VillageCare Today - Spring 2011

Spring 2011
TODAY
An Emphatic Exclamation Point
New Rehab/Nursing Center Caps Long-Term-Care Reform Effort
VillageCareToday
EdItOR-IN-ChIEf Louis J. Ganim MANAgINg EdItOR Brett C VermiLyea PublIshEd by ViLLaGeCare 154 ChRIstOPhER stREEt NEw yORk, NEw yORk 10014 ChAIRMAN DaViD H. siDweLL PREsIdENt & CEO emma DeVito www.vIllAgECARE.ORg (212) 337-5600
An Important New Residential Care Offering for the Community

By Emma DEVito, PrEsiDEnt anD CEo
thIs hAs bEEN AN ExCItINg tIME fOR us At vIllAgECARE wIth thE OPENINg Of OuR bRANd-NEw, stAtE-Of-thE-ARt vIllAgECARE REhAbIlItAtION ANd NuRsINg CENtER.
this wonderful new asset to our community will help people in need of rehabilitation and recovery services to get better faster and get back home more quickly. It has been gratifying that since we opened our doors in december, our referral sources and individuals in need of care have been sending a steady stream of patients so that they can benefit from the new care program at the facility. the villageCare Rehabilitation and Nursing Center, which is located at 214 w. houston st., offers the latest in post-hospital care for those who are recovering from a disabling injury, condition or illness and prepares them to return home. this reflects the demands nowadays on skilled nursing facilities to care for patients with greater clinical needs but who require shorter stays. the new center also offers residential end-of-life care and palliative care. the new facility is different from what you traditionally think of when you consider a nursing home. weve gone to considerable lengths to create a new, unique, patient-centered environment. Residential floors have common areas and neighborhoods where families and friends can visit with their loved ones. dining areas on each floor have self-serve hospitality food bars and full-service pantries. the staff has been specially trained to work in non-traditional ways with patients and their families, supported by state-of-the-art medicine and care and by an environment designed to promote healing and well-being. weve integrated a healing bamboo garden as a place for quiet social interaction and contemplation. I think youll find that our new villageCare Rehabilitation and Nursing Center will be a welcome asset to the village and our downtown community, and that it will serve as an important new resource in helping individuals toward recovery, better health and well-being.
Spring 2011
VOLUME 5, nUMBEr 1
F E AT U R E S
12 An Emphatic Exclamation Point

vIllAgECAREs NEw sIx-stORy, 105-bEd NuRsINg hOME Is CulMINAtION Of lONg-tERM-CARE REfORM INItIAtIvE
20 shawn thorne Is Moving forward with Momentum

thE dECIsION tO lEAvE A luCRAtIvE JOb ANd JOIN thE MIssION Of fEEdINg AIds vICtIMs lItERAlly sAvEd hIs lIfE
22 gatekeepers: looking Out for One senior at a time

vIllAgECAREs PROgRAM buIlds A COMMuNIty tO wAtCh AftER sOCIEtys MOst vulNERAblE sENIORs
24 fifteen years of Rivington house

lOOkINg bACk ANd AhEAd tO thE futuRE
In the News
D e Pa rt m e n t s
Most Older New yorkers want long-term Care at home; baby boomers turn 65 and face a doctor shortage; Rivington house hIv Conference; North shore-lIJ and villageCare Open urgent Care Center; Russian visitors to Rivington house; Participant Art Exhibited; 75 Percent of New yorkers living with hIv/AIds Are 40 or Older
senior Perspective
Concerns about health Reform
Opinion
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taking care of Mom and dad: why we Need a Quality work force; Elder Abuse Can happen to Anyone
the last word
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In the News
most older new yorkers want Longterm Care at Home
Zogby International poll commissioned by AARP indicates that the majority of New york state residents, age 50 and over, would prefer to receive long-term care services at home instead of going into a long-term care facility. unfortunately, the current long-term care system is designed to have more people access expensive Medicaid services instead of less expensive, but preferred, home and community-based care, said lois wagh Aronstein, AARP New york state director. AARP New york believes these poll results offer an important guide for policymakers struggling to provide essential and cost-effective services in an era of enormous budget challenges at state and local levels. there will always be the need for the type of intensive, round-the-clock, highquality care that nursing homes are best equipped to provide for our most vulnerable citizens, wagh Aronstein said. but other less-costly and more desired choices must be made available as well. the survey results found strong preferences by older New yorkers concerning the delivery of long-term care services, including: When long-term care services are needed, 72 percent of those surveyed prefer that services be provided at home. Only 3 percent of older New Yorkers wanted their long-term care services to be provided in a nursing home. There was strong support among those surveyed (74 percent) for AARP to ensure the availability of a broad range of longterm care services to help them remain in their homes.
2 vi l l a g e Ca r e t O dAy | sp ri ng 2011
Baby Boomers turn 65 and Face a Doctor shortage

his year is a significant milestone for the baby boom generation, as its first members will celebrate their 65th birthdays. with boomers beginning the transition into the years that traditionally denote the beginning of senior citizenship, attention is drawn to the graying of America. dr. stephen g. Jones, a geriatrician and director of the Center for healthy Aging, said the impact of these aging boomers on American health care will be significant on numerous fronts. It is wonderful news that we are living longer, but it also creates an entirely new set of challenges for families and the health care system, Jones said. the face of medicine is going to start to change rapidly because of this transition, One of the forthcoming concerns, according to dr. Jones, will be the shortage of doctors trained to care for an aging population. geriatrics, the sub-specialty
that focuses on the specific health needs of the elderly, is facing an acute shortage of physicians. low insurance reimbursements rates for the care they provide and other factors have reduced the ranks of doctors seeking geriatrics training. In 2007, only 91 American-trained doctors sought specialty in geriatrics compared to 167 in 2003, and spots in many fellowship programs were not filled. dr. Jones said the big question facing society is, who will care for this population? while the care burden, in many instances, falls on the shoulders of primary care physicians, they, too, are facing similar challenges to keep their practices solvent and viable. Meanwhile, longevity is advancing faster than our ability to keep up with the diseases of aging, he said, with arthritis, orthopedic problems and chronic illnesses having an increasing burden on the boomer population and the health care system.
north shore-LiJ and VillageCare open urgent Care Center

he North shore-lIJ health system and villageCare have agreed to a clinical affiliation agreement to deliver a range of new health services in lower Manhattan, including a 24-hour urgent care center. the urgent care center, or urgicenter, opened in March at 121A w. 20th street in a two-story building where villageCare operates a primary care center on weekdays and saturdays. using its physicians and nurses, North shore-lIJ will occupy about half of the 20,000-square-foot building for an urgicenter that would be open to community residents everyday, including weekends and holidays. Rather than locate the urgent care center in temporary space at st. vincents Catholic Medical Center, we are pleased to partner with villageCare to provide a long-term home for the facility eight blocks away, said Michael J. dowling, president and chief executive officer of the North shore-lIJ health system. As a long-standing provider of care in this community, villageCare has traditionally sought to identify needs and to create new and innovative responses to fill gaps in services, said Emma devito, president and chief executive officer of villageCare. the loss of st. vincents is a major one for the downtown community, and villageCare talked with the community about ways we could help respond to unmet needs that have resulted from the hospital closing. the affiliation with North shore is, I believe, in keeping with that villageCare tradition of constantly working to make sure that those we serve are getting the best care possible in ways that recognize the special needs of our downtown neighborhoods. the state approved a $9.4 million grant last spring to establish an urgi-
rivington House HiV Conference
ivington house held its fourth annual Conference on hIv, with nearly 70 medical professionals from throughout the New york City area attending. Nationally recognized speakers covered important topics related to hIv and AIds. topics for this latest conference were: HIV and the Brain by Dr. Susan Morgello, professor of pathology and neuroscience at Mt. sinai school of Medicine. Hepatitis C Treatment by Dr. douglas dieterich, professor of and director of continuing medical education at Mt. sinai school of Medicine. Heart Disease and HIV by Dr. Marshall glesby, associate chief of the division of Infectious diseases and director of the hIv Clinical trials unit at weill Cornell. Renal Disease and HIV by Dr. Jonathan winston, professor of medicine and nephronology at Mt. sinai school of Medicine.
center in the st. vincents catchment area. the new urgicenter will provide community residents with all of the healthcare services promised by North shore-lIJ in its original proposal to the state department of health. In fact, it will allow for greater continuity of care because of the relationship with villageCare. As part of the agreement, North shorelIJ will work closely with villageCare to enhance the existing primary care services it now offers at the 20th street location, adding outpatient pediatric care, imaging services and subspecialty care as needed, such as ear, nose and throat, urology, cardiology and neurology. the new arrangement will be especially beneficial for urgicare patients, who will have access to ongoing, followup care provided at the same location by villageCare. In addition, patients will be referred for a range of other services that villageCare provides in nearby locations, including adult day health care, day treatment, short-stay rehabilitation and palliative care. In keeping with the goals of health reform, North shore-lIJ and villageCare also will develop programs aimed at promoting wellness in surrounding communities and preventing chronic diseases like diabetes that are affected by lifestyle choices such as smoking, poor eating habits and physical inactivity. I am pleased with the agreement between North shore-lIJ and villageCare, said NyC Council speaker Christine C. Quinn. this collaboration will provide 24-hour urgent health care to residents of the west side of Manhattan. As I have said all along the west side of Manhattan still needs a full-service emergency room and hospital, but this is a good intermediary step that was facilitated by our office and the local elected officials.
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a momentum thanksgiving
Staff and volunteers prepared a feast for the 25th annual Thanksgiving Dinner sponsored by VillageCares The Momentum Project. Momentum fosters health and wellness by providing nutritious meals and supportive services to any person in New York City, especially those living with HIV/AIDS or other chronic illness, and those who are frail and needy. The dinner was held at St. Paul the Apostle Church, 405 W. 60th St., with some 400 individuals attending.
Russian visitors Come to Rivington house

