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Final Report:
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February, 1995
This study was made possible by a generous grant from the Weinstein Family Foundation.
Planning & Allocations Menu
On behalf of the Council on Aging and the Jewish community, I want to personally thank the Weinstein Family Foundation for their generous grant, which made this elderly needs assessment possible. I also want to commend the Council on Jewish Aging, whose members are listed in Appendix E, for their diligent and creative work over the past six months. The product that follows reflects both this contribution and the excellent support of Amy Wasser-Simpson, Director of Planning and Allocations of the Jewish Federation of Greater Seattle, and Denise Klein of Klein/Doerr, Consultants.
I also want to acknowledge the contributions of our Jewish social service agency providers who graciously gave their time and knowledge to make this a successful study: Sarah Barash, Sylvia Angel Epstein, Esther Friend, Josh Gortler, Mark Mullen, and Anita Reich.
The national and local experts on Jewish aging whom we interviewed, and the other Federations that generously shared information on similar studies they had conducted with us, must be thanked as well.
Finally, I would like to thank the 25 individuals--active and frail seniors and family caregivers--who participated energetically in the focus groups we sponsored to find out what our community needed and wanted in the area of senior adult services.
Sophie K. Meld
Chair, Council on Jewish Aging
Introduction/Executive Summary
The Role of the Council on Jewish Aging and the Jewish Federation of Greater Seattle
Conclusions: Projects Recommended for Funding
Appendix A: Documentation of Needs and Service Availability
Appendix C: Senior Service System Gaps
Appendix D: Summary of Critical Issues/Questions
Appendix E: Council on Aging Members
From August, 1994 to February, 1995, the Jewish Federation of Greater Seattle, with the assistance of Klein/Doerr, Consultants, conducted a two-phase needs assessment and planning study focused on Jewish elders and their families in the Greater Seattle area. The study had two major goals: to produce recommendations that could be implemented with regard to improving care and services for elders, and to determine the appropriate role of the Federation, and its newly-revitalized Council on Jewish Aging, in shaping this future.
Six important study findings were:
The remainder of this Report contains a description of the study methods, the mission and goals adopted by the Council on Jewish Aging, strategies the Council approved for service and resource development and coordination, and conclusions regarding the funding necessary to implement these strategies.
The first phase of the study documented the needs, resources, and service gaps that characterize the aging Jewish community of Greater Seattle. The second phase resulted in the development of a mission statement, goals, and strategies for meeting the documented needs and identified service gaps. The following were components of these two phases:
The consultants projected the number of Jewish elders, in five-year increments, from the present to 2010. The number of disabled Jewish elders was also projected. Projections were done for the entire Jewish population, broken out by age groups (under 18, 18-64, 65-74, 75-84, 85+). A thirty-one percent increase (934 individuals) in the community-dwelling Jewish population 65+ is projected over the next 15 years. Since the growth in the young elderly will be greater than for those at older ages, the percentage increase in disabled seniors will be just 28 percent (303 individuals). These data are presented in some detail in Appendix A-1.
Several of the Jewish community service providers and lay leaders expressed the opinion that these data were based on a study of the population that under-counted Jewish seniors in the area. However, the data used were drawn from the 1990 Jewish population survey conducted by the Jewish Federation of Greater Seattle, and we are confident that they reflect an accurate picture of this population. Additionally, others believe there has been a recent influx of Jewish seniors moving to be near their children that would tend to make these figures larger, and this may, in fact, be true.
Staff of the five community-based agencies or programs serving Jewish elders were interviewed individually, with a follow-up provider focus group to discuss several important emerging issues. Providers described their own services and gave their opinions about the most important needs and gaps with respect to Jewish elders and their families.
The consultants concluded that a mere handful of staff at the five agencies were struggling to meet burgeoning senior needs while taking care of administrative and marketing essentials. While the quality of services provided is excellent, numerous gaps in service exist. Furthermore, the knowledge base of providers (about those they serve and about the services available from other community providers) needs to improve.
Many of the strategies recommended by the Council on Aging (see Section IV below) are based upon the opinions of providers as reported in the materials to be found in Appendix A (Provider Focus Group Summary Report and Interviews with Jewish Agencies Serving Greater Seattle Elderly).
A final and very important step in gathering information about needs and available resources was a series of four focus groups that were held November, 1994 - February, 1995. Approximately 25 individuals (active and frail seniors, as well as those caring for disabled seniors) attended the focus groups and spoke eloquently, first-hand, about needs and service gaps. The report that summarizes this input is found in Appendix A-4.
A second source of information about Jewish community needs and available services were the ten key informant interviews (some local, some national) conducted by Federation staff and the consultants. A list of those interviewed is provided in Appendix B-1. Key informants not only expressed views on needs and services, but they gave opinions about strategic considerations that helped identify critical issues developed by the Council on Jewish Aging during the second phase of the study. Planning products from other, similar Federation studies from across the country were also reviewed. A list is provided in appendix B-2.
Documents summarizing: 1) all trend information, gathered from key informants, providers, consumers, and caregivers, and 2) the needs of seniors, gathered from key informants, providers, consumers, and caregivers, can be found in Appendixes B-3 and B-4, respectively.
Summary of Service System Gaps: In preparation for a discussion of critical strategic issues and the selection of goals, a document that summarized service gaps was prepared for Council on Aging members. Significant gaps were found to exist in the areas of housing, personal care and other at-home paraprofessional services, transportation, adult day care, nutrition, information/assistance/case management, and selected recreation/cultural and educational activities. This summary appears in Appendix C.
Issues identified through key informants and local providers were discussed by the Council on Aging. These appear in Appendix D. Ultimately, those issues that related to coordination, resources, marketing, and addressing specific service system gaps became those of greatest importance in the study's second phase, described below.
