Annual Meeting
Elder Services and the District Attorney: Working Together
What's Doing With Alzheimer's Disease
Know Your Rights: Protection Against Shut-Off by Utilities
From
the Director
Annual Meeting
Stephen Long elected Elder Services President
New officers of the Board of Directors were announced at Elder Services' 24th Annual Meeting, held at noon on October 28 at Wahconah Country Club, Dalton: President Stephen M. Long, Jr., Vice President Terrence Hanlon, Clerk Mary K. O'Brien and Treasurer Darlene Rodowicz. Current Board president, Dr. Robert V. Hamilton, is retiring from the Board. One new member, Karen Reilly, has been elected to the Board.
The new president, Stephen M. Long, Jr., is Executive Assistant to the President and Associate Vice President of External Affairs at the Massachusetts College of Liberal Arts in North Adams. Long has served as Chairperson of the Board of Trustees at North Adams Regional Hospital, Member of the North Adams School Committee, the North Adams Board of Health, and on the Boards of Northern Berkshire United Way and Hoosac Bank. He is a Board Member of the Northern Berkshire Community Development Corporation. Long holds a BS in Education from Lyndon State College, an MS in Education from North Adams State College, and lives in North Adams.
Vice President Terrence Hanlon is Vice President and Partner of Stevenson & Co., Pittsfield. He has served as President of the Berkshire County Independent Insurance Agents Association, and the Pittsfield Lions Club, and as Vice President of the Pittsfield Jaycees. Hanlon is active in the United Way and YMCA fund drives, and resides in Pittsfield.
Clerk Mary K. O'Brien, of Pittsfield, is Register of Deeds, Berkshire Middle District, first elected in 1976, now serving her fourth term. O'Brien is a Member of the Advisory Boards of Girls, Inc. and the Department of Transitional Assistance. She is Democratic State Committee member for Berkshire, Franklin, Hampshire and Hampden counties. O'Brien is Chairman of Berkshire United Way's Direct Services campaign committee.
Treasurer Darlene Rodowicz is Associate Vice President of Finance for Berkshire Health Systems and a Cheshire resident. She is a member of the Northern Berkshire Youth Hockey League board, the CT Plunkett School Council, and a catechism teacher for the St. Thomas and Notre Dame parish in Adams. She has a BS from the University of Massachusetts, and a Masters in Business Administration from Western New England College.
Karen Reilly of Pittsfield is returning to Elder Services' Board after a one year absence. Manager of Member Programs at Greylock Federal Credit Union, she is a member of the Williams School Council, a committee volunteer for the Central Berkshire Chamber of Commerce, and a past chairman of the City of Pittsfield's First Night Committee (1992-97). Reilly previously served on Elder Services' Board of Directors from 1991-97.
Lillian L. Glickman, Secretary of the commonwealth's Executive Office of Elder Affairs, was the Guest Speaker at the Annual Meeting. Glickman spoke about how elders, elder advocates, and professionals can best prepare for the future as the number of elders increases, while resources remain limited. Growth in the elder population will skyrocket as the baby boomers hit senior status, and no one is yet ready to respond to their needs.
Elder Services and the District Attorney: Working Together
By District Attorney Gerard D. Downing
In this changed era of law enforcement investigation and prosecution, the role of each participant in the criminal justice system has undergone significant change. A District Attorney's office is no longer narrowly confined to the activity surrounding in-court responsibilities. Although witness preparation, trial-related activities, bail hearings, arraignments, grand jury investigations and the like are still our central focus, we now find ourselves as active partners with a wide variety of human service agencies. These include the Department of Social Services, Department of Youth Services, United Way civic organizations, etc. In recent years, the relationship with Elder Services has expanded greatly and continues to evolve and deepen.
The relationship with Elder Services encompasses various areas, including education, outreach, investigation and prosecution. We are fortunate in Berkshire County to have developed a strong partnership in education with Elder Services. We participate in trainings for investigators and workers, and are involved in various public information and awareness efforts including broadcast programming with Berkshire Senior Television. Through programs such as TRIAD, we join Elder Services and other agencies in creating more direct contact between elders and the services they want, and need.
Elder Services provides the critical link between those who may have been victimized and the criminal justice system. In most instances, the first source of information about possible abuse is through Elder Services. The Berkshire District Attorney's office has become a strong ally to the protective service investigators who respond to reports of abuse of elders. These services have expanded dramatically in the scope of the investigations, including economic abuse and physical/sexual abuse. The success we have experienced in the prosecution of cases with elders/seniors as victims is a direct result of these close working relationships. Much of the expertise we have developed in these difficult cases is based on the training, understanding, and education of police agencies, both local and state, gathered as a result of the partnership between Elder Services and the Berkshire District Attorney's office.
