൨arities Under the Diocese of Allentown.phoebe.org/.../Gatekeeper-Presentation-for-Phoebe.pdf · The Gatekeeper Program is… A collective community approach to connecting seniors
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UNITED WAY GREATER LEHIGH VALLEY Gatekeeper Program
Welcome! Thank you for coming. I’m Amy, a Gatekeeper trainer, and I am here today to train you to become Gatekeepers also. Your organization has seen great value in this program and is investing in you, and in return is investing in our communities where we live and work. The Gatekeepers Program is through the United Way Alliance on Aging and is a partnership with Catholic Charities Under the Diocese of Allentown.
The Gatekeeper Program is… A collective community approach to connecting seniors in need to appropriate services.
Gatekeepers are trained to:
• Identify the warning signs that a senior may be in need of help • Call a Gatekeeper referral number and report their concerns
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Presentation Notes
The reason Gatekeepers are so vital here is because the majority of older adults living in the Lehigh Valley still live in their homes. When a Gatekeeper notices warning signs , they will call the referral number and report the concern
Who is Here?
Two types of people in this group: • Trained Gatekeepers • Informed traditional referral sources
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Approx. 1 hour
Gatekeepers 1. Apartment & living
community managers
2. Mail & newspaper carriers
3. Farm equipment dealers
4. Grocery store personnel
5. Home delivery 6. Fuel distributers 7. Utility company
employees, i.e. phone, cable, gas, electric
8. Repair / Cleaning personnel
9. Plumbers & septic employees
10. Bar & restaurant staff
11. Salons & barbers 12. Insurance agents 13. Bill collectors 14. Gas station staff 15. Local business
receptionists 16. Fire department 17. Transit employees
18. Pharmacy / drug store employees
19. Veterinarians 20. Ministers / clergy 21. State ID personnel 22. Neighbors 23. Trash collectors 24. Liquor store staff 25. Lawyers / clerks of
court 26. General community
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The Gatekeeper Program focuses on the non-traditional referral sources- people who do not work in social services and aging or health related professions. We train folks who’s job isn’t necessarily working with seniors alone, but whose job puts them in contact with seniors on a regular or semi regular basis. Take a brief moment to look over this list of potential gatekeepers in the community tailor
United Way Alliance on Aging
• United Way Alliance on Aging is an award-winning Collective Impact movement
• It advances United Way’s Healthy Aging goal of helping seniors stay healthy at home.
• 300 members
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How about the work of the UW? One of UW’s main focuses in Healthy Aging – helping people live longer and live better. The United Way brings communities together to focus on the most important needs in the community - building partnerships, forging consensus and leveraging resources to make a measurable difference The AoA has launched the Gatekeepers Project, which was developed in 1978 by Social Worker Ray Raschko at Spokane’s Mental Health’s Elder Services as a strategy to find the dependent seniors in the community who need help, but are not currently receiving it.
What is Collective Impact?
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How about the work of the UW? One of UW’s main focuses in Healthy Aging – helping people live longer and live better. The United Way brings communities together to focus on the most important needs in the community - building partnerships, forging consensus and leveraging resources to make a measurable difference The AoA has launched the Gatekeepers Project, which was developed in 1978 by Social Worker Ray Raschko at Spokane’s Mental Health’s Elder Services as a strategy to find the dependent seniors in the community who need help, but are not currently receiving it.
The Plan
Institutionalized
Healthy at Home
At-risk
Dependent
5%
25%
55%
15%
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We divide seniors into 4 categories Healthy at Home =what we want. These seniors live in the community and they are taking care of their own needs. These seniors are OUR DONORS, they volunteer for our programs and serve on our board, CIC and many of our committees. At risk= These seniors live in the community and are still taking care of their own needs. They may “look” from the outside EXACTLY LIKE the Healthy at Home. The difference is that they have at least one health problem that puts them at risk of moving into the next categories. Dependent=These seniors live in the community, but cannot meet all their own needs. They are dependent on others for help. Institutionalized=These seniors cannot take care of their own needs and we are unable to provide for them. They live in assisted living facilities or long term care, also known as nursing homes. We know from our research with LVRC, the approximate size of each of these categories.
The Need for Gatekeepers • 98,000 adults over the age of 65 • 25,000 dependent seniors living in their homes… need help from
others to meet their own daily self-care needs. • Of these dependent seniors, 4,950 dependent seniors report they are
not receiving any help from friends, family, social services or paid services.
