Nora Bristow - VillageCare

TODAY
46 & Ten’s
Nora Bristow
From the pages
of Life to around
the world
Nora Bristow in 1952
Life magazine photo
SUMMER 2012
Thank You
To Two Wonderful Men
F E AT U R E S
VILLAGECARE HELPS THE CITY CARE FOR PEOPLE
WHO CAN’T GET SERVICE ANYWHERE ELSE
BY EMMA DEVITO, PRESI
SIDE
DENT
NT AN
AND
D CE
CEO
O
14 Nora Bristow
LOUIS J. GANIM
MANAGING EDITOR
WELCOME TO THE LATEST ISSUE OF VILLAGECARE TODAY.
BEEN THERE, DONE THAT
BRETT C VERMILYEA
——————
PUBLISHED BY
VILLAGECARE
154 CHRISTOPHER STREET
NEW YORK, NEW YORK 10014
CHAIRMAN
DAVID H. SIDWELL
PRESIDENT & CEO
WE’VE DEDICATED THIS ISSUE TO TWO DEAR FRIENDS OF
VILLAGECARE.
The first is Harold Leeds, who was a board member for our organization for nearly
two decades. Harold was devoted to the cause of having VillageCare respond comprecomprehensively to the needs of persons living with HIV/AIDS and frail adults.
He also worked closely with his good friend on the board, the late Wilder Green, in
helping raise funds for the construction of Rivington House, particularly through the
Art Takes Care endeavor.
EMMA DEVITO
Harold died in 2002; he was a resident of Village Nursing Home at the time.
WWW.VILLAGECARE.ORG
(212) 337-5600
VOLUME 6, NUMBER 1
12 Protecting the Vulnerable
VillageCareToday
VillageCare
EDITOR-IN-CHIEF
|
16 Discovering the Inner Artist
RESIDENTS AT 46 & TEN PAINT THE WORLDS THEY SEE
20 What’s in Store for the
Treatment of HIV/AIDS
ANCHORED IN THE PAST – ACTING IN THE PRESENT –
LOOKING TO THE FUTURE
Last year, his longtime partner, Wheaton Galentine, who was a VillageCare home
care client for several years, passed away.
Recently, VillageCare was the beneficiary of a generous share of the proceeds from
the sale of Harold and Wheaton’s Perry Street townhouse in the West Village.
I hope you will join me in recognizing the contributions to VillageCare from these
two wonderful men.
24 One Step at a Time
TO HELP CLIENTS REACH THEIR GOALS, HOWARD HAUGHTON
OFFERS TRUST, SELF RESPECT AND THE PATH TO SUCCESS.
Because of Harold’s many contributions to VillageCare and his commitment to our
mission, in May we will be dedicating the outdoor bamboo garden at the VillageCare
Rehabilitation and Nursing Center in his honor.
Speaking of the Center, which opened in late 2010, it has been recognized by U.S.
News & World Report as one of the nation’s best nursing homes.
Being selected for this recognition adds to the value of this state-of-the-art facility and
its patient-centered rehabilitation and care program. It really shows that we are commitcommitted to offering patients the best and highest quality care that we can attain.
In the News
D E PA RT M E N T S
3
Single Baby Boomers Face Increased Challenges as
They Age; HIV Rates for U.S. Urban Black Women
Five Times Higher Than Previously Estimated; Medical
Case Management Thrives at VillageCare Health Center;
VillageCare Rehabilitation and Nursing Center Recognized
as One of the Best; VillageCareMAX – Managed LongTerm Care for Medicaid Recipients
Senior Perspective
9
Getting Older: Are there things in your life that you miss?
Are there things you enjoy more? What advice would you
give to others?
Opinion
26
National Study: LGBT Seniors Face Harder Old Age;
Beat the Blues: Defeating Depression in Later Life
In the News
Single Baby Boomers Face Increased
Challenges as They Age
N
ick and Bobbi Ercoline, the couple depicted on the Woodstock
soundtrack album cover, have
now been happily married for more than
40 years.
A new special issue of The Gerontologist
shows the Ercolines as they look today, a
portrait of successful aging. The journal
finds that their unmarried baby boomer
counterparts generally fare much poorer
in terms of economic, health and social
outcomes.
In 2011, the first of the 79 million
American Baby Boomers (those born
between 1946 and 1964) reached age 65.
Among this population, approximately one
in three people are unmarried; the vast
majority are either divorced or never-married, while only 10 percent are widowed.
One study reported in the latest issue
of The Gerontologist uses data from the
1980, 1990 and 2000 Census and the
2009 American Community Survey to
measure marital status trends over time.
The study’s authors, I-Fen Lin, PhD, and
Susan L. Brown, PhD, found that the
number of Boomers who are unmarried
has grown by more than 50 percent since
1980, and that these singles also face
increasing difficulties.
“Unmarried Boomers are disproportionately women, younger and nonwhite,” the authors say in their article.
2 Vi l l a ge Ca r e TOD AY | Summer 2 0 12
“They tend to have fewer economic
resources and poorer health. The prevalence of disability is twice as high among
unmarrieds.”
And despite this higher rate of disability, single Boomers are less likely to have
health insurance.
Among women, widows appear to
be the most disadvantaged as they have
fewer economic resources and poorer
health than divorced and never-married
women. In contrast, those who never
married are the least advantaged among
men. Despite having relatively high levels of education, never-married men have
poorer economic circumstances and are
most likely to live alone.
Overall, 19 percent of unmarried
Boomers said they received food stamps,
public assistance or supplemental security income, while only six percent of
married Boomers indicated they used
these services.
The article on marriage related disparities, “Unmarried Boomers Confront
Old Age: A National Portrait,” is one
of several in the latest issue of The
Gerontologist, which is titled, “Not Your
Mother’s Old Age: Baby Boomers at Age
65.” Other studies within the installment address caregiving issues, concerns among minority boomers, and
intergenerational relationships.
3
HIV Rates for U.S. Urban Black Women Five Times Higher
Than Previously Estimated
Data from Baltimore and five other cities cited
A
national team of AIDS experts at
Johns Hopkins and elsewhere say
they are surprised and dismayed
by results of their new study showing
that the yearly number of new cases of
HIV infection among black women in
Baltimore and other cities is five times
higher than previously thought. The data
show that infection rates for HIV, the
virus that causes AIDS, among this urban
population are much higher than the overr
all incidence rates in the United States for
black women and black adolescents.
The findings are from an ongoing, larger series of studies supported by the HIV
Prevention Trials Network. They reflect
testing and analysis of at-risk women
in six urban areas in the northeastern
and southeastern United States hardest
hit by the AIDS epidemic. The so-called
“hotspots” are Baltimore, Atlanta, RaleighDurham, Washington, D.C., Newark, and
New York City.
Specifically, the team found that among
2,099 women ages 18 to 44, 88 percent of
whom were black, 1.5 percent (32 women)
tested positive at the outset of the study
and were not enrolled. Among those who
remained, .24 percent tested positive for
HIV within a year after joining the study.
All study participants were HIV negative
when they volunteered for the study.
Experts say this rate of infection, or
seroconversion, is five times previous estimates from the U.S. Centers for Disease
Control and Prevention for urban AfricanAmerican women.
“This study clearly shows that the HIV
epidemic is not over, especially in urban
areas of the United States, where HIV
and poverty are more common, and sexually active African-American men and
women are especially susceptible to infection,” said principal investigator for the
Baltimore portion of the study, Charles
Flexner, M.D., a clinical pharmacologist
and infectious disease expert at Johns
Hopkins.
“We, as care providers and policy makers, have our job cut out for us in devising
HIV prevention programs targeted to sexually active men and women in Baltimore
4 Vi l l a ge Ca r e TOD AY | Summer 2 0 12
and other cities,” said Flexner. He says
prevention tactics should include more
counseling about sexually transmitted
infections, distribution of condoms and
intensive education about safer sex practices. Flexner is a professor at the Johns
Hopkins University School of Medicine
and the university’s Bloomberg School of
Public Health.
In Baltimore, for example, the study
conducted from May 2009 to July 2010
asked participating women about their
safe-sex practices and other health issues.
It then asked them to come to The Johns
Hopkins Hospital for HIV testing at no
cost. Those who tested positive were
offered counseling and treatment.
“While we have always known that
African-Americans had a higher risk
of HIV infection than other American
racial groups, this study confirms it and
underscores the severity of the national
and local problem, especially in cities,”
Flexner said.
Women of all races account for a quarr
ter of the 50,000 new HIV infections
each year in the United States, which
adds to the more than 1 million men and
women already known to have tested positive. Sixty-six percent of the women newly
infected each year are black, even though
they represent only 14 percent of the
U.S. female population. The national ageadjusted death rate for black women in
the United States is nearly 15 times higher
than that observed for HIV-infected white
women.
