By Peter Hirschfeld Vermont Press Bureau - Published: October 1, 2009
MONTPELIER – When Gwendolyn Hallsmith's mother suffered a debilitating stroke some years ago, the Montpelier director of planning came face-to-face with shortcomings in the region's elder-care system.
Too financially secure to qualify for government-subsidized home care but too strapped to afford the services she needed to exist happily in her own home, Hallsmith's mother occupied a middle ground in which coordinating even simple tasks took their toll on the stricken woman and her family.
"It was a real struggle for us," Hallsmith says. "She died two years ago, and I think the struggle we had with her ongoing care was part of reason she died when she did."
On Wednesday, Hallsmith got word that the city of Montpelier has been awarded up to a $1 million grant from the federal Administration on Aging to remedy some of the systemic elder-assistance problems that complicated the end of her own mother's life.
"I wrote the grant in my mother's memory," Hallsmith says. "I wanted to make sure when writing this grant that people don't have the same struggles she had and we had."
The money, $334,000 this year, with the potential for another two-thirds of a million dollars over the next two years, will fund a radical initiative that Hallsmith says could reshape elder care not only in Washington County but one day the nation. Rather than rely on traditional health care structures that use Medicaid, Medicare, private insurance or personal wealth to fund care services, the plan is to motivate local citizens to take a more active role in the lives of elders struggling in their midst.
Working through the Onion River Exchange – a local "time bank" organization that coordinates a side economy based on units of hours instead of dollars – Hallsmith hopes elders and their families can solve dilemmas that might otherwise force disabled or ailing seniors out of their homes.
"Time banks already exchange goods and services in this structure," Hallsmith says. "And so the motivation is not only that people are altruistic and want to care for elders, but also because there are benefits that accrue to you in the system."
The 300-member Onion River Exchange already facilitates an hour-based economy throughout Washington County. The grant, awarded by a federal program called Community Innovations for Aging in Place, will fund the staff that ORE and other partners need to expand the range of services available for seniors.
Shoveling snow, for example, or hanging storm windows, can prove a significant hardship for seniors on a fixed income. Tasks as elemental as grocery shopping might pose severe problem for older people whose failing sight prevents them from using a car. Those necessities, according to local health officials, generally aren't covered by private insurance or Medicaid.
But if seniors, or their family members, pay into the time bank by performing useful tasks, elders can trade that time for the kind of assistance they need to exist at home.
"We're really excited to be a part of this, and it's a unique opportunity which I believe allows recipients of care or services to be contributors of care or services," says Beth Stern, director of the Central Vermont Agency on Aging. "In most cases, these kinds of services aren't covered by Medicare or Medicaid unless you meet very specific guidelines. But they certainly are things people need to live."
The Agency on Aging will receive a portion of the federal grant money to hire an employee to coordinate care and services for the clients it serves. The Onion River Exchange also will have a staff member to oversee the elder-care program. An executive director, also funded by the grant, will oversee the process.
The time-bank system isn't based on money, but it certainly doesn't shun it. Hallsmith says the concept isn't intended to supplant conventional health care paradigms, nor would it do away with the agencies and organizations through which those services are provided.
"We aren't trying to replace dollars," Hallsmith says.
Rather the time-bank system offers access to services that people without dollars would otherwise struggle to obtain. Global markets might not reward the time spent putting together a homemade meal for four. But the single mother who uses it to feed her family does. And that same woman, the theory goes, would be willing to remunerate her benefactor by helping that person go to grocery store or clean her house.
Filling in those kinds of gaps in elder-care gaps, Hallsmith says, is what the time-bank concept looks to achieve. She says the model could be replicated in cities across the nation.
"MRIs and lab tests are never going to be traded in this system," Hallsmith says. "But things people can spend time on can be."
Hallsmith and Stern say massive projected increases in the number of elders in central Vermont will only exacerbate care problems. Between 2007 and 2017, the number of people aged 65 to 74 is expected to increase by 63 percent while the number of people over 85 is expected to grow by 23 percent. And demographers anticipate a 48-percent rise in the number of people 65 or older with at least two disabilities that limit their daily activities.
"The number of elders we know is increasing dramatically," Stern says. "It's not going to be a problem that goes away anytime soon, so we need everything we can get."
According to a federal official, Montpelier won't have to compete for the grant next year, but it will have to exhibit progress toward its goals. Project merit, and available funding, will determine whether the city receives the next two installments of the $1 million grant.