Spokane County's Elderly Services Project helps isolated elders remain independent through referrals by public and private service workers who link needy elders with at home support services.

Only 60% of America's senior citizen population is able to live independently in their own homes. A full 40% of the nation's elders require some form of long term institutional care, a solution that is often financially and emotionally costly to elders and their families, as well as to the larger community. State and federal governments shoulder much of the financial burden; in 1991, institutional elder care costs totaled $55 billion, half of which was borne by the public.

In Washington's Spokane County, Elderly Services (ES) seeks out elders at risk of institutionalization and offers them tailored services that help them remain in their own homes as long as possible. ES integrates the Spokane Community Mental Health Center and the Eastern Washington Agency on Aging, a state legislated regional agency that serves the 60,000 people who are over 60 years old in Spokane County.

Between 7,200 and 9,000 of Spokane's elders need some kind of assistance to remain in their homes and communities. Nearly 40% have no family to help them, and nearly two thirds live alone. About 50% suffer from some degree of dementia, and more than 40% suffer from depression, while almost 10% abuse alcohol and 10% are suicidal. Most have some degree of ill health: Spokane's at risk elders suffer from an average four chronic physical health problems, which require an average of six prescription medications daily.

But many elders are reluctant to seek out assistance. Others are incapable of seeking assistance: they may distrust strangers, fear being forced into an institution, or, as a result of dementia, may not even know they need assistance. A primary source of referral for elders in need of assistance is the Gatekeeper Program. This program gathers information from front line public and private service providers who come into regular contact with elders in their homes and communities. These service workers are often the only people with whom at risk elders come into regular contact people such as mail carriers, meter readers, police officers, bank tellers, fire fighters, pharmacists, apartment managers, supermarket employees, cable TV installers, billing clerks, building inspectors, ambulance workers, and fuel company clerks.

Gatekeepers are considered the vital first link in the service delivery effort: of the 745 new Elderly Services clients in 1990, 42% were Gatekeeper referrals. The remaining referrals came from more traditional sources, including families, government agencies, doctors, and hospitals. Gatekeepers are treated as partners by ES staff. They initially receive one and one half hours of training to enable them to detect the early warning signs of a potential problem that may require ES intervention or assistance. And after each referral is evaluated, the Gatekeepers are informed about the outcome. Elderly Services evaluates through home visits and if needed, offers assistance. Where assistance is requested or required, ES uses an interdisciplinary team of clinical case managers, nurses, psychiatrists, and physicians, who provide in home evaluation, treatment, care planning and ongoing clinical case management. To minimize obstacles to the elder's participation, the teams provide 95% of required support services in the client's home.

The evidence suggests that ES has been extremely successful in reaching its goals of keeping senior citizens in their homes and providing them services. The program admits an average of 65 new clients each month, provides in home case management services to 1,200 clients each year, and has an active caseload of 820 persons. Eight out of ten of the most severely impaired elderly are identified and reached each year through the Gatekeeper referral program. The interdisciplinary teams serve one third of Spokane's at risk, home dwelling elderly. As a result, these elderly are able to extend their independent lives at home by an average of nearly 22 months, or almost two years.

Moreover, while Spokane's elderly population has increased steadily since 1978, the supply of nursing home beds has remained constant during the same period, suggesting that more elderly are staying in their homes longer. The quality of life for those remaining in their homes appears to have improved as well; since the Gatekeeper program was implemented in 1978, Spokane's geriatric suicide rate has dropped from 28 to 16 per 100,000 people, and is now the lowest in Washington State.

Director
Eastern Washington Area Agency on Aging
W. 1101 College Ave., Rm. 365
Spokane, WA 99201
(509) 458-2509