contingent of Russian health and infectious disease policy makers visited Rivington house as part of a study tour looking at the integration of social and medical services to care for persons living with hIv/AIds. the seven-person group of Russian officials took a full tour of Rivington house and then sat down for a question-and-answer session with medical and care-giving staff. the Russian contingent explained that they were looking for best examples that could be used in their country so that the Russian Red Cross could organize a school of patients, described as a place where patients and families could get consultations from social workers, psychologists, peer educators and volunteers. the group said they were particularly interested in understanding the principles and criteria for the provision of social support for those living with hIv/AIds.
Participant Art Exhibited

ix clients at villageCare Adult day health Center were selected by fresh Art to have their works displayed at an exhibition called, untitled. the exhibition was arranged by fresh Art, a not-forprofit organization that is dedicated to providing artistic opportunities to artists with special needs. untitled, which was held at the gallery at hAI at 548 broadway, was a group exhibition of paintings and works by artists from villageCares program and four other New york City service and care organizations. In addition, another eleven day-care participants were selected to have their works exhibited at a second fresh Art showing. this exhibit, which was displayed at the galleries of st. Peters Church at 619 lexington Avenue, was titled, New york, New york life in the City.
75 Percent of New yorkers living with hIv/AIds Are 40 or Older, a third Are Over 50
Women comprise growing percentage of new HIV cases among older adults
Iv/AIds and the risky behaviors that spread it are often associated with youth, but as the epidemic ages, significant changes have taken place reflecting an older population now living with the disease. the New york City health department reports that more than 30 years into the epidemic, older adults now account for a growing percentage of people living with the disease. some 75 percent of hIvpositive New yorkers are now 40 or older, and more than a third are 50 or older. younger adults still account for most new infections, but 17 percent of the citys new diagnoses occur in older adults each year. As people with hIv live longer, the number of hIv-positive New yorkers aged 50 and older continues to grow. from 2004 to 2008, the number increased by 45 percent among men in New york City (from about 20,000 to 29,000) and by 58 percent among women (from roughly 7,000 to 11,000). because theyre generally assumed to be at lower risk, older adults may be less aware of hIv, and providers may be
HiV/aiDs in nyC: a snapshot
107,177 New York City residents are living with HIV/AIDS,

according to the latest surveillance data. 75% are 40 or older (37% are 50 and older) 70% are male 33% are men who have sex with men
new HiV/aiDs Diagnoses

81% 75% 54% 23%
1,823 people were newly diagnosed with HIV/AIDS in New

York City during the first half of 2009 were black or Hispanic were men lived in Brooklyn or Manhattan were diagnosed with AIDS at the time they first tested HIV positive
risk Factors
40% of new HIV/AIDS diagnoses were among men who

have sex with men
23% were attributed to heterosexual contact 5% were among injection drug users
less likely to recommend testing. Older New yorkers, like all New yorkers, are at risk for hIv if they have unprotected sex or inject drugs, said dr. thomas farley, New york City health Commissioner. health care providers should counsel all patients, not just younger
ones, about hIv prevention, and testing should be part of routine health care. that message is especially important for women. though new hIv infections are most common in younger adults, women 50 and older accounted for 22 percent of the citys
female hIv diagnoses in 2008 up from 17 percent in 2004. the earlier an hIv infection is diagnosed, the less harm it is likely to cause. when people with hIv are diagnosed early, they can take steps to preserve their health and protect their sexual partners. In New york City, 87 percent of young adults learn they have hIv before the infection has progressed to AIds, but older adults are often diagnosed late. Some 38 percent already have AIds by the time they first learn they are hIv positive. Receiving an AIds diagnosis when first learning they are hIv positive means these New yorkers may have gone undiagnosed for a decade or more, missed opportunities for medical care and possibly unknowingly infected others with hIv. Age is not a vaccine against hIv/AIds, said dr. Monica sweeney, the health departments assistant commissioner for hIv/AIds Prevention and Control. If you are having sex, be safe and use a condom. If your doctor gives you the eyeball test instead of offering you an hIv test, ask for it.
world AIds day

ll of villageCares AIds programs marked the most recent world AIds day with events and remembrances. Clients and staff were also encouraged to participate in a ceremony and program held at the 20th street AIds day treatment Program. A woman from the bronx who lost her mother, partner and two sons to AIds,
addressed the gathering at the day program in Chelsea. lets go out touch, reach out, embrace people and give them hope, she said. No one should die with rejection and loneliness. we all have that gift of healing. lets use it. All of us can heal. Emma devito, villageCares president and CEO, said the day was an opportunity for all of us to renew our commitment to fighting AIds. At Rivington house, where many residents are unable to leave the facility, a
world AIds day service was held followed by a ceremonial balloon release on the facilitys rooftop. In addition, villageCares services for those over 50 who are living with hIv/ AIds, was the subject of a nationwide feature on fox-tv stations that aired on world AIds day. dr. sapna Parikh, foxs medical reporter, conducted interviews at the AIds day treatment program and focused on the life and struggles of an older woman client at the program who has been hIv positive since her 20s.
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rOnALD HArrigAn, Kips Bay Presently I have no concerns. My AARP and Medicare benefits fully cover me for all of my health care needs. I have received information in the mail over the last couple of months indicating that I will not really notice much of a change in the way that I receive health care. My only concern is that the health reform plan put in place is actually as effective as it is in other countries around the world, and helps us to become healthier as a nation.
s e n i o r perspective
do you have any concerns about how heath care reform may impact the way you receive health care?
VErOnicA iVinS, SOHO so far, I feel that I have been lucky enough to have good coverage. Over the last year, I have had a few operations including a hip replacement, and I did not see much come out of my pocket. therefore, I am not so concerned about myself as I am concerned for the younger folks such as my daughter and her generation and younger. I am concerned that there might not be enough health care available for them. I feel that these new health reform ideas will push out some of our young a budding doctors, which may sacrifice some of the good quality health care that we Americans are used to receiving.
AnnE DESiMOnE, greenwich Village I have many concerns about the availability of health care to me. It first started for me with the closing of st. vincents, which was within walking distance for me. My Medicare benefits seem to be unchanged at the present time. I have received no literature or explanation of how that might change. I am deeply concerned that I will be turned away in an emergency situation, and I feel like I have no where to go to get clarification on where to go.
LEnny MAnOff, West Village Currently my health care plan is top notch. It has covered all of my necessary surgeries and medications. I am concerned, however, about not having a say in how I will receive health care in the future. lately, the word change usually points in a negative direction, and I am concerned that I will not be able to receive the same top-notch health care that I am currently receiving.
iLSA giLBErT, West Village Personally, I am thrilled that the government finally passed a health reform plan that will insure millions of people and assure them the proper health care that they need. On the other hand, I am really concerned with the increased costs that I may see in my prescribed medications. I am on an extremely tight budget, and I just dont see how I am going to be able to afford any sort of increase in the cost of my medications. fortunately, at this time I have seen no change in the way I receive health care. hopefully that will be sustained.
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Mirikitani Painting showcased at the smithsonian

