Community Care: Aging in place with dignity

Community Care, a private, non-profit, home and community-based agency serving Lake and Mendocino counties, has been supporting seniors with disabilities or illnesses for over 30 years, helping them to remain in their homes and independent in the community.

The Multipurpose Senior Services Program, under the fiscal umbrella of Community Care, receives funding from the U.S. Centers for Medicare & Medicaid Services — part of the Department of Health and Human Services — that is redistributed to 38 county sites in California which in turn provides the money to county government offices and private agencies.

In California, MSSP serves over 10,000 senior adults who are 65 years of age or older; Medi-Cal qualified with no share of cost; have a diagnosis of being at risk of having a skilled nursing facility placement; and are case manageable.

The three offices throughout Lake and Mendocino — Ukiah, Fort Bragg and Lower Lake — are staffed by social workers, nurses and care aides whose job it is to reach out to clients and provide them with what is needed for

them to remain at home, to age in place with dignity.

“If they are qualified to receive in-home service, a nurse or social worker might advocate for them to receive more hours, to take care of their needs,” says Program Director Corinne Jones.

They provide supplies for clients to maintain a good quality of life and items can include those that are not reimbursable under Medicaid such as wood for home heating, microwaves, air purifiers, nutritional supplements and incontinence supplies.

Some people need personal connection—someone to come by to talk and see how they are doing or respite for a family member’s caregiver.

An initial in-home assessment can determine areas of concern: Is there a fall hazard? Is increased lighting needed? Is there a need for someone to come and clean their home? Do rugs need to be removed or tacked down? Are the stairs rickety? Is a rail needed? A ramp?All clients are provided with emergency response buttons.

Presently the program serves 228 clients and has the capacity to serve up to 240.

Jones says, “We know there’re older adults out there who need us; we are here and ready to serve.”

Kathy Johnson, Community Resources Specialist, heads up Senior Information and Assistance, a program that receives federal funding funneled through the California Department of Aging, to Area Agency on Aging and to Community Care.

“Our program acts as a helpful reference librarian for support to individuals 60 and older or loved ones calling on their behalf,” says Johnson. “We engage with callers’ questions and check back with them a month later to see if they were able to make helpful connections.”

The SIA is not a direct service provider; it is a reference spot to help people connect with available services.

A family member may call from out of state on behalf of a loved one living locally, uncertain of eligibility options for programs. Are they Medi-Cal eligible for the in-home support services program? Are they a veteran eligible for veteran funds? Do they have long term care insurance or do they need to look into a licensed private caregiving agency or other options for which they might be eligible?

“Aging is not easy; there’s a lot of bureaucracy,” she says. “There are a lot of support systems but they all have their little ins and outs and they change. This resource is a way to save people time when they are starting to approach areas of need as they age.”

Prior to COVID, the MSSP program staff were able to visit clients in person once a month, eyes on, make assessments to determine changes that can occur rapidly in an aging person.

“One day they are fine and the next they could require a trip to the emergency room due to a fall,” says Jones.

Because of COVID, they are no longer able to make in-person visits but are instead able to communicate by phone, more frequently, assessing what they need in the way of physical support and providing much-needed social contact, especially for those living alone.

“We’ve been on the front lines in the past with wildfires and power outages, providing blankets, flashlights, inverters, solar panels, air purifiers, lanterns with USB outlets to power up cell phones and laptops — but COVID has been the biggest problem we have encountered in 35 years,” she says.

Staff at MSSP are mandated reporters for elder abuse and when necessary fill out critical incident reports in close coordination with Mendocino Adult Protective Services; hospitals know to contact them if something happens with one of their clients.

Jones says, “All that we do is similar to what would be provided in a skilled nursing facility except our clients are not at the end of a dark hall yelling, ‘Nurse, nurse, can you come?’ They can be in their homes, in their communities, with resources available to provide them with their needs.”

Johnson says she is receiving more calls at SIA from those who are experiencing feelings of isolation, directing them to telephone-reassurance programs, and from seniors who require help shopping for food or picking up prescriptions

“We continue to be available Monday through Friday to receive calls and respond to peoples’ needs,” she says.

For information on MSSP call the Ukiah office at 707 468-9347. For information on SIA visit www.seniorresourcedirectory.org or call 468 5132.