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Hilltown Archives — The Altamont Enterprise, August 5, 2010

Services are offered to but not forced on the elderly in Albany County

By Melissa Hale-Spencer

ALBANY COUNTY — About 1,600 people in Albany County get some kind of home care through the county, according to Patty Smith-Willsey, director for Adult Services.

This might include a personal care assistant who does anything from cutting food and giving baths to shopping, running errands, preparing meals, and doing laundry.

She has no way of knowing how many people may need help but don’t seek it. Smith-Willsey did say that calls for help are less frequent from the rural Hilltowns than from the county’s suburban or urban areas.

“I’m from the Hilltowns,” she said. “I know the Hilltowns are very closed about their people. They won’t call in. In more populated areas, we tend to get referrals. In the Hilltowns, they’re hidden. You’ll have even EMTs,” she said of emergency medical technicians who don’t call in referrals “that are hesitant because the people are alert; they’re oriented and they want to live that way.”

About a quarter of the 1,600 county residents getting home care, or 387, are in the Expanded In-home Services for the Elderly Program (EISEP), which serves people who are 60 and older.

Albany County plans to spend $2.5 million in 2010 on the EISEP program, with $1.2 million coming from the county, according to David Kircher, deputy commissioner of Social Services.

Referring to Michael Breslin, Kircher said, “The county executive a few years ago made it an emphasis; people would rather be in their homes and it’s fiscally more prudent.”

Breslin has advocated expanding home care for the elderly rather than constructing a new county nursing home.

Kilcher went on, “We’ve seen more people reach out. The county executive saw the need in the community and made it a priority to try and service everyone.”

If someone is eligible for Medicaid — the federal program to provide health care for the poor, which is funded by federal and state government — he is not eligible for EISEP, said Smith-Willsey. EISEP works on a sliding scale, based on income, she said, adding “It’s still cheaper than private plans.”

Countywide, there are 150 representative payee cases where Albany County manages an individual’s funds. “We pay for their rent and give them spending money,” said Smith Willsey.

There are also 190 people in the Consumer Direct program, which is funded by Medicaid. A county caseworker assesses a client’s needs — for example, 10 hours per week for meal preparation — and then the client is free to hire whoever he wants, such as a friend or neighbor, to do the job.

In addition to the 1,600 getting home care, there are 199 protective cases; of those 58 are guardianship cases.

The starting point for getting information on long-term care and services begins with a phone call to Albany County — NY Connects; the number is 447-7177. (See related story.)

“It’s an intake line to answer questions on aging and long-term care, manned by two caseworkers,” said Smith-Willsey.

Listening to the situation, the caseworker may decide an adult protective referral is needed or a home-care referral.

“If anybody has a concern about their neighbor, they should call,” urged Smith-Willsey. “Everything is strictly confidential. We can explore whatever programs meet their needs.”

Procedures and policies

Katherine Varin asked for help for her 93-year-old friend, Irma Garlock, who lives by herself in Knox. (See related story.) Varin became frustrated, saying the caseworker who visited Garlock “was more concerned about the old dog than the old lady.” She also reported that the caseworker said, “As long as she’s got a path from one room to another, that’s all that’s required.”

While both Kilcher and Smith-Willsey stressed that they could not discuss an individual’s circumstances or situation, they could speak in general terms about the kinds of help the county offers, and about the policies and procedures that are used to secure it.

Smith-Willsey did say of Garlock’s situation, “We can’t force help on her. We can only offer it.”

Smith-Willsey described the process used for adult protective referrals. “It’s available to anyone over the age of 18…They could be a multi-millionaire or penniless,” she said.

Three criteria must be met: they must have a physical or mental impairment; they must have an unmet need, which could be brought on by caregiver neglect or by self-neglect; and there must be no one willing and able to assist them.

“Then we do an assessment,” she said, which includes an unannounced visit to the person’s home “to get a true picture.” A variety of services can be offered, including home care, Meals on Wheels, and assistance with transportation.

“If we went into a home that doesn’t look livable,” said Smith-Willsey, a referral is made to the town and to the county’s health department. “They determine what has to be done with the house,” she said.

If the person’s house is deemed unlivable by the town’s building inspector and the environmental unit of the county’s health department, Smith-Willsey said, “We assist them if they need a place to stay…We would work with the client. If the person is alert and oriented, and has the capacity to make her own decisions,…we’re not able to force her to leave the house…unless these two agencies determine it is unsafe for human habitation. If the client lacked that capacity, we would take legal steps.”

Sometimes, a person will be temporarily disabled by, for an example, an infection that can easily be treated; other times, there is an ongoing problem like dementia, said Smith-Willsey.

“If people can’t care for themselves, Adult Protective would make arrangements to make sure that person is kept safe,” she said. “If she can get around and make her own meals, she might be placed in a shelter until a permanent housing arrangement is found. Someone with severe dementia can’t manage in a shelter and we would make arrangements to put them in a local hospital if there wasn’t a family member to take them.

“If the person is unsafe at home, we would do whatever we had to make them safe.…We would contact the police; the police would make the decision to take the person to the hospital.”

Adult Protective Services would then have a psychiatric evaluation done, said Smith Willsey, to determine “the functionality of the client.”

If it were determined a person could not look after herself, Smith Willsey said, guardianship proceedings would begin.

If a house is found to be structurally sound and is difficult to live in because of extreme clutter, Smith-Willsey said, “We might get someone in to do a mass cleaning of the house.”

Asked how such a clean-up or other services would be paid for, Smith-Willsey said, “If the client has money, we would expect them to pay.” If not, there are programs available through the Department of social Services, she said.

“We would have to do a review of the financial situation to see if she met the criteria,” said Kircher.

If a client owned her own home, Kircher said, “We would probably have to require her to sign an agreement for a lien to be placed on the home to recoup any expenses incurred.”

Asked about a process of careful and sensitive sorting of an elderly person’s treasured belongings from the trash that had built up over the years, Kilcher said, “That sounds like friends and family and concerned neighbors that would take that type of time to assist a person.”

Even if there is lots of clutter, Smith-Willsey said, “If a house has clear pathways, that’s like a sign it’s OK. It might not be what you or I would want to live in. It’s like a standard, like running water,” she said.

She stressed, “The client decides what help to accept and whether or not to accept help at all. We can’t force any services on someone who has mental capacity,” she said.

Smith-Willsey contrasted this with Child Protective Services, concluding, “Adults have the right to live the way they want to live.”

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