The answer was the "Gatekeepers" program, originating in Spokane, Wash., in the 1970s. Through the program, people who through their regular jobs - gatekeepers - get in touch with elderly people living independently are given the tools to know when, and where, to call if they feel one of their clients or customers might be in need of some kind of assistance.
Gatekeepers can include meter readers from the power company, heating company staff, bank tellers, mail carriers, bill payment collectors and cable TV installers, but also neighbors, apartment managers, and police officers.
People can stay in indepentent living much longer and more successfully with a little help, be it from community service organizations or friends and family.
Howell describes the program as a "win-win situation": It costs nothing, people learn a lifetime skill, the "gatekeepers" are empowered, and elderly Alaskans who might not ask can get information about services available to them.
The project, which is half-ways through the first year of a two-year grant from the City and Borough of Juneau, has already been successful, said care coordinator Julie DeLong, who is usually the first person to contact someone identified by a gatekeeper as being at risk.
Things Gatekeepers look for...|
Confusion or memory loss
Voiced thoughts of suicide
Changes in appearance (disheveled, poor hygiene)
Home in disrepair or unsanitary
No longer making the monthly deposit at the bank
Not paying bills
Not getting fuel refilled
"I called this gentleman up and we had a long, pleasant phone conversation, during which I discovered that he seemed forgetful -Ehe would say something and ten seconds later repeat the same thing," she said. "He mostly stayed home, but he was very friendly, and very open to a visit from a care coordinator."
If an elderly person wants a visit, a care coordinator can come by and assess what services they might need or want. The needs range from respit care and chores to just social interaction. "For some people, just going to the Senior Center for lunch a couple of weeks is all that they need."
"We don't ever try to push services on people," said DeLong, "and we always fully respect people's right to turn our offers of services down."
Because there are those who do choose to turn services down.
"We like to think that 'it's just elderly people'," said Mary Miller, who runs the Bridge Adult Day program and also holds the presentations for citizens in the Gatekeepers program. "But I think it's more a societal problem; asking for help is seen as a sign of weakness."
Miller notes that when she talks about chore services, middle-aged people tend to say they'd love to have that provided for them -- and she counters that yes, we do, "until the people who come in to do chores don't clean like we want to or don't cook the food like we want them to."
But, she said, providers of these in-home services have come a long way in training their staff to do things the way an elderly client wants.
"You enter their world," said Howell, and in order to be truly helpful, "you have to take on their perspective. They want you to start by cleaning the bathroom, you start by cleaning the bathroom -Eeven if that's not how you would do it."
A common fear in elderly people living independently is that if they admit they need help, someone is going to force them to leave their home.
"I think it's important that people realize that we come from a perspective of Home and Community Based Services," said Howell, "we want people to live at home as long as possible."
Making independent living possible for the elderly is beneficial not only to the person who can stay in his or her home, Howell said. It's also a cost-savings for the city and state.
"Every person staying at home instead of in a nursing home is a savings of $100,000 per year per person," she said.
"At least," countered Miller. "I think that's counting low."
Miller also recalls the story of an elderly person who, when she lost her glasses, called 911 and asked the police to come help her find them - because she didn't want to disturb her children, who lived in another part of Juneau.
"If we can get a person like that to be able to call a neighbor instead of JPD, that's certainly a good thing," she said.
And that brings up another point: Services offered to seniors don't always have to be formal. The Southeast Senior and Caregiver Resource Center always tries to figure out what informal support a person has in place, and try to build on the strengths of that. A person might have belonged to a church, but stopped coming to services - and maybe a visitor from the church would be welcome where a more "official" helper would not.
"Or someone might have belonged to the Elks Lodge, or a Veterans organization, and be more comfortable with someone from there stopping by."
So far, Miller has held presentations to, among others, employees from Alaska Electric Light & Power, GCI Cable, Wells Fargo, Denali Alaska Federal Credit Union, Alaska Housing, State Farm, and Juneau Medical Clinic. The response, she said, has been "excellent."
"At every presentation, there has been someone who said 'I know someone like that!'." Participants in the project may already have concerns, and through the presentation get the tools to confirm those concerns -Eand also be more aware of signs of deterioration in their clients, including confusion, changes in appearance, not paying bills or making the usual deposits at the bank.
Southeast Senior Services is available to make presentations to interested businesses and organizations. To make arrangements, business owners can call Melissa Howell at 463-6156.
Southeast Senior Services, a program of Catholic Community Services, serves thirteen communities, from Yakutat to Hydaburg. The number for the Senior and Caregiver Resource Center is 463-6177.