Addressing Senior Care Gaps in Rural Briscoe County, Texas

Abstract

Briscoe Residential Inclusive Care Service for Seniors (BRICSS) Rural Senior Care Initiative in [City, State] Team 7 Don Coscarelli, Director – Shady Rest Home for seniors Sam Axe, Director – North Texas Council on Aging Shemp Malone, Sheriff – Briscoe County Texas Ashley ‘Ask” J. Williams, Manager - S-Mart of Briscoe County Part 1: Introduction I. Abstract This is the summary of your proposal. This area should not exceed 45 double spaced lines or one full page. Note: You can format this page and complete it for you final proposal or skip this page for your specific aims submission. II. Table of contents This is the simple structure of reference for your application. Note: You can format this page and complete it for you final proposal or skip this page for your specific aims submission. Part 2: [City, State], has critical needs for elder services ranging from case management, residential care, and hospice. Local and state agencies recently have partnered in order to assess and develop an action plan to address these gaps in necessary service. Demographics for [City, State] Briscoe County is a 902 square mile county with 1,790 residents as of the 2000 U.S. Census in rural Texas. Nearly ninety percent of the privately owned land in Briscoe County is dedicated to either ranching or agriculture. More than two-third of the population (1,267) live in the town limits of the county seat of Silverton with a population of 825 or Quitaque with 442 respectively. The county ethnicity as of the 2000 Census is 95.2 percent white, 2.6 percent African-American, .5% American Indian, with 1.8 percent other and multi-racial. The economy of Briscoe County is primarily ranching and irrigated agriculture. The county tax revenue for 2012 was $907,255.74 which is very modest for a Texas county with the land area and population. There are a number of state parks which provide a few local jobs but no tax revenue. The remaining jobs are from business and government jobs. Unemployment is relatively low at 7.6 percent but median income (2000) of $28,795 is low compared to Texas at $39,293 and $42,148 for the US. The residents of Briscoe County are not impoverished per se, but do share many of the critical shortfalls of rural infrastructure and isolation shared by many communities. Aging Population Issues in Briscoe County The population of Briscoe County is aging. The 2000 Census identified the population as approximately 26 percent under 18, 7% from 18 to 24, 22% age 25 to 44, 25% 45 to 65 and nearly 20% over 65 years of age. Briscoe County’s population over 65 is over twice that of Texas, which is 9.9 percent according to the 2000 U.S. Census. The unusually high number of aging residents has placed unusual burdens on local resources and created a crisis among the senior community in Briscoe County. This situation has forced a partnership and request for funding to support the Briscoe Residential Inclusive Care Service for Seniors (BRICSS) initiative. BRICSS Partners The Shady Rest Home for seniors. The Shady Rest Home for Seniors (SRH) is a non-profit assisted living facility for seniors located in Silverton. The property and facility was donated in 1952 by estate of a local rancher. Residents in the twenty bed facility pay a sliding scale monthly. Local churches support the SRH with volunteers and donations. Part of the revenues from the annual Briscoe County Fair and Rodeo also help maintain and support the facility. The county health clinic, supported by W.J. Mangold Memorial Hospital, in [City, State], is adjacent to SRH where residents receive medical care and treatment. Unfortunately there is currently a wait list of over 58 seniors awaiting a bed. Only two or three beds open up annually. Shady Rest also only offers assisted living and no nursing home services. Those in need of nursing home services must travel to Lubbock Texas which is over 90 miles away, thus creating a burden of families and the necessary support systems seniors need. North Texas Council on Aging. The North Texas Council on Aging (NTCA) is designated by the Texas Department of Aging and Disability Services to coordinate services for residents living in north Texas. This state agency works in conjunction with eh North Texas Council of Governments with the objective to maximize services to residents while reducing redundancy. The NTCA has recognized the unique issue in the communities of Briscoe County and has mobilized staff to assist in assessing the issues, identifying critical needs, and locating critical resources for a long term solution. Briscoe County Sheriff’s Office. Briscoe County Sheriff’s Office (BCSO) is a three-member agency serving the entire county to include the two incorporated cities of Silverton and Quitaque. With a total annual budget is less than $200,000.00. BCSO has taken on a larger than usual role in assisting and checking on seniors due to a lack of local public and private facilities as well as many seniors who struggle with resources such as transportation and funds. There is often only one member on duty, to