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Monday, July 07, 2008

Word To The Wise: Speak Up Or Nothing Changes

By E.A. Roberts

Recently I had the opportunity to attend the Open House given at Atria Covell Gardens, an assisted living facility for seniors. Its purpose was to showcase the new double occupancy suites, which were created as a result of resident complaints. Rent increases for this residential care facility for the elderly (RCFE) jumped to as much as 16% over a two year period, a drastic spike in price. What ensued is a prime example of democracy in action.

Oddly enough, the Davis Senior Citizens Commission just so happened to have one of their regular off-site meetings at Atria Covell Gardens last winter. Without knowing what was coming, commissioners convening the session were greeted with a firestorm of protest. Atria Covell Garden residents had just received word of an extreme rate hike in rent and services the evening before. This feisty group of seniors were infuriated, and let the commission know just how they felt.

Our advice as a commission was for them to complain long and loudly, with Letters to the Editor of the Davis Enterprise, or to the Davis Vanguard, as a way of obtaining publicity for their cause. We also suggested contacting state and local legislators. There were also talks with the company that managed the facility as well. All avenues were sought for redress, including the state licensing board. Just about anyone who was in any way connected with the situation was contacted by these angry seniors.

The result was not only several different bills now wending their way through the legislature having to do with notification of rent increases at RCFEs. In addition, Atria Covell Gardens has made changes to several single suites to accommodate two persons in a shared arrangement - to cut costs for those of lesser income. More of these units are planned there for the future. Had the seniors in residence at Atria Covell kept quiet about their predicament, then nothing much would have changed.

Instead a private company has been encouraged to make necessary alterations to keep competitive with the current market. The fact of the matter is that Atria Covell Gardens represents the only sole RCFE in the city of Davis. University Retirement Commons is the only Continuum of Care Facility (Independent Living Facility; Assisted Living Facility; Skilled Nursing Facility; Alzheimer’s Unit all in one) within town limits. In consequence, these two facilities have virtually no competition, and have been able to charge prices at a rate that is as high as whatever the market will bear.

However, because of the complaints about the sudden, drastic rent hikes at Atria Covell Gardens, there has been the introduction of new legislation which may warn of perceived price gouging. There has also been talk of building another lower cost assisted living facility, for middle income older folks. Both of these factors surely played into management’s decision to devise a way to create more affordable units at Atria Covell Gardens. High praise goes to the seniors that spoke out against their financial predicament; and to private enterprise for coming up with a creative solution! It may not be the perfect solution, but it is a start in the right direction.

Legislation Pending:
  • AB 2101 Author: Wolk [D]; Title: RCFEs; rate increases
Requires RCFEs to develop emergency plans, give residents advanced notice of rent increases, and give prospective residents information about rate increases over the past 5 yrs.

  • AB 2370 Author: Bass [D]; Title: RCFEs; rate increases
Requires RCFEs to disclose annually to current residents their average monthly rate increases for each of the previous 3 years, to be posted near the entrance to the facility and provided to any prospective tenant upon request.
CA Commission on Aging Public Hearing: Health Access for Older Californians

The California Commission on Aging (CCoA) held a public hearing in Yolo County, on the topic of health access for older Americans in rural areas. CCoA is an advisory body to the governor of CA on senior issues. Its 25 members are appointed by the governor, Senate Rules Committee and Speaker of the Assembly. They serve as volunteers, for up to two three year terms.