Jimmy Mirikitani, bottom, painted Tule Lake, top, while he was interned there during World War II. It is his only known painting to survive the period and was recently displayed at the Smithsonian in Washington D.C.
Jimmy Mirikitani painting that was done at the Japanese internment camp in tule lake, California, during world war II was part of a yearlong exhibition at the smithsonian. the artist, who is a resident of villageCare at 46 & ten, sold the painting to hiroshi sakai during the war. hiroshis daughter, Pauline, identified Mirikitani as the author of the work, which hung in the sakai home in sacramento all these years, after seeing the documentary film the Cats of Mirikitani. when I first heard about the screening I thought maybe this guy would know who did dads painting, Pauline sakai told the Sacramento Press Tribune. when I went upstairs and took it off the wall, I got chills down my spine. I looked at the signature and realized this was the guy. At the screening, Pauline and hiroshis widow, lilly, met Mirikitani and filmmaker linda hattendorf. they learned that they own the only painting that has survived of those done at tule lake by the artist.
legends of the village honors Ed koch, father John Mcguire and brad Perkins
illageCare held its 12th annual legends of the village gala on November 8, honoring a diverse group of three quintessential villagers notable individuals whose contributions extend far beyond greenwich village boundaries. this years honorees were: EdwArd I. Koch, former New york City mayor, who received the distinguished service Award. ThE rEv. John P. McGuIrE, pastor of the Church of st. Joseph in greenwich village, who received the lenore Zola Award for Community service. BrAdford PErKIns, chairman, CEO and founder of Perkins Eastman architects, who received the village business legend Award. More than 300 persons attended this years Legends gala which raises funds that benefit villageCares array of programs that serve older adults, persons living with hIv/AIds and those in need of medical and rehabilitation services. Emma devito, villageCare president and chief executive officer, welcomed the guests, saying, Its gratifying to see so many of you here tonight, because as much as we want you to have a good time at this party, your donation and your contributions to villageCare are so important to us, especially in these days of government cutbacks impacting long-term care providers. the event was held at bridgewaters at the south street seaport.
Hizzoner Ed Koch spoke to the Legends of the Village audience after receiving the Distinguished Service Award from VillageCare Board Chairman David Sidwell.
New Rehabilitation and Nursing Center Ribbon-Cutting

ribbon-cutting ceremony attended by some 150 persons from throughout New york Citys health care provider and hospital networks marked the completion and opening of the new villageCare Rehabilitation and Nursing Center. Emma devito, villageCare president and chief executive officer, told those attending, weve been looking forward to this day for some time now replacing our aging village Nursing home, a place thats always been highly regarded resources for our community with a brand-new, state-of-the-art facility. that day has finally come. she explained that the creation of the new center was the final major piece of villageCares undertaking to reform and reconfigure long-term care services and serve as a model for others. In addition to the creation of a wide variety of community-based options that can delay and even prevent the need to admit someone to a nursing home, villageCare made a commitment to the state to rightsize its residential skilled nursing care capacity. Assemblymember deborah glick congratulated villageCare on its accomplishment with the new facility, saying that it is representative of the commitment and history of village Care to be in the center of efforts to support and serve the community.
Andrew w. brotman, chief medical officer at Nyu langone Medical Center, also congratulated villageCare for creating such a wonderful new facility. A facility like this will be a great addition to the health care resources available to the New york community, he told those at the gathering. the featured speaker for the event, senator thomas duane, said, for decades villageCare has been a model of excellence in our community. All of their services show respect for those they serve and are responsive to individual needs. he said that villageCare has always sought how best to provide services and how to keep people in the community. with its emphasis on short-stay care and getting people back home as quickly as possible, this new building reflects the progress we have made in rehabilitation care, duane said. the cutting of the ribbon was done by Judy McCusker, who was the first long-term care resident to move into the new villageCare Rehabilitation and Nursing Center. City Council President Christine Quinn, who was out of the country at the time of the event, provided a proclamation marking the occasion that was presented to CEO devito during the ceremony. In the evening, an open house was held, which was attended by more than 100 interested neighbors and others from the community. for staff moving from village Nursing home to the new facility, a reception honored their dedication and hard work in creating the new program of care at the center. the villageCare Rehabilitation and Nursing Center is located at 214 w. houston st.
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resident Obamas top AIds advisor, Jeff Crowley, recently visited villageCares Rivington house, meeting with staff, residents and touring the skilled nursing facility. Crowley also met afterward with members of villageCares board of directors and senior staff, where he discussed the Obama administrations AIds strategy, with one of its major goals being to lower the number of new infections by 25 percent. Also among topics raised during the discussion was the response needed to address the growing numbers of those over 50 who are living with hIv. More than half of the persons that villageCare serves in its AIds care programs are over 50, Crowley was told. he said the situation presents an opportunity
white house director of AIds Policy visits Rivington

for the hIv community to advocate for the creation of services for what he sees as an underserved population. Overall, Crowley said, he would like to see the day when new hIv infections are rare, and when they occur people would get unfettered access to the highest quality of care. there are many elements from prevention and education to treatment that are part of reaching such a goal, he said. the challenge we face as a nation is what are we going to do to get better results, Crowley said.
President Obamas top AIDS advisor Jeff Crowley with Rivington House residents Tracy Wheeler and Kathryn Dacruz during a tour and visit to the VillageCare skilled residential care facility.
Moving-in days
Over a two-day period in December, staff helped move residents from the old Village Nursing Home into the new VillageCare Rehabilitation and Nursing Center. Since it opened, the new facility has been in high demand among those looking for quality, state-of-the-art short-stay rehabilitation.
10 vi l la ge Ca r e t O dAy | s p ri ng 2011
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An Emphatic Exclamation Point

