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Getting Too Much of a Good Thing

18 Jul

Stanford Business Center for Innovation recently published an article on how to avoid “Social Good Fatigue” and to be honest it rang a bell with me. While my work still motivates me more than anything else I do in my life, I still feel sometimes I must try something else.

The article argues that social entrepreneurs live in a state of permanent emotional drain produced by dealing with people and problems all the time, selling hope and mobilizing others to create change. Creating change is never a straightforward event, we deal with complex issues requiring complex solutions. People prefer to stick with simple resolutions. The social entrepreneur is always dealing with urgent issues. In our case, we often deal with life and death issues, knowing that if we slow down some people are going to go without assistance that they often need to stay alive. This means that the rest of our lives get a back seat. My husband constantly argues that I do not have time for him or for the family. He is right. Because we concentrate so much on one issue, we often stop learning and growing, stop taking side roads, smelling flowers, enjoying the family, reading a good book. We are in a constant state of flux, that success often contains the seeds of failure. When I look at my journey, I see this so clearly, every success I have had has been followed by failure. I cannot forget that every single innovation has been met with failure to begin with. We get used to this, but it is consuming.

The article spells out several remedies to this “burn-out” syndrome. Most of them I have followed during my 17 years of being a social entrepreneur. Particularly during the past four years I have made time to reach out to friends, particularly childhood friends. Our conversations have nothing in common and perhaps that is the beauty of it all. We talk about things of no consequence. I engage in a lot of physical activity. I get up at 4:00 a.m., do a half hour of yoga, and then put my scull on the water and row for two hours. I have been doing this for 10 years, and I find that rowing in the dark allows me to meditate, calm my mind, and re-arrange things. I hope I am never forced to give this up. I am also planning my trip to Nepal, something I have been trying to do for many years. I know that if I wait longer, I may not be able to physically do it. Whatever I want to do, I do today.

I have told my daughter that I would like to retire in two years because I have a new idea that I want to develop before I leave this world. It is when you let go of things that you are truly creative and it is in this process of creation that I feel best. After all, like the article says, “You never conquer the mountain, you can only conquer yourself.”


What Can I Do for My Mother?

25 Oct



Every day we get panic calls at our office. Most if not all of them deal with “What do I do with my mother? She cannot live alone anymore. She has so few resources.” The problem arises not only because seniors find it difficult to communicate with the outside but also the outside is a hard system to navigate. The case of my 92-year-old mother, who speaks very little English, is a good case. She dreads the thought of having to speak with a computerized phone system and follow the instructions. It becomes a labyrinth of sometimes insurmountable barriers.

One of the essential benefits we offer, at the facilities we manage, is to help these seniors navigate the system. If you are low-income there are multiple benefits that can help you get help at home, pay for services if you live in an assisted living facility, get transportation, and many others. The problem is that most of these services are offered by different agencies and these agencies do not talk to each other. So you find yourself calling several agencies, that is, if you know whom to call, and getting different answers.

So let’s take the example of my mother again. She is low-income, has a small pension and several mobility issues that make it impossible to perform easy daily activities. The first step is to decide what services she needs. At this stage of her life, and mainly because she is of sound mind, she needs someone to come to her home 3 or 4 times a week to clean, prepare food, help her with bathing. She lives in Florida and although Florida is one of those states that has yet to place all senior services under one agency, she will first call the Area Agency on Aging for her district. This will be done with the assistance of the helpline (1-800-955-8771) a 24-hour service that directs you to the right agency and/or individual.

There are several programs that seniors and disabled adults are eligible for depending on age, disability and income. These are: Social Security Income Supplementation (SSI), Assistive Care Services (ACS), Medicaid waivers, Diversion programs and Veterans Aid and Attendance. We will cover, in this blog, the first step: applying for Social Security Supplementation.

