02:50 PM EST on Tuesday, January 24, 2006

Frank the moderator: Today at noon, our guest will be clinical social worker Susan W. Graefe.
Graefe, in private practice in Warwick, works with older adults and their families on the issues of aging. Her expertise focuses on coping with emotional and physical illness, care giving, loss and bereavement, and accessing long-term care services. She is an adjunct faculty member of the Rhode Island Geriatric Education Center at the University of Rhode Island and has been a mental health consultant to many R.I. agencies serving older adults.
Send in your questions now.

Tracy Breton: How big a problem is self-neglect with RI's elderly?
Susan W. Graefe: I believe that self-neglect is a serious problem. Many people who are self-neglecting have been self-neglecting prior to turning age 65. As a person ages, they often develop cognitive or mental deficits which make it difficult for them to function even at the level of their previous neglecting behaviors. In my work with older people, I find many who have had untreated emotional illnesses which now contribute to their self-neglect. Self-neglect may be manifested as hoarding behaviors, lack of medical care, not keeping clean, not paying bills which result in attention by public agencies.

Tracy Breton: Most elders want to remain in their homes until they die. They want to avoid going into a nursing home at all costs. But this may not be appropriate for them. What are the benefits of moving from home into an assisted living facility or nursing home?
Susan W. Graefe: A transition to a nursing home or an assisted living facility is very frightening for an older person. There is concern about a loss of independence and freedom and how they live their lives. Many older people become isolated in their homes due to physical limitations and diminished mental functioning. They may also have become unable to provide adequate nutrition for themselves, have lost the ability to take their medications properly and are unable to care for their homes or apartments adequately. The benefits of moving into an assisted living facility or nursing home are receiving adequate nutrition, medication monitoring and overall health-care supervision. The person is also exposed to socialization opportunities which enable them to function at their maximum physical and emotional capacities.

Tracy Breton: What can a family member do if they think a parent needs help?
Susan W. Graefe: The first thing is to have the older adult evaluated by a geriatric specialist who can access the individual's level of functioning and make recommendations to the family about resources in the community which would help the individual maintain the ability to either stay in their home or access the need for more supervision in assisted living or a nursing home. There are a number of geriatric assessment programs in Rhode Island, including Roger Williams Medical Center, Miriam Hospital, Butler Hospital, Rhode Island Hospital and Eleanor Slater Hospital. A geriatric assessment involves a team of professionals including a geriatric physician, a geriatric nurse, a clinical social worker and a neuropsychologist. That's what you would find at these facilities. A family needs to assess to what extent they can provide support services to their parent or loved one. This often involves the necessity of a meeting which includes as many family members as possible who are willing to be helpful. Friends and neighbors can also be part of a support team to assist an older person. Do a background check on them first. Older persons are often reluctant to ask family members for help. No one wants to be a burden to their loved ones. It's very rare that there's an older person who initiates the cry for help.

Tracy Breton: Can someone find a home in an assisted living facility if they aren't wealthy?
Susan W. Graefe: Yes. The State of Rhode Island has a program which finances a certain number of assisted living beds which are paid for with Medicaid funds. This program can be accessed through the Rhode Island Department of Elderly Affairs. There are a limited number of beds though. The assisted living beds are in a number of different facilities located throughout the state.

Tracy Breton: What can a family member who lives far away do if they suspect a parent is being exploited or abused by a sibling or caregiver?
Susan W. Graefe: Contact the police department in the community where the parent lives and hire an elder-care specialist who is an attorney. It is extremely important that you be on the scene with your parent to check to make sure that they are getting the necessary services. It's also important that you be in telephone or email contact with the professionals who are caring for your parent. Communication is the key to ensuring that there will be adequate service. There are also clinical social workers and nurses in the community who provide private case management services. You can find one of these providers by calling Aging Network Services at 301-986-1608. There also is something called an Elder Care Locator at 1-800-677-1116.

Tracy Breton: What's your sense of how well the state DEA operates?
Susan W. Graefe: Historically, there have been many problems in the administration and delivery of elderly, abuse and self-neglect services. When the laws were written, there were no teeth to enforce them. The Department of Elderly Affairs is limited by being able to offer services but they do not have the legal authority to force people to accept the services. The quality of the DEA staffing is variable. In some areas of the state, there is more success in assisting older adults than in other areas of the state. I would also say this is very difficult work and under the best of circumstances, it can be discouraging for those who do these investigations. There's a high degree of burn-out. The HIPPA laws have made it difficult for easy communications to take place between the department social workers and other helping professionals.

wiegandr: Is the new Part D for Medicare helping or hurting the elderly?
Susan W. Graefe: The new Part D for Medicare is a disaster. Neither the older persons involved nor their caregivers can understand the complexity of this new plan. Professionals in the community are equally confused and find it difficult to advise their clients and patients about the best plan. That's all I can say about it. It's a disaster.

talk: What are some signs of depression that family members should look for with older relatives? My special circumstance is that my older relative lives far away and most of my contact is through phone calls and emails. Any tips that you can offer would be great. Thanks
Susan W. Graefe: I would be sensitive to any changes in sleep patterns, either complaints of not sleeping or an awareness that the person is spending much of their time in bed. Has the person changed their eating habits? Are they losing or gaining weight? Is the person complaining about being depressed or sad or tearful? Has the person lost interest in the activities that they were used to participating in? For example, have they stopped playing bridge? Have they stopped going to church? Have they stopped gardening or fishing? Is the person showing any signs of memory impairment? Are they forgetting to pay bills, keep doctors' appointments or lunch dates? These can all be signs of depression and often when treated by a mental health professional, they can clear up. It would be most helpful if you could make a visit to access the situation first-hand or hire a private practice case manager to make that assessment.

Tracy Breton: How does loneliness play into elder exploitation?
Susan W. Graefe: Older persons who are isolated in their homes or apartments are very vulnerable to financial exploitation. As a result of their loneliness and fear of abandonment, they often give money to people who they believe will help them out or who will provide socialization for them. This can take many forms. It can be a telephone solicitation with someone selling something. The older person chats with this person on the phone and the next thing you know, the older person is sending money to some stranger in another country or has given their credit card number or bank checking account number to a stranger who then empties their account.
This can also be a lonely person who gets caught up in trying to win sweepstakes. They are asked to send in $20, $29.99 or $49.99 to ensure that they will win hundreds of thousands of dollars. In fact, they are sending money to receive bogus numbers that do not even enter them in sweepstakes. Older persons who are feeling financially stressed are particularly vulnerable to the sweepstakes solicitations. These solicitations also help the older lonely person feel important and noticed.
I've just discovered a friend who has been bilked out of $3,000 in the last seven months.
And this woman doesn't have much money.
It is important to be very cautious about who one gives money to for services because there are many people who are ready to take large sums of money for providing ensured companionship or the promise that the older person will never have to go to assisted living or a nursing home.

Tracy Breton: Many seniors turn over their assets to friends or family members because they think that by doing so, they can avoid having to pay for costly nursing home care and leave more in their estates. Do you think this is wise?
Susan W. Graefe: When older persons turn over their assets to family members or friends to avoid paying for nursing home care, they are jeopardizing their potential for getting into a good nursing home. People who have assets are much more likely to be accepted by good nursing homes. If a person tries to get into a nursing home as a Medicaid patient, they often end up in sub-standard facilities that are located in remote areas of the state. Having assets is a bargaining chip for the best nursing home or assisted living care.

Frank the moderator: Thanks to Tracy Breton and Susan Graefe for the insightful discussion.