New VillageCare Rehabilitation and Nursing Center Is Vital Piece in Care Reform
By Bonnie rosenstock
he opening of the new villageCare Rehabilitation and Nursing Center, replacing the aging facilities of the communitys iconic village Nursing home, offers an emphatic exclamation point for the accomplishments of an organization that grew out of a single, courageous act in the mid-1970s. that act was the rescuing of the village Nursing home from the ashes of a failed proprietary facility and its transformation into a valued, not-for-profit community asset. that effort prompted former villageCare President and CEO Arthur y. webb, to remark that back in mid-1970s none of those who fashioned together this tiny notfor-profit organization in order to run a single, 200-bed facility known as village Nursing home could have known at the time the seed they had planted. Emma devito, villageCares current president and CEO, calls the new six-story, 105bed facility the capstone to the array of community and residential care services that we have built since our formation. the Center, at 214 w. houston st., between sixth Avenue and varick street, is the first new construction of a skilled nursing facility in Manhattan in the last half-century. As CEO from 1993 to 2009, Webb remembers how one villageCare program begat another with the creation of strategy 2000 in summer 1994. At that time, villages board and management started to look at the future and lay out a system of continual care and alternatives to illness. the board adopted a bold strategy by attempting to build housing with services, expanding homecare programs, expanding management programs and instituting day programs for hIv/AIds and for seniors, which were ways to prevent unnecessary nursing home placements. then in March 1995, we opened Rivington house, one of the first and largest nursing homes for AIds in the city, webb explained. when strategy 2000 hit its mark, webb said, they began to look at the future one more time and focused on replacing and downsizing the aging nursing home. we
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went to the state government and put together a cooperative plan with them that began to look at further efforts to rationalize the whole system, moving from a nursing home-centric world, which long-term care tends to be, to a much more patient-centered approach. the state gave approval to replace village Nursing home with a smaller size stateof-the-art facility with a totally different configuration, webb said. we saw ahead that the hospital world was changing, he continued. since the late 1990s the national trend has been for shorter hospital stays, thus requiring a lot of post-hospital short-term and subacute rehabilitation averaging 20 days or less. this new standard even holds for individuals with two or more comorbidities, for example, diabetes and heart problems and most nursing home residents have two or more. since 95 percent of all nursing home admissions come from hospitals, one had to be sensitive to what was going on. we wanted to position ourselves as one of the go-to agencies, webb said. Deinstitutionalizing the institution upon entering the new center, the first notable difference is the non-institutional looking lobby, which feels more like a welcoming hotel. when they are coming from the hospital in an ambulance, they are probably on medication, on a stretcher, their first thought is, Im going to a nursing home, shoot me. how do you change that fear for the patient and family? asked webb. Its part of the design, how to get people in the door, up to the room, into comfort, almost like concierge service, so the paperwork is done, the food and medications are ready, and they are immediately integrated into the life of the facility. Perkins Eastman, which is renowned for its senior living and health care design, was the buildings architect. the firm has worked on other villageCare projects. so the center could accommodate a wide range of individuals, villageCare considered colors, layout, directionality and the latest research regarding visual and hearing impairments. Along the right side of the lobby is a glass wall looking out onto a bamboo
garden, fit with benches. the healing garden can be viewed from all levels, and adjacent to it is a meditation room, a place of calm and serenity for patients and visitors. there is also a rooftop garden with dramatic views of the New york City skyscape floors two through five are designated for short-stay patients, and the sixth floor is for long-term residents requiring palliative and end-of-life care. the floors are divided into two neighborhoods. In the rear of the building, on the downing street side, the neighborhood has 11 beds, and in the front, on the houston street side, there are ten beds. half the rooms are private, and the other half are doubles, all with a shower and a bathroom. (Each floor also has therapeutic bathtubs.) All floors have a bariatric room, which can accommodate people up to 500 pounds. (bariatrics is the branch of medicine that specializes in the study and treatment of obesity.) A third of the beds on each floor, that is 7 out of 21, have overhead lifts for frail and bariatric patients, which not only protect them, but also protect employees from back strain; lifts are also installed in the state-of-theart rehabilitation gym. there are oxygen and suctioning equipment in many rooms, and every room is outfitted with a flat screen tv with pillow speakers, satellite tv, wireless Internet service and a directory with basic information about the facility, local banks and services, along with menus from nearby restaurants if patients want to order out. Chair beds can be moved into the rooms for family members who want to stay overnight. there is a habitual divide in health care in which hospitals get a lot of resources to build an electronic medical record, but nursing homes do not. the villageCare Rehabilitation and Nursing Center has this technology capability to intake patient information and coordinate care with all medical specialists, providers and agencies within villageCares own network as well as with outside agencies and providers. this avoids the fragmentation of
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information. In this way, all their doctors have the same information, and people understand what services are available to them, CEO devito said. Coordinated care also generates savings. villageCare wanted to create a facility that had total It capability at the bedside and to become completely wireless, but the state said there must be back-ups. Although there is a call bell similar to whats found in traditional hospitals and nursing homes, every staff caregiver carries a wireless phone, which promotes responsive customer service and teamwork because the staff can call each other. In addition, roaming devices have been installed, so if a guest with dementia wanders, an alarm will sound. In between the two neighborhoods on each floor is a community area, the Commons, which includes a dining room and living room. the dining room has a refrigerator, freezer, coffeemaker and microwave available 24/7. the refrigerator is stocked with snacks and beverages. there is also a full-service pantry (locked at night) from which meals are served from a steam table, restaurantstyle. Mealtimes are flexible, and patients have the option of taking their meals in bed. Patients also decide when they want to wake up, when to go to rehab and when they want do other activities. you work hard all your life, why should you have to get up at 6 a.m. so the beds can be made or because you have to eat at a specific time? asked devito. It makes sense not just from a medical perspective, but also from a personal perspective. we try to keep the person as a whole and to accommodate their needs to the best of our ability. we want to deinstitutionalize the institution. thus, another feature was to eliminate the traditional nursing station to encourage staff and patient interaction, replacing it with a care-team room. In early 2007, a work force subcommittee was formed with union representation, staff and villageCare administration. together they transformed traditional roles and responsibilities to a patientcentered care approach, a recent trend in nursing homes. the certified nursing assistants are now client care associates; the food service workers are now hosts/ hostesses; maintenance staff are plant
operations technicians, and housekeepers became environmental service specialists. the care associates, who make up the majority of the employees, now serve food instead of handing it out on a tray line. they are also more involved with patient rehabilitation on the floors. Instead of wheeling a resident to the dining room or bathroom, they walk them whenever possible. they also work on range-of-motion activities on the floor, so the neighborhoods become an extension of whats taking place in rehabilitation. villageCare also received a grant from the samuels foundation to train staff in customer service and satisfaction. for patients, we put ourselves in their place and become more aware of their needs. It was also excellent for building good working relationships and team effort. we have all the technology and equipment, but we want to make sure we keep the warmth and caring, observed devito. all the bells anD whistles we have all the bells and whistles for a full, strong rehabilitation program, and hospitals are very excited about sending patients, said devito. Admissions come from Nyu Rusk Institute of Rehabilitation Medicine, hospital for special surgery, lenox-hill North shore-l.I.J., beth Israel and st. lukes-Roosevelt, among others many of which have rehabilitation expertise. so whatever program the patients had could be easily continued at the Center. we will work hard to get the person strong and discharged and if necessary, provide home care. Our rehabilitation outcomes are better than the city, state and nation as a whole, she said. there were more than 875 admissions in one year at the old village Nursing home, and 90 percent went home with home care for two weeks to a month. the goal is to keep people out of hospitals, which is the most expensive, devito said, adding that rehospitalization is not a welcome experience for patients or hospitals. the Centers clinical personnel consist of a full-time medical director plus another physician; a director of rehabilitation; physical, occupational and speech
17
therapists; certified occupational therapy assistants, and two nurse practitioners. Alternative services, like massage therapy and acupuncture, are available from a list of credentialed providers. Patients are adults of all ages with a lot of orthopedic conditions, like hip, joint and knee replacement surgeries, as well as recovery from cardiac surgery, strokes, cancer therapies and bariatric issues. the Center is working with hospitals to develop special programs, like respiratory and cardiac rehabilitation, and Roosevelt hospital is providing expertise for a palliative care program on the sixth floor. with health care reform there is more pressure for providers to offer high quality care with less money. Medicaid represents 78 percent of all revenues in nursing homes and continues to experience extreme reductions in reimbursement. so in talking with the board, we decided we needed to expand the range of revenues, expand our reach in Medicare and to offer something to commercial payers and private-payer patients, webb said. therefore, the majority of patients will be drawn from these insurers. building the nursing home from idea through finding a property to design approvals took about six years. you need a lot of patience to take on such a task, but the board understood the need to do it and was supportive, said webb. Presciently, village sold its old nursing home (to flAnk, a design/develop firm in Chelsea) at the height of the housing market with the proceeds allowing villageCare to build the new facility. that sale closed in february 2011. it takes a Village when construction commenced in March 2009, everything that could have happened did happen, said devito. After the parking garage, which stood on the site, was demolished, they discovered that the soil underneath was contaminated and the Minetta stream was flowing below. so before the foundation could be put in, they had to hire experts to figure out how to decontaminate and dewater, which took about five months. then they had to coordinate with the water pipe system project, which the city has been
friends, government officials, staff and architects to make it all work. thinking it through the building has a lEEd (leadership in Energy and Environmental design) green certification. Many of the materials that were specified and installed in the building are considered sustainable because they were either made of recycled material or manufactured regionally, fewer than 500 miles away. And more than half the wood used is fsC-certified, which ensures that the wood is harvested from a proper farm and not taken from endangered forests. given the delicate nature of the occupants, optimum indoor air quality was of great importance. the buildings mechanical systems bring in 30 percent more fresh air than what is required by the AshRAE (American society of heating, Refrigerating and AirConditioning Engineers) standard. the building will also use less energy and operate more efficiently through high efficiency light fixtures and mechanical equipment and occupancy sensors. the building installed low-flow water fixtures to reduce the overall water consumption by more than 30 percent. the construction team devised a plan to minimize the amount of building waste that went directly to landfill, so that approximately 83 percent did not. And many of the materials, such as steel, wood, glass and plastic, were recycled. the villageCare Rehabilitation and Nursing Center is part of the organizations larger effort to build a total continuum of care. If you look back at village Nursing home being saved from closure in the 1970s to being one of the first long-term care organizations in the country to open up programs for people living with AIds, villageCare has always been on the forefront of change in terms of responding to people with conditions that really need intensity of care, webb said. Put all that together and you have an interesting story of how one not-forprofit has approached the future and sought not only to change with the times, but to influence the shape and direction of change. g
