SOUTHERN MAINE
LONG TERM CARE GROUP MEETING
MINUTES
JULY 27, 2005
2:00 PM – 4:00 PM
Introductions:
Debbie DiDominicus, SMAA; Bette Jewett, SMAA; Perry Blass, Living Innovations;
Kate Dulac, SMAA; Dianne Fazio; Amy
Hatch, SMAA; Desiree Scott, SMAA; Barbara
Hopkins, Maine Center for Integrated Brain Injury; Lisa Keenan, Saco River Home Resources; Katharyn Ledoux, Monarch; Michelle Matt, Goodall Hospital;
Ann Murray, Foster Grandparent Program; Martha O’Connor, Visiting
Nurses; Susan Rosenbaum, Home
Health; Bill Jenks, Home Instead
Senior Care; Terry Roy, Bayside Neuro Rehabilitation; Margy Gambell, Home
Instead Senior Care; Perry Blass, Living Innovations; Kathy Candage, In Home
Senior Services.
UPDATES
Debbie announced that there would be no meeting in August.
The next meeting will be held Wednesday, September 28, 2005.
There is a correction to the minutes of June 22, 2005.
The section relating to Medicaid it should read “Bette was the only one
that gave comments on the state regulations in the whole state” not
deregulations as stated in the minutes.
Kate Dulac, Caregiver Program, SMAA passed out flyers
giving Caregiver Class Schedule for the Fall 2005 – August through December
2005.
Family Care Giver Mini Grants are being offered for
collaboration on caregiver projects for
new projects that didn’t exist before and which can be sustained after the
grant. The grant is $1500 startup.
The idea for the collaboration is for the caregivers to learn about the
agency and the Caregiver program and offer a new service to caregivers.
There will no be meeting in August, 2005.
Debbie hopes to have Dr. Fazelli either at the September or
October meeting.
Medicare
Prescription Drug Plan – Open enrollment for the Medicare Prescription
Drug Program (Medicare Part D) starts on November 15, 2005 through May 15, 2006.
This is a really a major change in Medicare.
SMAA is looking for partners to help us reach consumers and teach them to
identify choices for prescription coverage.
There are 77,000 Medicare beneficiaries in our region.
The agency is not the only place where we will train groups to assist
them. SMAA cannot reach all of
these people. A lot of older people
have ignored the mail regarding Medicare and Social Security and are throwing
the information away. Right now we are in the midst of helping people determine
whether they are eligible for some extra help toward the cost of the premium for
this benefit. In order for the
consumer to be able to get their drugs on January 1, 2006, we have to reach
those people before December 31, 2005, otherwise they will walk into their pharmacy to get their
prescription filled and will be told that they no longer have coverage under
MaineCare. If they are a Medicare
beneficiary then they have to get their drugs through Medicare. What MaineCare will do is automatically enroll a person
randomly in a drug plan. Organizations
need to have someone there who is familiar with the program and knows what to do
for the consumer needing help with Medicare prescription drugs.
If they all come to SMAA they may have to wait for the information but if
there is someone within an organization that can help, the consumer will get the
information much faster. If there is anyone here who has someone at their agency
who would like to be trained by our agency, please let us know.
The organization can also have their own address put on the printed
matter. This would be a good
marketing tool for the provider. If
there is anyone interested in doing this please let Bette Jewett, Program
Manager, Information and Advocacy at SMAA or the two contact people, Carol
Rancourt and Katlyn Blackstone know. The
first clinic for consumers will be September 8, 2005.
Consumers needing assistance will need to bring in a pharmacy printout of
their drugs. The different plans
will not be known until the middle of October, 2005 and we will not know how
many drug companies will be participating in the program until that time.
The companies will be marketing their programs.
Maine is aligned with New Hampshire. There
is an article in the SMAA agency newsletter “Senior News” outlining the
Medicare Prescription Drug Program. Below
is a list of clinics which will be held at SMAA during the fall.
September 8 and 22, 2005 - 9:00 am - Noon
October 13 and 27, 2005 - 9:00 am - Noon
November 3, 2005 - 9:00 am - Noon
December 1 and 15, 2005 - 9:00 am – 4:00 pm
Debbie introduced Arthur
Rowe who stepped in for Mike Nugent,
Portland’s Division Director of the
Inspection Division. Debbie
talked about how we go into people’s homes and see different things going on
that may not be safe. what we need to do but we would not want the person to be
kicked out of their home.
