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Nevada
Division for Aging Services
Nevada
has the highest projected rate of senior population increase in the nation, for
its percentage of persons age 65 and older, according to USA
Today analysts. Given
these projections, the 1999 Nevada Legislature demonstrated great foresight when
it enacted legislation that created Independent Living Grants (ILGs) to fund
vital services for Nevada seniors. This
funding has an ever increasing role, considering that federal Administration on
Aging funding has been flat for a number of years. A
2006 PBS production entitled, Living Old, says America is “on the threshold of the first ever
mass geriatric society.” Those
age 85 and older are the fastest growing segment of the population.
Of the projected 71 million seniors age 65 and older by 2030, nine
million will be age 85 and older. Between
1960 and 2003, the number of Americans age 65 and older doubled
in population – an increase of 116 percent according to Census data.
That population is expected to nearly double again when the last of the
“baby boomers” reaches age 65. Nevada,
more than any other state, will experience this senior population explosion. USA
Today analysts reviewed Census data, and in January 2007 reported that
Nevada will have a 264 percent increase in persons age 65 and older between 2000
and 2030 – the highest growth rate in the nation. Envisioning
the increasing need to provide services for Nevada senior citizens, the 1999
Nevada Legislature enacted legislation that created Independent Living Grants (ILGs).
This legislation sets aside 50 percent of Nevada’s share of tobacco
settlement funds, received annually from the Master Settlement Agreement (MSA)
with the four largest tobacco companies in the country.
This 50 percent set aside is deposited in the Fund for a Healthy Nevada,
with 30 percent earmarked for Independent Living Grants that support senior
services. The Nevada Division for
Aging Services (DAS) awards these funds through competitive grants to regional
and local providers. These
providers help senior Nevadans sustain independent living by providing services
in the following categories: Transportation; Respite Care or relief of family
caregivers; and Supportive Services, which is care provided to seniors at home.
The intent of these services is to prevent or delay institutional care. This
intent is in keeping with the Division’s mission to
develop, coordinate and deliver a comprehensive support service system in order
for Nevada’s senior citizens to lead independent, meaningful and dignified
lives. The
first Independent Living Grants were awarded in October of 2000, and ILG grants
awarded in October 2005 mark the sixth year of funding from the 1998 tobacco
settlement. In FY 2001, 40
Independent Living Grants were awarded, covering nine different services.
In 2003, the State Legislature expanded the basic ILGs to include dental
care. This service is provided in Clark, Washoe and Elko counties,
with outreach into rural areas as funding permits. On
October 1, 2006, for the FY 2006 grant year October 1, 2005 through September
30, 2006, $5,257,472 was awarded by the Division through 70 grants covering an
array of services. Of this:
$659,815 was awarded for the provision of Transportation Services; $265,046 was
awarded for Respite, and $4,334,608 was awarded for Supportive Services.
As service needs increase in some areas and decrease in others,
allocations are adjusted accordingly. Given
the array of services funded, Independent Living Grants provide vitally needed
services, as the following table. This
is especially true in light of flat
federal funding and an ever increasing senior population.
*
Dental
Services are included in Geriatric Health & Wellness, serving 338
clients with 2137 procedures.
Additionally,
and in accordance with NRS 439.630 (e) and (f), the Division has set aside
$200,000 of the 2006 Independent Living Grant funds for assisted living
facilities that satisfy the criteria set forth in NRS 319.147 and assisted
living supportive services that are provided pursuant to the provisions of the
home and community-based services waiver which are amended pursuant to NRS
422.2708. Another $150,000 was
allocated by the Division for programs that provide dental benefits to persons
who are domiciled in Nevada and are 62 years of age or older. Individuals
receiving services satisfy the residency and income requirements set forth in
subsection 2 of NRS 439.665, as adjusted pursuant to the provisions of that
section. TRANSPORTATION Transportation
services are vital to seniors. An
Administration on Aging national study found that 21 percent of all clients
using senior transportation services relied on those services for at least half
of their transportation needs. Of
those, more than 80 percent were either unable to drive or didn’t have a
vehicle. As
Nevada’s population ages, an increasing proportion of that population will
become isolated and immobile due to an inability to drive or a lack of
accessible public transportation. Some
will become dependent on publicly provided services because they haven’t been
able to retain their driving
skills, due to impaired cognitive, sensory and/or physical functions.