These seniors are falling through the cracks of the system & are likely to be institutionalized if we cannot find them and get them the support that they need.
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United Way of the Greater Lehigh Valley’s latest research (June 2014) shows that there are between 15,000 and 25,000 dependent seniors living in their homes in the Lehigh Valley. These dependent seniors may be blind, use a cane/walker or have the beginning signs of dementia, but they need help from others to meet their own daily self-care needs. Of the 15,000-25,000 dependent seniors, we are most concerned about the estimated 4,950 dependent seniors who report they are not receiving any help from friends, family, social services or paid services. These seniors are falling through the cracks of the system and are likely to be institutionalized if we cannot find them and get them the support that they need. If you have any type of interaction with an older adult, you have the ability to potentially help them in some way…. Even if they are not possibly at risk now, you may help prevent risk by shifting your awareness… Increasing awareness with: Information Experience Awareness Exercise Option 1: Divide group into 2 Form 2 lines which face each other, stand shoulder to shoulder 30 seconds given for partners to notice as much as they can about each other, taking in all details Both lines then turn away from each other 1 or both lines have 15-20 seconds to change 1 thing something about their appearance- discrete, but visible (removal of belt, unbuttoned shirt, watch on different wrist, etc Turn back around and 30 seconds given to notice the changes Awareness Exercise Option 2: Eyes closed, think about something like what you had for dinner last night or a favorite place to be Eyes open. share your experience (everyone has a different experience) (Ask about sounds, smells, etc) Eyes closed, now empty your mind of thoughts and just notice, using all of your 5 senses- sight, smell, taste, hearing, touch Eyes open, share what you experienced (focused on one thing- cannot notice other things about your environment, open
The Need for Gatekeepers
Dependent Receiving Support Stressed Support No Support
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Presentation Notes
How about the work of the UW? One of UW’s main focuses in Healthy Aging – helping people live longer and live better. The United Way brings communities together to focus on the most important needs in the community - building partnerships, forging consensus and leveraging resources to make a measurable difference The AoA has launched the Gatekeepers Project, which was developed in 1978 by Social Worker Ray Raschko at Spokane’s Mental Health’s Elder Services as a strategy to find the dependent seniors in the community who need help, but are not currently receiving it.
Catholic Charities • A private non-profit operating under the Diocese of Allentown • Offers services to meet the needs of people in our community
who need support, care and compassion Infants and children in need of a home Families in need of counseling and support Pregnant women in search of assistance Immigration assistance Those in need who face homelessness, hunger and
unemployment. Parish outreach Elders in need of care and special services
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Catholic Charities is working within the AoA’s goal to: Develop a comprehensive, regional, long-range plan for improving access to and the delivery of long-term care and supportive services for older adults Now that you know about the agencies involved in Gatekeepers and why, I would like to know who you are and what you do for (insert the co)…
Aging is Everyone’s Future
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Aging is everyone’s future In common exercise: Each person finds a partner and finds 3 things in common Each pair finds another pair and finds 2 things in common Each group of 4 finds another group and finds 1 thing in common Excluding the obvious like we’re all wearing clothing or regarding body parts or of course the commonality of working in the organization POINT: We are all human and aging, we’re all subject to time and space…
Accepting Help Can Be Hard Some seniors resist services:
• Denial of need • Pride and stoicism • Fear of losing control over life • Shame, suspicion or fear of letting others in • Negative stigma associated with using “social services” • Financial reasons • Mental health issues such as paranoia, memory loss,
depression • Lack of information about services
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Now, I’d like you to envision yourself at age 80. See your situation. See your home environment: Are you living by yourself or with others? Are you in a city or rural environment? What is your financial situation? How do you get your food? Do you have a social life? What brings you most enjoyment at this stage in your life? How do you feel about being 80yrs old? (Who said what?) Now envision your situation like this: You are living alone, your spouse who has always done the cooking, bill paying, and kept you up to date on daily happenings has passed away. You feel you can drive to the store to buy food, but your body aches and sometimes you forget how to get from your place to the market. When it’s time to go food shopping because there’s nothing left, you find your way to the store and you pick up a few items…stuff you like- chocolate marshmallow ice cream, tasty cakes, hershey’s kisses, and some chips. While shopping you run into someone in an isle who you KNOW you know, but can’t think of his name or how you know him, but you engage in conversation the best you could since you are a little hard of hearing, taking cues from him and responding accordingly to his body language. The checkout clerk, who knows you from years of frequenting the store comments “I have a sweet tooth too!” You laugh and fumble with getting to your money, pull out a wad of bills, and hand over the entire amount to her because you’ve left your glasses at home and can’t quite make out what’s there. She counts out the amount due and gives you back a dollar. Back home, you park and manage to make it up your steps with your bags and into your unlocked house. You put the food away and pour yourself your spirit of choice. Your only son who lives a few states away calls, as he does everyday, to keep you posted on his chemotherapy treatment, but besides that you don’t ever seem to have much to say to each other and he always calls during your favorite TV show. Which show is on right now…they all seem to blend together. You wish for the times when you were able to go meet your friends for coffee down the street, but they’ve all died and you haven’t met anyone new in ages and well, you don’t have the money to be spending on coffee anyway. Was there a difference between your vision and this vision? How does this version of your future make you feel? What are some of your thoughts about this scenario? In this scenario, why do you think you are not receiving any help?
