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O M M U N IT Y p O R U M views of readersA P I on T n hToon T 'ho Pnrcrwt n l TV* * J L M . I ^ V V I J L V / 1 1 V / 1 / J %u00a3 S JL------------------ f %u00ab /% %u2713 J L X ^ l k J X S I l \\ A l JL1 1 s ~ > kl / W C / lIV,1 f t %u00bb %u00ab / lV / U / c1 7 %u00bb %u00bb^ V !/ I yr/ cu C / i m / wU C tllK/ti f i r r / i n nl OBY CAROL BERKVJSTHeights and Hill Community Council is acommunity-based agency. Our staff of fourfull-time social workers and more than 20para-professionals offers a full range of services for the frail elderly, including counselling, entitlements assistance, escort service,drop-in centers, meals-on-wheels, and personal care. DFTA has attested to the effective service we have provided to our localcommunity, for fifteen years.Only about 25 percent of the population weserve is eligible for Medicaid, so we werepleased to learn that New York State is proposing to expand in-home services for thelarger groups. But on the basis of our experience, Heights and Hill is absolutely opposed to both central intake and central casemanagement of in-home services to the frailelderly. It simply will not work.New York is a city of neighborhoods. Anumber of studies carried out by governmentagencies have shown that senior citizens areparticularly attached to their neighborhoods.They look for all their needs to be met there%u2014 whether they require groceries, drycleaning, a library, a hot meal, or a place toworship. Like most elederly people, those inour area are not willing to go outside theirown neighborhood, and they are distrustful ofstrangers coming to them.When an elderly resident of our community, let%u2019s say a Mrs. Jones, has been ill or forsome other reason needs some help, she callsHeights and Hill, or a neighbor does so forher. She has known about us for years, andalmost certainly has friends that we haveworked with. So, she isn%u2019t intimidated, butrather feels that she is entitled to ask for ourhelp.On the basis of that one phone call, Mrs.Jones promptly and simply gets her meal, orwhatever immediate service need has led herCarol Berkvist is vice president for programs of the Heights Hill CommunityCouncil and is a professional socialworker. This article is excerpted from hertestimony before hearings of the NYCDepartment for the Aging on Nov. 12 aboutN.Y. State Expanded In-Home Services forthe Elderly Program (EISEP).to call. Then, our social worker will drop by,and, treating Mrs. Jones with respect, willprofessionally assess the situation, aided bylocal knowledge and the fact that Mrs. Jonesis comfortable with Heights and Hill and iswilling to trust our staff. Our social worker isthen able to pull together all the resourcesnecessary to assist Mrs. Jones and stabilizeher living arrangements.As we understand it, under the proposednew central intake, a remote, impersonalassessment will be involved. Mrs. Jones isfrom a group that is accustomed to beinggivers, not takers. It took great courage tomake a single call to ask for help, and it isvery hard for her to discuss her personalsituation with a stranger on a telephone. Provision of service may be slowed down or maybe denied because she is reticent about herneeds or finances.If Mrs. Jones is in a frail state, eitherphysically or mentally, and most of ourclients are, she is all too likely to becomediscouraged and give up on trying to get help.She may try to cope on her own, while hercondition becomes worse. She may fallthrough the cracks that inevitably come withbureaucratic structures, however well intentioned. Worst of all, Mrs. Jones may end up ina hospital or nursing home because she didn%u2019tget the help she needed on a timely basis.The proposed new regulation also calls forthe centralization of case management andthe separation of case management fromdirect service. On paper, they may make acertain amount of sense. In practice,however, in our experience, they will notwork.Under DFTA, recent request for proposalsfor homecare for administrative reasons allhomecare workers must be assigned in fourhour blocks to individuals, this requirementmust not be extended to all homecare ...Our agency has one personal care workeron our staff, for 25 hours a week. We try touse her effectively, in conjunction with providing other services through other staff, orthrough referrals to additional programs. Iasked our acting director to tell me whatSusan%u2019s typical weekly schedule would include, and I want to share that list with you.Susan visits an aged cancer patient in anSRO, bathes her, cleans her room and shopsfor medicines. In the same SRO, a diabetic,arthritic patient is bathed and helped with ashampoo. For another arthritic, homeboundclient, this one in a small apartment, Susanshops, does the laundry, cleans the bathroomand changes linens.Our agency has a satellite program at theYWCA. Our personal care worker sees threeroombound clients there, doing laundry andcleaning their rooms. She bathes a bedboundlady who suffers from osteoporosis and provides general assistance to a client whosebroken leg is in a full-length cast.In a 25-hour week, Susan sees 13patients, none of whom areMedicaid eligible. We think thisis a very humane and costeffective service, and we wouldlike to be able to