The new study, formally known as
HPTN 064 Women’s Seroincidence
Study, was funded by the U.S. National
Institute of Allergy and Infectious
Diseases (NIAID), part of the U.S. National
Institutes of Health. The study site leader
was co-investigator Anne Rompalo, M.D.,
Sc.M., an infectious disease specialist and
professor at Johns Hopkins. (Newswise)
VillageCare Rehabilitation and
Nursing Center Recognized as
One of the Best
U.S. News & World Report named the VillageCare Rehabilitation and Nursing
Center one of the nation’s best nursing homes.
The magazine made its 2012 selections of the best nursing homes through an
examination of data provided by the federal government’s Centers for Medicaid and
Medicaid Services. The magazine’s analysis looked at facility performance in health
inspections, nurse staffing and medical
care.
Only homes receiving five stars from
CMS were considered.
“I think it’s quite an honor for us to
be recognized as one of the best,” said
Patricia McGrann, administrator at the
VillageCare Rehabilitation and Nursing
Center. “Since we opened this new, stateof-the-art facility in late 2010, we have
worked hard to provide the highest level
of quality rehabilitation care and services. This acknowledgement by U.S. News
shows that we are taking the right steps.”
5
Medical Care Coordination Thrives
At VillageCare Health Center
By Chris Oliver
T
he VillageCare Health Center,
which provides primary care and
other services to the downtown
community, has successfully integrated
the concept of care coordination into its
everyday operations.
Care coordination efforts help
patients access and negotiate medical
care, arrange and schedule services, have
clear communications with their providers and monitor their health outcomes.
VillageCare Health Center provides
a wide range of medical care services to
adult patients, including primary care,
mental health, dental, gastroenterology,
podiatry and ophthalmology. Primary
care includes adult internal medicine,
infectious disease and women’s health.
The center has been licensed as an
Article 28 diagnostic and treatment center by the state Department of Health
since 2006. Seventy-five percent of
patients seen by the Health Center have
Medicaid, Medicare or private insurance,
with the rest being self-pay, including
the uninsured.
In the summer of 2010, the Health
Center was awarded a Helping Each
Other Live Positively (HELP Program)
grant for medical case management and
VillageCare COBRA Case Management
was awarded a city-funded grant for Care
Coordination, both of which operate out
of the Health Center.
The HELP Program is directed by
Gretchen Winterkorn, LMSW. Current
team members include Melissa Doelger,
MSW, medical social worker (and former COBRA case manager), Yaneth
Pichardo, medical case manager and
Richard Berrios, data coordinator.
The HELP program has seen more
than 300 patients since opening in
August 2010. The team seeks to empower patients to become more involved
in their case and teach them healthy
behaviors, while helping them move
toward higher functioning and independence. This is accomplished through
6 Vi l l a ge Ca r e TOD AY | Summer 2 0 12
team meetings with medical providers
“In the HELP program, we seek to
empower our clients to become active
participants in their HIV health care,
fostering independence and positive
relationships with their primary care
providers,” Winterkorn said.
“Among the services we offer are indepth psychosocial assessments, assistance with disclosure of HIV status,
HIV education, harm reduction and
evidence-based counseling and groups,”
she said. “Working from a client-centered approach, we have built a program
that assists clients with the health care
concerns that are important to them.
Our goal is an improved quality of life,
with fewer patient hospital stays, and
stability in their health they didn’t have
before they came to us.”
The program has been so successful
that the New York State AIDS Institute
has used the HELP program’s practice
models as a teaching tool for other
health centers in New York providing
medical case management.
The HELP program has also been
integral in integrating quality improvement processes at the health center. One
of the main projects the team worked
on included a monthly interdisciplinary
case conference at the center, a pivotal
meeting where the needs of complex
and challenging patients are discussed
by the entire team at the health center,
including Medical Director Lawrence
Hitzeman, MD, and Psychiatric Nurse
Practitioner Robin Foley, as well as front
office staff, medical assistants and Care
Coordination and HELP Program leaders.
Care Coordinator Jacquelyn Ruiz,
LMSW, supervises the Care Coordination
program of four outreach staff, called
patient navigators, who meet with clients in the community. The patient navigators include Patricia Hill, Antonio
Driver, Maria Naula, and David Vargas.
Data coordinator Nicole Nolan helps
input the program services into e-shares.
The Care Coordination program helps
patients deal with the challenges faced in
the community, such as housing, substance abuse, domestic violence, legal
issues and more. Since its inception, the
Care Coordination program has enrolled
more than 150 patients.
Success stories include helping
The care coordination team at VillageCare Health Center in Chelsea
patients find and move into needed
apartments, find gainful employment,
lower their viral loads and increase their
CD4 counts, enter vocational and educational training programs and maintain
sobriety.
Self-sufficiency for the patient is the
aim of Care Coordination. The program is particularly adept at finding
patients that have been lost to care and
re-engaging them with the health center
and primary care services. The program
specializes in patients who need intensive support, case management services
and health education. Care coordination
manager Victoria Lampado says “we
believe that a bridge between a patient’s
medical needs and community needs
will foster a better health outcome.”
Care coordination is a critical component of the medical home model of care
at the Health Center. The practices developed by the HELP and Coordination programs have assisted the Center in setting
up practices, policies and infrastructures
to provide medical case management to
all patients.
From there, it was a natural move for
the Health Center to apply to the National
Committee on Quality Assurance to be
certified as a Level 3 Patient-Centered
Medical Home. NCQA gave the health
center the Level 3 certification in January
2012.
With a medical home, individuals and
their families are partners in their health
care treatment with their primacy care
providers, Nicolas Rossetti FNP, administrator of the Health Center, said.
As a comprehensive primary care
approach, the medical home seeks to
improve health outcomes, patient access
and patient satisfaction in a patient-centered environment. Together the primary care and medical case management
teams have created a successful model of
integrated patient-centered primary care
at the VillageCare Health Center.
(VillageCare Health Center, located at
121A W. 20th St., is open Monday and
Friday 9-5 PM, Tuesday and Thursday
9-6 PM, Wednesday 10-7 PM, and from
9 a.m. to 4 p.m. on Saturdays. It is closed
Sundays. The Health Center’s phone number is 212.337.9290. For more information,
visit www.villagecare.org.)
7
S E N I O R PERSPECTIVE
New Downtown AIDS Memorial Park A Reality
By Emma DeVito
ANA DILORENZO As I look back at my life, I certainly do miss the precious time that I had with loved ones,
especially my children and my parents. That would also
be my biggest piece of advice to give to anyone. Don’t let
life pass you by too fast, enjoy the time with ones who
you love spending time with. Because when you look
back, the amount of time you spent may not have
been sufficient in your eyes. Getting older does have
it perks as well. I enjoy the freedom to do more
things with fewer things holding me back,
and I love the community where I live with
other older folks. Time sure does pass
by quickly though when enjoying the
conversations and activities I now get a
chance to do.
VillageCare President and CEO
A
“significant and prominent”
AIDS memorial will be the primary feature of a new triangle
park to be created across from the former
site of St. Vincent’s Hospital.
The memorial is the result of an
agreement between City Council and the
Rudin Management Company, owner
and developer of the St. Vincent’s property.
The agreement was a result of the
hard work and advocacy of the AIDS
Memorial Park Coalition, of which
VillageCare was an early member, and
came about through the efforts of City
Council Speaker Christine Quinn.
The AIDS Memorial Park is a fitting
reminder of how AIDS swept through
our community, and how the community
came together to help and to respond to
the epidemic.
We need a place to focus on and
remember individuals, not so much that
they died – too often too soon and too
young – but to recognize that for so
many even a life cut short can have tremendous meaning.
VillageCare was asked early on if we
would support the memorial park proposal, and we said that we absolutely
would, wholeheartedly.
In the early days of the epidemic in
the 1980s, VillageCare was one of the
first to begin to shape ways to address the
needs of those with AIDS, and to provide
unique, compassionate care.
In developing responses to the epidemic, VillageCare was led by caring and
wonderful individuals, as well as great
thinkers. They included Nick Rango, who
would go on to become the first director
of the state’s AIDS Institute, and Len
McNally, who was integral to the planning and design of the comprehensive
services VillageCare created in response
to the epidemic. There were so many others at VillageCare who gave everything
they had to combating AIDS.
Until the development of protease
inhibitors and combination therapies in
8 Vi l l a g e Ca r e TOD AY | Summer 2 0 12
The jury selected ‘Infinite Forest’ by studio a+i as winning concept.
the mid-1990s, VillageCare staff faced
a tremendously difficult time dealing
with the constant deaths. No more so
than the nurses and others working in
our Certified Home Health Agency, who
held weekly memorials in our offices for
those patients who had passed on. Weekly
memorials – because so many were dying.