Our own Dave Soto, of the Area 4 Agency on Aging, pointed out that his organization encourages:
1. A multi-disciplinary approach;
2. Disease and injury prevention;
3. Home-centered services;
4. Transportation options;
5. Technological innovation.
Dawn Purkey of Yolo Adult Day Health stressed the following:
  • Age distinctions should be made when providing services, because the needs for each age group can be so different, e.g. 65-75, 75-85, 85 and above;
  • Service providers need to be protected with programs like respite care;
  • Caregiver assessment tools should be developed;
  • Nontraditional models of caregiving should be tried;
  • Volunteerism should be encouraged.
Nancy Guenther, the Program Manager of the Office on Disability and Health, CA Dept. of Public Health, Injury Control Section advised as listed below:
  • Transportation networks; more transportation options;
  • Mobile units to dispense healthcare;
  • Use of new technology, e.g. videophones; internet interactions
  • Care calls to check on isolated seniors;
  • Health promotion visits;
  • Universal fund, paid by doctors, for language interpreters
Teri Boughton, Senior Program Officer for State Health Policy, CA HealthCare Foundation advised:
  • Allowing greater independence of nurse practitioners;
  • Align licensing requirements with the military, to encourage retired military medical personnel to practice in rural areas;
  • Raise reimbursement rates for Medicare and Medicaid, to encourage doctors to take more low income patients;
  • Encourage development of telemedicine by remote technological devices
Then questions were invited from commission members and the audience. Suggested solutions for improving access to healthcare in rural areas included:
  • Retail medical clinics, as long as there was integration with more comprehensive care;
  • Great ideas are funded through local, state and federal grants; volunteerism; and operating on a shoestring budget;
  • Recruitment of physicians (especially geriatric physicians) with: debt forgiveness as an incentive; and develop hospital districts;
  • Mobilization of resources to come together to meet senior needs, e.g. use of Fish & Game airplanes to medivac rural patients to urban trauma centers, recruit both Vets with medical experience and retired physicians; physicians should tithe 10% to public clinics; medical networks need to work outside the Medicare/Medicaid system, e.g. by municipalities paying doctors to come back on occasion and provide services;
  • National Health Services Corp - education is paid for if recipient doctor works in rural area for a period of years;
  • Provide more transportation options;
  • Push for universal health coverage;
  • Provide more public education on available services;
  • Have sliding scale with respect to fees charged for accessing services.
In proposing transit mobility training as a possible solution to get seniors to their medical appointments, I was lucky enough to be informed by a commission member that he was aware of Yolo County’s grant application to Caltrans for this teaching project. Transit mobility training instructs seniors how to use public transit, so they are not in fear of getting lost or stranded. It will assist them in using public transit to get to a doctor‘s office or medical clinic, by starting them off with group training for a social event. An out-of-service bus is utilized to take a cadre of willing senior citizens by the hand to the local downtown area for lunch, or the movies.

This program is being developed by the Triad Task Force of which I am Chair. Triad is the action arm of the Yolo County Commission on Aging, chaired by Mariko Yamada. The transit mobility training project is being facilitated in conjunction with a private company. Paratransit Inc. already provides this type of training in Sacramento County, so Davis Senior Citizens Commissioner Tansey Thomas and I asked them if they would be willing to expand their services into Yolo County. JD Culver and Kevin Walch of Paratransit Inc. were delighted to oblige! A pilot project would begin in Davis, and expand to encompass as much of Yolo County as possible.

I also mentioned to the CCoA some other projects in Yolo County that Triad has either completed or is in the works:
  • Rebuilding Together - a nonprofit organization that provides safety devices in the home, such as grab bars, wheelchair ramps, smoke detectors, custom railings, toilet risers, etc., regardless of income status.
  • Caregiver Registry - to provide trained caregivers to those seniors not wealthy enough to afford private pay services, but too wealthy to qualify for gov’t subsidized in-home supportive services.
  • Proposition 63 funded mobile assessment team known as the Yolo County Older Adult Program - to assist seniors in crisis.
  • Triad Task Force, a community-based organization willing to take on projects that assist seniors.
  • Building Bridges - an elder abuse prevention program, which is key to the protection of older adult health. Once a senior has been abused, either physically or financially, it begins a downward spiral that often results in the death of an elderly person.
Finally, I noted the need for elder abuse prevention, as key to the protection of older adult health. It was pointed out by me that once a senior has been abused, either physically or financially, it begins a downward spiral that often results in death.

Lesson to be learned: Speak out, or nothing will change for the better. Volunteerism, creativity, and a willingness to address problems are the solutions to a better life for senior citizens.

Elaine Roberts Musser is an attorney who concentrates her efforts on elder law and aging issues, especially in regard to consumer affairs. If you have a comment or particular question or topic you would like to see addressed in this column, please make your observations at the end of this article in the comment section.