Mass. elders living at home helped by free programs

COVID-19 has dramatically impacted older adults, through illness or the isolation often needed to keep them healthy. In Massachusetts, a free program is supporting those able to stay in their homes by partnering with families as the pandemic continues to take its toll.

Below is a link to a piece that aired on November 17th, 2020 on Boston’s WCVB 5 News on how PACE helping Massachusetts elders live safely at home.

https://www.wcvb.com/article/free-program-supports-massachusetts-seniors-living-at-home/34701206

PACE program assists with Care, transportation

For Norm and Mary Jo Zarella of Lowell, Massacusetts, MASSPACE is a lifeline. “We would be lost without it,” Norm said. Mary Jo, who has been diagnosed with dementia, receives comprehensive care from doctor visits to day care while Norm con­tinues to work, and even has caregiver support at home. Monday through Friday an aide arrives at 6:30 a.m. to help Mary Jo with daily tasks as Norm readies for work. At 8:30 a.m. she gets a ride to Fallon Health’s Summit ElderCare pro­gram in Lowell where she spends her day socializing, eating meals and doing recreational activities until early afternoon, when she gets transportation home. Another aide meets her there to accompany her until Norm returns from work.

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Home Care Magazine

5 Questions With: Candace Keubel, Executive Director of MassPACE

 

Thursday, October 15th, 2020

MassPACE, the Massachusetts chapter of Programs of All-inclusive Care for the Elderly, has taken an innovative approach to serving its clients, mostly patients who are dual eligible for Medicare and Medicaid, during the pandemic. While traditionally center-based, MassPACE shifted to an at-home model, sending caregivers out with tablets for telehealth and also setting up social activities, counseling and more. Some centers were even transformed into temporary infirmaries for COVID-19 patients to reduce hospitalization. HomeCare talked with MassPACE Executive Director Candace Kuebel about some of the lessons and about partnering with homecare organizations.

HomeCare: It sounds like MassPACE has done a great job pivoting in these crazy times. Tell me a little bit about what that looked like.

Candace Kuebel: Yes, we were able to pivot literally overnight and I’ll tell you why. It might have been our finest hour, because the PACE model of care was designed 30 years ago to be extremely person-centered. Many of our patients participate in the development and the practice of their daily care plan, along with an 11-member interdisciplinary team ranging from a geriatrician through transportation coordinator; it’s a pretty mind-blowing model. And it’s center-based. A PACE center can be thought of as an adult day health center, but co-located with a soup-to-nuts medical clinic and rehabilitative therapy gym. It’s like social cafe in the front of the house and it’s the Mayo clinic in the back.

Many of our participants traditionally visited the pace center on a regular basis for their social and medical rehab and nutritional needs. Now, some of our participants live in assisted living and they get their socialization at the assisted living, or they are very active in their supportive housing unit for various reasons. Does that mean that they don’t get the care that is delivered by all of these 11 disciplines? Absolutely not. They get in their homes, right? So that model existed already. While challenging, it was something that was already happening. And those challenges were met with opportunities to rapidly redeploy site-based staff to home-based care, as well as to introduce and deploy to more participants important technology—some of which was already happening, but went on steroids during the pandemic.

HomeCare: What was your biggest challenge?

Kuebel: The biggest challenge, and you’ve heard this many times before, was scrounging up the personal protective equipment (PPE). I know I’m singing to the choir here because the home health industry was at the bottom of the food chain in being able to secure PPE. And it is just mind-blowing to us; how do we deliver care into the home? Without it, we cannot ensure the safety of our workers and of our vulnerable patients… We had to be very creative and get it however we could. And then the testing, you know—it was just an unbelievable phenomenon that in America, we would have this situation. But you know what? This healthcare model employs innovative people and resourceful people, and especially the homecare industry; they are the unsung heroes. These are the angels in the healthcare system, the frontline workers who put themselves out there.

HomeCare: What worked better than you expected?