building since 1952 and is not expected to be completed for another 15 years. It goes down 600 feet and comes together at houston and hudson streets. throughout the design, planning and building phases, villageCare maintained steady communication with the two local community boards, block associations, neighbors, the Chamber of Commerce and all interested parties. since they are directly across from film forum, they tried to make sure that the drilling didnt interfere with the movie theaters showtimes. they placed the emergency exit on the residential downing street side in order to maintain a quiet environment on the block, and the main entrance is on the houston street side. It was important to get the neighbors involved, and we even sent emails if there was construction on saturday. they were very patient, and we hope to be a good neighbor and contribute to the neighborhood, devito said. the initial community concern was that the building was too large, so village brought it down a floor in response. there were other expensive changes, but good, webb said. so by the time villageCare went to the City Planning Commission, everybody was on board with the plans. devito acknowledged the instrumental support of City Council speaker Christine Quinn, as well as the invaluable assistance of state senator tom duane and Assembly members deborah glick and Richard gottfried. we have a lot of people to thank, she said. you dont do a project like this on your own. It takes a village to get this done. we worked with the community,
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shawn thorne Is
Moving forward
with Momentum
y 2001, shawn thorne was sitting on top of the world. he was the daytime sous chef at windows on the world at 1 world trade Center, a job that he had held since 1997. when the terrorist planes hit, thorne was visiting his daughter in Charlotte, N.C., whose birthday coincided with september 11. but for his decision to leave his glamorous, lucrative job a few months before, thorne would have perished along with many of his dear friends and former colleagues. Its destiny as god sees it, reflected the burly soft-spoken director of food services and site operations/executive chef for the Momentum Project, Inc., a villageCare program. I helped turn a one-star restaurant into a three-star, so it was the perfect opportunity to leave at the height of good grace. It was the best move of my life when I decided to come here. he was not talking about escaping the terrorist attack, but the immense satisfaction he gets in using his culinary skills to improve the lives of those living with hIv/AIds and meeting their unique nutritional requirements. Momentum provides hot, nourishing meals, pantry bags and a wide array of support services at four different church sites during the week. thorne plans all the menus and relishes being hands-on. I am always at the largest site preparing meals to support the team, he said. If I can get out of the office, I jump in at any given day. My staff knows not to relax too much, he added with a grin. Every wednesday, he cooks at the Church of god of Prophecy in the bronx, just six blocks from yankee stadium. Its a very poor neighborhood, and the pastor has identified some of his parishioners with hIv or AIds although some dont want to be identified in their own backyard, said thorne. this is thornes first non-profit experience although he used to volunteer at big events through his friend and high school classmate, don Mcgill, who was Momentums then executive chef and he loves it. In restaurants you are geared to making the customer happy. In a non-profit, you are geared to keeping the customer alive. Its a higher calling. youre not going to get rich off it, but the richness is seeing clients when they first come in all frail and unhealthy and then seeing them energetic and excited about eating vegetables and fruit. when I came here, that was the challenge. thorne described his dishes as home cooking with an ethnic twist, many reminiscent of those of his youth growing up in the projects in the highbridge section of the bronx. his father, who had cooked in the army, liked to take over for his wife on weekends even though he had a full-time weekday job. he said mama worked hard enough during the week, so it was his turn, recalled thorne. he is thrilled that his daughter, now 19, enrolled in cooking school. Ninety-five percent of Momentums clients are either African-American or hispanic, so his wide, eclectic menu will include arroz con gandules (rice with peas), fried chicken, ribs and oxtail. for the chicken fettuccini with sundried tomatoes, the
hook is the chicken and pasta, but in reality Im serving you vegetables, good stuff for your body. All right, chef, if you say its good for me, they will tell me. some of them had never even heard of broccoli or eaten a mango before. All of the menus are reviewed by a nutritionist for balancing, said thorne, 40, who sported a thick silver chain with a weighty pendant of scales (for libra). Momentums symbol is the dinner plate with a fork and knife forming an almost pyramid without touching each other, signifying unity and the circle of family and friends who share life by sharing food. Momentum is a food and nutrition program first and foremost, he said. Momentum was created more than 25 years ago by John s. damm, senior pastor emeritus of st. Peters lutheran Church on East 54th street, as an all-volunteer organization dedicated to feeding low-income and poor New yorkers living with hIv/
We are known for our food... It will always be the best as long as I am here.
AIds. In 2008, it became part of the AIds services array of villageCare. both our missions are the same. we care for people less fortunate than we are, and we try to provide housing and food. we are a low-threshhold type of community-based nonprofit. It was a match made in heaven, he said of the merger. for thorne, the clinical services are the icing on the cake, part of the bigger picture. Momentum provides nutritional, mental health and pastoral counseling, substance abuse intervention, prevention education, family services, life skills training, housing and entitlements advocacy, referrals to outside services and support groups, nursing services and health education and services. between 50 and 60 percent of the clientele living with hIv/AIds are 50 or over. Momentums team of social workers, nurses and housing advocates are on-site during the meals, and there is constant follow-up. If they dont have the resources to deal with the issue, they can refer them to villageCare for other options. thats where the relationship works really well, he said. In addition, Momentum has a large base of volunteers from corporate groups, volunteer organizations and the church missions themselves. At one bronx location, the church ladies dont want any outside volunteers. they say, we will make every baby better here, and if you dont eat your vegetables, they will beat you up about it, he smiled. thorne, ever the innovator, enthusiastically described an ambitious new dish he was creating, a soul roll an egg roll with red rice, collard greens, smoked turkey and black-eyed peas with a light turkey gravy dribbled over it. Its so time-consuming. I have to start prepping it way in advance, he acknowledged. but we are known for our food, he said. you can cut everything else, but when you start dealing with the food, I have a problem. It is too important to the clients we serve. It will always be the best as long as I am here. g
21
gatekeepers:
Looking Out for Seniors,
One at a Time
bank manager was worried about one of his clients. the man, in his 80s, seemed to be withdrawing an inordinate amount of money from his account and talking about visiting parents. A cashier in a local supermarket suspected that an aide who was working for a senior was buying too much food and wondered if this was a case of abuse. A cashier at a fast-food outlet was concerned that a regular customer who sat by himself might be isolated. because all three employees companies participated in villageCares gatekeeper Program, they knew who to call to voice their concerns. thats precisely the aim of the gatekeeper Program to train nontraditional sources to identify and refer older adults who appear to be at risk. the program was developed in 1978 by Mental healths Elder services in spokane, washington. since its inception, it has been replicated nationally and internationally. the model was successful, program coordinator of the gatekeeper Program, Charles Anflick said. It reduced hospital and suicide rates with low-tech intervention and available resources. the villageCare program, which began in May 2008, is funded by the New york state Office of Mental health and is one of three pilot programs statewide; the others are in westchester and Onondaga counties. st. vincents hospital was awarded the original grant, and they asked villageCare to provide some of the services. we partnered with st. vincents because they had the requisite behavioral health license and an outpatient mental health clinic. we had a stronghold in the village and Chelsea communities, and they had the stronghold in Chinatown. It was a no-brainer, said Renee Cottrell, the programs supervisor. After st. vincents closed, gatekeeper started collaborating with fEgs, a nationally recognized not-for-profit health and human services organization. st. vincents had a good behavioral health department, good therapists and good doctors, noted Anflick. fEgs is similar regarding referrals to mental health services. the program reaches out to those who
have signs of depression, anxiety, confusion or other mental health issues before these conditions compromise their ability to live independently. As villageCares ten-page training handout informs, If you consider yourself the kind of person who keeps an eye on your neighbors, you are a gatekeeper. gatekeepers are employees at local businesses, such as banks, supermarkets, drugstores, hair salons and food establishments. they are also nurses, home health aides, clergy, police officers, firefighters, paramedics, utility or postal workers, apartment managers, doormen, neighbors, friends, relatives, concerned strangers, or anyone who comes into contact with older adults on a regular basis. According to statistics from the New york City department of health and Mental Hygiene, some 366,000 adults 55 and older in New york City are affected by a psychiatric disorder or substance abuse. About 17 percent of older adults have substance abuse issues, and one in every five over 55 experiences a mental disorder, a figure which is expected to double by 2030. the gatekeeper Program links people to mental health treatment and other services through their partners in the community, imparts basic information about mental illness and follows up by phone, home visits and assessments. we try to screen each client, explained Anflick. there are screens for alcohol abuse and for mental status. After a client is in treatment, we again give them the screening and the score should go down, meaning the person is less depressed or anxious. we have seen scores go down to zero. senior centers in the neighborhood are a good source for referrals. social workers and other employees at the centers have direct knowledge of those individuals they believe are at risk. senior centers are more successful in bringing them to services because the clients are right here. In other situations, there are always confidentiality issues, noted Anflick. Added Cottrell, One of the challenges of the program is that when you are working with libraries or merchants, they need to look out for their customers and policies. the referral process is challenging,
but not impossible. sometimes we get a physical description and she lives in the building, or he comes in on such and such a day, and we try to follow up. banks cant give out personal information, so Anflick has to work around it. the bank manager in the above-cited case had a handy, wallet-sized yellow plastic card describing the gatekeeper Program and signs of mental health distress and called Anflick when the client came into the bank. I gave the manager information about who to call, to find out who his relatives are. the client is now in a nursing home. Anflick sees an average of five people daily, is actively involved with 30 cases, follows up on people he hasnt seen for a while and arranges training with potential gatekeepers. he has reached out to the local NYPD precincts the Sixth at 233 w. 10th st. in the west village and the Ninth at 321 E. 5th St. in the East Village. he also has gone to community board meetings, social services meetings, the greenwich village/Chelsea Chamber of Commerce, the Jefferson Market library and local houses of worship, to name a few. A supermarket chain has been especially receptive. Anflick has already trained managers, delivery people and some cashiers and is training more. If the clients that he refers for mental health treatment (and other services) dont have coverage, Anflick, who is trained in problem solving and short-term counseling, will work with them in the interim to improve their depression scores until the team can identify an appropriate provider. Its a matter of keeping up with the changing systems and new services that the city is offering, said Anflick, whose database is growing quickly. because of villageCares wide network of community-based services and facilities, the team can also offer services from the organizations own programs, such as Certified home health Care, adult day health care and licensed home care. were another link in the chain to what they want, Cottrell said. the program is a low-cost method of intervening and it helps people stay in their home. we accomplish this gatekeeper by gatekeeper, client by client. g
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serving AIds Patients since 95