As the elder population in this county continues to expand and our senior citizens strive to continue to live independent lifestyles, the need for this collaboration will only increase. All of us believe that maintaining high levels of awareness, information and protection are of great importance to the quality of the life of all citizens of all the Berkshire communities. The future holds the likelihood of an expanded working relationship between Elder Services and the Berkshire District Attorney, and I truly look forward to being part of that future.
What's Doing with Alzheimer's Disease
By Dr. Jay M. Ellis, D.O.
The terms "forgetful," "dementia" and "Alzheimer's disease" are terms that are often used incorrectly. Physicians who deal with this area every day have more specific meanings in mind. We try to divide memory functioning into normal for age, forgetfulness appropriate for age, mild cognitive impairment, and dementia. Alzheimer's disease is one type of dementia.
Normal for age memory loss includes impairments in the ability to remember people's names above the age of 65. This is so common that, in fact, more people forget names than remember them and, therefore, this is normal. It alone does not indicate the development of Alzheimer's. Benign forgetfulness of old age does not impair the activities of daily living.
The entity called "mild cognitive impairment" involves a progressive mild decline in memory and may involve mild dysfunction of other areas, but not severe dysfunction. These people function normally and yet they, and others, are aware of their memory defects. These patients may score below 30 on the standardized mini-mental status exam that is sometimes used for screening. These patients have a tendency to go on to Alzheimer's disease at a much higher rate than the aged matched general population with perhaps 45% going on to Alzheimer's within three years. This diagnosis is made when family or friends confirm that they see cognitive impairment.
We are currently investigating a new agent designed to try to prevent people with this category of symptoms from going on to Alzheimer's and we are recruiting people for the study at this time. The medication seems quite safe and without any significant side effects. The study is designed to prevent development of Alzheimer's and runs for about two years.
The diagnosis of dementia is made when the patient has a progressive decline in memory or other cognitive functioning from their baseline and this decline interferes with the functioning of daily life. Alzheimer's disease is far and away the most common cause for dementia. It is diagnosed now by clinical criteria. This clinical criteria includes a progressive decline in cognitive ability involving memory for at least three months plus the loss of functioning in at least one other area of cognition. This would include defects in language (aphasia), carrying out of tasks for which one has adequate skills (apraxia), ability to know people and things (agnosia), or disorientation. If such a patient has a neurological exam showing only cognitive impairment, and undergoes some blood testing and possibly a CT scan or MRI confirming that there is no other cause for the cognitive impairment, then the diagnosis of probable Alzheimer's disease is made.
The diagnosis of definite Alzheimer's disease is quite difficult to make. It cannot be made at this time. In fact, it is very controversial as to whether even autopsy data can confirm the diagnosis. Currently, the National Study Group trying to determine the criteria for diagnosis of Alzheimer's are not in total agreement. Although we know that so called senile plaque and neuro-fibrillary tangles are characteristic of Alzheimer's disease, they are also seen in normal aging. Therefore, the changes have to be quantitative and may not be the only changes. At this time, there is work being done to create a marker for the diagnosis of Alzheimer's disease which can be identified in life. There are several tests being looked at and the ones involving spinal fluid offer the most promise. The spinal fluid test for this analysis is currently available and has a high degree of sensitivity and specificity, although it is not absolutely diagnostic. There is a compound called AD7C which has been identified in cerebrospinal fluid and seems to correlate very highly and now this compound is being identified in urine samples. If the urine test is confirmed as being useful and valid, then we may, within the next few years, have a better diagnostic tool to discriminate between forgetfulness and Alzheimer's disease.
At present, there are no blood tests which discriminate between normal and demented patients, nor are there any blood tests which make a firm diagnosis of Alzheimer's possible. Similarly, none of the imaging procedures (MRI or CAT scan) can separate abnormal brain from aging brain or from Alzheimer's. Similarly, despite great efforts, neuropsychological tests have not yet been developed which are specific and correlate any more highly with Alzheimer's disease at autopsy. Thus, a marker would be of great help.
The Seven Minute Screening test is of some interest, but I am not convinced that it would currently have great clinical value. This test might allow someone other than a physician to screen for cognitive impairment but, in general, the greater impediment to identifying patients is reluctance of people to come and seek help with this problem. The absence of a proven effective treatment which can prevent early dementia patients from going on to full blown Alzheimer's limits the purpose in making an early diagnosis at the present time. All of the available agents to treat Alzheimer's were studied only in patients who had clear cut disease. There is no evidence that any of these agents were indicated for people with mild cognitive impairment. It would be of greatest help if we could make that diagnosis with a higher degree of certainty and have available an effective agent to prevent these patients from going on to Alzheimer's. That's the thrust of our current study.