Kuebel: We were so surprised to find that our participants and our employees were willing to do whatever it took to make this work. You think about health care and you think about the fact that these are people who have multiple chronic conditions. These are nursing facility, clinically eligible individuals starting at age 55, up to 65% of them have a comorbidity with some sort of behavioral health diagnosis. This is the kind of population we’re talking about. And they were in lock step with us…

It’s not just about the medical care though, right? It’s about our activity staff that developed activity kits or coloring kits and paints and they delivered them along with their meals. “Here’s your lunch and here’s something for you to do this afternoon,” they said. “And we’re going to call you in the evening while you’re getting ready to take your medication and make sure that everything is okay.” It was very high touch, and they had the ability to do that and the caregivers really appreciated that and were really willing to work with us… That didn’t require any kind of technology or any big shift or anything like that. It was just thinking through, okay, what will make this person’s day better?

HomeCare: What about on the clinical side? And infection control? You were able to keep infection rates really low.

Kuebel: Let me just talk about that for a minute. It took different plans, developing models where, you know, you don’t want to expose 11 members of the care team to one person who may be infected. They came up with these very complicated algorithms, really, such as having one caregiver be assigned to all of the individuals in one housing unit. And that person would go in with an iPad, something as simple as that and would have eyes on the patient and the interdisciplinary team with Zoom or something like that. … That is how we kept people well in the community and how the team pivoted. … You know, I mean, you know, given the highly contagious nature of the virus, its long incubation period and airborne transmission, that is why you’ve had the fatality rates in congregate settings. And that is why we needed to keep people out of there.

HomeCare: What should home health and HME providers know about working with PACE? Or are there things about the PACE model that they might be able to apply to their business model?

Kuebel: Let me just make a very, very important point, and that is that 11-member disciplinary interdisciplinary team is employed by the pace organization. I think of concentric circles; the participant is in the middle of the circle and then that first outer band is the interdisciplinary team. And then the second band is our contracted providers. We contract with thousands of home health agencies; they are our secret sauce and we can’t do this by ourselves. (In terms of working with HME providers,) the beauty of the capitated model is we aren’t limited; we don’t have to get permission. If our team decides that somebody needs a rollator and they subscribed it, it’s not, this person needs to get authorization so she can maybe have it tomorrow. She is at risk. And so let’s get that over to her this afternoon.

 

 

 

 

Demand for In-Home Senior Care on the Rise

An increasing number of seniors are opting for in-home care over nursing home facilities as a safer option amid the coronavirus pandemic.

Below is a link to a piece that aired on October 21st, 2020 on Boston’s NBC News at 11pm on how PACE is a great alternative to nursing home care.

https://www.nbcboston.com/news/local/demand-for-in-home-senior-care-on-the-rise/2215480/

Coronavirus Disrupts Routine for Dementia Patients” includes quotes from Element Care’s physician Dr. Eric Reines. [Lynn Daily Item]

She used to see her daughter and grandson every Sunday, go to church, and even help cook dinner that night if it was a recipe she is familiar with. But there are no more visits, no more church, and no more trips to places like the grocery store due to the pandemic of COVID-19.

Lynn resident Sam is his wife’s caretaker. She suffers from Alzheimer’s disease and the resulting dementia, but, under usual circumstances, the couple maintains a sense of normalcy by having a routine. Sam did not wish to identify himself or his wife by name.

“It’s not so much that routine helps her memory, it’s more that it gives her joy, a sense that there are people that come see her and care,” Sam said.

Sam said his wife has barely left the house since the coronavirus outbreak, and he has minimized his trips out of the home because he’s worried about getting them both sick in their old age. He has made lots of phone calls to friends and family, and always gets his wife on the phone, but it’s not the same as the frequent in-person visits.

“She asks (where her daughter is), and she asks when she’s coming,” Sam said. “It’s sad to hear, and there’s no sense in saying, ‘I’m sorry, we don’t know when she’s coming back.’”