At one time the Jewish Federation of Greater Seattle had sponsored a Council on Aging. However, over the past several years it had become inactive. It was reconvened, under new leadership, to serve as the review body for this planning process. At the same time, it was charged with determining its appropriate future role with respect to senior adults. The Council met five times throughout the study--from November, 1994 to February, 1995. A list of its members appears as Appendix E.
After reviewing the staff/consultant planning products described above, the Council spent several meetings discussing and developing its role and mission, along with goals and strategies to implement a desired senior adult future in Greater Seattle.
In February, Federation staff convened representatives of the five organizations that provide services to Jewish senior adults, in Greater Seattle, in order to obtain their feedback on the goals and strategies recommended by the Council on Aging. Their comments were reviewed by the Council on Aging at its fifth meeting and have been incorporated into this final version of the planning document.
At its third session, the Council on Jewish Aging, discussed critical issues and questions that had arisen during the study process. The result was an overall mission statement that delineated the purposes of both the Council on Jewish Aging and the Jewish Federation, with respect to elderly services, and draft goals for the ideal Jewish elderly service system of the future.
At its fourth meeting, the Council reviewed a draft of revised goals and proposed strategies and adopted the 5 goals and 14 strategies listed below as its draft recommendations to the Federation. (Some of the strategies are referenced more than once, since they address more than one goal.):
1. Improve access to, and use of, existing senior adult Jewish and non-Jewish community services.
1-1. Publicize existing and new senior adult services by means of a newsletter, brochures, etc. The newsletter could contain information on new programs, general service availability, and what activities are happening in the community, as well as including issue pieces related to senior advocacy, "tips," and other information of interest to senior adults, families, and service providers.
1-2. Establish a "Jewish Seniors Hotline" that provides information and assistance to Jewish senior adults and their families. Such a service could be staffed by volunteers during certain hours of the day; at other times, the caller would receive a recorded message telling him/her what to do if there is a crisis along with the regular Hotline hours. The Hotline would be well-publicized in the community.1-3. Develop a coordinating mechanism that could bring Jewish agency providers together, as well as improve linkages between Jewish agency providers and other community systems.
1-4. Establish a system for analyzing characteristics of the Jewish service system users, including data on funding, number of clients served, and client characteristics. The system could be developed under Federation auspices/funding and Jewish agency service providers would be asked to implement it and be provided resources for hardware and technical assistance in order to do so.
1-5. Create a mechanism whereby public and private sources of funds for elderly services can be better accessed by Jewish service providers.
2. Increase access of inadequately served Jewish seniors to selected services.
2-1. [See 1-1 above, "Newsletter"]
2-2. Conduct a study to explore the feasibility of: 1) a central transportation brokerage for Jewish agency vans, and 2) establishing volunteer transportation services as ways to address the well-documented shortage of transportation.
2-3. Pending the outcome of that feasibility study, funds should be sought to increase the access of Jewish elders to transportation services.
2-4. Explore the use of existing "senior service space" that could be used for Jewish cultural and recreational activities that require regular meeting space.
2-5. Conduct a study to explore the feasibility of providing a daily hot Kosher noon meal in a variety of neighborhoods.
2-6. Pending the outcome of that feasibility study, funds could be sought to increase the access of Jewish elders to nutrition services.
3. Strengthen the amount and quality of coordination among Jewish agencies serving Jewish elders.
3-1. [See 1-3 above, "Coordinating Mechanism"]
3-2. [See 1-1 above, "Newsletter"]
3-3. [See 1-4 above, "Data System"]
3-4. [See 1-5 above, "Fund Source Development"]
4. Create additional resources by increasing the effectiveness of relationships between Jewish and non-Jewish service systems.
4-1. [See 1-3 above, "Coordinating Mechanism"]
4-2. [See 1-5 above, "Fund Source Development"]
4-3. Explore the possibility of working with existing Greater Seattle in-home care agencies, to provide specialized training to selected workers who could then serve Jewish elders in a more culturally appropriate manner.
4-4. Explore the possibility of providing training to existing adult day care centers in Greater Seattle who could then serve Jewish elders in a more culturally appropriate manner.
5. Assure development of a wide enough range of services to meet the needs and demands of an increasingly diverse Jewish senior adult and middle-aged population, including those that would fill gaps in service areas that were identified by the elderly needs assessment process
5-1. Encourage the development of Jewish assisted living facilities that are most responsive to community needs and desires through Council sponsorship of educational events that provide information and elicit needs/desires from consumers
5-2. Create an annual symposium for seniors and providers that promotes dissemination of information about new technology, provides updates on innovative services, offers workshops on retirement planning, caregiver resources, etc.
5-3. [See 1-5 above, "Fund Source Development"]
At its fifth meeting, the Council discussed the types of projects that should be developed and funded to implement its adopted strategies. These were the recommendations, in order of priority:
The Council on Aging has high hopes for the outcome of the elderly needs assessment and planning study. It provided a solid base of evidence that while the senior services being provided by the Jewish community are of a high quality, they are not sufficient to address burgeoning needs. Further, the community is not well-informed about the services that are available. There is a considerable gap, therefore, between what is needed and what the senior adult population is receiving.
It is hoped that the recommendations in this report will be implemented in order to allow the Jewish Federation of Greater Seattle and the beneficiary agencies providing senior services to make significant improvements over the next several years, in the amount and availability of senior adult services and caregiver support. Action taken now will position us to respond effectively to significant senior adult population increases and, concomitant need, by the year 2010.
The data presented in this Appendix were drawn from the following sources:
Jewish Federation of Greater Seattle, Our People, Our Resources, Seattle, Washington, 1991.
