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Is Indiana ready for its changing demographics?

By Feature, Programming

By Lynn Sygiel, editor, Charitable Advisors |

Ellen Miller is an optimist, a person who sees the glass as half full. She looks at statistics that show the nation’s 65-and-over population is expected to double to 83.7 million by 2050. And while many see that as cause for alarm, Miller sees it as an opportunity.

“It’s no surprise to anyone that our society is aging. We’ve known it’s coming. It’s predictable,” said Miller, executive director of U-Indy’s Center on Aging since 2001. “People like to frame the aging of our society as, ‘Oh, my gosh, our society is aging.’

“It’s just as easy to say, ‘Cool, our society is aging, we’ve never had these kinds of demographics before.’ What’s the opportunity to think about this and use it to our advantage?”

In 2010, Indiana’s 65+ population was 13 percent, but by 2030 that will increase to 20 percent. The foremost question appears to be: Are we ready for this changing demographic?

That is precisely what the Central Indiana Community Fund’s (CICF) Senior Fund is focused on. Miller, H. Ken Bennett, executive director of the Center for At-risk Elders and Jim Leich, the CEO of LeadingAge Indiana, are three of the fund’s advisers, and each brings first-hand work experiences to the discussion table.

Since 2003 when the Indianapolis Retirement Home closed, the $10 million endowment which resulted has gone to support programs and opportunities for low- to moderate-income older adults in Central Indiana. The fund was placed at CICF, which manages it and relies on 10 advisers to help make grant decisions.

Over the past several years, the advisers have approved proposals that push the needle on issues such as community housing, social and civic engagement and the arts. The fund accepts requests in four areas of interest.

  • Basic needs. Among the services in this interest area are transportation, food and emergency food and services.
  • Health and wellness. Includes prevention and screenings and neighborhood community wellness and fitness programs.
  • Environment of choice. Services can be affordable housing and home modification programs and support for strengthening residential care programs for low-income adults.
  • Life-affirming opportunities. Creation or support for programs for seniors to thrive culturally and intellectually.

In 2009, the fund committed three years of support for the Elders at the Table (EAT) Initiative. The project brought service providers together to improve the food delivery system for seniors, and not only provide access to nutritious food and meals, but include chances to socialize. Key to the project was service providers working collaboratively.

“You shouldn’t have five service providers home-delivering meals in one area and zero in another,” said Miller. “Those organizations that we brought together are still working together.”

Although a portion of the grants still provides operational support for some programs, the Senior Fund has worked to spur new thinking said Leich.

“We’re always looking for new and innovative things. We’re seeing more innovative ways to do home modifications. We’ve seen some volunteer programs pop up,” he said.

These three advisers would like to see more grant requests in the environment of choice and in life-affirming opportunities areas.

Bennett, who has practiced elder law for 33 years, said one grant from the Senior Fund has helped nursing homes restructure to ease the paperwork burden and increase staff time with residents. Another grant funded adult daycare, Joy’s House, a nonprofit with innovative programming. Still another provides funding to Connect2Help 2-1-1 to help caregivers find information and referrals.

And while there is work to provide diverse programs for seniors on a local, state and national level, Miller said there has been a gradual shift in thinking.

“It cannot be just because it’s a nice thing to do for older adults. It needs to be ‘We need a healthier society, we need an economically sound society’ and it’s good on all of those fronts,” said Miller. “It’s this kind of general shift towards, ‘Let’s think about how we can support people of all ages.’”

In 2002, the United Nations’ Madrid Plan of Action challenged communities to think about ways to make cities and towns accessible to all, and that’s exactly what the statewide Lifelong Coalition has been working to build.

For several years, Marie Beason, the director of Special Initiatives at the Indiana Philanthropy Alliance, has spearheaded the group made up of public, private and philanthropic partners. They work across public and private sectors to secure broad, inclusive support for policies, investments and direct services that support more age- and ability-friendly communities.

Bennett urges groups to think about new long-term care models for Hoosiers. He cites Dr. William Thomas’s work, and said Thomas’s first project was the Eden Alternative in the 1990s. Bennett thinks another Thomas initiative, the Green House project, which designs group homes in residential neighborhoods where 11 to 12 elders – and their caregives – live together, is worth studying.

Bennett said how long-term care is funded in the state is the next big issue. LeadingAge’s Leich, who runs Indiana’s association of nonprofit retirement communities, said some communities are continuing to grow and do innovative things. But overall it is a stressful time as the funding changes. He is seeing more nonprofits working collaboratively and consolidating.

“In some ways our association serves as their corporate office. We do a ton of training, we did 54 education events last year, and we’re increasing that this year,” said Leich.

With an aging demographic comes the need for an array of services for everything from independent living for healthy vibrant people to end-of-life care for those in nursing homes.

“I think the challenge is being able to figure out how do we allow people to progress in that continuum in the best way, in the most independent way that they can,” said Miller.