A lack of regular communication has been the most difficult of the COVID-19 pandemic for his wife, Sam said, and the rest of their days haven’t been that different than normal. They wake up around the same time each day, and do things in a very specific order. They get dressed, then eat breakfast sitting in the same seats they do every day, with the television always on in the background.

“It can get tough trying to figure out what the rest of the day is like. We are watching a lot on TV,” he said.

Dr. Eric Reines is a physician with the nonprofit healthcare organization Element Care, which serves the elderly throughout Essex County and northeastern Middlesex County, with four offices in Lynn, and other locations in Beverly, Gloucester, Lowell, and Methuen. Reines has provided geriatric care to dementia patients at their homes, at Element Care offices, and at nursing homes during his past 12 years with the organization, and said having a normal routine is critically important.

“Right now, it’s rough. It’s a heartbreaking situation,” said Reines.

Element Care’s day care services are closed right now, and visitors are not allowed at its nursing homes, except in extreme situations such as end-of-life visits. And, for the many seniors with dementia who are confined to their homes right now, they can’t have visitors like children and grandchildren to brighten their days.

“The biggest thing is family and loved ones can’t visit. We try to set up ways to Facetime or Zoom or Skype between people with dementia and their families,” Reines said. “Sometimes families will visit just to knock and wave through a window, but, on a case-by-case basis, sometimes that can be more upsetting than no visit at all.”

Reines said people with dementia may not understand why they haven’t been visited. It’s also difficult that caregivers are getting sick, and strangers will have to fill in, confusing dementia patients. For those with very poor memory, doctors may even suggest that caregivers tell a white lie.

“If the memory is bad enough, you can tell them, ‘They were just here yesterday, they can visit tomorrow,’” Reines said. “I don’t like to tell white lies, but sometimes that’s the better part of the battle.”

People with dementia staying inside are being given activities like watching TV, doing puzzles, and playing word games. Objects that are familiar to them, or pictures, can be helpful in keeping a small sense of familiarity in their lives, Reines said.

“Some (people) are getting listless, just lying in bed, depressed,” Reines said. “Some insist on getting more upset if they are being held back.”

Reines said “it’s not worth the fight” if a person with dementia gets extremely upset and needs to go out for a walk. He added they should be wearing masks, and even gloves and goggles — that can be confusing as well — and staying 6 feet from others.

“Really, routine is important. If whatever part of routine is something you can still maintain, do that,” he said.

There are so many “unknowns” when it comes to COVID-19, Reines said, and that also applies to dementia patients. It’s unknown how long the pandemic will last before their routines may resume, and it’s unknown if they will be affected long-term by the current lack of normalcy.

Making sure that people with dementia are as comfortable as possible, while also minimizing the possibility of them getting sick, is about all that can be done.

The Changing Face of Aging Well [Merrimack Valley Magazine]

The Changing Face of Aging Well

Boomers and the New Wellness Paradigm

Today’s baby boomers think differently than earlier generations about what it means to age well. They want to remain independent, stay mentally and physically fit and maintain a wide array of interests. At the same time, achieving optimal health is no easy task for many of them, especially for those on fixed incomes who are challenged by the high cost of health care. 

Many boomers and other older adults ponder, “How do I continue being me and doing the things that I love when my income drops, my network gets smaller and many health care options are beyond my means?” says Bruce Jankowitz, director of marketing at Element Care, a nonprofit organization that provides health care to low-income adults 55 and older in the Merrimack Valley through its Program of All-Inclusive Care for the Elderly (PACE). “Today’s older adults want the best of both worlds,” continues Jankowitz, “[They want] health care that helps them to stay independent and live in their homes and communities for as long as possible and cool activities so they can continue to do the things they love.”   

Over the last few years, Element Care has used the PACE model to address the changing needs and expectations of its clients. Participants joining the program have access to services that help them stay active. For example, participants can receive avatar home companions — electronic pets such as virtual cats or dogs that operate on a 4G network. These electronic pets play games with their owners, provide reminders to exercise and take medications and allow 24/7 monitoring for signs of distress.

