Nora Bristow - VillageCare
Transcription
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. VillageCare 154 Christopher Street New York, NY 10014 Looking for doctors who care? HEALTH CENTER Open Monday - Friday. Early evening and weekend appointments available. 121A West 20th Street (Between Sixth and Seventh Avenues) 212.337.9290 We accept Medicare, Medicaid and most insurances. PRIMARY CARE Diabetes Cholesterol Preventive Medicine Infectious Disease Immunizations Nutrition Women’s Health MENTAL HEALTH SERVICES DENTAL SERVICES Dental Examination Prophylaxis Restorations X-Rays WALK-INS ARE WELCOME