At one end of the spectrum, U-Indy’s Center is working with IU’s Regenstrief Institute and IU’s geriatrics department to find ways to decrease unnecessary hospitalizations for nursing home residents.

Called the OPTIMIST project and funded by the Centers for Medicare and Medicaid services, the partners have been studying the root causes and systems that need changes, then suggests those modifications. Indianapolis was one of seven demonstration projects funded for four years, and the project has just applied for a second round of funding.

“We’re really excited to be a part of that one and our role at Center on Aging is to be involved in the education portion — what do staff who are working in nursing homes need to know to understand — knowledge, skills and ability – to be able to make this kind of transition,” said Miller.

There are other new programs that target specific populations. One in particular is for adults who have no one to help with medical and care decisions. In 2010, Robin Bandy and Dr. Lisa Harris began Wishard’s Volunteer Advocates Program, as the hospital struggled to find guardians to make health-care decisions for patients who did not have family members available. In 2013, it combined with the Center for At-Risk Elders (CARE) and began operations as a nonprofit. Since then CARE has assumed guardianship for 205 adults, 118 of which are adults over the age of 65.

And there is other work that still needs to be tackled. One area that Bennett sees a need for improvement is advocacy for elder issues.

The only way, according to Miller, that legislation and perceptions are going to change is awareness. The fact that the Indiana Housing and Community Development Authority (IHCDA) and other state agencies and organizations have an aging piece on their website is a win.

“We need to be ready to care for this aging population, but also determine how we benefit from the aging and use legislation to allow people to age with the maximum dignity, maximum choice, maximum independence for as long as they’re able.”

Miller said there are a number of Indiana schools that have aging studies programs and Bennett mentioned law schools that have elderly law courses. But is it enough?

“If I had my way, there isn’t a student who came out of undergraduate education without having a course in understanding the aging of our society and their own aging. Aging isn’t something to say, ‘Oh, I hope it doesn’t happen.’ How do we understand the aging of our society, the aging of our families and those that we love and care for, and the aging of ourselves?”

Center for At-Risk Elders (CARE)

By Feature, Programming

Center for At-Risk Elders (CARE)
H. Kennard “Ken” Bennett, executive director, senior counsel
120 E. Market St.
Suite 1190
Indianapolis, IN 46204
www.indianacare.org

When Ken Bennett started practicing elder law 33 years ago, it wasn’t with the intention of running a nonprofit. His practice focused on health-care advocacy.

During the course of his private practice and through personal experiences, he realized there was no surrogate decision-maker to help remedy issues of neglect, abuse and exploitation of elders. Prosecutors administer Indiana’s adult protective services.

Bennett said the state’s adult protective services don’t go far enough.

“They focus on criminal prosecutions. That isn’t to say that they won’t step in to provide remedies, it’s just that they don’t have internally the ability to do much about it,” said Bennett.

In 2008, the Adult Guardianship State Task Force was convened to determine the need and support development of adult guardianship services across the state.

As a result of that work and a grant from Indiana’s Family and Social Services Administration (FSSA), there are now 10 volunteer guardianship programs around the state, a state office and Volunteer Advocates for Seniors and Incapacitated Adults (VASIA) statutes passed in Indiana.

In 2010, Robin Bandy and Dr. Lisa Harris began Wishard’s Volunteer Advocates Program (WVAP) as the hospital struggled to find guardians to make health-care decisions for patients who did not have a family member available. The idea was to provide temporary, emergency guardianships up to 90 days and then turn them over permanent guardianship to other agencies with guardianship programs and services. Bennett worked as a volunteer on several cases.

“There was nobody that the law recognized with health-care decision-making authority, and this posed a significant problem for the hospital because you cannot very well treat someone except in emergency situations without consent,” said Bennett.

In 2013, the Center for At-Risk Elders (CARE) and began operations as a nonprofit. Since then CARE has assumed guardianship for 205 adults, 118 of which are over the age of 65.

Beyond legal guardianship, these services can include getting the individual an immediate medical assessment, liquidating assets, filing an application for benefits, including Medicaid, finding appropriate housing and checking in regularly with the person.

“As we were working together, Wishard got to know CARE, and it dawned on me, and it dawned on them, ‘Well, CARE’s the best nonprofit to take over our program.’ They were coming to the end of a funding cycle, through Retirement Research Foundation,” Bennett said.

Volunteers come from all walks of life, but have one thing in common — they are willing to go the long haul.

“We have about 65 trained volunteers, and we do a one-on-one match. These folks will live for years. So you may be matched with somebody, if you’re willing to go that long, for many, many years.”

Volunteers at CARE are medical students, law students, social workers, retired nurses and retired palliative care nurses. Part of CARE’s funding comes from three area hospitals and state funds that were split evenly between the volunteer groups in the state.