Vladek, Bruce, et al., "The Changing Face of Long-Term Care," 1993.
Washington State Long-Term Care Commission, Report and Recommendations to the
Legislature, Olympia, WA: January, 1991.
Washington State Office of Financial Management, Forecasting Division, County Population
Projections: 1990-2010, Olympia, WA: January, 1992.
This document summarizes the input received from participants in the provider focus group conducted as part of the Jewish Federation's strategic planning process for geriatric services. The participants were service providers from Council House, both the Northend and Mercer Island Jewish Community Centers, Jewish Family Service and the Polack Adult Day Care Center at the Kline Galland Home.
Between August 30 and October 11, 1994, Denise Klein interviewed five professionals with managerial or coordination responsibility for senior programs operated by four agencies that target services to older Jewish residents of Greater Seattle. The information gained through these interviews is presented in an attached table and, in narrative form, below.
Several overall impressions were created by this set of interviews:
This is a retirement residence sponsored by the National Council of Jewish Women. It was built with HUD (federal) financing and receives HUD rent subsidies. These, together with rents, comprise the majority of Council House annual revenue. Substantial other revenue comes from grants and donations. Currently 41% (68) of the 167 residents are Jewish, of whom 12 are Holocaust survivors. Seven percent of the residents are under age 62 and are considered disabled physically or mentally. The Director estimates that a total of 16% of the residents are mentally disabled.
The program does not routinely collect and compile client data other than those related to administration of HUD rent subsidies. However, the Director has recently begun keeping summary data on resident's income, age, race, gender, and disability. The Director states that residents remain in the facility for an average of five years.
Funding has been obtained to support a full-time social services coordinator/case manager. Given the increasing frailty of residents, a part-time nurse practitioner is also needed. The facility had an on-site weekly health clinic operated by Swedish Hospital until the hospital closed the clinic due to financial pressures. Foot care is provided on-site by a private physician. Other services include a daily meal that residents pay for (free lunch on Fridays), and transportation to the Jewish Community Center on Mercer Island for activities on Thursdays.
The Director sees a future for the facility that includes more supportive services, including those approaching assisted living, for residents who want to "age in place," rather than move to another facility. Coordination with other Jewish agency providers is not substantial. The fact that the facility serves both Jews and non-Jews makes such coordination more problematic. The reason the facility is available as an option for non-Jewish low income seniors and young disabled people is because demand from the Jewish community is not high enough to keep the studio apartments filled. There is currently no wait for studio units. Furthermore, federal regulations preclude giving preference to Jews. An issue in marketing the facility is its location. The neighborhood is perceived by many as transitional and not particularly safe.
The Community Center provides a rich array of cultural, educational, recreational and social services to a wide range of Jewish individuals and families. Services for mature adults and seniors are available free or for nominal fees. The actual dues and fee structure--including Center membership--is complex, but staff of the Senior Program are able to waive or reduce fees in cases of financial need.
An interesting approach to market segmentation is reflected in the rather wide array of age and interest groups that are separately identified and have their own events on different days of the week and month. At least three programs serve seniors.
The Golden Age Club has its own legal structure and has existed for many years. Some of its 300 members are founding members. Dues are $10/year and include a monthly newsletter. The group is highly organized and spirited, and members include both robust and more frail elders. The group has more immigrants and those who were in blue collar occupations than the other senior groups. Monday and Thursday are regular activity days, with attendance averaging 30 on Mondays and 60 on Thursdays. The group takes two long field trips each year of 2-3 days' duration, as well as 1 or 2 full-day trips. Center-based activities include a monthly luncheon, swim and exercise, movies, current events, crafts, folk dancing, bingo, bridge and guest speakers.
"Fifty-Five Plus" is a younger, more loosely affiliated senior group whose members are drawn primarily from the eastside. They tend to be newly-retired and, perhaps, newcomers to the area. Participants who are not members pay $1-2 for specific group activities (The Sunday Exchange, bridge, a book group). Other activities include retired men's and women's clubs. These have annual dues of $15-$20. Activities include speakers, roundtable discussions, social programs and outings. Bridge games occur on the second and fourth Wednesdays ($1/sessions for non-members). A book group occurs on the first Wednesday. There is also a monthly get-together on Sundays. Members who join the JCC may attend all regular activities free of charge. They also receive a newsletter (mailed to 250 households). There is also a singles group, formed in the summer, that is part of the Fifty-Five Plus.
These two programs are served by two staff, one of whom (the Director) works 25 hours a week. A second staff person spends 10 hours a week on Golden Age Club activities.
In addition to the Senior Adult programs at the Mercer Island site, there is an adult program for Jewish single adults called New Connections. The staff person for this group estimated the average age of members is 60, but there are members as young as 40. The group has more active programs than the Fifty-Five Plus singles group, including concerts, hikes, and golf.
This program and several others for younger singles and families are staffed by a 75 percent staff person at a half-time level. The other 25 percent of her time is spent with the Northend Senior Group.
There were two major needs identified by staff. The first was to increase the community's knowledge about their existing programs, in order to serve more individuals. The second is that of transportation. Many seniors who are younger drive to the Center and its programs, but many others are not able to, or cannot afford to, use a car. Busses are chartered for trips, but for weekly activities two van companies bring participants to the Center. On Mondays, one van serves Capitol Hill and Seward Park. On Thursdays, one van goes to Seward Park and two vans serve Capitol Hill. One of these is dedicated specifically to Council House. Metro has recently made the JCC a stop on its Monday/Thursday regular route to coincide with Golden Age Club meeting times. The JCC mini-bus is a great asset; however, its age would not warrant more use than the limited amount it presently receives. It is not lift-equipped and should probably be replaced.
