For most of every weekday, a 79-year-old Washington woman, suffering from a variety of ailments, was confined to her bed in an empty house. Her daughter and son-in-law, with whom she lived, had gone off to their jobs.
It seemed the only option open as the couple struggled to care for an invalid parent and still pay the bills. A very close family, they had ruled out a nursing home, preferring to provide what care they could on their limited incomes.
In our aging society, the problem is not uncommon, although the couple's solution left much to be desired.
Finally realizing help was needed, they went to the Homemaker Health Aide Service of the National Capital Area, one of a variety of Washington-area programs providing assistance to the over-60 population and their families. Five days a week, a "homemaker" visited the house to fix the woman's breakfast, tidy up the bedroom, do her laundry and provide some daytime companionship.
"At first we thought she was senile," says social worker June Galloway, a program supervisor. But after the nutritional quality of the woman's diet was improved, she began to perk up. Other therapeutic help eased her gout and arthritis.
Now, two years later at 81, the woman is ambulatory and, with the help of a walking support, able to handle most of her personal needs and even gets out of the house to attend church regularly. The homemaker's visits have been reduced to three a week.
"She's an alert, totally different person," says Galloway, who takes understandable pride in the woman's transformation. The success exemplifies the objective of postponing--or even eliminating--placement of the infirm or disabled elderly in nursing homes.
Such resources, both public and private, have emerged here and across the country in recent years to provide alternatives to institutionalizing old people who can no longer take care of themselves. Too often, say experts in old-age care, families mistakenly believe their only choice is to take a frail parent into their home--often impractical--or place them in a nursing home.
The programs are aimed at helping senior adults maintain their independence in their own homes or apartments for, if possible, the rest of their lives. This is what many elderly say they prefer (and so do their children), and it is what the majority can expect.
A big myth in our society is that sooner or later we are all destined for an old folks' home. The truth is that only about 5 percent of the over-65 population is in institutions--hospitals, nursing homes, extended-care facilities--says Dr. Raymond M. Steinberg, a senior staff associate at the University of Southern California's Ethel Percy Andrus Gerontology Center.
An additional 10 percent of the over-65 suffer a chronic impairment, says Steinberg, "but can manage in their own homes if they have access to certain services," such as home-nursing care or help with meals, household chores and shopping. In a great many cases, such aid is provided by family and friends.
While fewer elderly live with their sons or daughters than in past years, half of them, says gerontologist Ethel Shanas of the University of Illinois, live "within 10-minutes distance of a child--next door, down the street or a few blocks away." She sees them as sharing "intimacy at a distance." Even the childless elderly can turn to brothers and sisters, nieces and nephews or lifelong friends.
"Nursing homes are kind of the bottom line, appropriate when people have needs that can't be met anywhere else," says Kitty Arone a social worker with the Mount Vernon Center for Community Mental Health in Fairfax County. "When they have a caring family, they can go on forever."
On one Washington block, neighbors have "adopted" an over-80 widower who occasionally needs help with his yard or banking details, but otherwise is able to live in the house once shared with his wife. This kind of neighborly involvement, perhaps encountered more readily in small towns, remains a valuable resource to the elderly.
Nevertheless, when the burden of care is too much for the family, or there is no family, the elderly can turn to public or private resources. A good first step is to check with the city or county office or agency on aging, which can determine eligibility and assistance needed. Depending on income, many public services are provided at minimal cost. Because of limited funds, however, the applicant may be placed on a waiting list. Insurance, Medicare and Medicaid may pay some of the costs.
Some localities provide "respite" services--an outsider stays with a bedridden relative--to give family members a chance to get away from the house for a few hours or a vacation. Many mental-health groups offer group counseling in dealing with elderly family members.
"Everybody who comes in is feeling guilty," says Arone, who regularly leads one such workshop on "Relatives of Aging Parents" at the Mount Vernon Center, "because they have needs of their own." Helping a disabled parent "is taking more out of them than they have energy to cope with."
To help them get rid of the guilt feelings, she points out that bringing a parent into their home could make life "miserable" for both themselves and the parent. When they learn they have other options, "They don't feel so trapped."