When VillageCare’s nursing home
for those with AIDS (Rivington House
– The Nicholas A. Rango Health Care
Facility), was opened, people were staying at home as long as they could before
coming to the nursing home. Basically,
they came to Rivington House in its early
days because they were no longer able
to be cared for at home. They came to
Rivington House to die.
In its first year, the 219-bed Rivington
House had well more than 400 admissions. Sadly, the “discharges” that enabled
the facility to accommodate such a numbers were due to death.
For those of us who witnessed firsthand the devastation AIDS caused, the
plan for an AIDS Memorial Park simply
makes great sense.
The site is important, too.
For many years, and particularly during the first decade of the AIDS epidemic, VillageCare was a partner with St.
Vincent’s in caring for those with AIDS.
No other hospital took on the importance – both real and symbolic – of St.
Vincent’s. It is the hospital most closely
associated with the AIDS epidemic in
New York City, leading the way in caring
for those with the disease when others
were, in effect, turning away.
We need this memorial because people
need to remember. Those who were not
alive or were very young when the AIDS
epidemic struck may very well not understand how terribly a community was
impacted by a disease that was wiping out
neighbors and friends mercilessly. And
the memorial would serve as a reminder
of how everyone in the community pulled
together to do something about it.
We must not forget this. Not ever. Getting Older
Are there things in your life
that you miss?
Are there things you
enjoy more?
What advice would
you give to others?
PEARL NEIER Growing older sure has its ups and downs. When I look back
and think about what I miss most, I would say it would have to be living out the
many memories I have of doing things with my children. Good times were during family vacations, holidays and several milestones throughout our lives. The
decreased responsibility and stresses in my life are certainly a plus in getting older.
My advice to anyone concerned about getting older would be to look at the
positives rather than the negatives. Lay back and enjoy life. Go out and
enjoy all that nature has to offer, particularly when all the younger
folks are busy with their everyday hustle and bustles.
HENRY ROSS Believe it or not, as I grew
older and retired, I began to miss my career
and the stresses that came along with it.
I felt needed then. But as I grew older, I
didn’t feel as needed. I quickly adjusted
from that uneasiness and realized that
I do enjoy the quieter life. I have much
less headaches and some days just seem
brighter. My advice to anyone would
be to live life to the fullest. Life
can sometimes be way too
short. Enjoy each day and live
life with no
regrets.
KATHLEEN JONES I sure do miss my partying
days, that’s for sure. In my younger years there wasn’t
a party I would turn down, but now that I have grown
older, I am forced to slow down a bit and let most of
those parties pass me by. I suppose that isn’t a horrible thing, however. I do enjoy the various clubs and
groups I have joined along with the many new friends
I have made as I have grown older. We have come
from all different paths in life,
but somehow, we have all
ended up together with
one thing in common
– to enjoy our golden
years. My advice would
be to embrace the
change. If you visualize yourself as a
healthier and happier person, chances
are you will stay
a healthier and
happier person.
9
The Month May Be Cold,
But the Activities Are a Spicy Stew of Fun
BY AUDREY KESSLER
F
ebruary is one of the the neighboring St. Luke’s was provided by a client and
coldest months.
School.
former New Orleans resident.
The fear of falling
To celebrate Fat Tuesday,
To acknowledge Black
outside or the hassle of bun- a Mardi Gras carnival took History Month, we celebrated
dling up often deters NYC place, with face painting and the achievements by African
seniors from leaving their staff-run games such as ring Americans throughout U.S.
homes during winter.
toss and bead-containing history. Movies highlightFor the VillageCare Adult guessing jars. A menu with ing key historical triumphs
Day Health Center, it is an foods such as hobo stew, dirty and struggles of African
important time to attract older rice and Creole chicken and Americans were played. Jump
clients out of isolation from sausage was served at lunch, Start, a daily morning group
their homes to escape the along with a Cajun music that that staff uses to address curdepression that may ensue.
With its many holidays, special activities and the draw of
regularly scheduled therapeutic groups, this February at
the Center did just that.
To celebrate Super Bowl
XLVI, Eli Manning newspaper collages decorated the cafeteria walls. Trivia and Super
Bowl bingo were organized
by our sports enthusiast CNA
on the Friday preceding game
day. Key chains, cups and pencils with the Giants’ logo were
awarded as prizes.
As
Valentine’s
Day
approached, heart-shaped cutouts were hung from the ceiling, as clients anonymously
submitted their votes for king
and queen in a red tissuepapered box. On the big day,
a bell choir comprised of participants and conducted by
our music therapist, sang
well-known love songs such
as Unchained Melody. This
was followed by the crowning of the king and queen,
along with a Valentine’s Daythemed concert by the “Show
Stoppers,” a group of senior
singers and performers. Our
clients left with smiles on
their faces and a homemade
Valentine in hand, donated Alexandro Oquendo and Roslyn Asterball were elected VillageCare Adult
by first and third graders at Day Health Center’s King and Queen during activities in February.
1 0 Vi l l a ge Ca r e TOD AY | Summer 2 0 12
rent events, was often spent
discussing important African
American persons and milestones. Special lunches, trivia,
cooking classes and karaoke were weekly groups that
focused on honoring black
history.
In addition to these holidays
and special events, the month
provided other incentives to
bring clients into the center:
the comfort of routine. Weekly
scheduled groups such as
music therapy, action magic,
art, jewelry-making, Spanish
group, pokeno, word games,
tai chi, meditation, Wii workouts, sing-a-long and dance
continued to run. Monthly
and bi-monthly groups such
as Jackie’s Broadway, dog therapy, bilingual nutrition and
the international tea experience were on the activities
calendar as usual.
During a month easily spent glum and alone,
the VillageCare Adult Day
Health Center offered participants ample ways to become
involved, be entertained and
learn. And with the help
of some sunshine shining
through our grand day room
windows, clients were happily
reminded that Spring was not
too far away.
(Audrey Kessler is supervisor of Nutrition & Food Service
and supervisor of Therapeutic
Recreation at Village Adult Day
Health Center. To learn more
about the care and services at
the center, visit our website at
villagecare.org/communitycare/
adult_day_health. Or call the
Center directly at 212.337-5870.)
Legends of the Village
V
illageCare’s 13th annual Legends of the Village
gala was another success, raising funds to help
support the organization’s care programs and
honoring individuals for their contributions to the
community.
Those recognized at this year’s Legends event were:
Len McNally, who is the program director at the New
York Community Trust. He received the Lenore
Zola Award for community service. In the 1980s,
Mr. McNally was dedicated to planning community-based programs for chronically ill adults and
for persons living with HIV/AIDS. After the 2001
terrorist attacks, he also consulted for the September
11th Fund in the design and financing of environmental health and insurance programs for victims.
Lynne P. Brown, senior vice president for university
relations and public affairs at New York University.
She received the Distinguished Service Award. Ms.
Brown is responsible for NYU’s government relations, community outreach and strategic communications. She has led major growth and environmental initiatives at NYU over the past four years.
In addition, Village Business Legends awards were
presented to:
Don Rapaport and Jay Vogel, two of the founders of
The Camps Group, which serves clients over a spectrum of industries from finance to fashion to media.
The Camps Group works with not-for-profits to balance the financial and human aspect of employee
benefit programs.
Paul Staubi, president and founder of Employee
Benefit Solutions, Inc., a national company focused
on cutting-edge health and wellness solutions. Mr.
Staubi’s organization has been an innovator within
the health insurance industry, including the development of the “Difference Card,” a cost solution
designed to help employers achieve savings. Over the
past five years, the program has generated average
annual savings of 18.6 percent on health care costs
for participating employers.
Legends of the Village was held at Bridgewaters at
the South Street Seaport.
11
Protecting the Vulnerable
By Bonnie Rosenstock
VillageCare helps
the City look after
at-risk adults
F
our years ago, when the city put
out a call for private agencies to
help pick up their overwhelming
Adult Protective Services (APS) caseload,
VillageCare responded.
Kenneth Stewart, director of Community Case Management/Health Home,
asked rhetorically, Why would VillageCare
respond? There was no financial profit.
“Our corporate leadership said that
we should want to take the hardest cases
around and help the people who can’t
get service anywhere else,” Stewart said.
“Because that’s what VillageCare does.”
Stewart wrote a proposal explaining
how VillageCare would handle the cases.
The city awarded VillagCare one of the
three contracts it granted.
“CEO Emma DeVito recognizes that
when poverty, disease and mental illness
strike, it’s very sad, and we have to take
care of people who are suffering right near
our doorstep,” Stewart added.
Because VillageCare’s Community Case
Management is geared toward improving
the quality of life for persons living with
HIV/AIDS, it was a natural fit to extend
the program’s considerable expertise to
a wider population in need. APS, which
is state-mandated, arranges for services
and support for physically and mentally
impaired adults. It helps them live independently and stay in their homes.