It is clear that expanded transportation availability would allow more seniors who do not drive to attend JCC activities. At present a number cannot be served because they live outside the regular van service areas.
It should be noted that the JCC facility is not currently handicapped-accessible. A planned remodel will remedy this.
Stroum Jewish Community Center - North End Senior Adult Program, Sylvia Angel Epstein, Adult Programs Coordinator
The North End Senior Adult Program was revitalized in early 1993 and is supported in part by a grant from the Jewish Federation. The need for the program arose because the lengthy commute from North Seattle to Mercer Island was not feasible for most seniors.
There is no adequate program space, since the North End JCC is fully used during the week by activity programs and day care for children. The Coordinator described the North End seniors as less affluent than those who use the Mercer Island Center, as well as "warm and welcoming." 250 older adults are on the program's mailing list. Many of these individuals were identified through their north end synagogues.
Regularly-scheduled activities are the Seattle Yiddish Group (meets from 2-4 p.m. one Sunday/month); the Current Events Discussion Group (12-1:30 p.m. on the last Monday of each month), and the Senior Adults Advisory Council Planning Meeting (meets 1-2:30 p.m. one Thursday/month at Congregation Beth Shalom). In those months with five Sundays, a potluck is held on the fifth Sunday.
Special events include play readings, theater and other entertainment, brunches, lunches, picnics and field trips. Attendance at events is typically 20-25. The program mailing list grew from 150 to 250 households during the past year. The newsletter is published 6 times/year.
Three issues are paramount for this senior group. The lack of transportation has a dampening effect on attendance at activities (car pools are sometimes arranged). Seniors believe their membership fees ($35 for one person and $55 for a couple), coupled with activity fees of up to $2, and special events costs are too expensive and unfair by comparison to what is available to seniors who use the Mercer Island JCC programs. Finally, there is not adequate space to accommodate activities.
The renewal proposal to the Jewish Federation, submitted recently, calls for expansion of the staff position from 1/4 time to 1/2 time. This would allow expansion of programs and doubling of attendance at activities. Staff feel they have done a good job of identifying interested seniors in the north end, but limited staff time precludes the regular promotion of programs and arranging for transportation that would foster increased senior participation.
On the plus side, the Coordinator spoke of the lay leadership of the group with great respect and affection. Given severe limitations of staff time and other resources, it has been necessary for volunteers to come forward to help with outreach, reminder phoning, and transportation, and a number have done so.
The two JCC staff interviewed have "limited contact with other Jewish agencies." Jewish Family Services refers to JCC, but referrals going the other way were not mentioned.
Jewish Family Service provides a complex network of services through its Senior Services Program. Together these services promote independence, dignity, and understanding for Jewish older adults and their families. Offices are on First Hill in Seattle and in Bellevue. In addition to the Senior Services Programs, the agency's other programs such as the Food Bank and the refugee resettlement program also serve a significant number of seniors. Program funding comes from the Jewish Federation, United Way, client fees, donations, and Medicare (for counseling).
The program identifies two types of clients: those that are long-term or ongoing and those that are short-term. Clients in the first category are usually lower income and have little family support. Services these clients receive include case management, assistance in obtaining homemaker services--particularly while waiting for state-funded chore services-- telephone reassurance, and friendly visiting. Short-term clients are likely to have higher incomes, with a small percentage who are wealthy. Such clients also tend to have better family support. These clients receive in-home assessment and testing, counseling, and family consultation. Less often, they receive ongoing care management, friendly visiting, and telephone reassurance.
In part, the long term/short term categorization is related to whether or not the client is low income and, if not, whether they are willing to pay fees. Increasingly the program is emphasizing the need for those who can afford to pay for services, to do so. This has had some negative effect on program demand and use. Clients are resistant to paying for certain services (those that are less concrete), even when they have high income.
The Director observed that, generally, seniors will pay for homemaker services, Meals on Wheels, transportation, shopping assistance, financial management/bill-paying, and adult day services. Case management is too abstract to be marketable directly to older people. However, their families will sometimes pay for this service--particularly if it relieves them of some concern and direct responsibility.
Four individuals, totaling more than 2 FTE's deliver senior services. There is currently no significant wait for services, with the exception of those for which volunteers need to be recruited (friendly visiting). In the past there was not a wait for case management, but those who can't pay may wait in the future if demand exceeds available staff time.
Prior to more aggressive fee-generation efforts, case management clients sometimes remained "on the books" for several years; now the typical length of enrollment for the low-income client is one year. Short-term case management typically lasts only two weeks. Friendly visiting and telephone reassurance tend to be provided for an average of about five years. Counseling lasts from six months to one year. Fees for counseling go up to $65/hour, on a sliding scale, with Medicare enrollees paying a $10 co-pay per visit. Support groups and workshops are provided on an as-needed basis at no charge to participants.
The primary issue discussed in the interview was that of the effect of fee charging upon program revenue and usage. Approximately $8,000 was generated by fee-for-service activities during the past year (20% from Medicare; 40% from counseling; and 20% each from short and long-term case management). During last winter, when the fee schedule was enforced for the first time, caseloads declined. Staff recognize there is a complex inter-relationship among service need, income availability, perception of the value of the service, and so forth. They are concerned that people who need service may not receive it because they are not willing to pay fees (though perhaps able to do so).
Other program challenges include:
This program, located in the Carolyn Kline Galland nursing home in Seward Park, serves an enrolled population of 30 frail seniors or younger disabled individuals. The program operates four days a week (Mon.-Thurs.) from 9:30 am to 2:30 p.m. Its target populations are: chronically disabled Jewish individuals and older Jewish adults in need of medical/nursing, social or mental health services or those who could benefit from social services. The program is characterized as having a very high level of activities. According to the Director, "participants are here to be with other people."