“About 25% [of participants] are using the new technology,” Jankowitz says. “From keeping them happy and active to reminding them to take their medication, Element Care is adapting to a new generation of boomers.”

Element Care’s other programs include cooking classes; the PACE Olympics; Latino music, dancing, dominoes and food in Lowell and Methuen; and special events for the Cambodian New Year including past performances by the Angkor Dance Troupe. 

“The paradigm for aging well is changing and Element Care continues to innovate to engage older adults of all ages and cultures,” says Jankowitz. This commitment to innovation is on display at the PACE Element Care wellness center on Central Street in Lowell and at Ingalls Court in Methuen. There, an entire team of clinical and social service professionals proactively manage the health care of their participants. Element Care provides everything they need to age well, including primary, specialty, hospital and dental care; physical and occupational therapy; transportation to all medical appointments; and hosting activities that address the changing needs of older adults. There are no monthly premiums, copays or out-of-pocket expenses for those who qualify for Medicare and MassHealth. Medicare only and private pay options are also available.

There are other challenges that face boomers at any income level. Their generation faces an epidemic of obesity and diabetes. Alzheimer’s and dementia rates are skyrocketing. Increased traffic congestion in our area can make it feel as though the roads are less safe (although this isn’t necessarily clear from the data). And who knows what changes to our health care system will create unforeseen consequences as more and more boomers head into retirement?

Still, what matters most is that boomers seem unwilling to accept the old stereotypes about what it means to live and thrive in life’s later decades. How they, and we as a society work together to facilitate this process is a challenge we avoid facing at our own peril

Direct care workers are key to prompt action for long-term care patients with sepsis

[Betsy Lehman Center for Patient Safety]
Eric J. Reines, M.D.,is a practicing internist at Element Care in Lynn, Massachusetts. He specializes in geriatric medicine and sees patients enrolled in the Massachusetts Program of All-inclusive Care for the Elderly (PACE). The goal of PACE is to allow eligible patients who would otherwise need to live in skilled nursing facilities to remain in their homes and receive needed medical, social, recreational and wellness services. Dr. Reines serves as an advisor to the Massachusetts Medical Society’s Committee on Geriatric Medicine and on the Steering Committee that developed recommendations and toolkits recently released by the Massachusetts Sepsis Consortium.
The Betsy Lehman Center: Thanks to you and others, the Massachusetts Sepsis Consortium has developed recommendations for sepsis prevention and early recognition in post-acute care. There is now a great deal of focus on preventing and recognizing COVID-19. When it comes to long term health care settings, in what ways do the two concerns align?Dr. Reines: Indeed, there is synergy between practices to address both sepsis and COVID-19. The basic premise for people in long term care — the elderly, disabled or younger patients with multiple diseases — is to do all you can to prevent them from getting infections, such as influenza, pneumonia, pertussis and certainly COVID-19, on top of the health problems they already face. Everyone should take advantage of available vaccines and practice good health habits: washing our hands and coughing into our elbow, for example. Remember that sepsis is the body’s overreaction to infection. It’s not an infection itself, but avoiding infection also helps prevent sepsis.

Prevention is best; you want to do everything you can to avoid giving infections to people who are already ill.

To address COVID-19, nursing facilities must screen all professionals and visitors, if any, for travel history and current illness. At my practice and at PACE sites, we’ve been screening people at the door for flu symptoms every winter season. Prevention is best; you want to do everything you can to avoid giving infections to people who are already ill.The Betsy Lehman Center: There are some overlaps in the symptoms of COVID-19 and sepsis. When educating providers and staff about the need for quick action, is it important to draw distinctions between the two?Dr. Reines: The most important thing we can do is to encourage all caregivers to speak up when they notice changes that may signal infection or sepsis. Elderly patients often do not give the same signs that we see in younger people. It’s critical for direct care workers to be alert to changes in behavior or eating habits, to report what they observe to other clinicians and to feel confident that they’ll be heard. Whether changes signal early sepsis, COVID-19 or a different infection, caregivers who are in close interaction with patients — changing diapers, helping them eat and get dressed — are often the first to know. We must pay attention to our direct care workers who know our patients well, whether they be aides, nurses, family members or close friends; we must value them and listen to them. Changes in behavior may or may not be due to infection or sepsis; that’s up to a clinician to decide after evaluating the patient. The earlier we know there may be a problem, the better.