Andrew Hearn, the deputy director
of VillageCare Adult Protective Services,
oversees its daily operations.
Stewart said his case managers used to
complain that the City APS program was
not particularly active.
“So when I started this, Andrew and
I had several long meetings and mentoring sessions with a retired City APS
deputy director. I said I would run this
along social service concepts, but also the
VillageCare concept — that we are here
to serve the hardest cases. However, we
have to follow the city’s rules and try to
1 2 Vi l l a g e Ca r e T OD AY | Summer 2 0 12
Kenneth Stewart, director of VillageCare’s Community Case Management/Health Home
resolve the problem and close the case.
But Andrew and I, who are both social
workers, decided to take the extra steps
of whatever else could be polished up to
save a life.”
The primary goal of APS is to take the
least restrictive measures to resolve the
case. For instance, clients can face eviction
for a variety of reasons — nonpayment of
rent, rent increases they can’t afford and
issues about how an apartment is kept.
Others might be dealing with issues of
physical injury or financial exploitation.
“Sometimes it’s as easy as getting financial management for the person and we
become the payee for the Social Security
check.” Stewart said. “We pay the rent and
other bills, and they get a residual check
for the balance — and it keeps them in
their apartment.”
Before the APS program can take over
the Social Security check, the client must
submit to a psychological evaluation to
show there is mental impairment, while
physical impairment is proven by a doctor’s statement.
“Most often, the issue is mental impairr
ment,” said Hearn, “in which case we can
enroll them in a program with a mental health component, which would keep
them active and seen in the community.
Some might need home care through our
Certified Home Health Care.”
Persons 18 and older are eligible with-
out regard to income if they are not able
to care for themselves and no one is willing to care for them. Because of the aging
boomer population and current economic
instability, more people need these serr
vices. And, contrary to common belief,
it’s not just older adults. Forty percent of
VillageCare’s APS clients who have serious mental illnesses and are at risk of
landing on the street are under 60.
“Some have bank accounts, but not the
mental capacity to pay their bills,” Stewart
said.
The most restrictive measures to solve a
case are applying to the court for guardianship. It is not only a lengthy process, but
also something the courts are reluctant
to do. “It’s a very emotional experience to
lose the right to determine one’s own life,
but sometimes it’s necessary,” Hearn said.
VillageCare receives all its cases from
the city’s Central APS Intake. VillageCare’s
15 caseworkers serve 30 clients each, for a
total of 450. It started out with 300 clients,
but the City – after seeing the program’s
success in working with the original serr
vice for 300 persons – asked VillageCare
to increase services.
Stewart praised his staff for being
“amazing, patient, ethical and kind in the
face of abuse sometimes.”
About 90 percent have worked in the
program since it started, a very high retention rate and testament to their dedication.
He acknowledged that sometimes the job
can be demoralizing. “Our job as directors
is to know how to assist them in dealing
with such difficult problems and figure
out how to keep positive morale to knock
on a stranger’s door even though they
know the person will curse them out,”
Stewart said.
But the program is extremely successful despite its difficulty. Hearn has an
exceptional relationship with New York
City APS officials, Stewart said, and they
consult on complicated cases.
Meanwhile, VillageCare APS has gotten
glowing reviews for its work.
“The city has talked about using
VillageCare as a model for APS. We can do
a better job for less money,” Hearn said. H
Nora Bristow
Been There,
Done That
By Jess Espinosa
ere’s a question: What is the connection between
Judy Garland, penguins and the Biltmore clock?
Answer: They all played a part in the exciting and
adventure-filled life of Nora Bristow, a resident of VillageCare
at 46 & Ten.
At an early age, Bristow, born in Rockland County on March
12, 1927, showed a talent for dancing.
Her mother, recognizing her daughter’s talent, put Nora
under the tutelage of Miss Evelyn, a ballet teacher from New
Jersey who brought her to New York where received excellent
training.
That led to her gaining admission into the prestigious
George Balanchine company.
Bristow was only 16 years old then. The rigorous daily
schedule with Balanchine did not faze her at all; she was having too much of a good time. Her continued training – singing, tap and jazz – was preparation for a stage career.
Her mother enrolled her at the Gardner School for Girls,
which, at the time, was located in the Plaza Hotel, and she performed in some school productions.
She went on to perform in operettas, such as The Merry
Widow and Rosemarie, for J.J. Schubert’s group.
At 21, she appeared in her first Broadway show, Ballet
Ballads at the Music Box Theater.
Bristow became part of a group known as Ernie Richman
and The Mannequins, which served as the opening act for
Tony Bennett, Nat King Cole and Sammy Davis, Jr. From 1953
to 1955, she kept a grueling schedule of five shows a day, most
of them on the road.
One day, she found herself sitting next to Judy Garland,
who said to Bristow, “I’ve seen your work.” Bristow recounts
here comment back to Garland: “I’ve seen your work, too.”
When she turned 25, she was considered “old” in the theatrical field back in those days.
“Unless your mother or father is in the business, your dancing career is over at that age,” she said.
At the suggestion of a friend, she applied for a job at the
College Entrance Examination Board, an association of educational organizations that sells standardized tests for students.
She ran the kitchen and arranged breakfasts, lunches and
meetings for the staff. This drastic change in her career was
“different but not difficult.”
She stayed in that job until she was 66.
At that point, she said to herself, “I’ve had it.”
A NEW LIFE
Having adventurous parents implanted in her mind the
desire to travel.
In 1932, when flying was not a common mode of travel, her
parents flew from New York to Los Angeles for the Summer
Olympics, and that left quite an impression in the young
Nora’s mind. Her performing days had brought her to all parts
1 4 Vi l l a ge Ca r e TOD AY | Summer 2 0 12
of the U.S. and Canada, but not beyond.
So she got a passport for the first time in her life, and the
world opened up with one marvelous adventure leading to
another even more marvelous adventure.
She has cruised along Panama Canal, marveled at the
beauty of Victoria Falls in Zimbabwe (“They make Niagara
Falls look like nothing.”), ridden camels in Egypt, fed giraffes
in Kenya, played with Bachus in an underground winery in
Sydney, marveled at the 24-karat gold ceiling of the Queen
Elizabeth II, and been dazzled by the Fiji Islands.
Bristow traveled to Russia, Greece, Italy, France, Spain,
Portugal and Copenhagen. Her visits to Japan were so frequent
that the Tokyo airport staff recognized her – “Here she comes
again,” they’d say.
During a cruise to Argentina aboard the ship Marco Polo,
she disembarked in Antarctica and came face to face with penguins.
Her most memorable and longest voyage was when she
took a sailing ship from Thailand to Greece that lasted 43 days.
The ship was small, had only one bar and one restaurant. It
was a straightforward, far from elegant vessel and carried only
a few passengers – people from all over the world who were
working and traveling. She liked the simplicity of it all.
Bristow’s last trip was a while ago, 2006, when she went
to the South of France and Northern Italy and watched tailwagging, sniffing dogs hunt for white truffles. What’s next for
someone who describes herself as one who enjoys life, meeting people, learning from different cultures, and being happy
that way? The Norwegian fjord, in the summer of 2012.
STOOD UP IN LIFE MAGAZINE
Before she moved to 46 & Ten, Bristow had a fifth-floor
walk-up apartment on West 55th Street. She lived there for 50
years and loved it.
When climbing stairs became difficult, a friend led her to
the VillageCare residence, where she now enjoys living with
nice people. “They’re all old like me,” she says. She finds them
pleasant and enjoys their company.
Another adventure occurred in Bristow’s life that did not
have anything to do with her dancing, working and traveling.
It had to do with dating.
In 1952, when she was 25, Bristow was introduced by a
friend to a handsome, well-to-do man from Connecticut.
He made a date to meet her under the clock in the famous
Biltmore Hotel, a well-known dating spot at the time.
As she sat waiting, Ralph Morse, a LIFE magazine photographer was photographing the hotel’s well-dressed young men
and women for a photo series on the Biltmore clock.
Bristow’s date did not show up, but her photo appeared in
the April 21, 1952 issue of LIFE in a feature titled, Under the
Biltmore Clock.
It’s just one more distinction for Nora Bristow. 15
Josephine Quichic
By Brett C Vermilyea
Discovering the Inner Artist
I
t’s a warm mid-afternoon, and about
a dozen painters, mostly women,
work two to a table. Music from a
large boom box floods the space, which,
except for the carpeted floors, looks like
it could double as a classroom at most
modern campuses.
Claudia Teller, activities director at
VillageCare at 46 & Ten, moves about the
room, laughing with the painters, who
are all residents. She shares stories, commiserates about the need for glasses and
encourages them: “I love the caterpillar;
That water is gorgeous; You did a great
job and I think it’s done; You got some
neat space going on by the rocks here.”