“It’s really a remarkable volunteer group, but all come from the same commitment of wanting to help. I think there’s a lot to learn on everybody’s part on how best to recruit and train. I think it’s also fair to assume that we will never have enough volunteers for the demand,” said Bennett.

Right now, callers who are not part of CARE’s referral network have to be turned away. But Bennett hopes as CARE finds ways to increase funding, it can be expanded to the public at large.

Joy’s House

By Feature, Programming

Joy’s House

Tina McIntosh, president and CEO

  • 2028 Broad Ripple Ave.
    Indianapolis, IN 46220
  • 1615 Castle Ave. (new)
    Indianapolis, IN 46227

http://www.joyshouse.org

When Tina McIntosh was a student at Ball State University, she volunteered at an adult day center in Muncie, and that experience planted a seed.

In 1999, McIntosh launched Indianapolis-based Joy’s House and 10 years later, expanded its Broad Ripple operation. The agency recently announced the opening of a Southside location near the University of Indianapolis.

All this hard work and innovative programming recently won the local nonprofit a prestigious national award. This fall, the National Adult Day Services Association gave Joy’s House its top prize — outstanding and innovative adult day center — and encourages others to learn from its model.

“We might be scared to be in a room with people who have dementia or Alzheimer’s, because we don’t understand it. We think they’re sad and drooling and kind of sit around waiting to die, when the reality is, and I tell people a lot at Joy’s House, sometimes they may be a little sad, but they’re not waiting to die. They are lively and fun,” said McIntosh.

While Joy’s House’s primary work is to provide innovative day programs for adults, McIntosh realizes that caregivers needed services, too. She says that 1 of 3 adults is a caregiver for someone. Last year, that figure was 1 in 4.

“We have pulled together folks in Indiana who do caregiving programs. There is so much that needs to be done.”

About two years ago, WIBC (93.1) approached Joy’s House to seek input on a potential radio show.

“Caregiver Crossing” was the result and is a program for listeners who are caring for a loved one or who will be one day. The hour-long show can be heard on Saturday mornings from 7 to 8 a.m.  McIntosh co-hosts the weekly show with Terri Stacy and guest experts join them to discuss the many aspects of caregiving. The show has been No. 1 in its time slot for over a year.

“It is a program that has become an on-air support program for caregivers. We have a lot of fun in the process. It’s overwhelming how many support areas there are. And I truly mean that. It’s overwhelming in a good way. It’s just been an honor to have people reach out and kind of say, ‘Here’s our situation, what advice can you give.’

“I found myself talking on the phone with people countless times, I might not have all the answers for them, but sometimes they just need a place where someone’s going to listen.”

The radio program is just one part of Joy’s House’s education caregiver program. Twice a year, there is a free one-day retreat for caregivers. It also provides CARE Kits, a binder full of template information to help someone think through either when they are caregiving or when they are just looking toward the future. All medical and home information is in one place.

“We’ve given out over 1,000 of those into the community, and actually 1,000 more are arriving at our door any day. All people have to do is reach out to Joy’s House to get a kit free of charge.”

What Singapore’s plan for an aging population can teach the United States

By Feature, Programming

By Tara Bahrampour, reporter, Washington Post |

Singapore, one of the world’s fastest-aging countries, has announced a massive, multipronged plan to help its citizens age successfully — one that advocates say leaves the United States in the dust.

The $2.1 billion plan announced by the Ministry of Health, “A Nation for All Ages,” comprises initiatives on topics such as health and wellness, education, volunteerism, housing, transportation and social inclusion. A new “National Silver Academy” will offer post-secondary education to older people, and up to $142 million will go toward innovations in research to transform the experience of aging. The initiative also includes housing (with) elder-care and child-care centers in the same facilities to promote intergenerational bonding and piloting therapeutic gardens for dementia and stroke patients.

Singapore, an island city-state of 5.5 million, is one of the fastest aging populations in the world, with the number of residents aged 65 and over projected to hit 19 percent in 2030, up from 9.3 percent in 2011. Its plan is striking in that it focuses heavily on empowerment rather than just tending to the frail.

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The liberation of growing old

By Feature, Programming

By Anne Karpf, op-ed, The New York Times |

LONDON — WHY do we have such punitive attitudes toward old people? Granted, the ancients did hideous things to elders who were unable to work but still needed food and care, but in more recent times, that had changed: In 18th-century New England, it was common for people to make themselves seem older by adding years to their real age, rather than subtracting them.

Yet today, the language used to describe the changing age composition of the population is little short of apocalyptic. We’re told that the “graying of America” is an “agequake” or a “demographic time bomb.”

In 2050, Americans age 65 and over are predicted to almost double in number to 83.7 million, one-fifth of the population. An aging population does pose real challenges, but increasing numbers of people of working age (as traditionally defined) are unemployed today, while growing numbers continue to work beyond pensionable age.

In reality, age can no longer be neatly correlated with economic activity. In particular, old people are themselves significant providers of care, notably the childcare provided by grandparents.

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