Our common perception of long-term care has remained static for many years. Decades after Congress signed its first law providing federal assistance to the elderly and disabled, “long-term care” still evokes stale images: small rooms with bare walls, the constant hum and beeping of medical machines, and the pervasive atmosphere of isolation. To be part of a long-term care system, according to the ordinary understanding, means to be institutionalized.
Rarely do we imagine ourselves or our loved ones living in a nursing home. Indeed, it is difficult to envision a time in our lives when we cannot live independently in our own home and community. But according to a U.S. Department of Health & Human Services study, four out of every ten adults who turn 65 will use a nursing home at some point in their lives. At a time when healthcare costs are increasing and many are experiencing profound difficulty planning for basic retirement needs, such as housing, food and prescription drugs, saving for a nursing home seems nearly impossible. And, turning to the case of Philadelphia, with one-fifth (19%, or 39,155) of older adults living below the poverty level, the situation seems increasingly dire (Philadelphia Corporation for Aging 2004).
In an effort to provide a new type of service—and a new long-term care solution—to Philadelphia residents, the Philadelphia Housing Authority (PHA) opened an 8,000-square-foot adult daily living center, Ridge Avenue Eldercare Services, in April 2010. It is located at the corner of Ridge Avenue and West Glenwood Avenue in North Philadelphia. Adult day centers are different from nursing homes in that they are designed to enable individuals to remain independent longer, providing them with health care and programming that meets their daily needs.
An alternative to the nursing home, an adult day center is a long-term care model that serves older adults with disabilities or conditions that impede their independent living and functionality, but does not require them to permanently move from their homes into an unfamiliar environment. This type of facility allows clients to receive medical assistance, participate in therapeutic activities, eat nutritious meals, and socialize with staff, other clients and the surrounding community. Ridge Avenue Eldercare Services relieves the financial and emotional burdens on the family and friends of loved ones. It is cost-effective, high-quality, non-institutional care.
By constructing this center, the first of its kind operated by a public housing authority, PHA offers low-income Philadelphia residents a new type of service model, one that provides services near home and community.
The Elderly in Philadelphia: A Snapshot
Philadelphia has long boasted one of the oldest populations in the United States, second only to Miami in its proportion of residents aged 65 and older, according to 2000 U.S. Census data (Brookings Institute 2003). Although Philadelphia’s overall population is projected to decline in the next few decades, the percentage of seniors within the city and surrounding counties is expected to rise markedly (Philadelphia Corporation for Aging 2006).
Between 2010 and 2015, diverse populations of seniors will undergo significant shifts. The number of African-American elders will increase by 12 percent, or by about 12,000 older adults. Hispanic older adults will see their numbers rise by more than 50 percent, or 6,000 seniors. The population of Asian and Pacific Islanders over the age of 65 will almost double, adding 7,500 to Philadelphia’s older adult demographic (Philadelphia Corporation for Aging 2006). The need for appropriate long-term care and services, already pronounced, will invariably grow as these baby boomers reach retirement age.
The heart of Philadelphia has flourished in the diversity of its neighborhoods, both ethnically and generationally. Many older adults live in the homes in which they were raised; they have, in turn, raised another generation, or possibly even two or three other generations, in those same homes. North Philadelphia, where the Ridge Avenue center is located, is a cross-section of Philadelphia that exemplifies this intergenerational model. Neighborhoods like Strawberry Mansion, Poplar and the Temple University area contain significant senior populations woven into the fabric of the communities.
The Challenge to Care
North Philadelphia, once home to thriving manufacturing complexes and vibrant communities, now faces significant problems with crime, access to health care and availability of fresh food. The lack of services and businesses needed to keep a neighborhood healthy is evident. The 19121 zip code, home to PHA’s Ridge Avenue Eldercare Services adult day center, is one of the poorest in the city. According to 2009 U.S. Census estimates, over 45 percent of the population in this area lives below the federal poverty line.
This zip code also has the highest rate of nursing home referral and institutionalization in the city of Philadelphia.1 Relatives and friends, burdened with high healthcare costs and a neighborhood sagging under the weight of its historic losses, are forced to stand by as loved ones turn to nursing homes because of the lack of options close by. Funneling this high volume of frail and disabled individuals into skilled nursing facilities remains a high-cost, unsuitable and unsustainable method of providing services to older adults, according to the Agency for Healthcare Research and Quality.