Because of limited financial resources, the cost of owning, maintaining
and insuring an automobile adds to these limitations. What happens to seniors
when they aren’t able to drive or own a car? How do they manage essentials,
such as grocery shopping, healthcare access and socialization? Independent
Living Grants (ILGs) have helped alleviate transportation problems for Nevada
seniors, by funding transportation programs throughout the state.
During
the 2006 grant year, these grants assisted 5,659
seniors with transportation, with a total of 250,626
units
of service. Senior
transportation programs funded with Independent Living Grants and other state
and federal funds ensured that basic senior transportation services were
provided in all seventeen counties. Rides
were provided by senior center transportation programs, transit coalitions,
volunteers and through taxi-bus voucher programs. Seniors were
transported to local senior centers for nutritious meals, to medical
appointments, and to group outings that encompass social activities and
shopping. Escorted
Transportation, which is one volunteer escorting one frail senior to and from
appointments, was provided by RSVP programs statewide and by the Helping Hands
programs in Las Vegas. The most
vulnerable and frail seniors are able to get to and from medical appointments
with the assistance of the many dedicated senior volunteers who donate their
time and the use of their automobiles for helping Nevada’s elderly. To
help ensure the well-being of Nevada seniors using this vital service,
transportation programs funded by the Division for Aging Services are required
to provide and document annual Elder Abuse Training for all drivers and program
staff. Division grantees are
required to report suspicion of elder abuse, neglect, exploitation and/or
isolation pursuant to Nevada Revised Statutes (NRS) 200.5091 – 200.5099.
Additionally, drivers are required to have driver safety training
biannually.
TRANSPORTATION
SERVICE PROVIDERS IN FY 2006 The
Retired Senior Volunteer Program (RSVP) relays the following two client
experiences regarding transportation: Despite
cardiac problems, James was hitchhiking from the supermarket to his home, ten
miles away, when one of RSVP’s Lyon County volunteers stopped to offer him a
ride. This elderly gentleman had
been hitchhiking to the supermarket for serveral months, because he doesn’t
have a car. The RSVP volunteer gave him an information card for RSVP
services, and since then RSVP has taken James to get his prescription medicine
and for essential services. A
senior writes about his transportation service: This
letter is to let you know how very much I appreciate the services of C.A.R.T.
In my six so called senior years, I seem to have accumulated many health
problems and knew the time would come that I’d have to give up driving . This
is the most difficult decision I have ever faced. Without the services of
C.A.R.T., I wouldn’t have been able to face life. RESPITE Respite
Service is an important priority of the Independent Living Grant legislation,
because it provides
caregivers with a small break from their around-the-clock responsibilities.
In
2006, 921
Nevada seniors and their caregivers benefited from Respite Services, with 61,594
units of service provided. This
is important, because the non-stop demands of caretaking add considerable stress
to the lives of women and men alike. Much
has been written and said about caregivers.
They remain the backbone of the long-term supportive services system in
the United States, providing the majority of care for people who need help with
activities of daily living – activities that include bathing, eating, paying
bills and taking medication. Most
of this caretaking is unpaid. However,
the AARP research center has estimated its value may exceed $257 billion a year. Respite
Service has an especially important role for employed caregivers, who contend
with the
challenge of working outside the home while caring for an elderly parent, and
often children as well. Almost half
of the “sandwich generation,” the cohort of Americans between age 45 and 55,
have children less than age 21, as well as aging parents or aging in-laws. As
depicted in a 2006 PBS production, Living
Old, caretakers in their 40s, 50s and 60s are struggling to cope with what
has happened to their parents and grandparents.
Producers Navasky and O’Conner add that the elderly themselves are
living lives that neither they nor their families ever prepared for or imagined.
Millions are coping with chronic illnesses, increasing frailty and
prolonged periods of dementia, which can last for years, even decades.
They conclude: “For
families, the emotional toll of caring for dependent family members can be
overwhelming.” To
assist Nevada’s caregivers, Independent Living Grants provide vital funding
for two respite voucher programs: one in Northern Nevada and one in Southern
Nevada. Families are able to apply
for up to $1,000 in respite vouchers, to hire individuals who provide in-home
respite, pay for adult day care hours or perhaps pay for a short stay in an
assisted living or long-term care facility.
Sometimes such a stay is necessary because the caregiver needs a vacation
or may be faced with hospitalization. In
addition, funds have been awarded to companion programs, where volunteer
companions provide short periods of respite to a stay-at-home caregiver. Regarding
respite care, a client writes:
“I used most of the respite care funds to attend our son’s wedding in
Dallas. The airfare plus caregiver
costs would have been too much to spend. I
miss going to special family and other events.
