Introduction and Background
Between February and June 2000 the Grass Roots Organization for the Well-being of Seniors, Inc. (GROWS) conducted a survey of service providers to document the issues and unmet needs of Montgomery County older adults. This telephone survey expanded GROWS predominantly regional planning and grass roots action. Senior Needs 2000 kicks off a multiyear GROWS initiative to identify the greatest needs of seniors and areas with the greatest potential for successful collaboration and action. The survey taps the knowledge and commitment of the many agencies, business individuals and organizations that have a stake in making Montgomery County a place where all citizens can age with dignity. GROWS seeks to build momentum and commitment from the community in addressing the issues of importance to seniors.
GROWS is using Senior Needs 2000 for community education and advocacy as well as for internal strategic planning. The survey was timed and structured to complement other County planning initiatives for seniors. In specific, GROWS' survey complements two County efforts - a survey of seniors that will be conducted in 2000/2001 and a Vital Aging conference to be held in fall 2000. GROWS is working closely with the Montgomery County's Commission on Aging and the Department of Health and Human Services to maximize the impact of these planning activities.
GROWS chose to survey service providers because of the unique position they are in to see the unmet needs of seniors and caregivers. On a daily basis providers witness the struggles that seniors and families experience and that many would not acknowledge if they were surveyed directly. In addition, providers know what barriers they, as public and private stakeholders, face in providing the quality and level of service that the community needs.
Summary of Findings
While most stated that there are excellent senior services in Montgomery County, respondents identified some consistent unmet needs and problems. The three most frequently cited problems for older adults and caregivers involved (1) transportation, (2) service affordability and (3) difficulty in understanding and accessing services.
Almost all stated that this is the greatest unmet need despite the existence of some good transportation programs for the elderly and disabled. In order to stay independent in a suburban community such as Montgomery County the ability to drive and/or ready access to public transportation is very important. Loss of ability to get around is a tremendous fear of older adults. The need for better transportation exists throughout the County although it is perhaps more of a problem in the upcounty area.
Assisted transportation was cited as a critical need for those who are frailer. Respondents stated that many older adults with physical or mental frailty need help walking from their door to a vehicle. Services that pick riders up at the curb or street were not considered sufficient. It should be noted that the inability to get around can result in social isolation, which was also identified as a problem.
Affordable /Subsidized Services
Respondents frequently cited the need for services that are affordable or funds to underwrite the cost of services. This need for affordable/subsidized services pertained to the many in-home services (especially non-skilled aides and home repairs) that are necessary for older adults to maintain their independence at home, but also included assisted living and congregate housing (including housing for those with mental illnesses).
Awareness and Access to Senior Services
In order to get the services they need it is critical that program information and service access is understandable, convenient and accurate. Survey respondents stated that users find the delivery system fragmented, confusing, and scary especially if they are worried about having adequate disposable income. The need to improve awareness and access to senior services was cited even by eldercare professionals. The elderly and their families are unaware of many types of senior services and find them difficult to access. Elders and caregivers need help understanding what is available, what they can afford, and how to choose the appropriate service. Payment mechanisms such as those for Medicare, Medicaid, long-term care insurance and other payment sources and benefits programs are unclear and complicated.
Social isolation, and recruitment and retention of volunteer and paid staff came up less frequently but were still noteworthy themes. While rarely cited as a distinct problem, many respondents noted that the County is growing more diverse in culture and race. Survey respondents indicated that certain needs, such as transportation, service access, staffing and isolation, are even more of a problem for elders who have difficulties speaking English (e.g., Hispanic, Asian/Pacific Islanders, others).
A number of recommendations on how to improve awareness and access services were suggested but there were no recurring solutions recommended by the interviewees. (See page 12 for summary of solutions.) Respondents largely agreed that Montgomery County's strengths are that it offers excellent professional networking opportunities, that the providers are caring and generally offer good service and that the relatively high financial and educational levels of County older residents enhance service delivery. Respondents expressed an interest in expanding their services to meet the needs of the growing aging population, however, most stated that services will not change in the near future.