The disability level of participants ranges widely from those who are living fully independently but need socialization to those who reside in other nursing care facilities. Primary referral sources are the Kline Galland Home itself (from its waiting list), Jewish Family Service, family members and physicians.
Program services include transportation; a kosher noon meal; health monitoring by an RN; recreational and social activities (exercise, arts and crafts, entertainment, field trips); educational activities with Jewish content (shared by nursing home residents and adult day center participants); discussion groups, information, family support and counseling services.
No aggregate data describing the clients served is regularly compiled, but extensive data is kept for each individual participant: a social history, initial and re-assessments (the first assessment is done in the prospective participant's home), and monthly charting.
Participants come to the center from 1 to 4 days each week. Average daily attendance is 12. Those enrolled include Soviet immigrants who attend a bi-weekly Russian program. Average duration of enrollment is 3-5 years for those living in the community, and 6 months to 1 year for those who reside in nursing facilities. Fees are $20/day with transportation and $15/day without, and may be adjusted based on ability to pay.
With the exception of the Director and nurse time provided by Kline Galland, regular staff are part-time para-professionals who range in age from 50 to 81. They watch, listen, and report on the subtle changes in participant functioning to the Director, either immediately, or at twice monthly meetings.
The primary issue for the program is that of tapping into latent service demand, or increasing enrollment through successful marketing. The goal is 20 participants daily rather than the 12 who are currently attending. Demand exists that the program cannot now meet, primarily from those who are above Medicaid eligibility but cannot afford to pay fees, and from potential participants who have later-stage Alzheimer's disease. The program staffing pattern is not rich enough to serve these individuals, many who are incontinent and tend to wander.
Transportation is a severely limiting factor, as it is with all the other facility-based programs. The service area for transportation is from Seward Park north to 145th Street, including Queen Anne. Transportation is provided one day a week for Mercer Island residents. Those who live in Magnolia, West Seattle, and further south are not served. There is a significant number of people, especially Soviet immigrants, on the east side who would benefit from the program but for whom it is geographically inaccessible.
Two vehicles are owned by the center and it employs one full-time and one part-time driver. The Director believes a third van and driver are needed to meet current program demand.
She spoke, too, of the phenomenon whereby program publicity and outreach does not seem to generate an on-going, informed referral base sufficient to reach enrollment targets. Many individuals feel stigmatized by needing to go to a "center." She mentioned there is a potential role for the Federation in providing information and referral or assistance services for the Jewish senior adult community and developing a marketing program that would educate the community about Jewish services for the aged.
This document summarizes the input received from participants in four focus groups conducted as part of the Jewish Federation's strategic planning process for geriatric services. A total of 25 individuals contributed to the focus groups. Two groups included active seniors who are living in the community; another was comprised of frail seniors who have resided at the Kline Galland Home for less than 12 months; and the fourth was made up of caregivers who support elderly individuals in the community.
Each discussion question is set forth below. Key points of general agreement among the groups are discussed first. Divergent or minority responses are also recorded and identified according to the focus group that raised the issue. In this way, the summary provides information about areas of consensus and also highlights concerns that may be equally important but not generally recognized.
Active and frail seniors, as well as caregivers, agreed that those in acute need of assistance are most likely to turn to a Jewish social service agency for help. Illness, emergency situations, and other adverse life events were cited as reasons for needing help. Respondents identified those who are new to the community, who have no family or other resources, or who have recently lost a caregiver or significant other as most likely to seek assistance.
Active seniors discussed the fact that Jewish agencies offer services with a "Jewish flavor" that provide opportunities for older Jews "to feel useful in a Jewish atmosphere." They agreed that those seeking services from a Jewish agency are looking for cultural, religious, culinary, and/or historical linkages to Judaism.
Both active seniors and caregivers identified caregivers' needs as a mediating factor in turning to a social service agency. Active seniors talked about the need for a caretaker to get away from a spouse who needs care; the caregivers group discussed the need for help from a counselor in communicating with an elder.
Active seniors mentioned multiple sources of information about services. The Jewish Community Center (JCC) was identified as the "linchpin of it all." They also typically rely on information from the media, specifically the Jewish Transcript, daily newspapers, community papers, and radio. Synagogue involvement and word of mouth were also cited as important ways to obtain information on available services.Caregivers tended to rely on Jewish information sources, including agencies such as Kline Galland, Council of Jewish Women, Jewish Family Service, and the JCC. Jewish community publications, the Jewish Transcript, and local newspapers were also mentioned as resources. Caregivers also cited social workers as an important information source.
On the whole, frail seniors did not appear to be well informed about community services.
Several barriers to obtaining services from Jewish agencies were mentioned. Both seniors and caregivers discussed physical access (geographic location and lack of transportation) as problems. Active seniors identified ignorance about available services combined with isolation, loneliness, and fear as significant access problems.
Active seniors also talked about the need for more publicity so that the larger community is aware of resources available to seniors. Interestingly, they mentioned referrals from the non-Jewish community as important.
Active seniors and caregivers alike spent considerable time discussing the resistance of many seniors to obtaining services even when they need them. Some active seniors stated that many people will not ask for assistance until they are desolate. Others are not used to asking for help outside of the family or are resistant to change.
Caregivers described attitudes important to the past success of many seniors which now get in the way, such as self-reliance, stubbornness, unwillingness to compromise on what they want. Control of their own lives is a very big issue. Unrealistic expectations on the part of those receiving care also were perceived as a barrier.
