Institute Talk: A Conversation with Lisa Gurgone on Supporting Area Agencies That Provide Elder Services

Lisa Gurgone is the executive director of Mass Home Care, the trade association representing the Commonwealth’s network of 28 Aging Services Access Points (ASAPs) and Area Agencies on Aging (AAAs). This single, statewide network of coordinated care delivers home and community based services to over 60,000 individuals per month, providing over $600 million per year in services.

Gerontology Institute Director Len Fishman spoke with Gurgone recently about home care services and how the COVID-19 pandemic has affected both consumers and workers providing care. The following transcript has been edited for length and clarity.

Len FishmanLen Fishman: What would a composite profile of a consumer you serve look like?

 

 

 

Lisa GurgoneLisa Gurgone: The typical age is 82 and about one in five are 90 or older. About 55 percent live alone. We have a lot of women with basic homecare needs, someone to help with shopping and food prep. They may need some bathing assistance or have trouble getting dressed in the morning. People sometimes stay in our system for a very long time and may need additional services as they age. We might sub-contract with a visiting nurses association to provide more skilled care. It runs the gamut but the goal is to help these people stay in the community as long as they want.

LF: I understand that about a third of the people you serve would qualify clinically for nursing home care. So these are people whose needs for assistance to remain independent are pretty substantial.

LG: We’ve been fortunate that our Commonwealth has put services in place that allow us to provide nursing home level care in the home. Through something called the Community Choices program, we can provide as much services as someone needs in the home, if that’s their choice. Those individuals do need to qualify for Medicaid, but it’s obviously a less costly alternative because that person would’ve been in a nursing home. We provide emotional support to caregivers as well. That’s a big area.

LF: Let’s say I’m a family member calling you on behalf of my 88-year-old mom. After talking with me, it’s clear she needs assistance with several activities of daily living and would qualify clinically for nursing home care. I am now just exhausted trying to provide care or I’m moving to another part of the country. What might you offer someone like that?

LG: We start with a person-centered planning process. We assess the consumer and the home, but we also want to recommend the level of service that person is ready to accept. Initially, people are much more likely to take meals and basic homemaker or cleaning services. Personal care can involve bathing, dressing, washing their hair. Often we gradually add services. We can also offer mental health supports. We can offer chore services and help install a grab bar in a shower or authorize heavy cleaning, especially with COVID right now as people come back from hospitals.

If you want to help mom better control a chronic issue and become more self-sufficient, we could enroll her in an Evidence Based Program, which actually teaches people how to best manage their own needs. We’re beginning to offer a lot of these programs virtually now with COVID.

We try to make connections with community resources like the Councils on Aging because we don’t want people to feel isolated.  That is more difficult with COVID but some are offering virtual services and Zoom groups. Our staff are now making regular check-in calls with all consumers as well.

LF: What are the new obstacles that ASAPs face in serving their clients because of COVID-19 and how are they trying to overcome them?

LG: The biggest obstacle is the fear people have of becoming infected with COVID-19. We have seen a 28 percent decrease in new enrollments. Consumers are calling ASAPs and saying, “I want to hold off on my services right now because I just don’t want a lot of people in the house.” That’s obviously valid, but it’s also concerning. If someone does suspend services, we’re calling them on a weekly basis to make sure they’re okay. I heard a story today where a nurse was doing her weekly call. The number seemed to be going to voicemail and then the woman picked up and said she couldn’t breathe. They ended up calling 911 and really did save her life.

LF: What about meals?

LG: Demand has increased dramatically.  Some sites have seen a 50 percent increase in requests for meals. That is actually one of the areas where the federal government has been very supportive in the Families First Coronavirus Response Act and the Cares Act. The Commonwealth had received about $15 million in additional dollars for meals through Meals on Wheels. So we have seen good funding from the federal government for meals.

LF: How is the actually delivery being handled?

LG: The meals programs have really focused on contactless delivery, they’re not actually handing the meal to the person but they’re leaving it at the door. They still have to actually see the person and check on them, because we want to still have that connection. If we don’t see them, we are calling them or making sure that they see the meal.

LF: You mentioned the significant decline in active clients because they are trying to avoid contact that might lead to infection. Are you experiencing decline in your healthcare aide workforce for the same reason?

LG: ​We are experiencing a bit of decline. We actually surveyed homecare agencies to see why. The two top issues that came out were childcare and the idea of coping and making sure they didn’t contract the illness. Home care aides are certainly part of the frontline workforce and at a very low wage, so there’s always concern about having enough workers.

LF: What has been the evolving situation concerning personal protective equipment for home care workers?

LG: In March, when things were so in flux, there was a lot of focus on making sure hospitals had enough PPE. I think our state Elder Affairs secretary and staff worked really hard to make sure we [home care workers] were no longer at the bottom of the list. Now we’re included in the documents that identify essential workers. Moving forward, we know our network will need PPE for a very long time. We’ll need masks and gloves for every visit. We’re trying to figure out other supply chains, we are still hearing it’s much more costly than it was three months ago to get masks.

LF: We’ve been hearing from people who work on domestic violence or child abuse that there has been a decline in calls to call centers which is not necessarily a positive thing. Can you tell us what’s going on with elder protective services?”

LG:  That is one of the areas where we are still doing visits. We’ve moved to a lot of telephonic visits for assessments, but certainly with Protective Services that has to happen in person. So, we are still active in that area.

I heard a great example recently.  A Protective Services case manager wanted to check in with the consumer. The consumer wanted to talk about their situation but was not comfortable speaking with the worker over the phone or through a virtual platform. So, they decided to meet up in a parking lot, parked next to each other and talked through the car windows. It was just a good check-in because they were very concerned about this person.

LF: How do people get in touch with your network if they need help of any kind?

LG: Anyone can go online to www.massoptions.org, where there are resources and referrals to all of the programs. There is also a phone number, 1-800-243-4636. The MassOptions hotline is staffed Monday through Friday, 9 AM to 5 PM.

 

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