SSI – Supplemental Security Income

(Social Security Disability)

  • You may apply for this online at the Social Security website
  • The program is based on Financial qualifications ONLY
  • You must be a U.S. Citizen or an eligible non-citizen
  • You are eligible for SSI if you are over 18 years old and are deemed disabled by a physician, which means that you have a physical illness &/or mental problem expected to last more than one year or result in death or are considered blind.
  • You can get SSI up to age 65, after that your benefits automatically convert to retirement benefits (Monthly Social Security Check).
  • You must have worked long enough to have paid into the Social Security System.
  • The monthly income requirements, to qualify, are as follows: $00.00 to $710.00 for an individual and $1,066 for a couple.
  • Total assets must be less than $2,000 for an individual and $3,000 for a couple.
  • It takes 3-5 months to process claims.
  • SSI pays monthly checks to the elderly or disabled person to get their income up to $710.00 (i.e. your monthly income is $300, SSI will send you a check for $410.00, if your income is $600 your SSI check will be $110.00).
  • If you are in an Assisted Living Facility, the entire monthly income (less a personal needs allowance) will be submitted to the facility to pay for your care.
  • If you are on SSI you may be eligible for other State and County programs such as food stamps and Medicaid. (If the person is in a facility, food stamps will not apply).
  • Call the local offices for more information.

In subsequent blogs we will discuss and provide information on the other programs. Stay in tune!



The Journey Begins

25 Jun

On November 12, 1995, an event occurred that completely changed the course of my life. While serving as Florida Secretary for Aging Services I was summoned to a public housing building in Fort Lauderdale, Florida where a fire had killed 12 of the residents. For the first time I came face to face with the squalid and precarious conditions in which low-income seniors in this country subsist. The image of that day never left me and I made a promise to myself that I was going to make it better. Charged with this moral obligation and strength I was able to secure a deteriorating public housing building in downtown Miami with the promise of turning it around and creating something new. With my political ties in Tallahassee still fresh I secured $1.2 million to retrofit and license that building. In six months it was full with a long waiting list, had become the model for the nation and had won four national awards. Some may say it was luck, I believe it was stubbornness and commitment that made it happen. I had fulfilled my promise. To the 104 seniors living at Helen Sawyer this was the beginning of the best time of their lives. End of story. I never had the intention of doing this over and over in twenty-three states. But it was no longer up to me; the notoriety that this little program gained made it impossible for me to turn the page. And so it began, my journey in replicating this common sense approach to providing 24 hour services to low-income seniors where they live so they will never be forced into a nursing home.

There is no doubt that good publicity helps in creating an innovation, but that alone is not enough. I knew that innovation is almost always built on rejection. There were so many obstacles that had to be overcome. The worst was the mind set of policymakers and public officials reluctant to change the way we care for the poor elderly. They seem to have a spiritual blindside that prevents them from seeing the human side of the dilemma. If I was going to replicate this program in other counties and states, government funding was critical. My experience in government was important in understanding government, what moves them; how to obtain their collaboration. We needed to gather some ammunition to win them over. How about doing more with less? With the funds they spent for each individual forced into a nursing home, I was going to care for four. How about if we could prove to them that our care involved changing lifestyles and improving health? We started gathering data that proved that we were avoiding hospitalizations, emergency admissions, reducing the number of prescription drugs and 911 calls. That certainly caught their attention and in 2010 our little company was able to change national policy. Funding this type of program instead of nursing home care became a priority. The Community First Option program was started in collaboration with two large federal agencies: Health and Human Services and the U.S. Department of Housing. The program was initially funded with $46 million. Until now, they did not talk with each other, and now they were cooperating in making it possible for low-income seniors to live with dignity in the comfort of their homes. What a novel idea!

Now, I said, we can concentrate in avoiding other obstacles in scaling our program. What would it take to convince private investors to provide the capital to purchase distressed properties and hire us to provide the services to this exponentially growing and long neglected population? A good return on their investment perhaps? Although corporate America needs to be seen as having a social impact, what they are truly interested in is good returns. Conquering corporate America became a major goal for us. We never forgot, however, that our social mission had to be safeguarded.

