Aging in Place in Howard County

From Rabbi Sonya Starr

When I was asked to present on a Leadership Howard County panel, I explained that I was not an expert in this field and that mostly what I would bring to the table was anecdotal stories of 19 years working as a congregational rabbi in Howard County. In order to expand the pool of anecdotal experiences, I sent an email to key congregants and about 8 other clergy (Jewish and Xian) in the community. As a result, what I have discovered has validated my experiences and refined my observations. What I would like to do with you is share some of the pros and some of the challenges of aging in place in Howard County. The positives are very similar to what brought many of us to Howard County to start with: compared to a big city, a low crime rate; access to amazing medical care; loan closet. Now that we are talking about the greying of Howard County, elected officials are aware of the need to address aging in place: there are some volunteer organizations, like Meals on Wheels, Food Bank, and Coalition for Compassion. Neighbor-ride helps with the transportation gap. Senior services like the Bain Center and the Carter Center, access to free museums, and wonderful cultural and academic resources like HCC classes for a minimal cost enrich the lives of senior citizens. In other words, the amazing aspects of Howard County do not go away just because we are aging in place.

The challenges occur when we start having difficulty in accessing them. For the most part difficulty in accessing services can be divided into four different categories: difficulty in having sufficient funds, difficulty in physical ability, difficulty in local help and/or difficulty in cognitive capability. What do I mean? Let us start with transportation. Anyone who has tried to get almost anywhere with the exception of the mall without a car knows that transportation for everyone is a serious challenge in Howard County. We all like to say the problem is solved for the elderly because of Neighbor Ride. But Neighbor Ride has some serious drawbacks: no wheelchairs allowed; passengers must be physically and cognitively able to conduct their own business when they arrive at their destination; no transportation to the airport, Amtrak or the metro; people are only allowed 12 rides a month; availability is completely dependent on the volunteers’ schedules; it is not free and costs more than a bus. CJC congregants have not gotten a ride from Neighbor Ride for Shabbat services, though the website says that it is possible. Therefore, a person like my father, who cannot drive anymore, uses a walker with help. He cannot get into many businesses with steps by himself so he cannot use Neighbor Ride. Another example is those on a fixed income, who some would argue are “house poor,” cannot afford Neighbor Rides.

Transportation is not the only obstacle to aging in place successfully. Another is when you can no longer perform the necessities of life and cannot afford expensive in-home care not covered by Medicare. We have visited congregants and found the kitchen completely lacking in food. In fact, in one case the congregant was out of toilet paper! Another congregant had canned food but not the physical strength to use the can opener. As a congregation, we have had to pay for and build ramps, grab bars, and shower seats. If a congregant lives in a house like mine, where there is no option as currently constructed for a bedroom or full shower on the first floor, then a lift would need to be added to the house. My brother just paid $40,000 for a lift up to his 6 front door steps. Imagine what it would cost to get someone upstairs to the bathroom or bedrooms? Do you know how few ranches there are in Howard County? Aging in place requires keeping up the house and property. Who is going to pay for the lawn care, shoveling, or regular maintenance a house takes to keep it in usable shape? Do we really want to depend on Rebuilding America’s 5-7 houses in Howard County a year to maintain houses for those who do not have the financial ability to do so?

What if you have the financial means to pay for everything but you start forgetting things. Like what medicine to take when or calling five people to find out why they did not leave Meals on Wheels the day before when you were at a doctor’s appointment? Cognitive challenges can be slow. What is the tipping point? When can a person safely stay in his/her home when they forget to turn off the stove or don’t remember how their cell phone works? What happens when setting up social experiences, arranging for neighbor ride, and making sure you still get Meals on Wheels is too complicated you just sit home and watch TV all day? What is the likelihood that someone is going to have rapid decline of their cognitive abilities if there is no social interaction for days on end?

And the most difficult obstacle is the lack of relatives living locally. Do you know how hard it is to get a person to take a memory test when you have no legal rights? Have you ever tried to get a doctor’s attention in the rehab center when you are not a legal guardian? Have you ever tried to figure out how much someone can afford when you have no access to his/her financial records? Without a person who is local and cognitively capable, it is almost impossible to provide all the services a person needs to age in place.

Finally, there is something increasingly disturbing to me as a congregational rabbi that seems to be happening more and more in our county. There is a dumping, for lack of a better word, on our religious communities to pick up the pieces where social agencies fail. Now please do not misunderstand me. Congregations are and should be a piece of the puzzle in supporting someone to age in place. But we are not the whole puzzle. In my 19 years here we have been asked to support kids at risk, clean up highways and parks, be case managers for hospital frequent fliers, lobby for more bike lanes, take care of those who are shut-ins, welcome in those who suffer from mental and physical illnesses, provide a one week shelter for those who are homeless, and mentor those who are uneducated and poor – all while working full-time (when I first got to Howard county most of CJC’s congregants were working 1 ½ jobs; now it is an average of 2 jobs per household), taking care of children, and increasingly becoming part of the sandwich generation, i.e. taking care of your own elderly parents who might or might not live locally while being a parent. CJC is not physically, mentally or financially capable of doing 10% of the volunteer opportunities that are asked of us while still trying to maintain our primary job of being a religious institution with its own agenda and important work to do. Now do not get me wrong, taking care of the needy in our community is a religious mandate. And we do as much as we humanly can. But we are not and cannot be expected to pick up all the pieces that our county throws to the ground.

The bottom line is that aging in place works perfectly until it doesn’t and then it is a nightmare. Without an abundance of wealth, local legal guardians, or physical and/or cognitive capabilities, aging in place is bound to fail. Basically unless we as a county provide complete wrap-around services for the elderly to age in place for their whole life, we are for the most part, truly talking about healthy people in their 60s, 70s and, if they are lucky, part of their 80s. There is nothing wrong with that, but we should be honest about what aging in place really means.