n the lobby of Rivington house is a proudly displayed framed proclamation signed by Mayor bloomberg that recognizes the Nicholas A. Rango health Care facility for 15 years of caring for people with hIv/AIds. On the day it was presented, it was a low-key observance with a few local dignitaries and no media hoopla. yet, the story of how villageCare turned a shuttered 1898 schoolhouse on the lower East side into the countrys first AIds-only nursing home is cause for great celebration. In the early 80s, AIds was pretty much a death sentence. AIds is deadly, announced The New York Times on february 6, 1983. According to the Centers for disease Controls figures for late
Rivington House Looks Back, and Ahead to the Future
25
January of that year, of the cases reported before June 1981, 75 percent were dead. the first AIds cases reported in the city were in 1981, and the number of new cases was doubling every few months. by the fall of 1985 there were nearly 13,700 cases of AIds in the u.s., and almost 4,400 of them were in New york City more than any other city in the world, with most concentrated in greenwich village and Chelsea. yet services such as hospice care in a nursing home or skilled nursing care at home were virtually nonexistent. villageCare knew it had to act. In 1975, it had saved the abandoned nursing home on hudson and west 12th streets
At Village, we say, Whats our mission?
Whats our purpose?

What are we here for?
and brought it back to life as a viable institution, refurbished in 1982, so I think they came from the same place when AIds struck: men in our community are dying, said len McNally, director of village Nursing homes AIds project. Its our community. Its greenwich village. we are proud of our community. we are proud of our gay men in our community. McNally was instrumental in forging the first AIds day treatment program, which opened in 1988, the states first AIds-specific Certified home health Agency (ChhA), established in late 1991, and Rivington house. when dr. Nicholas A. Rango joined the organizations board in 1981, his vision was to make it a pioneer in AIds care in the country. A Milbank assistant professor of health and society at barnard College at the time, Rango was very tall, imposing, determined, gay and living in greenwich village, the epicenter of the epidemic. If Nick didnt have the vision and dream to have a small nursing home to do something for people with hIv, I dont think the AIds programs would have happened, not at villageCare, said bill Messina, a social worker, original staff member at the AIds day treatment
center and, for many years, its director. As the AIds epidemic continued to surge in their community the board devoted more and more time to looking for ways to provide help for those with AIds. One of the first ideas was to set aside a floor in the existing nursing home specifically for AIds patients. but in those days, little was known about the disease and there was a lot of fear. families even threatened to remove residents if AIds patients were put in the nursing home. It was the nursing homes medical director at the time, dr. Ellen Olson, who opposed the idea of using part of village Nursing home for AIds patients. she presented a paper to the board advising against creating the AIds floor, writing that the facility was not geared to the unique needs of AIds patients regarding emotional support, activities, and control of, and protection from, opportunistic infections. . . [which] would fragment and compromise care to all parties concerned, without significant reorganization of staffing and staff training and changes in the architectural design of the nursing floors to facilitate isolation procedures. In October 1985, members of villageCares AIds Committee informed the full board that they were prepared to use their expertise to establish an AIds-specific skilled nursing facility and hospice care. the committee began looking for sites for both long- and shortterm care with the help of community organizations, sympathetic clergy and health care providers despite having no money for it, a detail that never seemed to deter them. finances are not the bottom line, said Rev. James gardiner, longtime chair of the AIds Committee. At village, we say, whats our mission? whats our purpose? what are we here for? In 1987 Rango left the villageCare operations to become director of the states AIds Institute, where he succeeded in securing higher Medicaid reimbursements from the state for doctors and health care organizations treating people with hIv. Rango initiated AIds medical standards, a wider definition of AIds (entitling more patients to receive care), special nursing homes and residences, housing aid, prison health programs,
home care, tuberculosis programs, care for the uninsured, research to prevent accidental exposures like needle sticks, and special training for doctors and nurses. he also led the fight against proposed regulations by the CdC that would have prohibited doctors with hIv from performing medical procedures. when AIds began affecting Iv-drug users, women and children, he diverted money to programs serving them, much to the dismay of some gay organizations fighting for a piece of those same funds. key to the organizations effort to create a unique AIds nursing home was its track record of establishing day treatment and AIds-specific home health care. without the first two programs predating Rivington house, franklin d. diaz, Rivington houses first administrator, said hes not sure villageCare would have gotten it off the ground. villageCare had successfully put in place a network of services specifically for people dying of AIds. If they could be maintained safely in the community, then they could come to the day care program. If they were homebound and couldnt come to the day program, we would send medical personnel to their home. then if care could no longer be safely provided at home, they could come to Rivington house, he said. villageCare originally considered building a residential program for AIds with services, what today would be considered assisted living. but the organization couldnt find a source of revenue to support this project. the state said, why dont you build a nursing home? said former president and CEO, Arthur y. webb, who came to villageCare in 1993 to help build and open Rivington house. the nursing home would require a large space with at least 200 beds to be cost-effective. because villageCare didnt have a wealth of resources, McNally had to restrict his search to affordable publicly owned properties. he came upon P.s. 20, a school built in 1898, which had been closed for years and was in extreme disrepair. there was initial community skepticism and resistance to the facility. we were viewed as people coming in to steal their building. we had to convince [Community Board 3] to promote the
conversion of the school to an AIds nursing home, McNally said. what convinced them was the positive economic impact on the lower East neighborhood, one of the poorest in Manhattan. McNally pledged to hire around 250 employees nurses, housekeepers and aides from the area, and CB3 approved the project. then the city came on board, selling the property, valued at $3.6 million, for a nominal fee, provided that the patients in New york City health and hospital Corporation (hhC) facilities would get preference. we were the only one that had a plan to do it. Other nursing homes were running away from AIds like it was the plague. I knew the majority of patients were going to be poor, on Medicaid, and many of them would be in hhC facilities, said McNally. It took five years from inception to completion, and when the 219-bed facility at 45 Rivington street opened in March 1995, the crucial residential component of villageCares comprehensive AIds services was in place. It was the tenth nursing home and last approved by the state department of health with designated AIds beds. Our facility was only hIv beds, the largest AIds-specific nursing home in New york state and the country. All others were a combination of geriatric and AIds beds, said diaz, who was administrator during its first eight years. It was the best job I ever had in my entire career, he declared. On Wednesday, November 10, 1993, at the age of 49, Rango died of AIds. webb recalled Rangos energy and foresight. Even when he was dying, he was giving orders from his bed. unfortunately, he didnt live to see Rivington house the Nicholas A. Rango health Care facility open, but he knew it was being built. we named the facility to honor his extremely ambitious approach to dealing with AIds. the early years when Rivington house first opened its doors, many hospitals dumped their extremely sick, end-of-life patients, who averaged a stay of 12 days. Eighty percent got discharged to death. It was like running a hospice, not what we had anticipated, said webb. the hospitals
27
got rid of long-term patients, and in many ways we were glad we could deal with this because they were languishing in hospitals unnecessarily. At least in the last few days they had a place with loving care, he said. Administration had anticipated difficulty in hiring and retaining staff to work in what was then a drug- and prostituteinfested lower East side, but that never was a problem. Everyone here is committed and concerned, said deborah E. batson, coordinator of education, practice and development, who joined the staff seven months after the facility opened. Ninety-nine out of one hundred people work here because hIv/AIds has touched them in some way in their lives. I had friends with the disease. staff had family members with the disease who died or are thriving, and they want to give back. we know we are safer here than other health care workers because everyone here has AIds. If you inadvertently get stuck with a needle, you know what to do, there are no doubts. If you work in a geriatric nursing home and get stuck, you might not tell your supervisor. however, those early years took an emotional toll on the staff, said batson, we got close to the residents, and they died quickly. we didnt have the medications we have today. until we got all the protease inhibitors the combo cocktails [around 1996] the residents were dying because there was no treatment. Even when drugs became available, it took the body time to get used to it, and for many, they were just too ravaged by the virus for them to be effective. batson began as a night supervisor and recalled that the three-drawer morgue in the basement was always full. they rarely need to use the morgue anymore. reaching out to the hospitals diaz expected it would take six-toeight weeks to phase in one unit and by the end of six to nine months, they would have the entire facility filled. but patients were dying within three to four days, so they could never completely fill one unit and move on to the next. we
were constantly backfilling, so we had to rethink our enrollment and admissions strategy and become more aggressive in marketing Rivington house. diaz, who was hired approximately 18 months before the opening, and his directors of admissions, medicine and nursing, tried to visit every single AIds-designated hospital and discharge planning staff to begin pre-marketing. we tried to be as responsive as we could to the needs of hospitals, so we even admitted patients in the early evening and on weekends. they continued to admit acutely ill patients, but then started to admit other people who were not as medically compromised that they required a hospital or nursing home. however, they had other comorbidities, like homelessness, substance abuse and mental illness that other nursing homes were not accepting. It added some stability, a core, while we continued to accept patients that no other AIds facility was equipped to take care of, diaz said. villageCare also established an inhouse pharmacy, which no other nursing facility had. In the early 1990s, the average number of medications was 12 to 15 per patient. It was a nightmare for a company to come in with this number of patients, said diaz, so they obtained their own license and hired a dedicated pharmacy staff and stayed open six days a week, ten hours a day. by controlling it, we also controlled the quality, he added. because patients now need as few as one or two drugs, the pharmacy has closed. the present Rivington house provides residential services that integrate the traditional medical, nursing, medication adherence, substance abuse counseling and education, social services, nutrition counseling, therapeutic recreation and art therapy, physical, occupational and speech therapies, pastoral care with complementary and holistic therapies. In addition, substance abuse counselors are trained in auricular acupuncture, which can help with addictions. Medical personnel include a medical director, two staff psychiatrists, a doctor for each unit, a gynecologist and podia-
trist biweekly, an eye doctor every week and a dentist twice a week. Many residents are dually diagnosed, meaning that in addition to AIds, they may have psychiatric or psychological disorders and a history of drug abuse. there is on-site methadone administration, but Rivington house is not a drug treatment facility. we teach them harm reduction and other ways to keep healthier, like becoming part of a needle exchange program, said batson. to be admitted, you need to be at least 18 years old, have hIv/AIds, or if you dont have an AIds diagnosis, you have to be hIv positive and be symptomatic. One 18-year-old born with AIds needed in-patient care while taking investigational drugs because his medications stopped working. he did very well and went back home. two East has a subacute unit for residents who require a higher level of care, like highly vitaminized and amino acid Iv fluids or complex wound care. within the first 21 days of admission, an interdisciplinary team involved in each patients care does an assessment to determine what the team needs to do and the role of the patient in care and treatment. Residents are encouraged to be as autonomous as possible. sandy freeland, Rivington houses administrator says, its person-centered care, we make sure its a two-way street. for the homeless, who arent used to having three squares a day, social workers help with everyday adjusting, living in a nursing home, sharing a room each unit also has two private rooms and having a bathroom in the room. Residents may no longer be quite as sick with hIv/AIds, but they may be suffering from liver and kidney disease, hepatitis b and C and weakening bones and fractures as a result of their disease or years on medication. In the past, high dosages of AZt wiped out blood counts, and people were grossly anemic. Not many people are failing antiretroviral therapy these days. however, new international guidelines require that people with t-cells of 500 or less start on antiretroviral therapy. so we may see people who have been living in the community with 300-400 and thinking theyre doing
well. Now the doctor wants them to go on drugs, and they are freaking out. we can direct them to some of our care, bring them in and educate them. they can see our residents are doing well, said batson. looking aheaD to the Future lisa garay, villageCares chief operating officer, spoke at great length about the future direction of Rivington house. she acknowledged that it is going through a transition with respect to the type of population it serves, which is very different from when it opened 15 years ago when patients were much more acute. Now there are a more admissions and discharges, people coming in that get well and want to go back out to the community. so programming has to keep pace to deal with a lot of behavioral issues as well as medical issues, which is very stressful for our staff, garay said. they are also collaborating with st. lukes-Roosevelt hospital to develop a palliative care program around symptom management and end-of-life care. we provide a continuum of services for acutely ill patients, but there needs to be some palliative care as well. some patients are not going home, but they dont necessarily need to be as aggressively treated, said garay. freeland said these are also challenging times filling all the beds, though some AIds clinicians fear a new surge of patients. young gay boys dont know people who died from the disease, and they think they are invincible, freeland said. there are also fewer resources than 15 years ago. since the facility is primarily funded through Medicaid, budget cuts have made an impact, especially in longterm care. It affects everything from staffing to programming, so we have to be more efficient in how we provide services, garay said. In addition, with all of the pharmaceutical interventions allowing people to live much longer, aging issues and concerns such as frailty, pain, depression and organ failure have come to the fore. the average age at Rivington house used to be younger; now it is 49.9. Once you
hit 50 in the hIv/AIds world, you are an older adult, said batson, and you have to be screened for diseases of older adults, too. garay said that they see more cognitive deficits as the patients get older, not necessarily from aging, but possibly from the impact of the disease itself. so there are lots of changes in how we provide basic care. doctors also need to be more versed in issues of aging in hIv/ AIds, she said. Emma devito, villageCares president and CEO, pointed out that on any given day at Rivington house, 10,000 pills are distributed. that doesnt happen in a geriatric facility. Over 75 percent are drug users and over 80 percent are homeless, so
We will be there until there is a
cure for AIDS.