Josephine Quichic sits at the front,
leaning over a sheet of white paper three
feet long and two feet wide. While peer-
1 6 Vi l l a ge Ca r e TOD AY | Summer 2 0 12
ing through glasses perched at the end of
her nose, she applies thick lines of blue
paint slowly, deliberately.
On her left is an unusual black-andwhite studio photo of a rabbit towering
over a turtle. A large eraser holds the
photo down. Her tools sit on her right: a
10-paint plastic palette with three empty
spaces, two paint brushes (one thick, one
thin) resting on a paper towel, and an old
tomato can filled with water.
Up until a few months ago when
she moved to 46 & Ten, Quichic never
dreamed of painting. All through her
schooling — from elementary through
college — Quichic studied science. Just
sitting down and painting a picture didn’t
seem like a good use of time.
“I never painted my whole life,”
17
Quichic says. “I was always thinking, no,
I can’t do that, no, no, no.” She begins to
laugh loudly as she continues, “But look
at me now, 76 years old and now I have
the patience.”
In fact, her first painting was of
Patience and Fortitude, the lions in front
of the 42nd Street library. The lion is her
favorite animal and her mother came
into the world the same year as Patience
and Fortitude (1911). Quichic was a bit
apprehensive at first, thinking painting
might be too difficult for her, but Teller
encouraged her, saying directly “you can
paint it.” Quichic giggles when she talks
about it.
“Claudia is a very nice person,” she
says. “She never gets down on you when
I say, ‘I can’t paint that.’ She says, ‘try.’”
Margaret Armoogan sits near Quichic
and asks Teller for brushes. It’s harvest
time in Armoogan’s native Trinidad, so
she’s painting a harvest moon, grapes
and olives. This is her second painting
session. Her first was on her birthday,
and her fellow residents gave her a card
featuring palm trees of her homeland.
“So I thought, I’ll paint two palm trees
with some guy in the middle in a hammock and that’s what I did.”
It was so good that Teller hung the
work in 46 & Ten’s dining room. A visitor asks if she knew she had talent when
she started.
“I don’t think it’s talent,” she says. “I
just decided to do something and well…”
Her sentence trails off then she laughs,
“I’m enjoying it, but I’m no artist.”.
Claudia overhears her and jumps in,
“She’s doing a wonderful job.”
“I’m just trying,” Armoogan says.
“We’re all artists,” Teller says. “Some
people just get more encouragment than
others.” Claudia Teller, activities
director at VillageCare at
46 & Ten
1 8 Vi l l a ge Ca r e TOD AY | Summer 2 0 12
19
Anchored in the Past – Acting in the Present – Looking to the Future
What’s in Store for the
Treatment of HIV/AIDS
By Bonnie Rosenstock
2 0 Vi l l a g e Ca r e T OD AY | Summer 2 0 12
W
e’ve come a long way since
the dark days of the AIDS outbreak.
In the early 1980s, a diagnosis of HIV/
AIDS was a death sentence. Nowadays,
with early treatment and adherence protocols, most people with the disease have
the chance to live fully realized lives.
“Fifteen or 20 years ago, we were
dealing with a great deal of opportunistic
infections and a high mortality rate,” Dr.
Lawrence G. Hitzeman said.
After six years of people dying in
droves, in 1987, Retrovir (AZT,
Zidovudine) appeared on the scene.
Then in 1992, the addition of the drug
Hivid marked the beginning of AIDS/
HIV combination therapies – referred to
as the “cocktail.”
“Now HIV is a manageable illness,
and there are 26 antivirals out there to
choose from. People are doing quite
well,” he said.
Dr. Hitzeman is the medical director
of VillageCare’s Health Center at 121A
West 20th Street.
HIV-positive patients make up about
40 percent of the center’s clients but
account for the bulk of visits because
HIV maintenance requires more attention.
The health center follows an integrated-care model, trying to meet all of the
patients’ needs in one place with interr
nists for general internal medicine, GI
specialists, podiatrists, psychiatric nurse
practitioners, an ophthalmologist and
dentists, along with women’s health specialists. The center also offers routine
screenings for cancer and diabetes.
Currently, HIV patients can choose
from various treatment options, which
all consist of three different antivirals.
Since most of the providers at the center hold an HIV-medicine certification,
they can educate patients about the side
effects of each option to try to determine
which would best fit an individual’s lifestyle. Each regimen has its own variety
of side effects. For example, one causes
sleep disturbances, vivid dreams, depression, another gastro-intestinal distress,
and another, skin rashes and kidney and
liver problems.
Nonetheless, “they are equally efficacious,” Dr. Hitzeman said.
The medications have other side
effects as well, which require careful
monitoring of blood levels such as those
for lipid parameters, which can affect
heart and bone density, which relates to
osteopenia and osteoporosis.
Medical staff must also look for
accelerating aging effects, such as early
dementia. Dr. Hitzeman said that it’s
estimated by 2015, half of those living
with HIV will be over 50 .
Besides the psychological and physi-
ological effects of the drugs, many
patients suffer from depression related
to having HIV. The Health Center will
match patients with the staff psychologist, and will also refer them to agencies
“that work really well with patients struggling with issues related to being HIVpositive,” he said.
Newer drugs coming down the pipeline won’t have some of the side effects of
the older drugs, particularly lipodystrophy, which causes changes in the shape
or size of the body such as weight loss in
the face, a hump in the back of the neck
(buffalo hump), increased weight in the
middle and decreased fat in the arms
and legs.
Further, recent Hepatitis C (HCV)
research is offering new hope, since a
great deal of those living with HIV are
co-infected with HCV. Two new protease
inhibitors have been effective in clinical
testing and caused few side effects. They
have recently been approved by the Food
and Drug Administration (FDA).
There are also two, fixed-dose combination, one-a-day pills for HIV that have
been approved by the FDA, while a third
is expected to gain approval this summer.
Current regimens have most patients
taking three to five pills a day.
“If they can get it down to one pill
a day, it will make it easier to increase
adherence because that’s the key to suc21
Dr. Lawrence G. Hitzeman
Dr. Nanette Alexander-Thomas
Dr. Antonio Martinez
2 2 Vi l l a ge Ca r e TOD AY | Summer 2 0 12
cess with HIV,” said Dr. Hitzeman.
Also available today is Post-Exposure
Prophylaxis, or PEP, a drug regimen that
may decrease the likelihood of transmission if taken within 72 hours of exposure. The drug helps many, including
nurses who are subject to needle sticks
and exposure to patient bodily fluids. It
also can be used in post-sexual unprotected exposure and where there is condom breakage. This is a two- or three-pill
combination, which must be taken daily
for four weeks. The side effects can be
quite severe, as with most antiretrovirals.
But the drugs that are causing the
most excitement and controversy – similar to when the FDA approved the birth
control pill more than half a century
ago – is PrEP, Pre-exposure Prophylaxis,
which prevents HIV/AIDS.
The largest trial to date, conducted
by the University of Washington, began
in 2008 and ended in July 2011, a year
earlier than expected because of the overwhelming results. It showed that people
taking Tenofovir daily had an average of
62 percent fewer HIV infections than
those taking a placebo, while participants on a combination of drugs had
73 percent fewer infections than those
on the placebo. A second study, conducted by the U.S. Centers for Disease
Control, released similar results last July.
It involved 1,200 heterosexual men and
women in Botswana and found that
62.6 percent fewer HIV infections had
occurred in participants taking a combination of Tenofovir and Emtricitabine,
compared with the placebo group. PrEP
drugs will not prevent syphilis, gonorrhea, chlamydia, herpes, hepatitis
or other sexually transmitted diseases,
many of which play a role in facilitating
HIV transmission or speeding HIV disease progression.
PrEP has not been approved by the
FDA.
Also underway is a vaccine trial to prevent the disease, which is funded by the
National Institutes of Health.
“They have found two new targets that
they hadn’t previously elucidated against
HIV, so that raised a lot of excitement.
So far, however, the results are unsatisfying. The first vaccine trial showed
a 30-percent reduction, one of the first
that showed a slight effect,” said Dr.
Hitzeman. “An effective vaccine is years
away, but there is hope.”
Dr. Hitzeman observed that onequarter of people living with HIV are
unaware of it. So there is a big push for
more testing — especially in emergency
rooms and primary care centers in the
Bronx — because if someone knows they
have HIV, they do modify their behavior
and are less likely to participate in unsafe
sex and infect their partners.
In Washington, D.C., for example,
people who go to the Department of
Motor Vehicles for their driver’s license
have the option of getting free HIV testing and will get the results within 20
minutes.
Previously, there was opt-in testing.
