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The elder care conundrum

Christine Stanley
Photo by Ryan Salm/Sierra Sun Carmen Zirelli, Laura Horman and Jim Calhoon play Bingo with other residents of Tahoe Forest Hospital's extended care center on Tuesday.
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Social services and community outreach programs in Truckee and the North Shore pour countless hours and dollars into the community every year. But there is a vulnerable group that is under served: the more than 4,600 seniors in the region who are doing their best to age and die with dignity, but without the option of assisted living. Assisted living facilities that offer watchful eyes around the clock, companionship, activities and daily aid are non-existent in the area. And while they can be enormously costly for both the providers and residents, area elder care professionals say that the need and demand for such options are not only large, but growing. “We recognize the needs for different levels of care that are not provided in this community,” said Melanie Kauffman, executive director of Truckee Tahoe Seniors Council, which runs the lone senior center in the region. The center only offers independent living options. “For the last five years, the need for assisted living facilities in this area has kept coming to the surface, but no group or investor has been proactive in purchasing a building,” Kauffman said.Geriatric care isn’t a burning issue in the region, but as baby boomers enter their golden years, the issue of elder care will continue to rear its head, not only in the Tahoe area but across the country. “When the baby boomers come of age a couple of things are going to happen,” said Bronwyn Calkins, director of the Tahoe Forest Hospital Home Health Department. “There is going to be a need for care givers to provide care in the home; there is already a shortage of nurses that is only going to get worse. And yet, right now the government is making cutbacks in home care.”Extended careSeniors with serious health conditions who require medical assistance and can no longer live on their own have the option of entering the extended care center at Tahoe Forest Hospital. It is a wing of the hospital used primarily for permanent live-in patients receiving end-of-life care. Residents live one or two to a room, eat meals together, attend planned activities, and have 24-hour access to the general hospital.

While the option is a good one and is covered fully by MediCal and Medicare, it is often a difficult choice for seniors to accept. For starters, the waiting list for one of the 35 beds is long and constant. The setting is institutional, with beds separated by curtains. Some patients are not old at all, but are severely disabled by multiple sclerosis or other difficult diseases.There is no carpet or crackling fireplace. On the surface, the extended care center looks almost the same as any other ward in the hospital.”Is this the perfect place? No. Home with your family is,” said Jackie Peffly, extended care center resident relations designee and activity director. “But we work hard and we do the best we can. Our patients have immediate access to doctors, and since we are small we know everyone’s personality.”For many Truckee elders, the extended care center, with its medical perks, is the best option. But it isn’t for everyone. The gap between needs becomes apparent when a senior is home-bound and physically fragile but does not require constant medical attention. Rather the need is for part-time supervision and assistance bathing, eating and properly administering medications.Because Tahoe Forest Hospital and other county programs require specific medical conditions in order for seniors to be eligible, many are left out. They must either select an assisted living facility in Auburn, Reno, or Sacramento, or pay huge amounts for private in-home care, which is also difficult to find in Truckee. “We are starting to take a look at this problem and see how we are going to address it, but at some point the county, state and federal governments are going to have to change their tune,” Calkins said. “There are seniors in this community at risk, and the state is decreasing payments to home-health agencies.”Filling a needComplete Care Health Services is one of the only organizations in the area that can refer independently contracted registered and licensed nurses, and certified nurse aides for in-home care. Of the 10 nurses available, two live in Truckee.

“These girls are with their patients forever, around the clock, until [the patients] die,” said Complete Care owner Maribess Johnson. “They do anything from cooking, to baby-sitting, to feeding assistance, walking, diapering -anything that would help relieve the families’ needs.”But it’s not an option for everyone. Because the in-home nurses are often commuting and need full-time work, most require six to eight-hour minimum shifts. And at an average of $16 per hour plus travel, which is not covered by most insurance providers, many prospective clients cannot afford the service.”What would help is creating an awareness that this is a problem that is not going to go away,” Calkins said. “We need to come up with some creative ideas and solutions to address the needs. It’s going to take more discussions among community leaders, and the community is going to need to decide what [they] want to do.” SERVICES AVAILABLETahoe Forest Hospital Home Health Services582-3244Provides 60-day assistance to home-bound patients who are under a physician’s care, and have specific medical needs. Home care providers assist largely with post-operative or injury care, and will aid in administering IVs, medication management, and physical therapy. Home health patients are also entitled to other services.Complete Care Health Services

587-1351 A service that refers independently contracted registered and licensed nurses, and certified nurse aids for full-time in-home care. Nurses will assist will all needs, ranging from house work and cooking, to bathing, diapering, and dressing. Tahoe Forest Hospital Extended Care Center582-3251A 24-hour live-in care facility for patients needing medical assistance and supervision, and who are no longer able to live independently. Residents have access to doctors around the clock, receive assistance with personal care, and participate in a full calendar of activities and outings.Tahoe Forest Hospital Hospice Service582-3534Provide end-of-life care, cancer and fatal-illness support groups for both patients and families. Care providers assist with pain and symptom management, and maintaining a high quality and comfort of life in the closing days.


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