Physically, I’m in good health for being 74-years-old, but mentally I
need to get away. Thank you for the
grant – I think of the June wedding often.
My husband is still very patient, kind and gentle – I’m very lucky
and thankful for that.” SUPPORTIVE
SERVICES Supportive
services have an important role in eliminating or delaying the need for seniors
to enter assisted living or long term care facilities.
Grantees funded to provide Supportive Services delivered 402,861
units of service to help Nevada seniors remain at home. These services,
described below, are essential. For
many seniors, what should be the best time of their lives is not.
They are experiencing deteriorating health, illness and disability.
Many are unable to remain in their own homes, and illness can challenge
financial resources, causing some to become indigent. Most
seniors prefer to remain in their own homes.
However, without supportive services, they are often forced to relocate
– to move in with an adult child, move to an assisted living facility and in
the worst-case scenario, to move to a nursing home. When
moving to a nursing home becomes necessary, this is costly.
A 2005 Genworth Financial survey conducted by CareScout, an independent
firm, found that the average cost of nursing home care in Nevada is $65,595 per
year, or almost $5,500 a month. This
data is supported by a 2004 Met Life Market Survey of Nursing Home Care Costs,
which determined the average annual cost of a private room in a nursing facility
as $70,080 and $61,585 for a semi-private room. Many
seniors who live with disability, chronic illness and/or frailty, may be
surprised to find they have out-of-pocket expenses never before anticipated. A 2005 AARP research paper “Becoming Disabled After Age 65:
The Expected Lifetime Costs of Independent Living” cites the mean
monthly cost to maintain an individual aged 85 and greater in their own home at
$3,411 ($40,932 annually) and for someone aged 65 to 69 at $2,378 ($28,536
annually). Providing
seniors with Supportive Services helps to mitigate some of these unanticipated
costs, making it easier for them to remain independent in their homes.
In considering the following service descriptions, it should be noted
that many seniors use more than one Supportive Service within a year.
Because Division for Aging Services records are maintained service-by
service, the actual aggregate, unduplicated number of seniors who benefited from
Supportive Services is not available. However,
the number who benefited from each service is provided, along with the “Units
of Service” provided. The
definition for a Unit of Service varies by service, and is found on page 18. Adult
Day Care Ninety
dependent adults received this planned care in a supervised, protective,
congregate setting during some portion of a day. Adult Day Care providers
delivered 20,036 units of service. Referencing
Adult Day Care, a senior commented, “The staff is very caring.
I’ve seen kindness and helpfulness given to those in need of special
care.” Another senior’s
daughter said, “The staff have made a tremendous difference with my mom and
helping our family. We are so
thankful.” Case Management This
service provided care for 324 seniors in 2006, through the provision of 3,157
service units. Case Management
identifies client needs and the services to meet those needs, which are then
coordinated and monitored by a Licensed Social Worker.
Clients must be functionally impaired to be eligible for this service. As
an example of this service: John, age 62, was living alone,
and received a pension and Social Security. He was diagnosed with polio as a child and struggles with the
limitations it has caused his legs. The
case manager received a call from a concerned neighbor, stating that he had seen
John crawling to and from his mailbox, and while getting in and out of his car. The case manager visited and
assessed John, finding that he needed assistive devices for ambulating safely,
had very poor eye sight and was very lonely.
The case manager discussed using a walker for ambulating, but John was
reluctant to use it in public. After
several visits and with rapport established, the case manager convinced John to
accompany her to the senior center for lunch, using his walker.
