State Representative Daniel Bosley
Medicare+Choice
Healthy Holiday Food
Snow Bird
From the Director

Seniors Deserve Their Fair Share
By State Rep. Daniel E. Bosley

In the coming year, much of the legislation at both the state and federal level is also designed to ensure that health care remains accessible, affordable and effective.

One of the most promising pieces of proposed legislation is a bill to create a Community Care Ombudsman program to mirror the ombudsmen already established to monitor nursing and rest homes and assisted living care. A Community Care Ombudsman would work to ensure that seniors who receive care at home or in some other setting than a nursing home, rest home or assisted living facility receive the same attention and are given the same opportunity to report complaints as others. Other legislative priorities include expanding reimbursements for low-income people in assisted living situations and developing adult day health programs.

In the budget, the state has had to close the gap which was created when the federal government cut Medicare home health benefits, and I supported a provision in the 1999 budget to study the state's action in this area and ensure that people transferred to state programs do not receive less or worse treatment.
In addition, an Advisory Council on Alzheimer's Disease should finally get underway in 1999 to examine ways to improve and coordinate services to seniors who suffer from dementia. I will certainly work to pass legislation that helps seniors stay healthy and independent, and make sure elder service programs receive the funding we need. With your help, 1999 can be a great year for the senior community in our area.

Medicare+Choice

New types of health insurance: most to appear in Fall of 1999 or 2000

Congress passed a law in 1997 that will bring new types of health insurance plans into the marketplace for Medicare beneficiaries. Currently, Medicare beneficiaries have been choosing between retiree plans, individual "Medigap" plans, Medicare HMOs, Medicaid or free care programs to pay for Medicare's deductibles, copayments or to acquire medical benefits Medicare does not pay for, such as prescription drugs or routine physical exams.

Starting in 1999, some new types of plans and policies could be introduced in Massachusetts. It is too early to say at this point when and what types of plans we will see in Massachusetts. The new options are referred to generally as Medicare+Choice plans.

The most important thing to know is that Medicare beneficiaries do not have to change their current health insurance coverage. Indeed, there is no reason for Medicare beneficiaries to change their current health insurance plans unless they are unhappy with the plan's current benefits, premiums, out-of-pocket costs, or the health care delivery system (fee for service or managed care) the plan uses to provide medical care.
Medicare has written the rules for these new options. However, it will still take insurance companies and managed care companies 6 to 12 months before they gain approval from Medicare and start selling.

Over the next year, Elder Services and its SHINE program will work to help you understand the basics about Medicare and the variety of Medicare supplemental options. SHINE counselors located in local communities will continue to counsel elders individually about the new Medicare+Choice options as well as the continuing insurance options of Medigap, retiree plans, HMOs, free care and Medicaid.

Healthy Holiday Food

Festive Holiday Nog
Makes 8 servings
6 cups skim milk
1 (8 ounce) carton Egg Beaters 99 % real egg product
½ cup sugar
1 teaspoon rum extract
1 teaspoon vanilla extract
1/4 cup brandy, optional
Ground nutmeg and cinnamon, for garnish
In large saucepan, over medium heat, heat 5 cups milk, egg product and sugar until thickened, stirring constantly. Remove from heat; stir in vanilla and rum extracts. Cover; chill.
Just before serving, stir in brandy if desired; thin to desired consistency with remaining skim milk. Sprinkle with nutmeg and cinnamon.
Nutritional information per serving (without brandy): 128 calories, 133 mg sodium, 4 mg cholesterol, 0 gm total fat, 0 gm saturated fat.

Cinnamon Applesauce Loaf
Makes 12 (3/4 inch thick) slices
2 cups all-purpose flour
1 teaspoon baking soda
1 teaspoon ground cinnamon
½ teaspoon Davis Baking Powder
1 cup sweetened applesauce
3/4 cup sugar
1 (8 ounce) carton Egg Beaters 99% egg product
½ cup margarine, melted
½ cup seedless raisins
Confectioners' sugar glaze, optional
In small bowl, combine flour, baking soda, cinnamon and baking powder.
In large bowl, blend applesauce, sugar, egg product and margarine; stir in flour mixture just until blended. (Batter will be lumpy.) Mix in raisins. Spoon batter onto greased 9x5x3 inch loaf pan. Bake at 350 degrees for 55 to 60 minutes or until toothpick inserted in center comes out clean. Cool. Wrap and store at room temperature for up to 4 days. Drizzle with confectioners' sugar glaze if desired. Cut into 12 slices to serve.
Nutrition information per serving (1 slice without glaze): 226 calories, 173 mg sodium, 0 mg cholesterol, 8 gm total fat, 1 gm saturated fat.
These recipes courtesy of "Nutrition Update" periodical "Holiday Meals" issue.

Snow Bird
By Beatrice Londergan

I saw the robins winging southward,
then I felt that urge to roam.
For years I beat them there by jet,
this year I'm staying home.
There, the palm and pine trees sway and shape
from the constant ocean breeze.
Tourists crowd the sandy beaches;
they enjoy this life of ease.
Suntanned children build sand castles,
then for shells they must explore.
Waves roll in and claim their buildings;
children laugh and just build more.