PORTLAND’S
INSPECTION DIVISION
Arthur Rowe gave an overview of the Inspection Division and
how it evolved from enforcement to problem solving for seniors.
It is ultimately in best interest of all people concerned considering
their age and living conditions and to help that person understanding when it is
in their best interest to move from their home.
One of the biggest problems is having people believe in the Inspection
Division and that the program is there to help the person move to a safer, more
appropriate place. One example is
of a person who lived on Peaks Island who was very articulate but eventually the
division had to use force to remove this person from their home and off to the
hospital. There were alcohol
problems which reached a point where the person couldn’t function.
This gentleman had lost his wife and he no longer was able to function
without her. It was 28 degrees in
the house and because of this and not taking care of them properly some of the
cats had died. This situation went
on far too long and he just wasn’t able to cope with everything himself.
Now this gentleman is living in a nursing home and is extremely happy.
There are times when a decision has to be made under co-enforcement which means
‘here is what needs to be and let’s do it.’
Years ago force was used but persuasion may have worked much better.
Another example is of a woman who lived in a Condo and was suffering from
depression, was missing appointments but was able to keep us at bay for about
six weeks. Little force was used
when encountered with Police. There
was a warrant and the Police were able to convince her to come out using
walkie-talkies. At the present time
the lady is back in the Condo and refusing to leave and that is where it stands
at this time.
Question: Can
people refuse to let the Inspectors come into their home?
Yes they can. Every case is different. Calls are made ahead and as an example in this particular case the person would call us on a really good day and would converse as if she were fine. The condition of the home was not apparent over the phone and she was also well educated. The impression this person gave to the outside was not reality. The toilet was broken, she weighed 500lbs and there were physical problems; her depression would cause her to eat a lot and she would drive around in her car. Unbeknownst to us one of the other Inspectors had been able to get into the home and talk with other people and communicate with other facilities. There was negligent ownership of the building. Our mission is primarily to enforce which means force.
Question: What
constitutes evidence to get a warrant?
A statement by neighbors, who were afraid something was
wrong, from Police, pictures of the home by the Police who forced the door and
the possibility that there could be a life at risk. This would allow a warrant to be issued.
Question: Would
Legal Services for the Elderly get involved or Pine Tree Legal:
If the Division feels that issues warrant legal services
and if there are Landlord/Tenant issues present we may be encouraged to call
Legal Services for the Elderly and Pine Tree Legal.
If it is a Landlord/Tenant situation this would be different and should
be addressed by Legal Services for the Elderly or Pine Tree Legal.
There are different types of law involved and the codes which the
Division deals with. People will
call the office and sometimes they think it is an Inspection issue when it is a
Police matter. We encourage people
to talk with their attorney because often it is a civil matter not an inspection
issue.
Question: Where
this is the City of Portland, are there health codes?
Under the health codes of the City of Portland, anything
that creates a health hazard deploys the Inspection team as the authorized agent
of the Health Officer.
Question: If
you were talking to someone what would you say?
Sometimes it is necessary for the Inspection Division to
come right away but we would start by asking general questions.
For example if the house was immaculate but there was a pile of
newspapers on the gas stove which could cause a fire that would be a time to
call the Inspection Division. In this particular case a family member was called.
Question: Is
the Division available 24/7?
The Division is available if needed.
In an emergency there would be a Police and Fire dispatch.
Question: If there was a problem at a restaurant and they were not up to code, do you give them time to get out or if there are signs things are getting better do you give them time to bring up to code.
Yes we do an inspection of the building and give owner or
person living there so many days to correct whatever needs to be done in the
building to bring it up to code.
Question: Is
there a Code Enforcement Officer in every town.
According the State Statute there is supposed to be a Code
Enforcement Officer in every incorporated town.
Question: Who
is the Health Physician of Portland?
This can change every other week.
Question: How
many Inspectors are there in the department?
There are six regular field Inspectors and in the office
there are between 11 and 12 people working.
The City of Portland is more at risk.
Question: Are
there financial resources available?
There are no financial resources within the department. There
are Social Service agencies who the department works with.
Discussion.
Question: How
did the Inspection Division evolve?
It just evolved and has been in existence for 29 years.
Initially there were different inspection officers.
