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!



Replication – An uphill battle?

27 Jun

Replication becomes a moral imperative for social entrepreneurs. Once we find out that we are making a difference in our communities we have this undying desire to replicate our idea. Most, if not all, social issues are global, and a good solution can travel anywhere, with some caveats. We know through experience that global aging is posing challenges to all developed countries. In places like Japan & Italy the growing senior population comprises over 30% of the population. This aging wave affects may aspects of society: work, retirement and healthcare among others. So why not introduce our idea to them? While it makes common sense, for an idea to travel many factors must be in place. Capital, connection, understanding of regulations, the culture and language are critical if we are going to be successful. These were the issues we confronted when we tried to bring our program to Japan last year. While both parties agreed that it could be transplanted and we were both eager to do it, several obstacles had to be overcome.

Last year, through the Ashoka network, we discussed introducing our model to a very prominent woman that started a large nursing home business in Japan. She was interested in bringing about a less institutional model like ours. There were few if any regulations in Japan that would prevent implementing such a program, no competition exists and the government could reimburse for services through their healthcare/pension plans. However, for our program to work, we needed to overcome some major barriers like language and raising the capital to establish relationships in such a close knit culture. Overcoming the language problem (only 3% of Japanese converse in English) required the hiring of a full-time interpreter. We also needed to employ an agent so we would have a direct presence there. Trying to raise capital in Japan became difficult as there are today very few foreign investors. The initial investment proved to be too onerous for us.

Raising capital for our social ventures is an arduous job, absorbing a big chunk of our time. We knew that when we started and that was the main reason we decided to create a for profit company. We were also in a hurry and could not wait the time it takes to create a non-profit entity. Our first contract was the most difficult. Once you have created a successful and replicable model, it becomes easier to sell to others. There are no blueprints and no road maps with a new idea and a lot of non-believers. We took three steps, first: change individual behavior, second: create a successful program and third: change national policy so we can replicate with ease. We never wasted the opportunities that this global crisis offered us. From the onset we knew what we wanted to achieve and what outputs we needed to derive (number of people served, cost efficiencies, operating margins) and the impact we wanted to effect (change the way we care for low income seniors). From day one we established clear outcomes and collected data to measure progress. Performance management became our principle. When you provide data to mission driven people, the results are profound and these measurable results are essential if we are going to obtain capital needed to scale.

Connections and collaborations were a turning point to our small firm. We have never acted alone, but we realized that we needed to be connected to a larger network if we were going to make a difference. These connections are not easily made; it takes a lot of time and effort to achieve. Becoming an Ashoka Fellow in 2010 opened a multitude of doors and connections that have propelled our mission inside and outside the U.S. We formed a Board comprised of private investors and successful business owners that have guided our steps, re-engineered our firm and paved our way to the corporate world.

My years of working in government made it possible for our firm to change national policy. I understood how it works as well as their reluctance to deal with social issues. My approach in understanding regulations, culture and language has always been to understand before asking to be understood, respect and a sensible approach has served us well so far. We would have thrown out many babies with the bathwater if we were not able to work with the government as an ally.

Every single day for the past sixteen years I wake up in the morning and ask myself a simple question, if not now, when? 

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.

The Hispanic Paradox

11 Dec

The growing numbers of ethnic seniors throughout the U.S. continue to experience a litany of problems when accessing services. Among them, language and cultural barriers, a fragmented service delivery system and a lack of properly trained bilingual staff with heavy case loads. But they have a big advantage – longevity despite their lack of access to healthcare, lack of health insurance, lack of education, acute poverty and obesity and diabetes rates that hover at epidemic levels, they live longer than any other group in the U.S. Hispanic men live an average of 80 years, 2 years longer than their white counterparts and Hispanic women live to be 85 years, 7 years longer than any other group. 33% of them have lower mortality rates from heart disease and 36% lower incidences of cancer.

Over one million individuals in Florida, that are over the age of 60, are Hispanic. An advantage of catering to Hispanic elders is what it is commonly called the “Hispanic” paradox. Hispanics, despite their socio-economic hurdles and lack of access to healthcare, live longer than blacks by seven years and whites by five years. Overall, Hispanic seniors are much healthier than expected. The reasons for this paradox are still a matter of debate. Many suggest that factors such as diet, comprised mostly of beans, rice, fruit and vegetables; lifestyle choices and strong social-support networks are key to understanding Hispanics’ better-than-expected health.
However, these benefits, that they bring with them, gets weakened in the U.S. Second generation Hispanics do not benefit from this longevity. Many argue that the reason is the fact that being in the U.S. produces a change in their diets and exercise routines. Researchers in the U.S. are perplexed about this phenomena but at the same time, they are studying the factors responsible for the longer life expectancy in the hope to arrive at a set of principles that will reduce disease rates for all racial and ethnic groups.

