| St. Louis Five Year Consolidated Plan Strategy | |||||
| Chapter 3 |
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Anti-Crime | Youth | Seniors | Economy | Planning | Codes | Preservation | Energy 
During the 20th century, the number of persons in the United States under age 65 tripled. At the same time, the number of persons aged 65 and over has jumped by 11 percent. Consequently, the elderly, who comprised only one in every 25 Americans in 1900, made up one in eight in 1994. Within the City of St. Louis, the ratio is even higher. According to the St. Louis Department of Human Services, seniors over the age of 60 represent 21 percent of the City's population, more than one in every five people. Current Services As a result of the 1973 amendments to the federal Older Americans Act, states were required to divide their state into planning and service areas, and to designate Area Agencies on Aging to develop and implement programs and services within specifically defined geographic boundaries. The St. Louis Area Agency on Aging (SLAAA) provides a comprehensive and coordinated system of community-based services for older adults in the City of St. Louis. SLAAA provides three important services for St. Louisans aged 60 and older:
The primary services currently available within the City of St. Louis are broken into four categories: Community Services, In-home Services, Alternative Living, and Financial Assistance. These services are funded through SLAAA or other community-based organizations. These include the following: Community Services are those available on a community level to help older persons live independently.
In-home Services are those available to seniors in their homes to help them live independently.
Financial Assistance:
Some programs are described in more detail below. St. Louis Area Agency on Aging (SLAAA). The St. Louis Area Agency on Aging offers a variety of services for seniors. The agency's FY 1999 service delivery report indicates the following services were provided: [ TABLE III-i-1, 1999 Services Delivered to Seniors in St. Louis ] Memory and Aging Project Satellite (MAPS). The Memory and Aging Project Satellite (MAPS) of the Washington University Alzheimer's Disease Research Center was developed to meet the medical, social, and housing needs of minority and medically underserved elders with cognitive impairments. MAPS, located in the offices of the St. Louis Area Agency on Aging, provides multidisciplinary outreach, as well as home-based diagnosis, treatment, and case management. It differs from most other satellite programs in that it seeks to provide service to individuals who do not voluntarily seek help for dementia. Missouri Care Options Program. The Missouri Care Options Program was started in 1994 by the Missouri Department of Social Services Division of Aging. The program was established to inform individuals of available long-term care options and moderate the growth of state-funded nursing facility placements. Alternatives such as in-home care or a community setting are provided if the individual meets the program guidelines. In 1998, the MCO program received 2,403 referrals from the City of St. Louis. Friedens Haus Senior Services. Friedens Haus Senior Services serves the Hyde Park area. The program delivered its first hot meal in January 1998 and now serves 64 elderly. Twelve people visit and call on the elderly, and look for problems with taking medicine, keeping the house clean, or any signs of elder abuse. Eleven workers from Friedens also go to elder's homes and help with cleaning, bathing, and shopping. A study completed by St. Louis University's Geriatric Department shows that the program has improved participant's nutrition and decreased their depression. Program of All-Inclusive Care for the Elderly (PACE). Alexian Brothers Community Services, a division of Alexian Bothers Health Services, was selected by the Missouri Department of Social Services to start and manage this program which emphasizes preventative and holistic care. The program is designed to give the frail elderly help they need to delay or avoid nursing home care. The program is open to people 55 and over whose income and health make them eligible for nursing home benefits under the Medicaid program. Pepper Older Americans Independence Center. The Pepper Older Americans Independence Center (named for U.S. Senator and Representative Claude Pepper) is completing its fourth year in a five-year series. The program is designed to determine if a supervised exercise regimen for the elderly will keep them from needing a nursing home. The program, held in the gym at Washington University, is one of 11 similar programs throughout the country. As of 1998, there were about 150 participants. The program is funded by the National Institute on Aging. McCormack House at Westminster Place. McCormack House, a 96-unit complex at 3915 Olive, is the first apartment facility in the metropolitan area to offer such services as meals and limited medical attention for the low- and moderate-income senior citizens. The apartment complex provides services for residents who might need help with dressing, bathing, and taking medication. It is designed for elderly who wish to stay independent and not live in a nursing home. American Red Cross Adult Day Care. The American Red Cross operates adult day care services at several locations including one on Pershing Avenue and one on Lemp Avenue. The facilities are staffed by a team of professionals including a registered nurse, clinical social worker, and trained program assistant. Fees are set on a sliding scale and services are Medicaid covered. H.O.P.E., Inc. (Housing Options Provided for the Elderly). H.O.P.E. counsels persons 60 years and older concerning almost any kind of housing problem. CCBF House Repair Program for Senior Homeowners. Senior homeowners who live in the Carondelet area or 11th ward may apply for house repairs, if they own the house, live in it, are 55 years and older, and have financial need to do repairs. The program is funded 70 percent by the Community Development Association and 30 percent by private industry. Home Security. Home Security is a federally funded, independent nonprofit organization. It lends the elderly and disabled homeowners a helping hand to make minor repairs with plumbing, electrical, carpentry, and guttering repairs. The organization also makes safety and security improvements and provides energy and weatherization services. Northside Preservation Commission. The Northside Preservation Commission offers forgivable loans for up to $5,000 for exterior repairs to very low-income homeowners and occupants. City of St. Louis Home Repair Program. The City of St. Louis offers an $8,000, 5-year forgivable loan to low- and moderate-income residents. A $30,000 exterior improvement loan program is also available. The first $8,000 is forgivable and the remaining $22,000 is deferred and paid whenever the property is sold. Needs and Challenges The elderly face many needs and challenges. Because of the variety of problems they face, a case-management approach is necessary. Need for a Case-Management Approach. The