Originally there were other agencies within the Health department such as
a Social Worker department, who had more of an educational role than the
Building Inspection and Housing Inspection teams.
Debbie thanked Arthur Lowe’s for his presentation and for
coming in Mike Nugent’s place.
Debbie introduced Dr. Mark Kiefner, Ph.D., Clinical Director/Administrator, Neuropsychological Evaluations, Bayside.
Dr. Keifner gave an overview of the program and passed out
a flyer which relates to testing and deals with the Concept of Intelligence as
the ability to take information and do. The
90’s decade of brain interactions didn’t look at the cognitive part.
You cannot look at cognition without looking at the brain, which deals
with depression, bi-polar, manic and someone who is not able to think in an
organized manner. Intelligence is
distributed in a bell curve. There are people in the middle who are average which is most
of us; then there are a small group of people who are in the lower part of the
pyramid and a few who are above average. Sometimes
the older population can talk up a storm but have a hard time concentrating on
what needs to be done at that particular moment.
Human beings are very different from other animals.
What the psychologist is trying to figure out is where the person has
problems. Another part is a person’s emotional function.
Is it medical or is it psychological.
Medical things that affect cognition
would be medications and the fatigue level which in turn will affect
cognition and emotion which are all intertwined.
One of the things we know is that it is not possible to look at a
person’s emotional state without looking at cognition.
For example, if you have ever been depressed, it is really hard to think
clearly and be organized and get things done.
That is not just cognition but how the emotional part works with
cognition. Sometimes it is really
hard for the average person to concentrate and figure things out at the end of
the day, but if we wait until the next morning it becomes much clearer to
understand.
Neuropsychological is looking at chronic pain, such as a
knee problem; also the history of medical problems and doing comparisons, taking
into consideration the medications a person is taking and what that person like
before. Doing standardized testing
without making judgments. An
example is of a young man who went through testing and the scores were high.
This young man was so nice, charming, good looking and smooth. The
testing was so low on this young man and because of the way he interacted it was
very surprising to find the scores so low. Testing allows to measure.
What seems to be average is not necessarily average. If
you went out and got 100 people to take a standardized test the average IQ would
probably be 100 but it doesn’t mean necessarily that was your IQ before or my
IQ before the assessment was done. The
score is not necessarily going to be good.
There is a computerized test of attention which is called the Connors
Performance Test requiring a person to look at a computer screen with letters.
It is supposed to be an excellent test and measures in mili-seconds
whether a person has or has not responded.
Dr. Keifner showed an example of using blocks to show a
visual image and to perfect image in block and solving the problem but not in
the score you get. What is looked
for is the way a person solves problems as it may not show on the score sheet
because they have developed other ways of solving a problem. We look for patterns of strengths and weaknesses in scores
and the process by which a person scores on the test, in order to put the
picture together. On a given day
the score may not be the same.
Question: Do
you ever ask other people who know the person now what was the person like
before the tests were done?
There are standardized questionnaires given to family
members in order to find out if the person had any symptoms before taking the
language tests.
Cognitive impairment
– It is important to give more tests than less to make sure the person is not
being labeled. The consultation
fees run from $125 to $150 hour and would involve a couple of hours.
Insurance pays most of this. Evaluation
tests are costly and one has to be either independently wealthy or have a very
good insurance plan.
Question: Who
would be a typical person to be seen?
Typically it would be people with Parkinson’s, MS,
Strokes,Traumatic brain injury and car accidents.
History section
– This would be the medical and biographical history, test and behavioral.
There would be a summary of conclusions and recommendations and also if
the person has been medicated and there was no prior extensive testing done.
Question: What
are the side effects of different meds?
An example is of a depressed young man.
His cognitive skills did not improve so allowances have to be made for
that; there was some depression also. Also,
seeing if the person needs to come off their medication because of sluggishness.
In this case you would need to reschedule the appointment.
When a person is most alert would be the time to talk to the doctor.
The person would be pretty sedated in the am.
More people are being seen in the office.
They often come with printouts of meds.
Question: Are
home visits done?
No home visits. Bayside
is a day program so people come into the office.
Debbie thanked Dr. Keifner for his presentation.
Next Southern Maine Long Term Care Working Group meeting
will be Wednesday September 28, 2005 – 2:00pm - 4:00pm.
Meeting adjourned.
Respectfully submitted
Vivien Eisenhart