I do not fit in that pigeon hole

31 Oct

I have always had a problem with how we arbitrarily place individuals in neat categories for the sake of understanding them. With time stereotypes are developed and when we speak about a certain individual what we remember is the stereotype. I believe in the timeless relevance of people, whatever their age, whatever their background. I am more relevant to others today at age 67 than I was when I was 25 years old, and yet, most people think that I should retire, that I have completed my life cycle. This is a shame. Individuals like me have so much to contribute given their life experience. Although we have made great progress in changing the way others see older adults there is still much to be done. Ageism, a phrase used to denote prejudice against older adults, is alive and well in this country and others. Recent articles present us as selfish and greedy. I take great exception to Joel Kotkin’s article in Newsweek, Are Millennials the Screwed Generation? (July 16, 2012) in which he claims that we have screwed the young generation by taking away jobs by not retiring when we ought to. In my case, the opposite is true.

I am still working and do not plan to retire anytime soon. I created my own company fifteen years ago. The last ten years have been the most productive years of my life. I have been able to better provide for my family, create hundreds of new jobs, change the way we care for low-income seniors in this country and improved the lives of thousands of seniors by providing affordable housing and services to them. I feel more relevant and satisfied than ever before. But make no mistake, I am not exceptional. Thousands of individuals like me are changing the world so that the next generation has it better than us.

In 2006 I was awarded the first Purpose Prize, an award given to those over the age of 60 that have made great contributions to society. Every year since then, awards have been granted to those who have made unique contributions to the welfare of children, young disabled adults, service men returning from wars, reversing climate change, opening the doors to young adults to go to college, among others. It is an impressive group of individuals wishing to leave their mark on this world for the betterment of others. Being among them makes you wonder why we are so vilified and unrecognized. I must conclude that it has to do with the historical phenomena global aging. Never in the history of our world have seniors outnumbered teenagers two to one. Because we have limited resources, this event has pitted young against old.

It is time to set the record straight and the media can do so much. I welcome the New York Times’ recent Boomers website (Booming, Living Through the Middle Ages; http://topics.nytimes.com/top/features/timestopics/series/booming/index.html) where we can begin shattering stereotypes and think of life as having no age but timeless relevance.

Housing is the Platform to Improve Health

29 Oct

For several years our firm has advocated providing support services at home to ensure improved well-being and cost savings. In doing so we have run into the silo mentality that exists in most government organizations. The US Department of Housing and Urban-Development (USHUD) insisted until recently that housing was just a roof, whatever happened under that roof was not an issue for them. In 2003, with several successful projects under our belt, we approached both USHUD and the Department of Health and Human Services (HHS) to collaborate so that appropriate services could be combined with housing. It took several years for them to accept that this concept was vital to serving the very individuals for whom they existed. A recent article published by USHUD speaks of housing as the platform to improve health and that stable housing was essential in addressing the health needs of chronically homeless individuals. What a novel idea!

The article highlights several programs undertaken in Boston, New York and Chicago. In Boston it was revealed that health issues impeded the ability of residents to obtain and retain housing. New York Common Ground organization found that in order to meet the needs of the homeless population a partnership between health and services was essential. The Chicago project demonstrated that a strategy to marry healthcare and stable housing was successful and cost-effective by reducing unnecessary hospitalizations and emergency calls.

All of the collaborating institutions, however, realize the difficulty of establishing collaboration and integration among disparate systems, programs and organizations. They call for a focus on individual needs, system reforms and elimination of existing barriers to collaboration and integration. All is well you may say. However, in our experience there is a chasm between identifying the issues and doing something about them. Time will tell if we can do it right.

Do I want to live forever?

30 Aug

I’m not alone when I say that I would like to live long enough to see my grandchildren become young adults, but only if I am in good health. There are many in my generation that feel the same way. Much has been written about the potential longevity of the baby boomer generation and the effects it will have on entitlement programs like social security and Medicare. However, recent studies present a different picture. According to a University of Illinois study baby boomers will not live longer than their parents have despite the healthcare improvements, new drugs and the long 20th century experience of ever-rising life expectations; the culprit – factors like elevated rates of obesity, cancer and suicide.

Another study by Rice University claims that it would be a mistake to project longevity gains of the last century throughout this one. Health status of the baby boom versus the preceding generation reveals that they are in worse shape. There is a higher propensity to suicide particularly for those in their 40’s, a time when those rates typically head down. And then there is the ‘Big C’. The post war generation has a higher rate of cancer at younger ages than the previous generation. Women of this generation are the heaviest smoking cohort in U.S. history and they are now suffering its effects.

Obesity among boomers is linked to rising disability and serious health problems like diabetes and heart disease. However, the true impact on longevity that obesity has cannot be seen until we get older. Socioeconomic factors will also significantly impact longevity. It is a well-known fact that rich people live longer than poor people do. We know that the gap between rich and poor keeps widening in this country and that the impoverishment of individuals keeps creeping up. The most at risk, of course, are Latinos and Blacks who swell the ranks of those living under the poverty level. They will see drastic declines in health status over the years.

The moral of the story is that in order to live longer we must have been blessed with good genes and the absence of major health problems, a socioeconomic position that allowed us to have access to preventive healthcare and live healthier lives, otherwise it makes no sense to live forever.