Change is Underway

3 Aug

In the beginning we felt a moral obligation to change the way we care for those less fortunate in our society, the poor elderly and disabled. We soon realized that by changing living conditions, we were improving the health of those individuals, cutting healthcare costs, reducing Medicaid spending, creating new jobs and economic activity, revitalizing neighborhoods and increasing the affordable housing stock. This was the argument we used in convincing government to invest in our project.

Global aging is a historical phenomenon impacting all segments of our society, work, retirement, entitlement programs and healthcare among others. The demographic tsunami of the baby boomer generation will only compound this crisis. Tackling the challenges of global aging must be a priority of all countries. We need to keep seniors healthier, away from institutions, working and engaged because our society drives when everyone in it does. Yet we continue to segregate the elderly, not to be seen or heard. We know so little about them, no wonder our younger generation does not see them as role models.

However, it is going to be hard to continue to ignore seniors in this country. Those of us who belong to the “boomer generation” will be demanding changes. After all we are known for our activism, a trait that has not diminished as we age. We have not given up on changing the world, we are more adamant than ever that we can.


The Untouchables – Alzheimer’s Clients

10 Jul

I am alarmed to hear of the number of Alzheimer’s clients that are projected in the next decade and thereafter. Even more alarmed when I see the complete disregard our current long term care system has for those afflicted with the disease. It is almost like we want to keep this as a secret, which does not help very much when advocating for change.

In 1995 the State of Florida was putting together the assisted living waiver and establishing who would have priority for this new funding. My thought immediately was – those who are suffering with Alzheimer’s in the hope that it would incentivize assisted living providers to take care of them. The provision was added to the waiver eligibility requirements but it did not move those private providers to open their doors. One of their reasons was that it costs more to care for an Alzheimer’s client as they require more staff to avoid elopement. Florida is one of a dozen states that pays a fixed rate for the care of an individual in an assisted living facility no matter how much service they require. This leads to a lot of what we call “cherry picking” and who in their right mind will pick the Alzheimer’s clients.

But cost is not the only reason. In a study conducted in 1996 it was found that half of the states had admission and discharge criteria that prevented the admission and retention of people with cognitive impairments (Alzheimer’s). Later studies continued to reveal a reluctance of assisted living providers to admit/retain residents with the type of behavioral symptoms brought about by the disease. The Alzheimer’s Association supports the ability of residents to age in place, however, the fact remains that the few that do offer dementia specific units to Alzheimer’s clients do so at the detriment of the residents. There are cases of residents being neglected and ostracized and care needs are very high. This is a reason why most of the nursing home residents are in fact Alzheimer’s clients; individuals who do not need medical attention but basic supervision. However, they end up there because no one else would take them. According to a 2006 study, over 40% of discharges from assisted living facilities to nursing homes were because of cognitive impairments.

How dementia friendly are those brave assisted living facilities that cater to Alzheimer’s clients? Universally all dementia units use methods of exit control and clients are served in separate areas of the buildings – not to be seen or heard. At the first facility we opened here in Miami we welcomed Alzheimer’s clients and half of the population was in fact afflicted with the disease. Morally opposed to any type of segregation, our dementia clients were interspersed through the eight (8) floor facility. They ate their meals with everyone else and partook of the activities with the rest of the community. There were complaints from those who were able and fit, particularly during dinner hours. But, the complaints did not persist when they were asked if they too would like to be locked up if ever afflicted with the disease. After one year of this experiment, Florida International University performed an evaluation of our program and found, to everyone’s surprise, that our clients’ cognitive health had drastically improved because they were allowed to be part of the entire community. What a novel idea!

Senior Myths Shattered

2 Jul

I am a 67-year-old woman and always found it incongruent how I was supposed to feel at this stage of my life. I only realize that I am this age when I look at myself in the mirror; otherwise I feel exactly the same as I did when I was twenty years younger. Labels like: my brain doesn’t work well anymore, I don’t enjoy sex as much, my social life is down the toilet, unhappiness is the way of life or there is no way I can learn anything new, somehow do not fit me.