There the cooling fans are blowing;
here, up north the fires are glowing.
Yet, the Northland has a beauty
that the Southland never sees.
Through the night a steady snowfall
draped a bridal veil on all my spruce trees
making lovely, pure white visions to behold.
Beneath the boughs are tiny sparrows hidden,
they have found a safe protection from the cold.

Through my windows, I see children
sledding down a snowy hill,
Hear their joyful shouts of laughter
for each ride is such a thrill.
Jack Frost has nipped at toes and noses,
painted cheeks all rosy red.
Children here can't build sand castles,
they have built snow forts instead.
Though the robins headed for the Southland,
and I felt that urge to roam,
I prefer the cold beauty of the Northland,
this Yankee Snow Bird is staying home.

This poem written by Beatrice Londergan of Pittsfield in 1982 remains true for many today.

From The Director: Annual Report Presented on October 28, 1998

Elder Services' 24th year of assisting Berkshire elders to live in dignity and independence was also its first year as the free standing ASAP (Aging Services Access Point), designated by the Executive Office of Elder Affairs to be the single point of entry to Home Care and Medicaid services for all older persons in this large rural county. ASAP designation has required an enhanced and enlarged focus on Continuous Quality Improvement; thus, a former Casemanagement Supervisor became our Quality Specialist, and the agency's Quality Committee is energetically paving the way to an enhanced level of quality service for all consumers.

Expansion of our computer technology and expertise over the past year strained both the budget and the staff, but I'm proud to report that Elder Services is fully equipped and trained, with a fully utilized computer, yes, at every Casemanager's workstation!

Concerns that elders calling the agency might have to talk to or even see several staff before receiving what specific service addresses their particular need led to much work around establishing "seamlessness" in our operations and communications. The goal of this effort is to see that any caller or referral needs to know only that Elder Services is the helping organization - and not be bounced from program to program. The seamlessness group has generated a "universal assessment tool" to speed up and smooth the process, and teams of multi-program staff now meet daily to determine which program area will best serve each elder's needs, and who will be the first responder.

Increased nursing activity was required this year to assess the appropriateness of additional Medicaid services, to determine whether these services could be replaced by less costly Home Care services purchased by Elder Services and to assess and monitor the ever increasing personal care services to clients. Reductions or terminations of elders' home health services by certified home health agencies, to conform to the Interim Payment System created by the federal Balanced Budget Amendment, resulted in referrals of elders who needed far more service than the $199 per client per month our funding will purchase. Limited state resources do not fill the gap left when Medicare home health services are reduced or terminated.

One of Elder Services' Long Term Care Ombudsman volunteers has just received the Executive Office of Elder Affairs' Mary Casey Award as the statewide Ombudsman of the Year. Betty Bicoules is a volunteer assigned to a 60-bed unit in a large facility that requires much attention. All Ombudsmen are unique individuals, as evidenced by their desire to assume this difficult role. Betty, however, has served in a situation that continually tested her skills, and her dedication to the residents she serves. She rose to meet the needs of the residents again and again. Betty demonstrated, in a very short time, all the characteristics that make her worthy of the Mary Casey Ombudsman of the Year Award.

Elder Services more and more must look to the community to help us help Berkshire elders. Nearly four hundred volunteers, at work throughout the county, bolster the efforts of staff and save precious purchased services dollars we can then use to buy services that require trained and supervised professionals.
Northern Berkshire United Way, the Williamstown Community Chest, and the City of Pittsfield's Human Services funds have made it possible for us to help elders at immediate risk of losing their independence, by funding enhanced intervention services in their respective geographic areas.

Membership in Berkshire United Way, secured this year, will soon help Elder Services extend these vital, yet currently unfunded services to underserved areas of Central and Southern Berkshire.

As the ASAP for all 947 square miles of Berkshire County, we continue to provide information and referral, in home services, congregate lunches and Meals on Wheels, protective services for abused and neglected elders, respite, housing programs, money management, the Senior Pharmacy Program, long term care ombudsman services, the SHINE program, and community education through the Berkshire Senior monthly newspaper, Berkshire Senior T.V., and the Gallagher Alzheimer's Resource Center.

In the end, supporting elders in their desire to remain independent requires a commitment from so many:
a commitment from our elected federal and state legislators to adequately fund and support Berkshire elders (and this commitment is always there);

a commitment from the Executive Office of Elder Affairs to work with the ASAPs to develop, and support programs responsive to evolving elder needs;

a commitment to wise and judicious governance from the Board of Directors;

a commitment from the greater Berkshire community to support their older friends and neighbors by volunteering and/or giving generously to the Elder Independence Fund and the federated charities, like United Way, to help Elder Services meet the growing need.

a commitment from all our service providers, to maintain and deliver the highest quality services and direct care.

and finally, and most importantly, an unshakable commitment from the 136 skilled staff of Elder Services to make it all come together for needy elders; to be there, offering the many kinds of assistance they need to continue to live in dignity and independence.

Thank you, all of you, for helping Elder Services help Berkshire elders.