include State Troopers from DPS, at any given time and assisting with a senior quality of life issue, normally serviced by social agencies or residential infrastructure, creates a burden on services. When needed services fall short in any community residents depend on law enforcement for help. Rural communities can really be impacted in their ability to respond to law enforcement emergencies when called upon frequently to fill gaps in other needed services. S-Mart of Briscoe County. S-Mart is a regional superstore in the north Texas area that services rural communities. It offers groceries, pharmacy, and general mercantile to residents. S-Mart buys locally and supports the community. Each store has five percent of its profits available for donation to local initiatives. The Briscoe County S-Mart recognizes the critical need for additional senior services and has agreed to partner with other local agencies to create a solution. The aforementioned organizations, along with other community partners, have met and discussed the opportunity offered by the Sebastian Haff Foundation for rural senior care initiatives. We believe that the critical need for quality senior residential services in Briscoe County result from the unusually high percentage of aging residents, lower mean income, and distance to larger centers. We believe that BRICSS can leverage the resource of community action with the necessary funding to make a major impact to the quality for everyone in Briscoe County. Vision and Mission Statement Vision Statement The vision of BRICSS is to create a partnership and infrastructure within Panther County to assess, respond, plan, and meet the needs of its senior residents in a concerned manner that improves quality of life utilizing dignified options for remaining in their community, close to home, friends, and loved ones. Mission Statement The mission of BRICSS is to provide the critical services necessary in Briscoe County to help seniors live with dignity and independence through an array of resources to include home-based services and support, adequate access to assisted living facilities, nursing home options, hospice care, and family education. Literature Review A review of research and literature resulted the reoccurring theme and factors associated with quality of life (QOL) for elders. The agency members of BRICSS embrace QOL as a core value of the proposed program. Quality of Life Sullivan and Asselin (2013) conducted an integrative review of 26 empirical articles regarding QOL and report individual factors associated with QOL for elders that included physical function, environment, social support, and individual mood and/or spiritual outlook. They also point that a common theme for action in the 26 articles included a more personal environment, increased physical activity, and meaningful interactions as increasing QOL. BRICSS believes that the elder population of Briscoe County would benefit from programs focusing on improving these individual factors. Being Active and Sense of Home Horrowitz and Vanner (2010) interviewed 131 residents from 12 assisted living facilities and concluded that assisted living residents reported much more positive quality of life when they experienced a diverse array of physical, cognitive, and social activities. The BRICSS initiatives embrace a holistic approach with a practical infrastructure for elder living in Briscoe County that leverages the seniors being wither at home, or in their community, and living with a sense of purpose as a valued part of the community. Social Cohesion Güven and Sener (2010) discuss the issues of integrating older members into mainstream society and the critical role that being in their community and with and around family is to their health and quality of life. They further discuss aging throughout the life course and the critical role of being involved, contributing, and valued as part of the family and community. They further discuss that families and communities have a responsibility to take positive steps toward facilitating a harmonious and inclusive relationship with elders. BRICSS fully embraces this notion as if the elders in any community are not cared for and valued by family, friends, and their community then who will? BRICSS also believes that rural communities, such as ours, are better poised to help new initiatives requiring community support be successful. Where Seniors Prefer to Live Heidi Ewen and her associates (2014) examined future housing option by interviewing more than 400 older upstate New Yorkers, to include rural residents, and they determined that staying in their home, with or without the need for home modification, was the preferred choice of most of the seniors interviewed. This preference was followed by moving into a retirement community which was much actually more desired than moving in with family. This discovered forced the members of BRICSS to inquire with Briscoe County seniors. This was accomplished in a town hall meeting and four church group meetings in a focus group style discussion. The seniors that attended (N=64) agreed with the