again reduces costs for everybody. Plus the stress that it relieves on the family. If you think about it from that perspective, everyone’s stretched so thin right now because of not being able to find enough people to fill the jobs. If you have somebody that’s just calling because they’re kind of lonely, and they don’t know what else to do, that really takes a toll on everybody.