Isolation
• Geographic
• Economic
• Social / Emotional
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Presentation Notes
Our modern society is not by nature a tribe society anymore. It has become more important to protect our privacy than to appear vulnerable and in need of assistance for fear that we’ll be taken advantage of or harmed in some way. Fear of accusations can cause us to not help out someone who we know needs assistance. Our societal norms and individual beliefs can add to an already self isolating society. This can cause our seniors to become isolated. Geographically, seniors may not be able to get out of their homes or rural communities to access services and information Financially, they may not be able to afford the travel expenses to and from physician appointments, senior centers, stores or other services Socially isolated individuals are more likely to experience negative health outcomes, such as failing to seek treatment for conditions before they become life-threatening. Individuals with vibrant social networks are more likely to encounter friends, family, or acquaintances who encourage them to visit the doctor to get a persistent cough checked out, whereas an isolated individual may allow the cough to progress until they experience serious difficulty breathing. Isolated individuals are also less likely to seek or get treatment for drug addiction or mental health problems, which they might be unable to recognize on their own. Older adults are especially prone to social isolation as their families and friends pass away.
General Warning Signs The Gatekeeper should notice:
• Physical appearance
• Mental condition
• Emotional state
• Physical losses or changes
• Economic or social conditions
• Living conditions
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Presentation Notes
Up to this point we’ve talked a lot about Gatekeepers and the importance of observing these early changes in a senior’s routine that may mean they need help, but haven’t gotten into the specifics about what these changes might look like. So now together with your group, take a look at these categories and come up with a list of changes related to each category that you may observe in your profession that could alert you to a potential problem with a senior. Just 2 or 3 per category is good. (Use of flip charts-?) or One general list highlighting common signs from each table
Change as an Indicator
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As a Gatekeeper, you want to focus on changes in behavior. But keep in mind that some of the behaviors we previously discussed are not always necessarily warning signs alone, but combined with others, they may be. Examples: If you notice a person who loves gardening and took great pride in her flower beds and now they all overgrown and unkempt, there may not be an issue that needs attention…maybe had a stay in the hospital or was out of town for while. BUT, if they’re overgrown and you happen to see her walking around outside her home, looking confused or disheveled, you may want to make a call to the Gatekeeper referral number. A neighbor grieving after his dog’s passing is normal so you wouldn’t be calling to report an issue, but if he says that he appears depressed and says to you that he has nothing to live for anymore and wishes he would just pass away, then there is a reason to call the Gatekeepers referral number.
