Foster Care for Elderly: Like a New Home

Foster Care for Elderly: Like a New Home

In the middle of the night, when she gets a hankering for something tasty, Mary Taub slides into her slippers, goes into the kitchen and raids the refrigerator.

If she were in a nursing home, which is where some people thought the 77-year-old woman should go last year when she became too forgetful and scared to live on her own, she would not be able to indulge in the pleasure of a bologna sandwich at midnight.

But in a cozy brick house here surrounded by trees, Mrs. Taub has found privacy, companionship, a hand to help fix her soft white hair, three healthy meals a day and even after-hours snacks, living with a foster family paid to provide her with the amenities of home she can no longer provide for herself. ‘I Want to Stay’

“I like it here, I want to stay here,” said Mrs. Taub, who has been living for the last three months with Cora and Fred Mondonedo and their two daughters, Cathy, 27, and Casandra, 12. “It’s nice to be with a family. They make me laugh.”

Foster care, a system developed to find homes for abandoned and abused children, is growing in the New York region and across the nation as a way to keep elderly people in home settings and communities they know.

As the number of elderly and frail elderly people in the country rises, along with the cost of nursing homes, the government, health policy experts and families are looking for alternatives to both save money and afford older people the greatest freedom in choosing a safe and comfortable place to live.

With monthly costs averaging about $1,000 — one-third those of nursing homes — and the immeasurable value of living within the embrace of a family, supporters say foster care should play an increasingly vital role in caring for the elderly.

Two states that have had extensive experience with foster care for the elderly, Oregon and Washington, have found few drawbacks. So far, cases of abuse have been very limited, people who work in the field said, although they add that as programs proliferate, they will have to be vigilant in looking out for such problems.

The problems that arise most often tend to involve emotional attachments, experts say. When the elderly person becomes too ill to stay in foster care and must move on to a nursing home, the move can be wrenching for all parties.

And the use of foster care can be difficult for relatives of the elderly. They often feel guilty that they are not taking in their aged parent, aunt or grandparent. Sending the elderly to a nursing home, experts say, offers the illusion that a greater level of care is needed, even when it is not.

There are no overall figures on how many older people are living in foster homes since there is no single agency or organization that monitors the dozens of programs nationwide. Experts estimate that tens of thousands of older people of varying ages and conditions are in foster homes and they see those numbers increasing. Responding to a Need

“We started this program as a response to a need we saw,” said Eleanor Frenkel, director of programs for the Bergen County Visiting Homemaker and Home Health Aide Service, which administers a pilot adult foster-care project in northern New Jersey with 27 placements so far.

“We saw people wanting to be cared for at home,” Ms. Frenkel said, “frail elderly not wanting to go into a nursing home but not having a situation that could support care at home either because they had no family or they needed more supervision than they could afford, or they were in substandard homes that were unsafe or unsanitary. But it was very important to them to stay in the community, not in an institution. This is not their original home, but it creates a home where they can be cared for.”

In New York State, Gregory Giuliano, who heads the adult foster-care program in the Office of Housing and Adult Services, said the state had about 800 licensed adult foster-care operators, with 1,600 people in the program. “The important thing is to be creative, to look at many options and to realize that no one alternative is right for everybody,” he said. Less Expensive

Foster care for adults is like foster care for children: a person or a family is paid to take in other people and provide them a home — meals, laundry, a place to sleep, someone to talk to and watch over them. While children are placed in foster care when others decide it is best, the elderly in foster care choose it themselves.

In some programs, the residents pay for the care with their own money, although often a government agency or a nonprofit organization brings the family and the participant together. Mrs. Taub was matched with the Mondonedos through the Family-Type Home Program for Adults, run by Westchester County’s Social Services Department, but she pays the family $950 a month out of her own income, which includes Social Security, dividends and her husband’s pension. Medicaid Waivers

Some elderly people have their foster care paid for with Supplemental Security Income. And in some cases, states have received Medicaid waivers that allow them to spend Federal long-term nursing funds for community-based care programs like adult foster homes.

“It’s a very cost-effective option for the elderly,” said Dr. Susan Sherman, a professor of social welfare at the State University of New York at Albany, who has studied foster care for older people. “And one thing we have found is that it provides as much of a family for care providers sometimes as it does for the residents.”

Taking in Mrs. Taub and Julia Schlegel, a 63-year-old mentally disabled woman, has allowed Mrs. Mondonedo to be home when Casandra gets out of school each day. The Mondonedos first became a foster family for adults when they were living in California and then in Oregon.

“Not everyone can do it — it’s a 24-hour-a-day job,” said Mrs. Mondonedo. “It takes a lot of love, a lot of compassion, a lot of ear to listen to them. But I love elderly people and my daughter needs a grandma. Casandra just loves Mary.”

“Casandra makes me laugh,” said Mrs. Taub, her pale blue eyes crinkling as she giggled.

Regulations and licensing requirments vary with the programs. In New York a foster family can care for up to four adults; in Massachusetts, up to three; in Washington State, up to six, and in Oregon, up to five.

Many people in Oregon and Washington have made a business of adult foster care by buying several houses and hiring families to live in them and care for elderly people. ‘More Humane’

“It is a more humane and human environment than a nursing home for many older people,” said David Olson, coordinator of the adult foster home program in Oregon, which has licensed more than 8,600 adult foster-care beds. “There is independence with supervision but without the feeling of an institution. It’s a home and it quickly does become their home.”

Helen Roethe brought her own chest of drawers, end table, bed and television set when she moved into a foster home in Gladstone, Ore., 13 months ago. She put some prints on the walls and family photos on the dresser top. Then it felt like home.

She is 81, was never married and was living with her sister and brother-in-law in Milwaukie, Ore., but it became too difficult for them to care for her.

“What else was there to do — go live in an institution?” Miss Roethe asked. “Not me. I don’t want it. We care for each other here, like a family. That suits me better.”

Elderly people in foster care, even those with serious medical conditions, do not focus on their health problems, said Thomas Tobin, director of the Family Care Program of Cape Cod Hospital in Hyannis, Mass., which has had an adult foster-care program for 15 years.

“The whole focus is on wellness despite whatever might be wrong with them,” Mr. Tobin said. “Someone in a nursing home is constantly confronted with infirmity and so it becomes a center of their lives.” ‘Very Excellent Break’

Richard Connor spent five years in a nursing home in Wareham, Mass., after a stroke. He was divorced and could no longer live alone, and it was not feasible for him to live with either of his two daughters.

The nursing home was confining and dispiriting, he said, and he considered it “a very excellent break” when he heard a year ago about the adult foster-care program on Cape Cod. He now lives in Yarmouthport with Matthew Keanan, a widowed psychotherapist, and his 18-year-old son, James, a college student.

“Nursing homes of necessity are very restrictive, very crowded,” said Mr. Connor, 68, a retired physicist. “They can’t take you for rides or to the beach. But here with Matthew, I can go out and do things. I can visit Boston for some plays and musicals.”

The transition from the confinement of a nursing home to the freedom of living in a home with a family, Mr. Connor recalled, “was almost shocking.”

“I had to readjust myself to my own way of doing things,” he said. “There was a renewed pleasure in dealing with normal chores: what would I like to eat, or should I bake some bread? In a nursing home you tend to adopt the depression of people around you. In a home, you adopt the atmosphere there, and this is a happy one.”

Published: March 08, 1994


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