Caregiving gaps

In 2005, Roanoke sociologist Paula Prince authored a report for the Council of Community Services on the state of seniors. Based on her research and on interviews conducted for this series, following are the most critical stumbling blocks to caring for the region’s seniors:

• While the home-care service industry is growing fast, many seniors report the experience as being hit-or-miss. Employee turnover is sometimes high as aides search out employers that pay higher wages and offer health insurance. Only one Roanoke agency offers sliding-scale rates for personal care, and some needy seniors literally die in their homes while on the waiting list for services.

  Click to enlarge

  “It’s a great service — if you have the money and can find the right person,” said Dr. Gary Oberlender, who does private-pay, in-home geriatric assessments. “I call it ‘hire-a-daughter.’ ”

• Meals on Wheels is an oft-lauded and relatively cheap meal-delivery program run by the LOA Area Agency on Aging. But the demand grows as funding wanes, and there aren’t enough volunteers to staff some routes. The breakfast program was cut recently to serve just 9 percent of the clients qualified to receive it. “We have a client with literally one stick of butter in his refrigerator,” LOA director Susan Williams said.
• There aren’t enough geriatric professionals, from certified nursing assistants to geriatricians and internists who specialize in geriatrics (and are still accepting new patients). Although Carilion Clinic is trying to recruit more geriatricians, “The medical profession at this point does not have an adequate capacity of trained, geriatric specialists to handle the oncoming demand,” said Dr. Tony Stavola of Carilion North Roanoke Family Physicians.
• Senior advocates report a shortage of government-funded beds targeted to low-income seniors in area nursing homes and assisted living facilities. “Nursing homes are so full that it creates a backlog into assisted living facilities, and that creates a backlog into retirement centers,” said geriatric psychiatrist Dave Trinkle, who is also Roanoke’s vice mayor. “The backlogs go all the way to where people at home need more help than anybody, especially low-income people.”
• Even in high-end communities such as at Smith Mountain Lake,

  Click to enlarge

  access to acute health care is inadequate. Longtime civic leader Tom Smith retired to the lake in 1995 but recently put his house on the market in preparation for a move closer to his children — and to a hospital. “There’s an adage among a lot of us here who are leaving: ‘If you have a heart attack, you’re a goner.’ It’ll take you 45 minutes to get to a hospital,” Smith said.

• Public transportation is not readily accessible. Even if uncle Ralph can get an appointment with his busy internist, he may not be able to get to the doctor’s office. “If someone’s really sick, we try to work them in, even if we’re booked for months,” Stavola said.
  “That said, you have to make a RADAR appointment a day in advance,” he added, referring to the public transportation service provided for those unable to ride a Valley Metro bus. “So if somebody calls me this morning and they’re having trouble breathing and I want them here this afternoon, they can’t always get to me,” added Stavola. They may resort to calling an ambulance instead.

Bottom line to all the needs: “These folks will eventually get care, but they’ll get care inefficiently and expensively and at a much later stage than what we’d like them to get,” Stavola said.

“And that costs everybody a lot of money.”