we are dealing with people who are marginalized and desperately in need of services. People get stabilized. we help them get housing, primary care and they are doing well. but they need a support system, she said. garay said its important to form and maintain community partnerships, especially at the point of discharge. they come in, get well after a couple of months, improve their nutritional state, are able to manage their disease, take their medications and feel strong enough to go home. but if the person isnt connected to care, connected to a physician, in stable housing, has support services, he is going to wind up in a revolving door. that has been the struggle for these patients. since villageCare was established, it has always taken on and met great community challenges. the organization remains a very strong advocate for persons living with hIv/AIds. devito put it this way, we will be there until there is a cure for AIds. g
29
standpoint taking Care of Mom and dad: why we Need a Quality work force
By Vera salter
More pay, better work relationships, being appreciated, listened to and
treated with respect.
he number of Americans needing long-term care is expected to double in the coming decades from 13 million in 2000 to 27 million in 2050. In 2008 there were 3.2 million nursing assistants, home health aides and personal assistants in the united states and that number is projected to increase to 4.3 million as early as 2018. Most direct care workers receive low wages (on average $10 an hour), little or no benefits and insufficient training and professional development. As a result, this profession is plagued by high turnover rates that compromise the quality of care of the people they serve. If we are to retain direct care workers in this profession we will need to provide basic labor protections, livable wages and benefits, training and opportunities for advancement. Training: All direct care workers should be required to receive adequate training. federal regulations require only 75 hours of training for nursing assistants and home health aides, and there are no federal requirements for personal care assistants who provide services under the Medicaid program or to private individuals. All direct care workers should receive at least 120 hours of training and continuing education on the job as indicated in the 2008 Institute of Medicine report, Retooling for an Aging America: Building the Health Care Workforce. recognition and certification: All direct care workers should have com-
petency-based professional credentialing programs available to them so they can receive recognition for their knowledge and skills, including, specialty credentials in such areas as dementia, peer mentoring, wound care, diabetes management and many other areas. respect and opportunities for Advancement: It is imperative for direct care workers to have improved working conditions and opportunities for advancement within their field if they are to remain in this work and provide the quality care that our elders deserve. there are many ways that senior aides can serve as peermentors for new recruits and receive training and compensation for their expertise beyond their entry-level skills. Peter kemper, a professor at Penn state university, interviewed direct care workers in all settings in his role as evaluator of the better Jobs better Care project. he summarized what they say is most important to them: More pay, better work relationships, being appreciated, listened to and treated with respect. In other words, what we all want in our work. unfortunately these efforts are limited and sporadic. what is needed is a broad public policy that changes the way direct care work is managed and compensated. (Vera Salter is the professional development director for the Direct Care Alliance in New York City. She spoke on this topic to the Senate Special Committee on Aging.)
viewpoint Elder Abuse Can happen to Anyone, Even the Rich and famous
By mickey rooney
hroughout my life, I have been blessed with the love and support of family, friends and fans. I have worked almost my entire lifetime of ninety years to entertain and please other people. Ive worked hard and diligently. but even with this success, my money was stolen from me, by someone close. I was unable to avoid becoming a victim of elder abuse. Elder abuse comes in many different forms physical abuse, emotional abuse or financial abuse. Each one is devastating in its own right. Many times, sadly, as with my situation, the elder abuse involves a family member. when that happens, you feel scared, disappointed, angry, and you cant believe this is happening to you. you feel overwhelmed. the strength you need to fight it is complicated. youre afraid, but youre also thinking about your other family members. youre thinking about the potential criticism of your family and friends. they may not want to accept the dysfunction that you need to share. because you love your family and for other reasons, you might feel hesitant to come forward. you might not be able to make rational decisions. what other people see as generosity may, in reality, be the exploitation, manipulation, and sadly, emotional blackmail of older, more vulnerable members of the American public. I know because it happened to me. My money was taken and misused. when I asked for information, I was told that I couldnt have any of my own information. I was told it was for my own good and that it was
none of my business. I was literally left powerless. you can be in control of your life one minute and in the next minute, you have absolutely no control. sometimes this happens quickly, but other times it is very gradual. you wonder when it truly began. In my case, I was eventually and completely stripped of the ability to make even the most basic decisions in my own life. Over the course of time, my daily life became unbearable. worse, it seemed to happen out of nowhere. At first, it was something small, something I could control. but then it became something sinister that was completely out of control. I felt trapped, scared, used and frustrated. but above all, I felt helpless. for years I suffered silently. I couldnt muster the courage to seek the help I knew I needed. Even when I tried to speak up, I was told to be quiet. It seemed like no one believed me. but I never gave up. I continued to share my story with others. I told them about the abuse I have suffered. I am now taking steps to right all the wrongs that were committed against me. I am so thankful to my family, friends and many fans all over the world who have expressed their love and support for me. to those seniors and especially elderly veterans like myself, I want to tell you this: You are not alone and you have nothing to be ashamed of. You deserve better. You have the right to control your own life, to be happy, and not live in fear. Please, for yourself, end
You can be in control