Essential Intervention
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Presentation Notes
So let’s emphasize again that the Gatekeeper’s role is essential in identifying changes that may be a problem and allowing early intervention before that problem becomes critical for the health & well being of the senior. Depending on company: 1st time interaction? Or ongoing relationship? You know when there is a problem… intuition
Physical Appearance • Poor hygiene • Inappropriate clothing for weather or situation • Missing articles of clothing • Bruises or injury • Weight loss or gain • Looking lost or disoriented
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Change in usual appearance or behavior related to personal presentation
Mental Condition • Confusion to time, place, person • Forgetfulness • Inappropriate verbal / non-verbal responses • Difficulty understanding written information though able to read • Fabricating stories or excuses for behavior • Excessive shopping (OCD, more than realistically consumable) • Delusional Aspirations or overly gullible
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Names Missing appointments Repetitive questioning or behaviors Missing deadlines with bills or assignments Believing they have or will win the lottery Believing telephone scams or fraud
Emotional State • Depressed, apathetic, withdrawn, dependent, passive
Crying more than usual “I don’t care anymore” attitude
• Anxious, nervous, fidgety or rapid mood changes • Angry, hostile or irritable with themselves, you or others • Stubborn, refuse to cooperate, demanding or negative • Exhibit lack of trust, suspiciousness or excessive jealousy • Exhibit excessive emotional reaction to stressors
Major- death / Minor- accomplishing a task • Expressions of hopelessness
“No one cares”, “I’m all alone” attitudes Actual expression of suicidal thoughts- “ I wish I was dead”
Physical Loss or Changes • Sensory changes, such as loss of sight or hearing • Loss of hearing aid, dentures or glasses • Decreased functional ability • Acute physical illness • Recent or chronic illness, especially is progressive • Numerous AND scattered medication bottles • Inability to drive appropriately • Loss of ability to control urine or bowel movements
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Talking Walking Control of body parts in order to do work
Economic or Social Conditions
• Loss of job or means of support • Confused about handling money • Lack of social contacts and support • Lack of family involvement • Homebound
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Doesn’t pay for things / shoplifting Allowing new people or strangers to handle their money Inappropriate gifting Change in banking habits
Living Conditions • Walkways not shoveled • Garden or flowers neglected • Garbage or litter accumulation • Neglect of animals • Shades down- house appears closed
off • Strong odors • Many pets • Old newspapers lying around • Calendar on wrong month or year
• Dilapidated & dangerous exterior / interior home environment
• Little or no food • Excessive or not enough heat / AC • Numerous empty alcohol containers • Car has not been moved for an
extended amount of time • Numerous lights on throughout the
day or none at night
Making the Call & What to Expect
• Your ONLY responsibility is to let us know that there may be a problem.
• We will contact the person in need within 72 hours.
• Because of your anonymous call, help is on its way.
And we thank you!
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Presentation Notes
No one will tell the senior who made the call The person from the designated agency will say something like- “Somebody thought that we might be able to help you” In some cases, the person will able to refuse help. In some cases, we will be able to make an emergency intervention (OAPS) The United Way has provided a special fund to help people who need something and do not have any other way to pay for it. The information you give will result in follow up by an agency within 24 hours- this follow up is also confidential, so we won’t be able to tell what actually happened with the case…but know that there was follow up. Your only responsibility is to let us know that you think there may be a problem- you don’t have to know for sure or be right! So even though the call is anonymous, you are still protected under the law since you are not a mandated reporter
How to Make a Referral CALL: Lehigh County Northampton County 610.782.3200 610.559.3270
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Okay if you call the wrong county- there’s one central intake line Out of service area--- AAA
Details for the Call 1. Call the County AAA where the person lives. 2. State that you are a community Gatekeeper and would like
to make a referral. 3. Be prepared to provide: Basic info about the older adult Name Phone number Address Information for a friend or family member who can be
contacted A brief description of the problem or situation Your Gatekeeper ID number
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Presentation Notes
Remember that awareness of change is key… Noticing the warning signs… in some cases 2 or more warning signs may be needed to alert you to the possibility of a problem. Like in the example of noticing someone’s garden that is not kept but it used to be a neat garden- this may not on it’s own be a reason to call BUT once you do ID warning signs, you follow these steps
Routine Referral Process
Gatekeeper calls AAA
Gatekeeper gives ID # Says the purpose of the call is to make a Gatekeeper referral
AAA will track the calls, assign case managers and coordinate services
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What happens after you call? AAA will attempt to contact the individual, determine need & offer services If the person agrees, AAA either visits the person, arranges for them to be newly connected to services or offers them more services
Gatekeeper ID Number Keeps your call anonymous so that the Area Agency on Aging
(AAA) will not know who you are. TIPS:
• Save your ID number on your phone • Keep your ID number in your vehicle or near your office phone
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Presentation Notes
Your Gatekeeper ID number is very important. It is what keep calls anonymous. You are not getting an individual ID number. You’re getting a generic one that only the UW will be able to link to today’s training. When you make the call, if you only give your Gatekeeper ID #, the person taking the call will not have access to your name. That means you can feel comfortable calling about your neighbor down the street or an acquaintance who is in need of some help. No one will ever know who made the call! Also, if you are worried about a senior who is driving- get their license plate and give that to the AAA when you call as well.
How Can You Help?
You can: • Join United Way Alliance on Aging! • Distribute Gatekeeper brochures and encourage businesses to
become trained • Make a Gatekeeper referral • Let others in the field know about the Alliance and the