We must pay attention to our direct care workers who know our patients well, whether they be aides, nurses, family members or close friends; we must value them and listen to them.

The Betsy Lehman Center: Collecting meaningful data on the prevalence and progression of sepsis has proved a challenge in all settings, which can make it more difficult to focus resources on improving sepsis outcomes. Do you have thoughts on ways to underscore the importance of advancing sepsis care?Dr. Reines: I will say again that for patients in long term care it’s most important to recognize a change in condition and then evaluate the patient appropriately. Defining sepsis — which we must do to collect meaningful data — gets technical and arcane, even for physicians. Direct care workers, who play a critical role, don’t need to know how to diagnose and treat sepsis, which evolves along a continuum. It starts with an initial infection — say, in the bladder — that may spread to the kidneys and into the bloodstream. The body’s automatic response is sometimes helpful and sometimes, when uncontrolled, can result in sepsis.Recognizing and responding to signs of change early can help, but in the case of advanced sepsis, not always. It is not always possible to save people, especially if they have serious underlying health problems. There seems to be an acceptance of death when it follows a heart attack or cancer, but not following infection, which brings up another important topic.Everyone and especially those near the end of life should talk with their loved ones about what they would like done when they are not able to make their own decisions. As a physician, I want to be able to make the right decisions for patients and families. It helps to know the patient’s priorities and wishes. We should do everything possible to prevent and treat sepsis and also prepare for the difficult decisions that we sometimes face.The Betsy Lehman Center: You served on the Steering Committee for the Sepsis Consortium that produced the new report, recommendations and toolkit for sepsis identification. What are the most important takeaways from that work for your peers? Where should they start?Dr. Reines: First, I want to acknowledge the Betsy Lehman Center, and our project leader, Lisa Conley, for bringing the Post-Acute Steering Committee together and for polling providers to understand current practices. It’s an important topic, and I’m glad we were able to address it together.I come back again to supporting direct care workers, at home as well as in nursing facilities. They are the ones who will first notice that something is “off.” If they don’t understand the significance of their observations or don’t feel empowered to say something to a nurse or another clinician, we miss an opportunity to address problems early, when we can be most effective.The Betsy Lehman Center: The post-acute care provider community has also faced challenges when it comes to ensuring that all staff members get their annual flu shots. Do you see any signs that the current COVID-19 outbreak is raising greater awareness of the need for vaccination or infection control in general?Dr. Reines: The families and friends of my patients in nursing homes have accepted the order not to visit. This is heartbreaking, but they realize the necessity. All staff at our hospital are required to wear a surgical mask throughout their shift, and this rule may soon come to our nursing homes. The clamor for a vaccine against the coronavirus is making many rethink their objections to the flu vaccine. Regarding flu vaccine, I think we should work to better understand the socioeconomic factors that influence health and help our direct care workforce make good decisions for their own well-being, as well as the health of their family members, coworkers and patients. Long term care facilities are often understaffed, which is a big problem. Direct care workers receive low pay and often not much respect. They may feel they need to work while sick or have trouble accessing childcare during this difficult time. These are societal issues that impact health for everyone.

Find out how to get free health care for seniors over 55 [Brazilian Times]

Element Care is a non-profit healthcare organization with a simple mission: to help the elderly to live safely and comfortably in their homes and communities for as long as possible. Here are some questions that can help you learn about the program and how to benefit from it.

To read this article in Portuguese click here [Link to article]   by clicking this link, you will be leaving Element Care’s website and are going to a website not operated by Element Care.

