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Special Perspectives on Home and Community Care Charlotte K. Flynn The Gray Panthers is an advocacy group that is concerned about people having access to what they need, whether it be health care, income maintenance, or housing, regardless of chronological age. We are also very concerned about "ageism," a subtle factor in our society that some- times produces problems for older people. The observations I would like to share today come from two perspectives. One as a listener to those who call our office for help and the other as an advocate. SURVEY OF ABUSE AND NEGLECT OF THE ELDERLY This past year, ~ have been involved with the State of Texas, coordinating a statewide survey of abuse and neglect of the elderly. The survey was conducted specifically to point out to our legislature He needs for community-based services. We surveyed key informants including people in the medical, judiciary, financial, law enforcement, and social service fields. The survey was a collaborative effort: the Gray Panthers coordi- nated the survey; He Texas Senate Select Subcommittee chaired by Senator Barr~entos offered support; Dr. Tra Iscoe, chairman of He Geron- tology Committee at the University of Texas, assisted us by having ad He information from the returned surveys entered into He university com- puter, the data from the survey was given to Dr. Jeffrey Anderson and Dr. John Thiess of the Texas Department of Human Services, who made the analysis. The survey provided us He documentation to reinforce the need for an adequate continuum of care through quality community-based 48

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SPECIAL PERSPECTIVES ON HOME AND COMMUNITY CARE 49 programs. Providing education and support to caregivers win provide significant help in preventing elder abuse and neglect. PROBLEMS IN CARE OF THE ELDERLY Case Management and Control Our members attach great importance to case management and control. They Link that the client or the patient does not have enough say in controlling what happens to him or her. The patient is not being given choices or being informed of those choices. The family and the patient need to participate in making choices based on what the family arrangements are, what the cost of services will be, what types of proce- dures are needed, and what services are available. Autonomy and Social Support There are two very important psychosocial aspects of growing older: autonomy or control, and social support When an elderly person has these, old age can be enhanced; when they are not in place, old age can become very defeating. In their article published in Science in May 1987, called "Human Aging, Usual and Successful," John Rowe and Robert L. Kane commented that past research has dealt with the negative aspects of aging and not win the extrinsic factors that might be preventive in the aging process. These factors apply to Hose who are ill as well as to those who are healthy. Record Keeping Better record keeping would be a great help, from He client's point of view. CoRect~ng records from aU of one's doctors becomes a night- mare for patients or their families. I fee] hopeful that there win be improvement In this situation after hearing Dr. Kane say Cat there may be some way of getting a data base that would be transportable from one place to another by the patient or by the family.2 ' See Earl M. Collier, Jr., "Framing the Issues of Home and Community Care: Response," in this volume. 2 See Robert L Kane, "Home and Community Care of the Elderly: Framing the Issues," in this volume.

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so CHARL07TE K. FLYNN Continuity of Care Continuity of care should be planned so that the patient receives appropriate care. At times, temporary placement in nursing homes fol- lowing surgery, for example, might be advantageous, especially if the nursing homes emphasized rehabilitation of the patient. Planning Patient Services Patients need their hospital discharge preplanned. Services need to be more specific to the individual patient. If a person has arthritis and needs help in the morning to get going, ~ hour of assistance in the mowing every day win be much more helpful then 3 hours every other day. Education Caregivers need education. Our organization has several members who are hospital social workers and handle discharge planning. They are very much aware of the lack of knowledge on He part of caregivers. As a result, we published a caregivers' manual Ail. It lists Be see/ices avail- able in Austin, but it also has "how-to's," not only for the caregiver but for Me individuals ~emseIves who need the supporthelping them to iden- tify their feelings and work Hugh them. This area is an onnorh~ni~v for the private sector to initiate needed activities. Payment Hi . ~-~r~ ~ In-home services do not have adequate standards, are often of poor quaky, and are very expensive. As a result, many older persons exhaust their meager incomes quickly. This area is a challenge to aB of us. We ad know that Medicare is cutting back on community care services. One of our survey informants stated that "the only conspicuously absent category of abuse In our list is government abuse, be it by cutback of funds or withdrawal of services." We need especially to look at He problem of the large segment of older people who live just above the poverty level and do not have the resources to pay for those (or indeed other) services.

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SPECIAL PERSPECTIVES ON HOME AND COMMUNITY CARE 51 REFERENCE 1. Aging: Every Generadon's Conce~A Manual for Caregivers. Austin, Tex., Gray Panders of Austin, no date.