Continuing to make people who are at risk aware of their risk has some benefits, but also has some problems. Many elders spend a great deal of time worrying about the potential that they might lose their mental ability and become dependent. I am not convinced that increasing their level of anxiety will be truly a blessing. Thus, I think the general application of the Seven Minute Screening is going to be delayed until there are more useful treatments.
Dr. Jay Ellis, D.O. is a neurologist with Berkshire Associates for Neurological Diseases in Pittsfield. For more information about the study mentioned in the article, call 413-499-2831.
Know Your Rights: Protection Against Shut-Off by Utilities
If all members of a household are 65 or older, utilities cannot be shut off without written permission from the Department of Public Utilities after a hearing procedure. If desired, an elder can fill out a Third Party Notification Form identifying a contact person who will be notified when overdue bills and shut-off notices are being sent.
Utilities that are used for heat cannot be shut off between Sept. 15th and June 15th. A minimum of 64 degrees must be provided between the hours of midnight and 7a.m. and 68 degrees during the day. A financial hardship form must be submitted stating that the utility is necessary for heat.
If someone in a household is seriously ill, the utility must be notified by your Doctor that a serious illness exists and a financial hardship form must be submitted.
If a landlord fails to pay a utility bill, shut-off cannot occur until the tenants have been given 30 days notice.
From The Director: You Do Not Have to Make Any Changes in Your Current Medicare Insurance!
This November all Medicare users will be receiving the "Medicare and You Bulletin " from the Health Care Financing Administration (HCFA) containing an introduction to the Medicare + Choice options that may be available for sale later in 1999.
The most important message we can give Medicare beneficiaries when they read this bulletin is ‘YOU DO NOT HAVE TO MAKE ANY CHANGES TO YOUR CURRENT HEALTH INSURANCE. YOU ARE STILL IN THE MEDICARE PROGRAM. YOU CAN CONTINUE TO RECEIVE MEDICARE BENEFITS IN THE SAME WAY YOU DO NOW. THE DECISION TO CHANGE OR TO STAY WITH EXACTLY WHAT YOU NOW HAVE IS ENTIRELY UP TO YOU!" At this time, none of the options described are available in Massachusetts. The state's Executive Office of Elder Affairs has put together information to clarify the bulletin for Massachusetts Medicare beneficiaries, as follows:
"As the Medicare & You Bulletin is a national publication, some details in the Bulletin do not apply to Massachusetts. When you get the Bulletin, you may be confused by the following details or wording:
1. First, the basic Medicare program is now going to be called the "Original Medicare Program" to help distinguish basic Medicare from all the new Medicare + Choice supplemental options. As always, with Original Medicare, the beneficiary finds his/her own doctors and hospitals, arranges for and pays for his/her own Medicare-covered services, and can change his/her doctors or specialists as often as they wish.
2. Second, many people in Massachusetts with Original Medicare have a Medigap policy which pays for gaps in Medicare, such as the part B $100 deductible and 20% coinsurance. Medigap policies continue in force and will continue to be sold to new buyers. The Medicare & You Bulletin will refer to ten standard Medigap plans that are sold in 47 of the 50 United States. However, in Massachusetts, we have three standard Medigap plans.
3. Third, many Medicare beneficiaries in Massachusetts are enrolled in a Medicare Health Maintenance Organization ("Medicare HMO"). An HMO is one kind of "coordinated care plan". By the middle of 1999, several new types of coordinated care plans may start business in Massachusetts. These new coordinated care plans could be either a "Provider Sponsored Organization" (PSO), a "Preferred Provider Organization" (PPO), or a "Health Maintenance Organization" with a ‘Point of Service' benefit (plan may pay for certain out-of-network benefits.
4. Do not expect to see any PSO or PPO coordinated care plans for Medicare beneficiaries until late 1999. Before any of these new plans can enroll members, the new plans must go through a careful and lengthy review by the Massachusetts Division of Insurance and the Health Care Financing Administration, the federal agency that administers Medicare.
5. As of January 1, 1999, most of the current Medicare HMOs in Massachusetts will change to Medicare + Choice HMOs. Officially, they will become Medicare + Choice Coordinated Care Plans. Some may decide to close. If a current HMO is planning to close, it must inform its enrolled members no later than November 2, 1998.
6. During November 1998, Medicare beneficiaries currently enrolled in Medicare HMOs will receive letters from their plans explaining any possible changes in premiums or benefits for 1999.
7. Our Specified Low-Income Medicare Beneficiaries (SLMB) program still uses 120% of federal poverty level for setting its income eligibility level. The Bulletin lists higher income figures that other states are using for their SLMB programs."
As more information is forthcoming about some choices that are available, (well into 1999), Elder Services will update our readers through this newspaper and through the SHINE program and its coordinators in local communities.