Some older people find new situations frightening--they need help in building self-confidence and self-esteem in order to access services. Others perceive that there is a stigma attached to needing services. It's important to find ways to overcome this resistance so individuals don't seek help only as a last resort. Elders should feel comfortable no matter what the situation is.
Both active seniors and caregivers identified medication dispensing and management as vital in an assisted living facility. Caregivers cited support groups and meal regulation as important components. Additionally, personal hygiene assistance, and help coming down for meals were important to active seniors as services to be included in assisted living. They suggested the development of "foster homes" for senior adults, similar to those for children. While cost is a factor, people will be willing to pay for good services if they have the financial resources.
There is also a need for alternatives that enable frail seniors to stay in their own homes, perhaps with the assistance of a home health aide to clean, cook, and assist with medications. There was consensus that, in many instances, this is better for seniors and they will remain happier and healthier.
Active seniors advocated for better advertising about available programs and better targeting of existing programs by assessing the needs of those served. They lauded the availability of more services in North Seattle but noted the need for more financial resources. They expressed the need for more community-based exercise programs, perhaps held in synagogues, to improve access. Teaching Yiddish to more seniors and organizing a buddy system so seniors are able to get to programs together were also proposed.
Some active seniors expressed concern about the artificial separation between seniors and others because it makes seniors feel isolated and categorized. More inter-age activities should be planned to overcome this separation.
In general, frail seniors are very pleased with the quality of services offered at Kline Galland. The care was characterized as "outstanding," and the quality of administration is considered to be "superior." Physical therapy was also mentioned as "fabulous."
There were two areas for potential improvement in Kline Galland services. Short-stay services should be redesigned to better separate them from permanent residents. Double-occupancy rooms, in particular, should be eliminated and perhaps a separate part of the facility should be designated for short-stay patients.
Some frail seniors felt that the kitchen staff could be better trained and more patient, but there was some disagreement on this point.
Participants in the focus groups indicated a willingness to participate in the cost of services. People want to pay something so they don't feel they are accepting charity. This helps seniors feel financially independent and in control of their own lives as well as overcomes the welfare stigma of social services. They suggested that it be done on a sliding scale depending on income so the individual situation of a senior can be taken into consideration.
Active seniors expressed a strong need for more information about available services. Ideas to address this need included a comprehensive directory of services, public service announcements, a senior welcome wagon, a quarterly newspaper targeted to seniors, a "talking library," free directory assistance calls, pamphlets on financial and housing services, and a centralized transportation center with information on all options. They stressed that information should be provided on all services, not just those targeted at Jewish elders.
Active seniors want planners to understand that seniors are not a homogeneous group; they have different needs and want access to different activities and services that respond to these preferences. They also discussed the implications of the growing senior population, especially in terms of longevity and the need to assist those who have problems. They called for a bold plan that involves seniors in a total way to address political issues, social security, and health care.
Caregivers emphasized a realistic approach to planning for the needs of elders. They expressed the belief that it isn't possible to solve all problems and make seniors totally happy, and that we must be realistic in terms of what can be provided. They were concerned about whether Jewish institutions are meeting needs of those over age 85 and proposed that this be evaluated.
Caregivers also urged that services be provided before people become infirm. This means that more options must be offered and provided more than one time before many seniors will accept what they need.
Caregivers discussed the conflict between keeping seniors physically healthy and safe vs. preserving emotional and spiritual happiness. Their most difficult dilemma was with which comes first and how do you let them live independently while assuring they are healthy.
John Capitman, Director, National Aging Resource Center, Brandeis University, Boston
Mary Liz Chaffee, Case Manager, Second Family (a private case management agency), Seattle
Josh Gortler, Executive Director, Kline Galland Home, Seattle
Frank Jose, Director, Seattle-King County Division on Aging, Seattle
Kathy Leitch, Manager, Planning and Program Development, Aging and Adult Services Administration, DSHS, Olympia
Murray May, Director, Hebrew Rehabilitation Center for the Aging, Boston
Phyllis Mitzen, Director, Home and Community-based Services, Council for Jewish Elderly, Chicago
Arthur Patsiner, Program Director, Manhattan Branch, Jewish Association for Services for the Aged, New York City
David Stern, Director, Jewish Association for Services for the Aged, New York City
Reva Twersky, consumer and former Chair of Division on Aging Advisory Council, Seattle
Jewish Federation of Greater Houston, TX
Jewish Federation of Greater Kansas City MO/KS, Kansas
Jewish Federation of Greater New Haven, CT
Jewish Federation of Greater Vancouver, Vancouver, Canada
United Jewish Appeal Federation of Greater Washington, Inc., Washington, D.C
United Jewish Federation of Greater Pittsburgh, PA
Winnipeg Jewish Community Council, Winnipeg, Canada
SERVICE PROVIDED BY JEWISH AGENCY PROVIDED BY NON-JEWISH AGENCY NATURE OF GAPS
Housing Council House is a A wealth of housing options exist in General gaps that exist
subsidized apartment King County and, to a lesser degree, are primarily with respect
retirement residence with in South Snohomish County. These to assisted living for low
a number of social /health include: income individuals. For
services on site and is Subsidized, independent, low income the Jewish community, the
expanding by adding an units both public and private--some gap is clearly in the
on-site service have social services provided spiritual, cultural,
coordinator. 41% of the on-site. social, and nutritional
residents are Jewish. Middle and upper-income assisted features that would make a
living units. retirement "home" Jewish
Two assisted living A small number of subsidized in character.
facilities are described assisted living units. Of the 65 Jewish elderly
as "caring to Jewish Life care communities with multiple living in 22 of the 48
cultural and religious levels of housing which range from retirement homes in King
needs" though they are not fully independent to living in a County with assisted
run under Jewish auspices. nursing home. living, half have
Retirement homes--some are almost extensive contact with
Kline Galland owns entirely for independent seniors; Jewish life. 25% were
property it plans to others provide a range of services. described as having
develop as an assisted Adult family homes. limited contact with the
living facility for Jewish Congregate care facilities for the Jewish community. Contact
elders. low income (these are the assisted by the remaining 25% was
living precursors--they provide unknown. Retirement home
services but have two residents per staff did not know how
room). many residents desire more
contact with Jewish life.