Among services available in many Washington-area communities:
* Adult day care: Men and women, age 60 to 90, show up daily weekdays at the Downtown Cluster's Geriatric Daycare Center, 900 Massachusetts Ave. NW, one of several in the city. They are either dropped off by relatives on their way to work or picked up by the city's transportation service for the elderly and handicapped.
One of the oldest is a woman with senility problems, whose family delivers her at 8 a.m. and picks her up at 5 p.m. Since she cannot be left alone and both family members work, she might otherwise, says administrative assistant Dave Singleton, be forced into a nursing home.
Physical and mental therapy through arts and crafts is a major emphasis. There are outings to museums, movies and picnics. Lunch is provided at no cost, though contributions are requested from those who can afford to pay.
* Homemaker and health-aide care: The service and cost varies depending on the need, from help with bathing and other "hands-on" assistance to aid with tidying the house, changing sheets, emptying trash and preparing meals. Often the assistance may be needed only temporarily, while an elderly person recuperates from surgery.
"We don't want to cross the line to encourage dependency," says Miriam Felder, executive director of the Homemaker Health Aide Service, a United Way member that has contracts with several local county and city agencies. The idea, she says quite firmly, "is to keep people out of nursing homes when that's not where they belong."
The Fairfax County Agency on Aging maintains a register of 80 to 90 people willing to work on a paid basis to provide personal care and light housekeeping to the elderly.
A number of private firms, many of them national and listed under "Home Health Services" in the Yellow Pages, provide similar assistance. Among them is Upjohn Healthcare Services, which offers help with routine chores beginning at $5.75 an hour (minimum two hours); personal "hands-on" care at $7.20 an hour; skilled medical care by a practical or registered nurse, $13 to $19.10 an hour. Arrangements also can be made for permanent live-in companions.
* Visiting Nurse Association: Frequently utilized by recent hospital patients during recovery, or by individuals needing injections or other repeated care. A private, non-profit agency, the association also provides nursing and related assistance to the young. The fee is based on the ability to pay and may be covered by insurance, Medicare or Medicaid.
* Group meals: In the District of Columbia, about 3,000 senior adults are served lunch at 60 sites. The daily gathering also gives the live-alones a chance to socialize. There's no charge, but a 50-cent contribution is encouraged.
* Meals on Wheels: On weekdays, volunteer groups throughout the area deliver hot lunches and a cold meal in a bag (for the evening meal) to shut-ins. The current charge is $18.50 a week. Recipients include low-income elderly as well as the more-prosperous residents of Spring Valley in northwest Washington, says Marika Aires, a volunteer at the National Presbyterian Church program. That site currently serves Hot Shoppes-prepared meals to 106 homes from Georgetown to Chevy Chase.
"It gives a shut-in a chance to see somebody every day," says Aires, who cites a need for volunteers willing to put in an hour or two one day a week delivering meals to 10 residences.
* Adult foster care: Patterned after foster-child care and available on a limited basis in Montgomery County. An approved family is paid $450 to $650 monthly for taking an elderly person into their home.
* Shared-living arrangements: Public and private alternatives to living alone.
The Jewish Council for the Aging in Rockville has leased 13 two- and three-bedroom apartments, which it rents to elderly individuals at a cost of $650 per person a month, including food and utilities. A homemaker, assigned 20 hours a week, does the food-shopping, prepares one hot meal a day and helps with other household tasks.
Operation Match, a program that originated in Montgomery County, links people with spare rooms (often the elderly) with someone needing lodging, in exchange for companionship or housekeeping help.
A different approach is offered by William Hill Manor in Easton on Maryland's Eastern Shore, a planned retirement community where residents buy cottages ($55,000-$95,000) or rent apartments adjacent to a health-care center. A monthly fee pays for meals in the community dining room, maid service, maintenance of buildings and grounds and on-duty nurses.
* Counseling: Among the additional services available from some local offices on aging are legal help and assistance in handling financial accounts.
For the future, these kinds of community-based options--which prolong the independence of the elderly--should be emphasized over construction of nursing homes, says D. Richard Artis, head of the D.C. Office on Aging.
Though his office runs a nursing home, the alternatives, he says, are "less expensive and more humane."