by Wayne Sheridan
Coastal Journal contributor

This is the third in a series of articles on the current state of eldercare in the nation, the State and the midcoast region, focusing on the innovative work of Dr. Allen S. Teel of Damariscotta. 

In the first (“Does midcoast Maine harbor a potential solution to the nation's mounting eldercare crisis?” The Coastal Journal, February 2, 2012) we looked at the changing demographics of the nation, region and Maine. If current trends continue, Maine will be the oldest (that is a population with the oldest average age) state in the nation by the next national census; we ranked third as of the last census in 2010, just behind West Virginia and Florida. Today, midcoast Maine is the oldest region of what soon may be the oldest state in the country. We also looked at the growing financial crisis this aging population represents.

In the second (“Dr. Teel of Damariscotta Pioneers Innovative Approaches to Eldercare” March 1, 2012) we related how Dr. Teel became involved in elder care and looked at the principles on which he and his colleagues have based their innovative approach, “The Maine Approach,” to helping alleviate the crisis in elder care in the region, state and the nation. We noted that the problem is actually international in scope.

(To read those previous stories online, visit www.coastaljournal.com, and search enter “Wayne Sheridan” in the search box.)

In our last article we listed the 13 principles, elicited from both a panel of elders and a group of experienced eldercare professionals, on which “The Maine Approach” is based. I re-list them here for your convenience:

• Emphasize elders living in their own homes as long as possible.
• Engage elders as fully as possible in living every day fully.
• Empower elders to take back control of their lives.
• Promote elder independence and interdependence.
• Encourage intergenerational contact and relationships.
• Offer diverse volunteer opportunities to everyone regardless of age.
• Find volunteering opportunities for even the most infirm elder.
• Offer a variety of support choices, but insist on as few as possible.
• Showcase and celebrate whenever possible elder wisdom and experience.
• Provide a reasonable level of safety and reassurance.
• Elicit and refine elder goals and new or old interests.
• Make connections to family friends and community.
• Harness elder talents and abilities as an untapped resource.

All these principles are important, primarily, but not only, because they were developed in large part by elders themselves reflecting on what they and their cohorts would need to live a healthy and productive life as they age. Among the professionals providing advice on the development of these principles, the nurses who provide day by day care for elders, seemed to be the most influential. They know of what they speak, as they live it every day.

To me the first four principles comprise the foundation of The Maine Approach.

1. Emphasize elders living in their homes as long as possible. Estimates vary on how many residents of assisted living facilities and nursing homes could actually be cared for in their own homes, but the consensus seems to be that 25% of assisted living residents and 10% of nursing home residents could be cared for at home, with savings that range from 50 to 90%. This change, if fully implemented, would go a long way to helping solve the financial side of the growing eldercare crisis in Maine and in the nation. 

2. Engage elders as fully as possible in living every day fully and

3. Empower elders to take back control of their lives. But the financial aspect is only part of the value of elders living at home as long as possible; it also conforms to elders' overwhelming desire to live at home as long as they can. Often elders are pressured by family, even by medical professionals, to enter an institution, presumably for the elder's own safety, sometimes for other reasons, without full investigation of other options. Ask any elder where would they prefer to live, in an assisted living facility or nursing home, or at home? Virtually all would answer “home.” Often, after entering an institutional living situation, whatever condition may have prompted such a move, whether dementia or a physical condition, the elder will actually deteriorate.

4. Promote elder independence and interdependence. Living at home in itself promotes independence. Creating a community of elders, elders helping elders, supplemented by family, neighbors, other volunteers and a few professionals, promotes interdependence and provides continued meaning to life. 

All the other principles are offshoots or refinements of these four. The Maine Approach addresses each additional principle in innovative and empowering ways.  However, there is not enough space here to look at each one in depth. I would urge the reader to read Dr. Teel's book, Alone and Invisible No More, for a more detailed explanation.

The Maine Approach incorporates traditional personal service, called “touch,” with some of the latest, yet user-friendly, technology, to help provide a high level of independence, with safety, and to open the whole world to elders, for their own self-esteem, but also, to use their years of accumulated knowledge and wisdom for the betterment of society. Our elders, as Dr. Teel never tires of saying, “are our most under-utilized national resource.” With elders poised to become a larger and larger portion of our population over the next decades, we cannot afford to ignore this overlooked resource.

I was impressed by the range of easy-to-use, inexpensive, technical resources utilized by the Maine Approach. With the rapid advancement of technology (our computers and cellphones seem to go out-of-date, sometimes, in a matter of months now,  not judt years), these resources will grow, be refined, and costs are likely to diminish further. Some seniors, who grew up in a less technically pervasive culture, are at first hesitant to use some of the technology available in The Maine Approach; but, usually, since the systems are made so user-friendly, it is not a major problem. As others move into their senior years, those who have more experience using technology from their youth or even early childhood, the technology of The Maine Approach will be a natural lifestyle fit. 

There are a range of services offered in The Maine Approach for elders who choose to participate: A Personal Member Advocate; Video/Telephone Calls (daily); Errand Service; Videophone; FCA Website (full access); Member Care Center (open 9 a.m. to 5 p.m. Monday through Friday); Weekly Planner (unlimited updates); Monthly Activity Calendar (with reminders); Deep Support Services (transportation, repairs, errands, shopping, meals, laundry, bath, etc.); Volunteering (in community or at home); Webcams/Gateway (for video monitoring); Sensors (for door, motion detection, temperature or water-leak detection); Video Monitoring (hourly/continuous); Home Health (at-home weight, pulse, blood pressure, oxygen saturation); Mental Health Assessment (family wellness toolkit to help with depression, anxiety, cognition, attention, behavior or functional problems); Monthly Summary (for family/doctor); “Home Away from Home” Network. 

There are three basic levels of service utilizing the above, and further customization is possible depending on individual needs. Most important, the elder client is able to live in his or her home, and she, with her family, doctor or advisors, chooses the parts of The Maine Approach that best fit her needs.

In our next and last article in this series, scheduled for the first Thursday in May, we will look at plans to take The Maine Approach nationwide, and assess the obstacles this approach faces in Maine and throughout the nation. In the meantime, if you'd like more information on Dr. Teel and his work, we recommend you access the internet site, www.fullcircleamerica.com, or pick up a copy of his book, “Alone and Invisible No More.”