[This information was
obtained in a survey done
by JFS staff]
SERVICE PROVIDED BY JEWISH AGENCY PROVIDED BY NON-JEWISH AGENCY NATURE OF GAPS
Health Kline Galland Nursing Home Health services in the Greater 40 of the 46 elderly Jews
is the only health care Seattle area are well-developed and in non-Jewish nursing
facility designed for accessible, including good options homes were described as
Jewish elders. The Jewish for low income elders such as the having some contact with
Family Service (JFS) network of community clinics. The Jewish life, although most
survey identified 46 Health Department provides of this was limited.
Jewish elderly living in subsidized flu shots and contracts Interest was unknown.
27 other nursing homes. for foot care and blood pressure The Stroum Jewish
monitoring at senior centers in Community Center (JCC)
suburban King County through the facilities are not
visiting nurse service. handicapped-accessible.
No mention was made of
Other senior centers also have on-site "convenience"
on-site health services available. health or health-related
Preventive and Monitoring services services at the JCC.
are free and there is a charge for It is likely that
foot care. transportation to health
care is not as convenient
or plentiful as would be
desirable.
SERVICE PROVIDED BY JEWISH AGENCY PROVIDED BY NON-JEWISH AGENCY NATURE OF GAPS
Personal Care at These are not provided by There is complete geographic Personal care for
home. Includes Jewish agencies. coverage for King and Snohomish other-than-very-low-income
assistance with counties by a number of agencies individuals is a service
bathing, that provide state-funded personal gap. It is not typically
dressing, eating, care services for low income elders. covered by health
grooming, etc. insurance and usually not
by long term care
This service is also widely insurance except sometimes
available for those who can afford for very disabled
to purchase it. individuals.
SERVICE PROVIDED BY JEWISH AGENCY PROVIDED BY NON-JEWISH AGENCY NATURE OF GAPS
Housekeeping/ Jewish Family Service Available for seniors who can afford JFS is looking for a way
Chore Services (JFS) provides assistance to pay. Available on a very limited to improve/transform their
in obtaining homemaker basis to low income seniors through homemaker services,
services for low income a state-subsidized program. including better screening
clients who are waiting of workers without
for state-funded chore assuming more liability.
services.
SERVICE PROVIDED BY JEWISH AGENCY PROVIDED BY NON-JEWISH AGENCY NATURE OF GAPS
Transportation Council House provides Transportation is widely available There will be gaps in the
transportation to Stroum to access senior nutrition sites and availability of
Jewish Community Centers adult day health care. Gradually, transportation for
(JCC) for Thursday Metro is implementing extensive van other-than-severely-disable
activities. JCC can bring service for severely handicapped d seniors for the
participants to the center seniors. Van transportation is now foreseeable future. These
in their own vans and available for medical appointments gaps will be most notable
charters busses for field if reservations are made enough in during evenings and
trips. Metro brings yet advance. weekends, and with respect
other seniors to the to cultural and
center. There is recreational activities.
transportation to the
Polack Adult Day Center, Transportation is not
but not for all area consistently available to
neighborhood residents. those who live on Mercer
Island and in southernmost
Seattle. Those who live
north also do not have
transportation but would
have a very long ride even
if it were available.
SERVICE PROVIDED BY JEWISH AGENCY PROVIDED BY NON-JEWISH AGENCY NATURE OF GAPS
Adult Day Care The Polack Adult Day Care Nearly 30 adult day/day health sites This service is not
Program at Kline Galland are found in the Greater Seattle available in every
daily serves 12 of the 30 area. They operate from 4 to 12 neighborhood or
enrolled frail seniors or hours per day and from 1 to 7 days community. Many programs
younger disabled per week, with the norm being 6 suffer from chronic low
individuals. Service is hours a day, 5 days a week. Many census that keeps program
provided 4 days a week provide door-to-door van service. growth low and inhibits
from 9:30 am to 2:30 p.m. Most sites provide lunch; some offer expansion, despite
breakfast and dinner as well. Fees presumed need. Day
vary, with some programs offering a centers know they need to
sliding fee scale and state-funded expand their marketing
slots for low-income seniors. efforts and are doing so.
Polack's goal is 20
enrolled participants; it
cannot now meet all
demand, primarily from
those who are above
Medicaid eligibility but
cannot afford to pay fees,
and from those who have
later-stage Alzheimer's
disease (because the
staffing pattern is not
rich enough to serve
incontinent or wandering
individuals). A third van
and driver are needed, in
the Director's estimation,
to meet current demand.
SERVICE PROVIDED BY JEWISH AGENCY PROVIDED BY NON-JEWISH AGENCY NATURE OF GAPS
Recreation/ The Stroum Jewish Numerous area activities for seniors There are probably not
cultural/education Community Centers (JCC), exist. These are provided by Senior enough weekend activities.
al activities both Mercer Island and Services of Seattle-King County Transportation for
(including North Seattle, provide (senior centers), and King County weekend and evening
advocacy) these types of activities. government (for unincorporated activities is not
An average of 45 people areas) and recreation departments of sufficiently available.
attend on the two primary suburban governments. The Seattle
days of Mercer Island Parks department also provides a Transportation also
activities. Typically, number of activities, and there are severely constrains
20-25 attend North End several free-standing senior attendance at JCC
events. There is the centers. activities--particularly
approximate equivalent of in the North End.