But now, as part of a regular check-up,
doctors inform patients they are also
testing for HIV, and patients would have
to opt-out.
“Of course, the patient can say he is
not interested, but it makes it easier to
get HIV testing without a separate counseling session, written permission and
pamphlets. And they are finding more
asymptomatic HIV positive people this
way,” said Dr. Hitzeman.
Despite all these breakthroughs, of
immediate concern to Dr. Hitzeman’s
patients is how the economic downturn
and resultant job loss has impacted their
ability to pay for the expensive medications as well as basics, like food. They
might also have housing issues, but they
don’t yet qualify for Medicaid. Each HIV
medicine costs close to $1,000 a month.
“But we have case managers working on
it,” he said.
The AIDS Drug Assistance Program
(ADAP), which provides free medications for the treatment of HIV/AIDS and
opportunistic infections, continues to
face cutbacks. The program helps those
with some insurance, and those who have
a Medicaid spend-down requirement.
People that don’t qualify for Medicaid,
yet don’t have a job or the resources, are
allowed to have up to $48,000 in income
if uninsured, and the program will pay
for doctors’ visits, labs and medications.
Because of the economy, some states
have a waiting list and don’t have the
funds to enroll new people.
“It’s never been that way until recently
because of lack of funding,” said Dr.
Hitzeman.
There is also generally less attention
being paid to the disease, what the doctor
characterizes as “HIV fatigue,” so fewer
resources are being put toward it.
“Because HIV can be managed, my
concern is for future funding for research
and the government commitment to the
disease. We must still raise awareness,
especially regarding prevention,” Dr.
Hitzeman said.
Frustratingly, all of the health warnings and talking about safe sex is not
really decreasing the incidence of HIV.
The difference is that people are no longer dying at the rates they once did, so
there seems to be less immediacy.
Dr. Hitzeman said, “It’s an epidemic
that is now moving more toward lower
socioeconomic groups.
VillageCare’s Howard Haughton [see
Q&A, page 22], for example, focuses on a
subpopulation that is not responding to
the general message of HIV prevention.
You have to be on their level, their turf.
The older population that we work with
has different needs, he said.
The number of new HIV infections
had pretty much leveled off, but now it’s
beginning to peak again for those under
30, concurred Dr. Nanette AlexanderThomas, medical director at Rivington
House, VillageCare’s skilled nursing
facility for persons living with HIV/AIDS.
“Because they haven’t seen the real
force of what HIV infection can do, they
think that taking a medication is not a
problem. We need more education for
young people if we are going to stem
that tide.”
Rivington House, at 45 Rivington
Street, is VillageCare’s residential treatment center for sub-acute care and postacute and transitional services for those
with a diagnosis of AIDS or who are
HIV-symptomatic. There are between 185
and 190 residents at any given time. The
average age is mid-40’s, and 60 percent
are men. All are at the poverty level.
“At this point, we aren’t dealing with
the functional part of society. We are
dealing with individuals who, because
of mental health and substance abuse
issues, are not adequately able to take
care of themselves. Until we alter or
change the way we approach substance
abuse or mental illness, we are going to
have those residents that fall through the
cracks,” said Dr. Thomas.
“This is the perfect place to help them
get on their feet,” she said, “but it’s often
difficult to send them back out into the
community because we have seen that
they start going through the same issues,
revert to their old habits, and go off their
medications, so the disease is not under
control, and within a period of time, they
are back.”
Patients are referred to Rivington
House from local hospitals, doctors and
through the VillageCare network.
“We serve as a bridge until they get
proper housing. Sometimes they can stay
here from several months to years,” said
Dr. Antonio Martinez, assistant medical
director at Rivington House. “They know
we are going to provide the same level of
care as a hospital setting, but we are not
really equipped to provide acute care.”
He said that working with this population requires a multi-discipline approach,
which Rivington House provides – mental health/substance abuse services with
supportive therapeutic strategies for individuals with co-occurring conditions.
“The residents we have don’t have the
“Because HIV can
be managed, my
concern is for future
funding for research
and the government
commitment to the
disease.”
family structure. They have been homeless at intervals, have drug issues and
some of them are going back into the
incarceration system. They have many
obstacles in terms of getting them into a
normal setting.”
Dr. Martinez sees Rivington House
playing a key role in what is termed
“directly observed therapy.” In the 1990’s,
what broke the pattern in the control of
the multi-drug-resistant tuberculosis in
NYC and other cities was giving the
patient medication, watching them and
ensuring they were adhering to the proper regimen. Tuberculosis is similar to
AIDS in that it requires multiple medications.
“We bring the residents to this setting, where they do very well and then
go home. However, within a few weeks,
they’re not doing well. Medical adherence is an important factor, but only one
of many factors. But then the problem
becomes how do we continue to help
them orchestrate all their issues around
their life? Sometimes within 48 hours
they call us. A setting like this plays a
necessary role for this type of patient,”
said Dr. Martinez.
As for the advent of PrEP, “That would
definitely be helpful,” said Dr. Thomas,
“especially with the population at greatest risk. If there is such a thing that can
help people from getting infected, that
would be fabulous.” 23
One Step at a Time
them to have that conversation and open
up about it is the first step to getting
them to understand the importance of the
condom.
To help clients reach their goals, Howard Haughton
offers trust, self respect and the path to success.
By Bonnie Rosenstock
Q&A with Howard Haughton, MSW, Program Supervisor, Supportive Case Management,
Community Case Management, 112 Charles Street.
W
hen Howard Haughton took
over as program supervisor in
VillageCare’s supportive case
management five years ago, he made
younger MSM (men who have sex with
men) of color a priority because they
are at high-risk and can be the toughest to get to protect themselves. In this
Q&A, Haughton describes the program, its challenges and the rewards.
VillageCare: Why did you want to focus
on this age group?
Howard Haughton: If you’re 18, 21,
your life is just beginning. You are finding
yourself. For many gay black and Latino
men, they don’t understand they can live
past 30. If you don’t have a high school
diploma and you are 25, your choices are
really day-to-day. You are not living for the
future, which drives up the infection rate.
They can’t get the fact that they need to
plan for the future, which means wearing
a condom, going to medical providers,
getting Medicaid if necessary.
VillageCare: Aren’t young gay men of
color the fastest growing segment of new
infections?
Howard: Yes, the fastest growing population is black and Latino gay men or MSM
of color between 13 and 29. Statistically
it’s becoming younger and younger —
the average age of our clients is 27. It’s
men who have sex with men and identify
as gay, and it’s not because they are DL
[or, on the “down-low,” slang for men
who identify as heterosexual but have sex
with men] or in the closet; some are just
physically attracted to men, but not emotionally. The rate is also increasing for the
young black female population.
VillageCare: Why is that?
Howard: I think it’s different in differ2 4 Vi l l a ge Ca r e TOD AY | Summer 2 0 12
ent parts of the world. In New York City,
it’s totally possible for a Brooklyn MSM
to date a Bronx MSM. There aren’t that
many places where young men of color
can congregate. The places are a large
mix of people, so the possibility of mixing it up is higher. And if you live in a
community that has a higher percentage
of persons who are HIV positive and you
are having sex, chances of becoming positive increase. Some people can point to
a higher percentage of intergenerational
dating, so persons who are positive are
mixing it up with younger men who are
HIV negative.
VillageCare: Why are men of color affected more?
Howard: Some men of color have been
historically told they do not matter. It’s
really profound when you find someone
who says you do matter and you are not
alone, I like you just the way you are. Also,
they don’t get the same role models. A lot
of the clients I work with, when we are
talking about dating, they mention they
had sex. They’re taught that to be gay is
to be sexually active. That’s not necessarily the marker of a successful date, I say.
How did you feel about him? When people do not feel loved and want to be loved,
sometimes sex can be confused for love.
I feel the difference is, I felt what love
should be like in my family, even after I
came out. But from my clients I’ve only
heard negative reactions, like, “I told my
parents, and my father fought me like a
man.” Or, “My mother threw me out.” If
you can’t go home, or it’s not safe there,
you have to find somewhere else to stay.
A lot of younger clients engage in transactional sex. They hook up, stay the night
and repeat that pattern the next day. If
you don’t have a place to stay, you can’t
negotiate what you are going to do. I had
one client that was sex working, and he
stopped when he got $200 a month in
food stamps. It really helped him to make
better choices.
VillageCare: Since HIV can now be
treated as a chronic condition, do young
people engage in risky behavior because they
think it’s no big deal to be positive?
Howard: That works with persons who
are negative. I have yet to meet the person
who has been tested positive who is happy
about it. The people I work with still have
a great fear of being HIV positive. But
some clients are homeless. They know
if they are positive, it admittedly opens
up another wall of benefits for them. But
mostly there is general fear [of being positive].