I am relieved to find that some of the most prominent researchers in the U.S. have once and for all shattered those stereotypes. The research conducted among a significantly large sample group found that there is a gap between chronological age and “felt” age. Senior moments, increasing isolation, inability to grow and change are largely proven to be wrong according to the results. Scientific America’s research found that a large percentage of seniors 75 years and older enjoyed sex and were sexually active. Respondents of a survey conducted by the Journal of economics reported being the happiest they have been all their lives. Level of happiness seems to dip around age 40 years and then goes up. An empty nest does not contribute to unhappiness, just the opposite. Respondents to a New York Times survey reported that now they had more time to work on their relationship and uninterrupted time contributed to their quality of life.

Seniors are better at sizing up people and understanding how relationships work and are more socially active. But the most important finding came out of research conducted by the American Psychological Association that dismissed the myth that our brain stops working after a certain age. A process called neuroplasticity, that basically changes the structure and function of the brain in response to experience, is responsible for a higher ability to handle verbal and math problems and the improvement in spatial and abstract reasoning. It may take us longer to solve a problem but the final product is so much better.

I remember arriving in Palo Alto, back in 2006, to receive the first Purpose Prize award. This award is given to individuals over the age of 60 that have made lasting and important contributions in resolving a critical social problem. In the room were over 200 individuals, average age 70 years, whose innovative power had revolutionized the way foster care works, adoption systems in China, drastically reduced carbon footprint by changing the design of buildings and so much more. My first reaction was that we must show the world that how they think about us is all wrong and we must work to remove the disconnect that exists between young and old. The conclusions made in these research reports will go a long way in achieving this. At last.

Stop Forcing Low Income Seniors into Nursing Homes!

8 Jun

This has been our battle cry for over twenty years. The benefits of keeping seniors at home with needed services has proven to be cost-effective, beneficial to the health of these clients and responsive to seniors’ desires. And yet, change has come slowly particularly in southern states. Under the pressure of skyrocketing Medicaid budgets fueled by the increasing numbers of low-income seniors our policymakers have had to shift toward funding more community instead of institutional care (nursing homes), what is called in the industry: “rebalancing long-term care.”

One state that has been successful in doing so is Oregon that rebalanced their budget back in the early 1980’s. Many other states have followed, including Washington and Colorado. The number of people receiving Medicaid-funded nursing facility care in these states grew at a much slower rate than in the rest of the nation from the inception of Medicaid home and community-based waiver programs in the early 19080s to 1994. The number of people in nursing homes as a proportion of the population age 75 and above in these states decreased faster than the average for the rest of the nation. Total annual Medicaid spending on nursing facilities also increased at a slower rate in the study states than nationally after controlling for growth of the age 75-and-older population.

Today only a handful of states remain committed to forcing seniors into nursing homes when no longer able to live independently – Kentucky, Virginia, Alabama and West Virginia do not pay for assisted living services. Although an increasing number of states have created Medicaid waivers to pay for assisted living services, the funding always falls short of the need which creates long waiting lists. clients in need of assisted living services cannot wait the two or three years it takes to receive an allocation. So seniors and disabled adults are still forced into nursing homes and we continue to pay for poor quality and undesirable care.

In 2003 our firm started the conversation with the Department of Housing and Urban Development urging them to join forces with the Department of Health and Human Services (federal Medicaid program) to properly fund community care at least for those living in public/subsidized housing. Seven years later, it happened and both departments partnered to create the Community Living Initiative that funds housing and services for low-income disabled adults. Seniors, however, have to wait longer and as of today no initiatives have been taken to address the issues of the seniors.

Apparently financial crisis alone will not prompt the federal government to act. I firmly believe the issue of low-income seniors ending up in nursing homes prematurely must arouse public opinion. Those most affected, the seniors, the families, the advocates, need to demand this change. Rather than being remembered as the “silent minority” we must be remembered as the generation that changed the way we care for seniors in this country.