Many older people have difficulty understanding and accessing services and resources available to help them maintain their health and independence; still others are stymied when they encounter problems with the benefits and services that they receive. Family caregivers may also experience challenges when assisting their older family members in finding help and resolving issues related to care and services. Unfortunately, the systems that are designed to help provide assistance to the elderly are often overly complex. Through CARIE’s intervention, the quality of life for clients is enhanced by accessing needed services and benefits, resolving complaints related to care, and receiving assistance to prevent abuse and exploitation. Research suggests that demographic, service delivery, and other trends are converging to increase the number of older adults who are at risk of losing their independence.
With more than 20% of Philadelphia’s seniors below poverty and many more near poverty, the need for assistance with access to and maintenance of publicly-funded services and financial entitlements is critical. Traditional outreach and education efforts often fail to reach those most in need. For example, currently an estimated 18,000 low-income Medicare beneficiaries in Philadelphia have not yet applied for the “extra help” available to help them pay for their Medicare Part D expenditures, despite repeated written notices from Medicare/CMS. The fact that two-thirds of those 85+ in Philadelphia have only 5-8 years of formal education creates a challenge for communicating complex information in written formats (The Socio-Economic and Health Characteristics of Philadelphia’s Elderly Population, Philadelphia Corporation for Aging (PCA) June 2004). In the Southeastern Pennsylvania (SEPA) area as a whole, 18% of seniors have not heard of senior activities or centers; nearly 9% have not heard of meal programs, and 10% have not heard of transportation discounts and services for the elderly (PHMC 2006 Household Health Survey).
In addition to structural barriers to access, the current economy is especially challenging for the elderly, who have lost 51% of their buying power since 2000 (Senior Citizens League, May 8, 2008) while the costs of heating oil, key food items, gasoline and medical premiums have more than doubled. Meanwhile, waiting lists for aging services grow as service providers are faced with increasing costs of service delivery and flat or shrinking funding.
Elder abuse and other crimes against the elderly pose another serious threat to the ability of older persons to remain in their homes and communities. A recent comprehensive study on the prevalence of elder abuse in the nation found that more than 10% of elderly Americans are mistreated, most commonly by someone who verbally abuses or financially exploits them (“Elder Mistreatment in the U.S.: Prevalence Estimates from a Nationally Representative Study,” 8-19-08, University of Chicago). In 2007, there were 3,144 reports of elder abuse in the five counties of SEPA, 2,127 of them in Philadelphia. Violent crime against the elderly, while low compared to other victim age groups, is still a serious problem and a persistent fear.
The region’s 85+ population – those most likely to need long term care services at home or in a facility- increased 24% from 2000 – 2007. More than 82,000 seniors over the age of 85 live in SEPA, nearly 40% of them in Philadelphia (U.S. Census Bureau, American Community Survey, 8/7/08). In Philadelphia alone, there are over 42,000 elderly persons with ADL (activities of daily living) limitations and over 86,000 with IADL (instrumental activities of daily living) limitations: in the five-county region, more than 81,000 (11.4%) have ADL limitations and 166,000 (23.1%) have IADL limitations (PHMC SEPA 2006 Household Health Survey).
Most long term care services are provided by unpaid informal supports. Statewide, there are more than 1.3 million informal caregivers for the elderly. Despite the incidence of limitations among older adults in SEPA cited above, less than 7% received formal in-home care. More than 50,000 older persons in Philadelphia are caregivers for spouses, friends, or other relatives. Supporting caregivers in their challenging role has been found to help older adults avoid or delay institutionalization, and nationally, 67% of caregivers say that they need help or information about services. (“Looking Ahead: Philadelphia’s Aging Population in 2015,” PCA, 2006).
CARIE’s ability to intervene on behalf of older adults and their caregivers and identify creative ways to meet their needs, coupled with intensive systemic advocacy to improve the availability of affordable quality care, offer a safety net to help those who would otherwise fall through the cracks of the service system.