VillageCare: If they don’t want to be positive, how do you convince them to practice
safe sex?
Howard: I say, “Give me your cell
phone. It’s off. What’s your pass code?”
They say, “No, I won’t give it to you.” I say,
“Would you give it to the person you’re
sleeping with?” “No, of course not.” I say,
“You have all the precautions to protect
your cell phone, but you can get a new
one. But the same person you would not
trust this information with, you have
given complete and total access to your
immune system when you allow him
to have sex with you without a condom.
What is so magical about having sex without a condom that for you all the other
risks are completely void?”
Whatever questions or concerns or scenarios they can come up with, I counter
with, “It still doesn’t give me an answer
that makes me understand why you are
so protective of your phone but not your
body. This is something you really have
to practice and stick to your guns. You’re
not just having sex with one person; you
are having sex with all the people they had
sex with and you’ve had sex with.” Getting
VillageCare: Where do you have these
conversations?
Howard: In the office, Starbuck’s, anywhere there’s an in. I have seven staff,
who are either social workers or who
think like social workers. We role-play
and have these conversations. So if the
client has opened the door and is willing
to have the conversation, we are walking
in because we don’t know if we will have
the chance again. Sometimes in the field
we spend all day with someone, and we’re
going to talk about something.
VillageCare: Do you go around picking
up people?
Howard: I’ve done it. We used to canvass the gay bars in the area [Charles Street
is two blocks from Christopher Street,
where gay youth congregate], and we just
started up again. But I can count on at
least four new referrals a month from
clients. We also get referrals from HASA
[the HIV/AIDS Services Administration],
an agency within HRA. HASA clients
receive intensive case management.
VillageCare: How do you get clients to
come to your office?
Howard: It’s not so much how we get
them in here, but how we keep them in
here. I have a work BlackBerry, so I am
always accessible. It’s also letting them
know this is a safe place that isn’t going
to exploit them. Our first rule is share at
your own pace. There are times when we
arrive in the morning and three clients are
in the waiting room. They don’t have an
appointment. They just drop by because
they know somebody will be here to listen
to them. The staff is very welcoming.
VillageCare: How many clients are you
counseling?
Howard: Our current roster is over
60. As we are closing them out, a whole
new batch is coming up. We are funded
for 125.
VillageCare: What are your goals for
your clients?
Howard: We think of ourselves as
OnStar operators. Sometimes we will do
the roadside assistance, but our main
goal is to get them in the driver’s seat of
their lives. We help them prioritize their
goals and make sure they are attainable.
If you want to be a lawyer and you don’t
have a GED, the first step is not to go
to law school. The first step should be
to study for your GED. However, our
main focus is medical, to make sure they
adhere to their medication. We track
their HIV viral load and CD4 [T-cells]
cell count. The other part of it is to
build a relationship with them, one they
can trust so they come here. Then they
reevaluate: “These are goals when I first
met you, but I realize that now I can have
so many other goals I want to add to the
service plan. How can I do that?”
VillageCare: What services do you provide?
Howard: There are two models of
HIV/AIDS case management: supportive
and comprehensive. We are supportive,
responsive to the immediate needs of a
person with HIV/AIDS, which can be
addressed in the short term. However,
around 85 percent of our clients fit the
comprehensive medical model. A lot of
them have histories of substance abuse,
troubled sexual trauma, sex addiction,
crystal meth use, high-risk issues around
mental health diagnoses, undiagnosed
health issues. They haven’t gone to medical in several years, but because we’re
tailored to work specifically with HIVpositive men of color MSM — our entire
funding is for this purpose — they stay
with us. For the most part, our guys are
really good and meet their markers. We
have a really great success rate in getting them into medical and staying into
medical.
At VillageCare, our services include
getting our clients housing, entitlements, medical assistance, food stamps,
helping them choose the right apartment, legal assistance if necessary — a
lot of our clients are undocumented from
the Caribbean and are HIV positive. We
refer them to Immigration Equality [an
organization for lesbian, gay, bisexual
and transgender immigrants], get them
medical assistance, a green card or asylum. Many of our clients do not have
medical coverage and have not been to
a doctor for a long time. Once they are
clear medically, we get them back into
housing, support groups, mental health
consultation, etc. When we do reassessments, we read the entire chart and have
huge case conferences, where the entire
team shares all their information about
the client.
VillageCare: What support programs do
you provide?
Howard: Currently we offer a psychosocial group, “Dinner and a Movie.”
We have dinner in the cafeteria every
Wednesday from 6:30 to 8:30 p.m. We
watch about an hour of a gay-themed
narrative or documentary for the first
half and then have a discussion about
being HIV positive. The movie allows
the participants to share how they feel.
Some of these movies have a profound
impact on them. Our psycho-educational
peer support group is STEPS, Striving to
Enhance Personal Strength, on Fridays
from 3:30 to 4:30 p.m. The client has a
goal: to go back to school, to stop using
crystal meth, to increase condom use,
lose weight, etc. The group is going to
help you devise steps to reach your goal.
Each week you report back to the group
on your success, and then they help you
develop new steps.
VillageCare: How can the black community and all politicians be responsive to the
needs of this at-risk population?
Howard: Martin Luther King said it
best: “The ultimate measure of a man
is not where he stands in moments
of comfort and convenience, but where
he stands at times of challenge and
controversy.” For black churches, their
message should be inclusive. If your
congregation member really needs you
and if you are not willing to listen,
how effective are you really? Politicians
should fully realize when they cut services what they are really impacting. If
people can get Medicaid, it’s going to prevent them from going to the emergency
room and from getting to a point where
they are going to need a life-long medication. City Council Speaker Christine
Quinn and State Senator Tom Duane
are really doing great work and advocacy.
Comptroller John Liu is continuing to
do the Directory of LGBT Services and
Resources. There are a lot of good people
out there. Legalizing same sex marriage
was a good start. 25
STANDPOINT
VIEWPOINT
National Study: LGBT Seniors Face Harder Old Age
Beat the Blues: Defeating Depression in Later Life
A
merica is aging. The first of the
baby boom generation are now eligible for Medicare. By 2030, 72 million – 1 in 5 Americans – will be over 65.
As boomers are learning, getting
older means graying hair or losing hair;
it means increased wrinkles and slowed
metabolism. But depression, described
by Winston Churchill as “the black dog,”
absolutely is neither normal nor a natural
part of later life.
It’s a real, treatable illness from which
people, including older adults, can and do
recover.
Sociologist Laura N. Gitlin, PhD, of
Johns Hopkins School of Nursing and
director of The Aging Intervention Center
at Johns Hopkins, is working to help older
adults learn about depression and to reengage in valued activities.
Through “Beat the Blues,” an innovative, five-year, community-based project
in urban Philadelphia created with community partners, she’s using home-based
intervention to target depression among
black seniors, one of the fastest growing
groups of older adults.
As with other older adults, depression
in black seniors arises from a variety of
factors, among them increased physical
challenges, profound losses, effects of
chronic illnesses and waning independence. Untreated, depression can give
rise to an exorable downward spiral of
isolation and increasingly poor overall
health. But, while many other older adults
may obtain treatment for their depression,
Gitlin notes that older black people tend
to be both under-diagnosed and undertreated.
“Between cultural mistrust and services that don’t match their needs, many
older African Americans, particularly
those with chronic conditions and functional difficulties, suffer from depression.
The problems are compounded because
most interventions haven’t been tested
among individuals in greatest need, most
of whom have no knowledge of depression
ging and health issues facing lesbian, gay, bisexual and transgender
baby boomers have been largely
ignored by services, policies and research.
These seniors face higher rates of disability, physical and mental distress and a lack
of access to services, according to the first
study on aging and health in these communities.
The study, led by Karen FredriksenGoldsen and colleagues at the University
of Washington’s School of Social Work,
indicates that prevention and intervention
strategies must be developed to address
the unique needs of these seniors, whose
numbers are expected to double to more
than 4 million by 2030.
“The higher rates of aging and health
disparities among lesbian, gay, bisexual, and transgender older adults is a
major concern for public health,” said
Fredriksen-Goldsen, a Washington
Unisversity professor of social work
and director of the Institute for
Multigenerational Health. “The health
disparities reflect the historical and
social context of their lives, and the serious adversity they have encountered can
jeopardize their health and willingness to
seek services in old age.”
The study highlights how these adults
have unique circumstances, such as fear
of discrimination and often the lack of
children to help them. Senior housing,
transportation, legal services, support
groups and social events were the most
commonly cited services needed in the
LGBT community, according to the study.
Fredriksen-Goldsen and her co-authors
surveyed 2,560 lesbian, gay, bisexual and
transgender adults aged 50-95 across the
United States. The researchers found that
the study participants had greater rates of
disability, depression and loneliness and
increased likeliness to smoke and bingedrink compared with heterosexuals of
similar ages.
