A Better Quality of Life: by Lillian Glickman
Guard it Wisely: A Poem by Walter Richardson
Vaccinations Save Lives
Tom Kelly Award
From the Director

A Better Quality of Life
by Lillian Glickman, Secretary of the Executive Office of Elder Affairs

With leadership from the Governor, I present an agenda that includes plans to improve the quality of life in local long term care facilities, provide enhanced support services to elder housing facilities and expand the statewide access to the SHINE Program, which provides free information and counseling to help elders meet their own health care needs.

Supporting the 347 councils on aging will continue to be a priority. Over the last six years, we have more than doubled funding for councils on aging - from $2 million to nearly $5 million. Councils throughout the Commonwealth continue to maximize the use of each dollar they receive through an impressive array of resources, including local and private organizations and volunteers.

We will continue to work to assure that the Senior Care Plan for elders eligible for both Medicare and Medicaid strengthens the community-based care currently being offered by Elder Services of Berkshire County, the regional Aging Services Access Point agency, and the Home Care Program. We are now serving 13 percent (or 4,400) more elders than we were in 1992 through the statewide Home Care Program.

As Secretary, I am fortunate to be in a position to build upon the solid foundation provided by the legislature and the Weld and Cellucci Administrations. Funding available for home care services, for example, has increased by $24 million in the last six years.

These are just some of the many issues facing older adults in the Berkshires and elsewhere in Massachusetts. With your support, we can make the Commonwealth an even better place for adults to age.

Guard It Wisely: a Poem by Walter Richardson

You got it from your father and mother,
It was all they had to give.
So it's yours to use and cherish,
For as long as you may live.
If you lose the bracelet they gave you,
It can always be replaced.
But a black mark on your family name,
Can never be erased.
It was clean the day you took it,
And a worthy name to bear.
When you got it from your mother and father,
There was no dishonor there.
So make sure you guard it wisely,
After all is said and done,
You'll be glad the name is spotless,
When you pass it to your son or daughter.

Vaccinations Save Lives

This fall, SPARC, Sickness Prevention Achieved through Regional Collaboration, and Elder Services, working in collaboration have mounted a campaign to increase the delivery of pneumococcal vaccine to persons age 65 and older residing in Berkshire County. SPARC has been active in North Berkshire County for the past two years, working with local providers to increase access to and utilization of influenza immunization. This year, SPARC includes agencies and organizations throughout the county.

Pneumonia and influenza rank sixth among the ten leading causes of death in the United States - with approximately 90 percent of deaths from these illnesses occurring in persons age 65 and older. In each of ten U.S. epidemics between 1972 and 1991, influenza caused an estimated 20,000 deaths. Pneumococcal infections are the most common cause of bacterial pneumonia requiring hospitalization, and cause an estimated 40,000 deaths annually in the United States.

Many of these deaths are preventable through immunizations. Flu shots have been shown to reduce rates of hospitalization for pneumonia and influenza (and for all acute and chronic respiratory conditions), and to lower death rates by 39 to 54 percent. Although some physicians have expressed uncertainty regarding the preventive value of pneumococcal immunization, the vaccine has been shown to be more than 57 percent effective against invasive pneumococcal disease.

On the national level, the Centers for Disease Control, in the Morbidity and Mortality Weekly Report of April 4, 1997, published recommendations of the Advisory Committee on Immunization Practices entitled Prevention of Pneumococcal Disease. Utilizing this information, SPARC and Elder Services have been working with area organizations that provide immunizations. For those that have previously given pneumonia immunization SPARC has supplied updates, and information about clinics in other states. For those whose pneumonia clinics will be a new initiative, SPARC has been working to provide them with the information and support needed.

Locally, flu and pneumonia clinics usually begin in October; clinic schedules are provided in local papers. Flu shots are recommended annually if you are 65 or older. Pneumonia shots are usually indicated only once, at age 65. If you are 65 or older, check with your doctor. If you have not had a pneumonia shot, GET ONE. You can receive the shot from your doctor or at local clinics that are offering this immunization in addition to influenza.

Remember, vaccinations are not just kids' stuff!

Tom Kelly Award

Missing a good friend
By Barbara Palma

As he walked up the path to her home, the door opened. She was waiting for him. Perhaps it was the angle at which he wore that "Irish Tam", or the reassuring smile she looked forward to. Or the "Good morning, Mary! There's a chill in the air. Are you dressed good and warm?"

Mary had another appointment for an eye examination, visits were getting harder to keep. Her sight was failing. She was happy to have Tom Kelly as her driver this time. "He is so kind and so patient and he makes me laugh. I wish I could have Tom drive me all of the time."

Mary is one of many who need transportation to medical appointments. She is also one of many who requested Tom Kelly as their volunteer from Elder Services. "He is so gentle! He always holds the door and gives me enough time. When it is slippery, he always says, "Here, have a wing, so you won't fall." In the summer his car is always cool. In the wintertime it is always nice and warm."

Sometimes Tom would hurry because he had someone else to drive to a doctor or grocery shopping. But when Mary had an appointment he scheduled his time so she wouldn't be rushed. Mary sensed that and appreciated his special care.

Mary had a long time to wait in the doctor's office. She was happy to see Tom's smiling face and his strong arm waiting for her. She knew she would be home, safe again. "Thank you, Tom!"

Mary misses her good friend, Tom Kelly, and still talks about all he did for her. Those of us who worked with Tom miss him and his captivating spirit. What a grand legacy he has left us.