seniors from the upstate New Your study. Staying at Home. The 2010 study by Horrowitz and Vanner, as previously discussed, report that their subjects living in assisted living facilities ‘overwhelmingly’ prefer to be either at home or in their home community. BRICSS intendeds to help seniors, and their families, better assess the senior’s ability to remain in their home. This can be accomplished by home modifications, technology monitoring, and the home assistance program. Clusters of Assisted Living Homes. The second phase of the BRICSS living options is the senior community where seniors live, with modest assistance, in small homes. A 2000 study by Mitchell and Kemp examined over 200 residents from over 50 California assisted living facilities. They explored, as other studies reviewed, the relationship between individual characteristics, social involvement, characteristics of the facility, and social climate of the facility to quality of life. They concluded that homelike and warm environments improved quality of life. Mitchel and Kemp (2010) suggest building clusters of smaller homes as opposed to large facilities. This promotes a cohesive environment but also encourages increased autonomy, which was also shown as important to quality of life for seniors who did not perceive themselves as frail. We believe that clusters of homes where six seniors live together creates a cohesive environment were staff and other senior residents can create an inclusive and interdependent community that improves QOL and social cohesion. Long Term Care Facilities. Long term care facilities offer more medical and daily assistance than assisted living facilities. The only current facility in Briscoe County is SRH which offers both assisted living and long term care. The proposal of BRICSS is to convert the facility to completely long term care for residents that consider themselves frail or have medical conditions that do not allow them to reside in the assisted living homes. Brandi and associates (2003) explored quality of life with seniors living in nursing homes were transitioned to assisted living. Satisfaction was significantly higher in the assisted living environment as opposed to the nursing home. Participants reported less anxiety and depression. This distinct role change will allow better continuity of care and efficient use of existing resources Hospice Care. Current hospice care is coordinated from North Texas Hospice in Lubbock. The Director of North Texas Hospice (NTH) reports a lack of requests from Briscoe County and therefore less requests for services. NTH believes a perception of not having a nurse of doctor quickly available is part of the problem. BRICSS believes that many terminally ill residents in Briscoe County either spend their final days in the hospital. The case management offered by BRICSS will allow better coordination of in-home hospice care options. BRICCS also plans to build a six bed hospice house in conjunction with W.J. Mangold Memorial Hospital which is 30 miles from Silverton in [City, State]. Health Care. Norah Keating (2011) revisited a previous study examining the issues of aging in rural Canada. She also discusses the importance of social engagement and connection with family and community, independence, and rural health services. While poverty can limit a senior’s ability to access health care, Keating also stressed the criticality of access to seniors with health problems. Briscoe County has limited medical services. The region’s hospital is W.J. Mangold Memorial Hospital (MMH) which is 30 miles from Silverton in [City, State], and has most necessary services. It also supports the Briscoe County Community Clinic which is adjacent to SRH. BRICSS plans to contract a nurse practitioner with MMH who will work with the case manager to monitor, visit, and support seniors, families, and the community. Education and Training The BRICSS case manager and nurse practitioner will also facilitate education and training for elders, their families and support systems, as well as staff at elder care facilities. The BRICSS initiative includes providing curriculum to areas schools during in-service training, training for residents in the assisted living homes, group sessions for family members coping with aging loved ones, and continuing education and training with service providers. Literature Support for BRICSS Initiative The 2010 Güven and Sener study concluded with some considerations and recommendations that resonate with the BRICSS vision and mission. They encourage government and community organizations work proactively to insure homecare services and other monitored services are available and accessible through intergenerational social unity. The BRICSS proposal includes a social worker and a nurse practitioner who will help assess and manage care senior services in the homes of seniors and work with families who support the seniors. Güven and Sener (2010) also encourage new organizations, such as BRICSS, to enhance and utilize existing services for seniors more effectively. The members and community supporters of BRICSS plan to leverage...