PHA’s Vision: Creating a New Model of Enriched Services
Since 1998, PHA’s Executive Director, Carl Greene, has frequently sought to move beyond the surface challenges that many public housing residents face. Stable housing is just one factor in supporting a healthy lifestyle for low-income Philadelphians. Whether by reducing homeowners’ energy costs via certified appliance installation or connecting public housing complexes to commercial or transportation hubs, PHA has provided resources that can aid residents in maintaining self-sufficiency.
During Greene’s tenure, his administration has built or totally renovated over 7,000 houses and apartments while managing more than $1.6 billion in funds. Now, armed with $126.9 million in stimulus funds, PHA will begin the restoration and refurbishment of more than 1,000 new units, tearing down outdated public buildings in the process.
Greene hopes to take PHA’s mission to the next level, implementing a new service model that enriches the environment of tens of thousands of PHA residents. Supportive housing programs and on-site health clinics, though not new, are integral parts of this effort. The Ridge Avenue Eldercare Services center will build upon these programs.
“Ridge Avenue Eldercare Services will transform the definition of long-term care in our city,” Greene explains. “Our older adult residents will find a lively place with a focus on rehabilitation and therapeutic activity, all while sharing meals with others. We will bring together multiple generations as they care for one another, strengthening bonds and rebuilding ties.”
A Day at Ridge Avenue Eldercare Services
The typical adult day client is an individual who, whether through age or a disability, faces significant challenges with daily activities. It may be difficult for relatives or caregivers to both maintain employment and care for their loved one; the family may be teetering on the edge in their efforts to keep this individual out of a nursing home. The adult day model allows older adults to remain at home, living in a familiar community setting with family and friends.
Though many clients of Ridge Avenue Eldercare Services live in the connected Nellie Reynolds Garden senior apartment complex and neighboring Johnson Homes, the adult day center provides transportation to and from the facility. A full-time nurse and trained staff administer basic medical and personal care such as insulin injections, bathing and blood pressure readings. Lunch and snacks are prepared to meet each client’s nutritional needs.
An essential piece of the adult day model is therapeutic programming or activities. Each client is assessed at the point of enrollment, and staff members work with the client to develop a “person-centered care plan” that addresses physical and psychological needs. A registered nurse supervises the medical care of the adult day clients.
On an average day, clients in the early to moderate stages of Alzheimer’s or dementia may be creating “memory collages” of images from their past. Staff might be helping clients paint figurines in preparation for an upcoming holiday, an activity that strengthens basic motor skills and triggers cognitive function. Volunteers from a local school may be reading newspapers with the clients and discussing daily events. The goal of the programming is to offer meaningful activities to stimulate social interaction and maintain or even improve physical and cognitive functioning. Physical fitness activities are offered throughout the day to improve circulation, increase stamina and improve motor function.
Often, the social interaction itself is the most therapeutic aspect of a client’s day. “I want to be around people,” a client said recently, when questioned on his reasons for being at the center. “It takes my mind off personal matters.”
PHA has assumed a definitive leadership role in providing solutions to the challenges that we all face as caregivers. Though Ridge Avenue Eldercare Services is not the first adult day center in Philadelphia, it is the first to be administered solely by a public housing authority.
The center’s staff continues to enroll older adults from the North Philadelphia community, bringing low-cost, high-quality care to those in need. This practical innovation will set a new standard for long-term care in Philadelphia and in cities across the country.
- ^Based on research done by Jim Pizzuti, former Director of the Pennsylvania Bureau of Community Development in the Office of Long Term Living. These data are based upon an 18-month study, from 2006 to 2008, on the nursing home referral rates of various zip codes in Philadelphia.
Nora Dowd Eisenhower is the former Pennsylvania Secretary of Aging and current principal at OnePoint Public & Private Solutions, LLC. She continues to focus on improving the quality of life as we age. Ashley Humienny, a recent University of Pennsylvania graduate, is a research assistant at OnePoint Public & Private Solutions, LLC, specializing in housing- and aging-related issues.
Brookings Institute. (2003, November). Philadelphia in Focus: A Profile from Census 2000. Available at http://www.brookings.edu/reports/2003/11_livingcities_Philadelphia.aspx.
Philadelphia Corporation for Aging. (2004, June). The Socio-Economic and Health Characteristics of Philadelphia’s Elderly Population: Summary of Findings. Available at http://www.pcacares.org/Files/socioeconomic_and_health_keyfindings.pdf (accessed April 29, 2010).
Philadelphia Corporation for Aging Report. (2006, January). Looking Ahead: Philadelphia’s Aging Population in 2015. Available at http://www.pcacares.org/Files/2015_report.pdf (accessed April 29, 2010).