Nominations sought for Tom Kelly excellence in volunteering award

Last April, Elder Services announced the establishment of an award to recognize excellence in volunteering. The award is being presented in memory of Tom Kelly, a volunteer for Elder Services, in honor of his excellence in providing volunteer services. In this issue of the Berkshire Senior, you will find a nominating form which you may submit to honor the volunteer of your choice. We are trying to find the volunteer who best exhibits the qualities of flexibility, willingness, commitment, love of helping and reliability that made Tom Kelly so special both as a volunteer and as a person.

Here are the answers to questions that you may have.

Who may nominate? Anyone who receives service from an Elder Services' volunteer or who has observed the results of volunteer service delivered by an Elder Services' volunteer; for example, an elder, a family member, another volunteer or an observing professional.

Who is eligible to be nominated? Anyone who is a volunteer in any Elder Services' program. Volunteers for other agencies are not eligible for this particular award. The Tom Kelly Excellence in Volunteering Award is intended to honor a person who is volunteering in a program sponsored by Elder Services. The nominee may (or may not) be volunteering elsewhere as well, but the nominee must be volunteering for Elder Services.

How can I tell if a person is a volunteer? The best way is to ask them. If that is not possible, check with Volunteer Services at Elder Services (499-0524 or 1-800-544-5242) Generally, volunteers provide transportation, grocery shopping, assistance with bill paying, visiting. Volunteers serve noon meals at community centers and Senior Centers and pack the Meals-on-Wheels. Volunteers help with special projects at the Elder Services' office and visit with persons in nursing homes. Volunteers provide health insurance counseling through the SHINE program. Some Meals-on-Wheels drivers in Sheffield and Otis are volunteers, but most are not. Volunteers do not do housekeeping or laundry. Most all of the people who do provide these services are wonderful as well, but they are not volunteers.

How will the volunteer chosen be honored? The volunteer selected will be honored with a plaque which will be presented at the Volunteer Recognition Dinner Dance in April. A permanent plaque with all the winners' names will be hung in the lobby of Elder Services' offices at 66 Wendell Ave. All volunteers who are nominated for the award will be acknowledged.

What is the deadline? In order to be considered, the nomination must be received at Elder Services by November 15, 1998. Nominations received after that date will not be considered. To honor the volunteer who helps you, fill out the nomination forms now!

From The Director: Managed Care for Seniors: Massachusetts Version

Despite widespread public outcry, neither the state nor federal legislative bodies have yet provided consumers with the tools to successfully appeal and change the decisions of the health management organizations (HMOs) that are now managing the medical care of so many Americans.

The popular movie, "As Good As It Gets," tells of a young child with chronic and severe health care problems, whose access to specialized care and medication is limited by the HMO that covers his health care. His condition improves only after he is seen and treated by a specialist who actually comes to see the child. When Helen Hunt, portraying the child's mother, lets fly a volley of expletives to describe the HMO, audiences around the country have burst into applause, much as audiences cheer when the bad guy is brought down.

Managed care has few supporters, especially among those seeking medical treatments which are denied by one's insurer - usually an HMO. Yet, the basic problem of how to pay for increasingly expensive medical care is indeed real, and managing care does result in managing cost.

Unfortunately much of the savings realized by managed care, simply stated, goes into the profits of the managed care organizations, thereby taking anywhere from 10 to 40% of the patients' (or employers') spending on health care out of the actual provision of care. A large and greedy third party, unregulated, can severely restrict the patient's access to health care.

As the outcry grows nationwide about the problems with managed care for the general population, Massachusetts is about to embark on a major managed care initiative for older people, a plan that will offer elders who are eligible for both Medicare and Medicaid membership in a Senior Care Organization (a SCO).

The SCO plan has been developed by the state's Department of Medical Assistance, (Medicaid) and will soon receive the approval of the federal Health Care Financing Administration (HCFA) to begin offering this plan. Before the SCO actually becomes available to the eligible consumer, the state legislature will have to approve the plan through enabling legislation. Thus, our elected legislators will be able to look very carefully at this managed care senior plan.

Some important items legislators should look for in the SCO plan include:

Is enrollment in the SCO voluntary, and can one disenroll within 30 days?

Does the SCO plan require that consumers (those who can use the SCO) have 25% of the seats on the organization's Board of Directors?

Does the SCO plan give enrollees the choice of at least two SCO plans within their geographic area, and the choice of any provider within the SCO one chooses?

Do enrollees have the right to appeal the plan's decisions, and access to an independent ombudsman to help resolve complaints?

Will the enabling legislation require that the SCOs be private non profit organizations, or large for profit HMOs?

Will the legislation set limits on profit taking?

Will mental health care be provided as a fully integrated benefit in the SCO enrollees' benefit plan?

Will the legislation include an "anti-gag rule" so that providers can freely discuss with patients any reimbursement provisions of the plan or other financial incentives which could impact one's care and treatment?

Will the legislation require SCOs to use the "prudent lay person" standard to determine whether to pay for emergency room care?

Will SCO enrollees have access to custodial home care services so they are able to remain at home?

Will ASAPs, as the provider of such custodial care, have an important role in consultation with the other members of each patient's primary care team?

The 1998-99 state legislative session will develop and approve the enabling legislation for the SCO, a plan which Medicaid hopes will serve over forty thousand Massachusetts residents within five years. The General Court has much information on managed care and how it does not work for consumers; it now has the opportunity, through the SCO enabling legislation, to see that this managed care plan does work for those who look to it for quality managed health care.