We would like to know what services you offer to people in need of assistance by filling out forms to help them access free medical care.

Element Care’s PACE is a nonprofit healthcare organization serving North Shore and Merrimack Valley. It provides complete and highly personalized service to help people aged 55 and over to live independently, safely and comfortably in their homes for as long as possible.

If you qualify for Medicare or MassHealth and need assistance to apply for the senior care level, PACE at Element Care is Free ”, with no monthly premiums, extra payments or direct expenses. There are also options available for those who have Medicare only and for private payments.

Element Care has a specialist who can fill out MassHealth forms for you and a team to guide you through the application process.

Tell us a little bit about Element Care?
Element Care provides everything that those looking for us needs to stay healthy and independent in the community, visiting the doctor, nurses and the rehabilitation team at our wellness center – dental, hearing aids, glasses, access to care services as needed and more.

PACE at Element Care includes primary, specialized, hospital and dental care; physical and occupational therapy; transportation to all medical appointments and to the PACE Wellness Center, where you can see the service team and enjoy fun activities and meals; prescriptions at no additional cost and medical equipment, as clinically necessary.

Here are some other things that make PACE in Element Care special:
– Our doctors treat only about 150 patients (the average doctor treats about 2,000 patients). This way our doctors know everything about you.

– Our patients are usually seen by a doctor or nurse on the same day they become ill.

– We provide free dental equipment, glasses, hearing aids and medical equipment as needed.

– We offer fun wellness and creative programs, including our PACE Olympics, gym and exercise classes, Tai Chi, music, painting, bingo, Wii bowling and more.

– Participants can receive free medical companions per avatar. These virtual cat or dog games play music for our participants – and provide reminders for exercising and taking medication, as well as monitoring health 24 hours a day, 7 days a week.

What are the requirements that people need to get your services?
You are eligible for PACE at Element Care if:

– You are over 55 years old

– Live in our service area, which includes North Shore and Merrimack Valley in Massachusetts

– Want to live at home, but need enough assistance to qualify for the level of care in the nursing home

– You can continue to live safely at home, after being evaluated by our team of experts

There are also limits on income and assets that change over time; therefore, call 877-803-5564 for updated information.

Where can people find your services? Which locations?
Element Care provides services on the North Shore and Merrimack Valley with the PACE Wellness Centers in Lynn, Beverly, Gloucester, Methuen and Lowell. We have clinical and activity teams at each PACE Wellness Center, so you can see your doctor, nurse or social worker, do physical / occupational therapy, stay for fun activities and have lunch – all with round-trip transportation that is provided for you.

I know you have some workers who speak Portuguese. Are they available to help the Brazilian community? Are these services offered for free?
Yes. Portuguese interpreters are free and available to anyone who wants to learn more about Element Care.

After registration, interpreters are available during visits to the medical team and for activities in our Wellness Center. If live interpreters are not available, we also provide virtual interpreters in Portuguese.

If someone needs to ask for information and wants to speak to someone in Portuguese, is there a number?

Yes. They should call our information line at 877-803-5564 (TTY 711). Please mention that you speak Portuguese when you call and we will put a Portuguese interpreter on the line. You can also send an email to Element Care through our website www.elementcare.org and request a call back with a Portuguese interpreter.

 

A New Kind Of Friend [Lowell Sun]

Seniors, in the Merrimack Valley, are expanding their friendship avenues with a device that helps them with daily activities and helpful reminders. Developed by care.coach, a California based company, this device offers 24-7 support and interaction with an animated cat, or dog. To read reviews, and experiences from seniors, click here. [By clicking the link, you will be leaving Element Care’s website and are going to a website not operated by Element Care]

Technology: Helping Seniors One Day At A Time [Scripps TV]

Element Care’s Avatar program is a huge success! This device is operated by care.coach and helps seniors with medication reminders, socialization, exercise and more.  It is loved by participants and the staff.  Hear Their Story Here  [By clicking the link, you will be leaving Element Care’s website and are going to a website not operated by Element Care]