expand it.In Cobble Hill, Susan works with one elderly, homebound client, doing shopping andlaundry and giving sponge baths. She escortsanother client to Long Island CollegeHospital for weekly medical care.On another day, she helps the wife of an80-year old diabetic man with a leg ulcer totransfer him to a wheelchair and teaches thewife how to handle the wheelchair so he canget out of the house.In another SRO, she bathes and shampoosthe hair of a 90-year old woman who is bedbound. She changes her linen and clothingand does the laundry. She also gives a spongebath to a woman in her eighties, helps her todress, and helps her to use a walker to getsome exercise.Susan regularly sees a bedbound man,bathes him, changes his linen, shaves him,and trims his hair when necessary. She thencleans his room and gives his wife, who hasmild dementia, simple instructions on how tocare for him until her next visit.On an as needed basis, she providesemergency assistance %u2014 a sponge bath for apatient recently discharged from a hospitalwho has dressings that can%u2019t get wet, a lessonin how to use a walker or how to get out of atub for a client recovering from an injury.During all of this, she walks through theneighborhood, a visible and recognizedrepresentative of our agency.In a typical 25-hour week, assigned bysocial workers who know their clients well,Susan sees 13 patients, none of whom areMedicaid eligible. We think this is veryhumane and cost effective service. We wouldlike to be able to expand it, and we feel that ifEISEP were structured differently, we could.We feel strongly that the service provideris a vital part of case management andshould not come from a separate agency. Allof our direct care workers have been trained%u2014 under a grant from the NYS Departmentof Mental Hygiene %u2014 and are sensitized topick up and report minor signs of growingproblems or decreasing function. We areproud of them for their close monitoring ofclients and their calls for professional intervention before a crisis occurs. Such actions, which are vital in maintaining thequality of life of our clients, only take placewhen the direct care worker interacts withthe social work staff on a regular basis andknows himself to be a vital part of the team.We are opposed to the current EISEP proposals for centralizing access and casemanagement services because, as I have justillustrated, we believe community-based programs are effective. We are opposed to thearbitrary separation of case managementand service provision, because uniting themavoids potentially disastrous gaps. We would,however, have no objection to a centralized,possibly computer-linked monitoring of recipients. We would be pleased to tap into aborough-wide directory of available services.We welcome the decision of the StateLegislature to expand in-home services to thefrail elderly who do not qualify for Medicaidfunded programs. But we believe these services can most effectively be providedthrough community-based agencies that canprovide direct service to their neighborhoodseniors, with case management from professionals who are sensitive to individual needsand who can, on the basis of close knowledge,deploy their staffs most appropriately.F ed eral, S ta te and C ity le g is la to rs and le g is la tiv e a id e s g o t a p eek at w h a t%u2019s h ap p en in gat th e B ro o klyn C h ild re n %u2019s M u s e u m on N ov. 13 at a s p e c ia l b rie fin g an d to u r. A bove, Flatbush A s s e m b ly m e m b e r R h o d a J a c o b s (cen ter) is sh o w n a cu d d ly o b je c t fro m th em u s e u m %u2019s c o lle c tio n o f m ore th a n 40 ,0 0 0 o b je c ts by D ire c to r M in d y D u itz as m u seu mtru s te e C a ro ly n D o ttin B eck lo o k s on. M u s e u m P res id e n t P ete r E ik e n b e rry (b elo w ) lead sth e o ffic ia ls th ro u g h th e m u s e u m %u2019s u n iq u e tu n n e l e n tra n c e , a c c o m p a n ie d by boardm e m b e r J o a n n a D ean. (H u rley P h o to s)low income tenants and homeowners. Steinsays %u201cthe new law will make a big differencefor those on fixed incomes struggling to makeends meet.%u201dThe new law will permit income-eligibleseniors to apply for tax abatement certificates if they are homeowners or seniorcitizen rent increase exemption certificatesexempting them from most maximum rentor regulated rent increases if they arerenters.Under the new law income eligibility levelswill increase from $10,500 to $12,025 for seniorcitizens, who are 62 years of age or older. Theeffect of this provision, Stein said, %u201cis moreseniors will now be able to benefit from theprogram.%u201dSeniors Need FundsDowntown Brooklyn City CouncilmemberAbe Gerges has introduced legislation thatwill increase the income levels exemptingsenior citizens from rent increases. Currently, the net household income for seniors cannot exceed $10,500 per year and Gerges%u2019 billwill raise it to $12,250. The terms would takeeffect immediately and would be retroactiveto Aug. 2.Lambda Dems to MeetShow Is f.Bazaar9T f t a p u i i o u a & a a i , a n e w s i i u t r o i i u vby the Center For Defense Information, wilbe featured at a Flatbush SANE forum oiSaturday, Dec. 13. The show covers tradishows conducted by business corporation:for the Pentagon and will be presented an