After lunch, John said he was very grateful and excited to make his next
visit to the center. The case manager arranged for the senior center to pick him
up daily for lunch and activities at the center. John’s poor eyesight meant he
couldn’t easily read and pay his bills, so the case manager began doing this
for him. The case manager was also
concerned about John driving with such poor eyesight, so she contacted the
Department of Motor Vehicles, which terminated his license until an exam could
be conducted. She then arranged for
an appointment with an eye doctor. The
doctor found that John had cataracts and performed surgery. Once the cataracts
were removed, John as able to see and resume driving. Due to his medical condition,
the case manager helped him apply for Disability, and took him for an
appointment at the Social Security Administration. He was awarded Social Security, which has increased his
monthly income. John is now
flourishing in his community and continues to attend the senior center daily. Case
Management – Elder Protective Services Elder
Protective Services Case Management helped 136 senior Nevadans, through the
provision of 975 service units. DAS
Elder Protective Services staff assess victim needs and identifies appropriate
services during an investigation. Then
Case Management is provided to ensure that identified needs are managed and care
is coordinated and monitored to promote client safety and well-being. Caregiver
Support Services Caregiver
Support Services provides education and supportive services for frail older
adults, their families and professionals caring for elderly adults in their own
homes. In 2006, 612
clients benefited from this service, through the provision of 8,832 service
units. The
Alzheimer’s Association of Northern Nevada provides this story:
Adelaid was a patient of St. Mary’s Hospice and a resident at a local
nursing home. Her care was fully
covered by Medicaid. Her husband
James was loving and devoted to her. He
managed to visit her twice daily, even though he was without transportation, had
little money and was confined to a wheelchair due to is own serious health
problems.
His devotion to Adelaid and desire to give her comfort and care during
her final weeks of life led him to the decision that she should be at home with
him during this time. James lived
in a small room in a shelter, but advocated strongly for Adelaid to come home.
This was a significant decision for him, as he would have to provide
24-hour care for her, but James believed in his heart that was where she
belonged. With Independent Living Grant funding, he was able to realize their dream of being together. He was able to pay for caregivers to help him with the more demanding activities of daily care that he couldn’t do alone. This allowed her to die with dignity, literally in his arms, in her bed at home.
Information/Assistance/Advocacy Seniors
often need assistance accessing services, and even knowing what services may be
available to address their needs. During
2006, Information/Assistance/Advocacy programs served 4,458 seniors through
23,816 units of service. It helped
seniors access many needed services, medical appointments, errands, social
activities, programs and benefits. It
includes indirect and direct representation of clients, and also provides
transportation services necessary for seniors to access services. The
following describes experiences with Advocacy:
Ms. D’s companion for 15 years had just passed away, when she came for
an office intake. This left her
emotionally and financially drained. Ms.
D lives on a limited income and her social security only covered her rent,
leaving little money for food, much
less utilities.
I was able to assist Ms. D in many ways.
She had recently applied for lot rent subsidy, which was to start in the
next two months. We applied for
monies through Catholic Community Services, and the STARS program to assist with
rent. She wanted to be active in the process and take her applications to the
agencies. However, she had no
transportation. I provided her with
a seven-day ride pass. We had also
applied for Lifeline and Low Income Heating and Energy Assistance (LIHEA), which
reduced the cost of her utilities. Finally,
before she left, I asked if she had food. She
was able to count on her fingers that she had seven cans for today and the
weekend. We were able to provide
her with a pantry bag. Two weeks later, Ms. D called and thanked me for the services
she received that day. She had
enough money for rent, and reported that she is on a better path now. A
social worker writes:
In October, a senior called very upset because the RV park where she
lived had raised her space rent for the third time in a year. She said she didn’t have enough income to cover rent and
utilities. I called the landlady
and was told she had to increase the rent as the owner directed her to, and
there is no limit regarding how often it can be raised. I then called several senior apartments, and found a
subsidized apartment that the woman could move into within two weeks.
The client is now living in the apartment for half the cost of the space
rent, and says she feels good being able to pay her expenses, while also having
enough left to “eat right.” I
also signed her up for energy assistance. She
is going to the senior center for lunch and is receiving commodities and food
bank. Another
writes:
A senior called saying he and his wife are raising their eight-year-old
grandaughter. His wife had terminal
cancer, and he worked to ensure health insurance coverage for her illness,
because she wasn’t old enough for Medicare.
He was in need of someone to watch his granddaughter, when he took his
wife for weekly chemotherapy appointments, and also to be at the house two days
a week when his granddaughter
arrived home from school.
During the interview, I learned that the client was not able to put his
granddaughter on his medical insurance, and that they were on a very tight
budget because of his wife’s illness.
I called the Advocates for Cancer Care and was able to obtain help with
transportation costs, and applied for respite through the Grandparents raising
Grandchildren program. Through the
Cancer Association, the wife was given assistance with chemotherapy co-pays and
prescription drugs. I also helped
the client with applying for Medicaid for the grandchild, and she qualified.
The wife has since passed away, and the client is now retired and able to
stay home to care for his granddaughter. He
called the Advocacy program soon after his wife passed away and said he will
always remember how the program helped him through the darkest time in his life. | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