1.75 staff providing The Seattle-King County Division on Jewish seniors who do not
senior activities at the Aging has a 30-member Advisory live on Mercer Island or
two JCC's. Council that engages in educational North are probably not
and advocacy activities. There are being adequately served.
a number of senior organizations The activity space for
that offer political and other North End JCC activities
activities for active seniors. is woefully lacking. Some
seniors object to paying
recently-increased
activity fees. Given
program dues to join JCC,
charges for recreational
activities may be high
enough to prevent
participation by
low/moderate income folks.
SERVICE PROVIDED BY JEWISH AGENCY PROVIDED BY NON-JEWISH AGENCY NATURE OF GAPS
Nutrition Kline Galland provides a There is a vast network of daily and The Kosher hot lunch
Kosher lunch to 30-50 other nutrition programs for seniors program is available to a
people every Tuesday. throughout Greater Seattle. Most of limited number of seniors
Transportation to and from these programs also have recreation due to its location at the
Council House is provided, and other services available before Kline Galland Home.
and social activities are and after lunch.
included in this 2-3 hour There is a frozen home-delivered There is no daily Kosher
program. Kline Galland meal program that includes the lunch program available in
also caters a frozen Kosher option for any senior who either North or East
home-delivered meal that resides in Seattle. Seattle.
is available to any area
senior. Approx. 700-900 Not all nutrition sites
frozen meals a month are provide transportation.
prepared
SERVICE PROVIDED BY JEWISH AGENCY PROVIDED BY NON-JEWISH AGENCY NATURE OF GAPS
Information and re-JFS provides information The Division on Aging funds an There is no Jewish section
ferral/assistance and referral/assistance, extensive system of of the Yellow Pages.
and case but this is not a widely information/assistance (I & A). The
management publicized service The general I & A program is provided by With respect to
management JFS staff is very small telephone through Senior Services of information/
(2+ FTE professionals). Seattle-King County. Other referral/assistance
They offer service on specialized programs serve services, what JFS
First Hill and in non-English-speaking elders and provides is limited unless
Bellevue. They have residents of the eastside. Senior I the client is a continuing
lately tended to emphasize & A does triage for case management client.
services for which there that is provided for clients of all
is reimbursement or a income levels by the Division on With respect to case
private market. Higher Aging (20+ case managers), as well management services, those
income clients (who are as by other agencies that are who are middle or upper
usually short-term) specialized in terms of language or income and cannot pay or
receive in-home assessment geography. do not want to, are
and testing, counseling, increasingly likely to be
and family consultation. There are a several small firms that un-served by JFS due to
provide private case management limited funding for staff.
services to
Less often, they receive individuals or families who can pay
ongoing case management, for them. These services are very
friendly visiting, and flexible and tailored to the
telephone reassurance.. clients' particular situation.
Low income individuals,
who are typically
longer-term as JFS
clients, receive ongoing
case management,
regardless of ability to
pay.
SERVICE PROVIDED BY JEWISH AGENCY PROVIDED BY NON-JEWISH AGENCY NATURE OF GAPS
Friendly Jewish Family Service There are a few These programs tend to be
visiting/companion (JFS) provides friendly telephone-reassurance programs small and proliferate
/ visiting--primarily for operated by area senior centers. through voluntary
telephone low-income, long term Volunteers of America operates a agencies, such as
reassurance clients. Senior Companion program. Sometimes churches, for their own
companions can be found through members.
Catholic Community Services
Volunteer Chore Program or Community
Services for the Blind.
SERVICE PROVIDED BY JEWISH AGENCY PROVIDED BY NON-JEWISH AGENCY NATURE OF GAPS
Counseling JFS provides counseling, Many private counselors provide Convenient and
some of which is Medicare services on a private pay or non-threatening counseling
reimbursable. The other insurance-reimbursable basis. A is probably not
Jewish programs/ agencies number of senior centers provide sufficiently
provide a certain degree support groups related to particular available--particularly
of informal counseling via issues or disabilities, as do for resistant individuals.
professional staff. various health systems.
Spiritual counseling is
available through the
synagogues.
SERVICE PROVIDED BY JEWISH AGENCY PROVIDED BY NON-JEWISH AGENCY NATURE OF GAPS
Intensive mental Severely mentally ill individuals Services are not
health services can receive services through the sufficiently available for
and substance King County Mental Health System. seniors who have serious
abuse services Very little in the way of substance but not chronic/severe
abuse services are available from mental health problems.
the public system. Swedish/Ballard
Hospital has both an inpatient and More substance abuse
an outpatient program that is services need to be
Medicare-reimbursable. There are provided that are
other private in- and outpatient integrated with other
substance abuse services available, services used by seniors.
some of which are covered by private In-home services are
or government insurance. needed as well.
SERVICE PROVIDED BY JEWISH AGENCY PROVIDED BY NON-JEWISH AGENCY NATURE OF GAPS
Education, These are provided by JFS There are numerous programs at no or There is no "Jewish
counseling, on a short-term basis as low cost, sponsored by hospitals, services" section of the
support for need for them is senior centers and other Yellow Pages, nor are any
caregivers identified. There is no organizations. Several of the Jewish agency
charge. publications, including Access, senior services listed
published by Senior Services, keep under "Senior Citizens'
Jewish services are people abreast and aware of them. Services."
publicized through several
JCC newsletters and the There are ongoing caregiver support
Source. groups in the community, including
those sponsored by the Alzheimer's
Association and various health
systems.
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