Those seniors are also at greater risk
2 6 Vi l l a ge Ca r e TOD AY | Summer 2 0 12
for social isolation, which is “linked to
poor mental and physical health, cognitive impairment, chronic illness and premature death,” Fredriksen-Goldsen said.
Study participants were more likely to live
alone and less likely to be partnered or
married than heterosexuals, which may
result in less social support and financial
security as they age.
Histories of victimization and discrimination because of sexual orientation or
gender identity also contribute to poor
health.
The study showed that 80 percent had
been victimized at least once during their
lifetimes, including verbal and physical
assaults, threats of physical violence and
being “outed,” and damaged property.
Twenty-one percent of respondents said
they were fired from a job because of their
perceived sexual orientation or gender
identity. Nearly four out of 10 had considered suicide at some point.
Twenty-one percent of those surveyed
did not tell their doctors about their sexual
orientation or gender identity out of fear
of receiving inferior health care or being
turned away for services, which 13 percent of respondents had endured. As one
respondent, a 67-year-old gay man, put it,
“I was advised by my primary care doctor
to not get my HIV tested there, but rather
do it anonymously, because he knew they
were discriminating.”
Lack of openness about sexuality “prevents discussions about sexual health, risk
of breast or prostate cancer, hepatitis, HIV
risk, hormone therapy or other risk factors,” Fredriksen-Goldsen said.
The good news? “LGBT older adults are
resilient and living their lives and building
their communities,” Fredriksen-Goldsen
said. Of the study’s respondents, 91 percent reported using wellness activities
such as meditation and 82 percent said
they regularly exercised. Nearly all – 90
percent – felt good about belonging to
their communities. And 38 percent stated
“The health disparities
UHÁHFWWKHKLVWRULFDO
and social context of
their lives, and the
serious adversity they
have encountered can
jeopardize their health
and willingness to seek
services in old age.”
that they attended spiritual or religious
services, indicating a promising social
outlet.
Social connections are key, the study
noted, because unlike their heterosexual
counterparts most lesbian, gay, bisexual
and transgender seniors rely heavily on
partners and friends of similar age to provide assistance as they age. While social
ties are critical, there may be limits to the
ability of those older adults to “provide
care over the long-term, especially if decision-making is required for the older adult
receiving care,” Fredriksen-Goldsen said.
The study was funded by the National
Institutes of Health and the National
Institute on Aging. (Newswise)
A
or that it is a treatable illness like diabetes,” Gitlin said.
Opening doors to research on a topic
like depression, still the subject of stigma
and misunderstanding, is difficult. Thanks
to an approach called community-based
participatory research in which the community itself becomes a research partner,
Beat the Blues has reached into the homes
and neighborhoods of urban, older black
people with depression to test an intervention to help improve their well-being.
Even the program name itself, Beat the
Blues, originated in the community; it was
a phrase used by older black people who
participated in focus groups conducted
before launching the project.
“By being in tune with the lives and
concerns of the persons we want to assist,
we have had success enrolling people in
the program. The intervention provides
education about depression, care management, referral and linkage, stress reduction techniques and most importantly,
it helps people identify and reengage in
valued activities and social involvement,”
Gitlin said.
She hopes to show that the intervention
will decrease depression, increase knowledge about depression and enhance daily
function. Also, she and her team are testing whether a non-traditional approach to
providing mental health services, such as
involving multipurpose senior centers, can
play a successful role in educating about,
detecting and helping to treat depression
in underserved populations.
In the short-term, Gitlin believes the
program already has given people—from
older adults to senior center service providers—the tools and permission they
need to talk about depression. It has
taught seniors and their families that
depression is a treatable health problem.
If the program is as effective as she
believes the study may well find, she
hopes to translate Beat the Blues for other
low-income and undertreated populations.
(Newswise)
“Between cultural
mistrust and services
that don’t match their
needs, many older
African Americans,
particularly those
with chronic
conditions and
IXQFWLRQDOGLIÀFXOWLHV
suffer from
depression.”
27
THE L A S T WORD
BY LOUIS J. GANIM
We’re a Caring Nation; Will It Stay So?
T
his past winter, I, as usual, settled myself down to watch It’s A
Wonderful Life. I’m a sucker for that
movie.
But a funny thing happened as the
Jimmy Stewart movie came on. After dozens and dozens of viewings of this movie,
I had finally learned to just say no.
There are many things to like about
these old black and white movies, not the
least of which is the dialog. Yeah, often it
wasn’t “real,” especially when compared
to the dialog of today’s movies. But the
words often carried much more meaning.
I think it’s kind of funny that an industry
that demands that we suspend disbelief
wants to be awfully sure that dialog is like
having a conversation with your next-door
neighbor.
I don’t know why I like the 65-year-old
movie so much. Maybe it’s because it harr
kens to a different time and place, making
me nostalgic for what America used to
be like. Well, at least the visible, fantasy
America of the time anyway.
The run on the bank in the movie
reminds me, poignantly, of my “Uncle
Joe.”
Uncle Joe was a shrewd and successful
businessman that had amassed a substantial sum of money. When the Great
Depression struck, however, there was a
run on the bank where he kept his funds.
He lost everything. My dad said Uncle
Joe was never the same after that. I used
to visit Uncle Joe a lot. He had great stories to tell about his adventures that took
him all over the United States. He lived
in Houston for a while during that time,
and had many tales about the burgeoning
Texas city. He was a fascinating person.
Uncle Joe died poor.
Getting back to the era, my youth
was spent in an environment not unlike
what you see in Wonderful Life. All-white,
Christian values, and, dare I say, intolerr
ant. Of course, I learned that wasn’t the
entire community. Blacks had their own
part of town, and they weren’t a significant
2 8 Vi l l a g e Ca r e T OD AY | Summer 2 0 12
population when I was growing up in
Binghamton. You rarely saw black folks
out in the community.
The city at one point built a highway
along the Susquehanna River to link the
South Side/West Side with the neighborhoods in the North and East sides.
Unfortunately, the highway cut a huge
swath through the black community. I’ll
bet it destroyed half the housing there.
Do I think this was done on purpose? Not
really. The road made perfect sense in its
location. Still does. It’s just that the black
community was smack in the way. I’m
sure, though, nobody pined over the loss of
housing in the black community. Except,
of course, those who lived there. The highway also nicked the Italian community too.
Things started to change though.
Jump forward to my newspapering
days.
I was fortunate in many ways because,
since I was in my early 20s, the paper
thought I was a perfect fit to cover the
turmoil of the era. So my “beats” became
antiwar, antipoverty and civil rights.
The civil rights one was tougher than
most. The paper had no black reporters,
(I don’t recall any black employees at all),
so it was up to a white guy like me to try
to gain some semblance of credibility in
the community and cultivate sources who
might give me some insight to what was
going on behind the scenes. I did OK, I
guess. Maybe it’s worth noting that on
the evening of Binghamton’s sole “racial
disturbance,” I was on the “wrong side.”
When the police moved in, I was in an
apartment talking with members of the
family where the incident started. Earlier
in the day, the police had burst into the
apartment and taken one of the family members into custody. The family said
the cops acted brutally, but nothing in
the review that was conducted really confirmed that. But, the family’s story is what
got the community riled up that day.
In covering antiwar activities, the city
was a hotbed of this movement, led in
great measure by the students of SUNYBinghamton. To get into this fray, I had
to make friends with a variety of people
– ranging from Mitch, who headed up the
local Students for a Democratic Society
(SDS), to the poor military guy whose only
job was to notify families of a Vietnam soldier’s death. In person, of course. He got
extremely cynical as time went on. How
many times can you tell a family their son/
husband was killed in the line of duty?
What I think I learned most from coverr
ing antiwar is the power that people have
to change things.
Antipoverty. The things I was taken
around to see were eye-openers to me.
The conditions under which people were
living were atrocious. This was especially
true when I went into Appalachia, where
rural poverty was the norm in those days,
I think. I knew the term “poor,” but I’d
never understood what it really meant. I
learned.
All of us around the country who had
this beat hailed Lyndon Johnson’s Great
Society ventures. This included Medicare
and Medicaid. You have to understand
that before these programs, the poor had
virtually no health care, and older adults
were not much better off. Another one
was Head Start. While many of the Great
Society endeavors have vanished, Head
Start remains to this day. It has helped
countless children get a leg up before
entering the school system, and get them
on the right track.
Some disclosure here: My wife, Linda,
was one of the very first Head Start teachers, and to this day, she might have
chance encounters with those who were
in her classes way back those many years
ago. It amazes me that they remember
her so well, and how much they say Head
Start meant to them.
I bring all these things up because there
are people out there who want to undo all
that’s been accomplished.
And because I worry they will be successful.
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