success of the MAPS program mentioned above has demonstrated the need for a case-management approach for all of the elderly served by SLAAA. The MAPS program has found that case management involves service arrangement as well as counseling and family education. Interventions may include scheduling and transporting clients to primary care physicians and specialists, arranging for home nursing, home repairs or relocation, applying for Medicaid, and many other services. A similar case-management system for all SLAAA clients would greatly improve the seniors' access to services. The challenges which follow contribute to the need for this case-management approach. Many elderly live alone. While most elderly men are married, most elderly women are not. Thus, elderly women are more likely to live alone than elderly men. If they are not able to care for themselves, they are likely to need in-home care or nursing home care. Even if they are capable of living alone, they often feel isolated and depressed. According to the U.S. Census Bureau, there are more than 40,000 people over the age of 60 living alone within the City of St. Louis. Many face dependency. As more people live longer, there will be more who face chronic, limiting illnesses or conditions, such as arthritis, diabetes, osteoporosis, and senile dementia. These conditions result in people becoming dependent on others in performing the activities of daily living. The need for personal assistance with everyday activities increases with age. Although only nine percent of those aged 65 to 69 years needs assistance, 50 percent of those aged 85 years and over need help with everyday activities. The number of frail elderly--especially those with incomes of $10,000-$20,000 a year-- is expected to grow dramatically over the next decade. The elderly cannot always rely on family and friends. Family sizes have been getting smaller, family members are often dispersed across the country, and many women work outside the home. The traditional support from family members is often not available. Nutrition is a concern. Adequate nutrition is a concern for many elderly, but especially for those who live alone and are frail. The St. Louis Area Agency on Aging (SLAAA) has seen the number of congregate meals served decrease while the number of in-home meals has increased because the number of frail elderly are increasing and they are unable to go to the senior centers. Medicaid reimbursements have not kept pace with costs. Medicaid long-term care reimbursements have been increasing, but the rate of increase has been declining since fiscal year 1996. Total Medicaid long-term care reimbursements increased 12.5 percent in fiscal year 1998, down from the 16 percent and 25 percent increases in fiscal years 1997 and 1996, respectively. Thus, more people have looked for alternatives such as in-home care or community services. Changes in Medicare decreased home health care. Because new Medicare regulations and payment caps put pressure on home health care organizations to constrain costs, many home health care organizations are not surviving. St. Louis' two largest home health agencies, Call A Nurse and the Visiting Nurse Association, stopped Medicare operations in May 1998. Thirteen other agencies in the area closed down. Heart disease, cancer, and stroke are the leading causes of death. Although death rates from heart disease have declined for the elderly since the 1960s, it remains the leading cause of death among them. Death rates from cancer, on the other hand, have increased since 1960. Poverty rates vary greatly among subgroups. In general, elderly women have a higher poverty rate than elderly men. Minority elderly have higher poverty rates than non-minority. According to the St. Louis Department of Human Services, 18.3 percent of those over the age of 60 in the City live below the poverty level. Lack of income results in housing problems. Although many elderly have incomes that are above the poverty line, they are still living on a very limited budget. This results in a large part of their income going toward rent. Problems develop if they own their home and the home needs repairs. Mike Nickel (Missouri Division of Aging) believes that home repairs now are the major problem that many seniors face. Because they do not have enough income to pay for minor repairs (i.e., leaking plumbing), the minor problem continues until it results in a major problem. Major repairs, such as a new roof, may be totally impossible for seniors on limited incomes and this in turn causes a variety of other problems. Home Services (formerly Senior Home Security) provides minor home repairs and has a waiting list of 1,500 people. The list would be much longer but the agency stopped taking names when the number reached 1,500. GOALS The St. Louis Department of Human Services, Area Agency on Aging, has identified the following five goals (The order listed does not indicate priority ranking):
Recommendations One of the greatest challenges in the coming years will be the increasing number of elderly. The American Council of Life Insurance predicts that by 2030, every state will experience at least a tripling of its Medicaid costs. With the number of elderly increasing each year, it is imperative that additional services be provided to help them remain independent and avoid the need for a nursing home. These services include the following: a) Develop and maintain a case-management system.
b) Increase funding for housing and utility concerns.
c) Bolster programs for assistance with daily activities and home health care.
d) Increase funding for home-delivered meal programs.
e) Create additional assisted living housing complexes.
Resources The St. Louis Area Agency on Aging receives funding from a variety of sources including the Missouri Division of Aging, the City of St. Louis, the St. Louis Community Development Agency, and a very small amount from community contributions. These sources are detailed below. The Missouri Division of Aging. The Missouri Division of Aging funds SLAAA from two sources-federal funding and state general revenue. Federal funding includes block grant funds, Title III, Title V, Title VII, the U.S. Department of Agriculture, and Medicaid. Federal funding comprises approximately 43 percent of SLAAA's funding. State general revenue funds include funding from the Missouri Department of Transportation and the Missouri Department of Social Services through the Division of Aging, which offsets funding cuts experienced since 1992. State general revenue funds comprise almost 44 percent of SLAAA's funding. The City of St. Louis provides funds through the Department of Human Services to the St. Louis Area Agency on Aging. This funding comprises approximately seven percent of SLAAA's budget. The St. Louis Community Development Agency provides funds to SLAAA, comprising approximately five percent of SLAAA's budget. Community contributions from individuals and corporations comprise a small portion of funding and account for approximately one-half of one percent of SLAAA's budget. | |||||
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SENIOR PROGRAMS
