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Managing the gray tsunami

It is of no value to live twenty- or thirty-plus years beyond retirement and mostly just exist or worse yet, be waiting to die. – Dr. Allan S. Teel

My parents died within two years of each other nearly thirty years ago, leaving me and my brother in that odd status of adult orphan. They were both in their late fifties, and as time marched on, I looked around at friends dealing with their elderly parents and decided we dodged a bullet.

Thus, I may not be the best person to review Teel’s book,  Alone and Invisible No More, which describes how to stop warehousing “elders,” as he calls them. Except for this: in thirty years or so, I’ll be the one whose family is trying figure out what to do with Mamo Duncan.

Teel’s book describes a future for elders that anyone could envy—non-institutional, living at home, and at less cost. If it could only happen.

Tidal wave wall?

In the opening, Teel warns of a “gray tsunami,” some 76-79 million baby boomers needing geriatric care. Unfortunately, it’s not a new warning. Dr. Ken Dychtwald warned about this coming flood in his 1989 book, The Age Wave: How The Most Important Trend Of Our Time Can Change Your Future. But where Dychtwald merely waved red flags, Teel offers a possible solution. Teel began his medical practice in a Maine town with several senior care facilities ranging from nursing homes to assisted living. His book describes how he developed a theory of better treatment from this experience. From his patients, Teel learned a key element in elder care: “each successfully aging person [needs] a purpose in his or her life.” He saw too many vital and vibrant elders relegated to nursing homes or assisted living by distant families who had decided they were too difficult to have around. This came full circle when his ninety-three year old grandmother moved near him after a fall in her Brooklyn home.

What is “care?”

Unlike what the rest of his family suggested, Teel didn’t institutionalize her—and he considers assisted living facilities and home help just other forms of institutionalization. He put her in an apartment close to his home, got her involved in local activities, found her a new circle of friends, made sure his children got to know her, and checked on her regularly. In this way, she lived happily and healthily for several more years—he believes far more years than if he’d put her in any of the facilities near his home. From this experience and from using his patients as focus groups, he developed a new type of assisted care he called the Eldercare Network, with facilities that were more “home-like” than existing assisted living places. Unfortunately, he doesn’t go into much detail describing how Eldercare Network was an improvement. Rather, he cites anecdotes from residents about how wonderful living there was. Frankly, from what detail he did provide, I didn’t see much of a difference between his Eldercare Network and a typical assisted living facility like Greenspring Village in Springfield, VA. Eldercare Network was smaller in scale. Unlike Greenspring, it took in those who could not afford private assisted living and provided care at a cheaper rate. That economy, in fact, led to the State of Maine providing Eldercare Network even more funds to take in its indigent elderly. State funds meant following state regulations on paperwork and state requirements for senior care, which Teel found tedious and distasteful. After a dispute with the state over some unintentional paperwork mistakes, Teel concluded that when it comes to care of elders, we need to “…separate the bureaucrats from the process…” But does he understand what that would mean? I certainly, in a few decades, don’t want to be someplace where the bureaucracy has been separated from overseeing that facility. Eldercare Network eventually failed for lack of funds, though not completely from bad management. When private assisted care institutions had exhausted their residents’ funds, they kicked them out into Eldercare Network. The state could no longer afford the $2,500 per patient it paid Eldercare Network.

The Maine Approach

But the experiment with Eldercare Network led Teel to develop a better concept, which he calls the “Maine Approach.” At its simplest, the Maine Approach is virtual assisted living from the elder’s own home coupled with a broad social network which emphasizes adjusting the level of care provided to the individual’s need. Also, the elder gets to determine the level of care and independence, not just the elder’s immediate family. They are involved, of course, but the elder’s wishes take precedence. The Maine Approach involves a volunteer network of care providers and non-medical volunteers who drop in to check on a person, engage them in volunteer work, or run errands. The aim is to keep the elder in his or her own home for as long as possible using this volunteer system, video monitoring, regular check-in phone calls, panic buttons, and home doctor visits. For elders who can no longer drive, a transportation and errand service is provided. Teel suggests the Maine Approach works best on a community by community basis rather than as a large, state or multi-state system. Very technology-dependent, the Maine Approach uses Skype, video-conferencing, broadband Internet, and WiFi to allow home-bound elders to virtually attend club meetings, interact with family living far away, or consult with healthcare providers. Teel has worked out deals with cable Internet providers and other ISP’s for reduced-cost contracts. Equipment such as computers, web cams, and other technology are covered by the cost of the package of individualized elder care services. Training, based on the elder’s level of technology awareness, is also provided. Teel maintains that even given equipment, wiring homes, and other factors, that costs are considerably less than regular at-home care, assisted living, or nursing homes.

Cradle to grave

Teel is right when he says that warehousing our elders in nursing homes and assisted living facilities deprives us of a tremendous source of knowledge, experience, and skills. Seniors have knowledge that could help in a post-oil world. Skills such as canning, curing meats, sewing, farming and in-person community organizing come to mind. They also have a font of knowledge in their memories, sometimes more detailed than any history book. By shutting elders away in nursing homes, the insular assisted living, or home care where they are alone most of the time, Teel says we not only rob ourselves of that knowledge, but we probably hasten their demise. Consequently, part of the Maine Approach is to set a schedule of activities each month for the individual, which includes volunteering at schools, day care, or looking in on other elders. The schedule is adjusted and developed according to the elder’s cognitive abilities. Teel accepts that in many cases dementia is inevitable. But, he claims, again anecdotally, that the Maine Approach allows elders many more productive years before that unavoidable decline. Teel also believes the Maine Approach could address our health-care costs in this country. In the communities in Maine which have adopted Teel’s approach, the cost for the community per elder is around $300 a month, compared to $10,000 a month for people in hospitals or nursing homes.

Rah-rah us!

The book closes on a plug for money for Teel’s organization, Full Circle America, which provides communities with the information they would need to use the Maine Approach in other states. Teel’s vision is an admirable one, but now it’s also more of a utopia than reality, especially with its emphasis on technologies and transportation that are not alternative-fuel based. However, it’s community-based nature, i.e., grassroots, is certainly evocative of the philosophy of mutual care and benefit in the Transition Movement. The book is a worthwhile read because if enough of us believe in that vision, it could become a reality. –Maggie Duncan This article was reposted from Transition Voice. Listen to Dr. Teel speak about the Maine Approach on Frankie Boyer’s podcast.


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