of your life
one minute and in the next minute, you have absolutely no control.
the cycle of abuse, and do not allow yourself to be silenced any longer. Tell your story to anyone who will listen and above all, HAVE HOPE. Someone will hear you. If we all stand strong together and speak up, we can begin to take the necessary steps to end the cycle of elder abuse. If elder abuse happened to me, Mickey Rooney, it can happen to anyone. (Excerpted from testimony given before the U.S. Senate Special Committee on Aging.)
31
the l a s t word
by lOuIs J. gANIM
do you tweet?
hile we tend to think of social networking as the province of the young, more and more older adults are finding their way to these websites, particularly facebook. for those of you who dont get the whole social networking thing twitter, which recently celebrated its fifth birthday, particularly puzzles a number of folks, including me the adoption of social networking by seniors is something that makes a great deal of sense. seniors are much less likely to, um, tweet than they are to share information and stay in touch by way of facebook. while writing this, I logged on to twitter and these are among the tweets I found: Big weekend coming up! My Star Trek club is going to dress as Klingons and ambush some loser civil war re-enactors/ Just ate some tacos / Now my stomach is aching / I have diarrhea. As the sun sets, the moon rises...
I dont know the age of these twitterers, but Im going to take a guess and say this group tops out at maybe 21 years old. It would seem to me that most older adults wouldnt want to waste their time sharing intimate thoughts such as the ones noted with their twitter followers. Im not sure, even, that most would be interested in sharing any of their 140-character-limited thoughts. Im sure there are exceptions. Most older adults who have embraced the Internet continue to rely on email as their main method of communication, according to research thats been conducted in the past year. More and more, however, they are heading toward facebook as a way to keep in touch with family and friends. AARP says that 25 percent of their members are using facebook. And the number is growing.
A 2010 AARP survey found that 40 percent of adults 50 and older consider themselves comfortable using the Internet. In other research, Pew Internet surveyed older adults and found that while social media use has grown dramatically across all age groups, older users have been especially enthusiasticabout embracing new networking tools. social networking use among Internet users ages 50 and older nearly doubled from 22 percent in April 2009 to 42 percent in May 2010. A digital measurement company Comscore says that the number of those 55 and older who are engaged in social networking rose from 16 million in 2009 to 27.4 million in 2010. whats the attraction? for one, facebook, for example, is a way for seniors to stay in touch with family members who may be far-flung. videos and photographs of grandchildren can be readily shared and family news items can be posted, offering a quick and frequent way, if not daily, for older adults to learn whats going on. Mary Madden, senior research specialist for Pew, told NPR recently that while email is still at the center of older adults social communications, social networking is a growing supplement for their everyday communications. Once they start, she told NPR, they are using it more frequently. being online and being involved in social networking helps older adults, especially those who are frail and with limited mobility, who may be cut off from everyday activities outside the home, and those with children living in different states and long-time friends who dont live nearby. todays seniors also want to stay connected to their neighborhoods and to continue to be a part of society. An AARP study revealed that a third of those 75 and older live alone, and websites like facebook can relieve the stress of loneliness and isolation, and the
depression that sometimes comes with that stress. social networking also gives older adults a way to make new friends and to reconnect with old ones that they have lost touch with over the years. while social networking remains the domain of the younger generation, older adults are fast encroaching on this Internet space. Comscore found in 2010 that in a single year, the number of those 65 and older using social networks increased from 16 million to 27.4 million. the Pew study said that the increase between 2009 and 2010 went from 13 percent to 26 percent. while the numbers pale in comparison to the younger generation (75 percent of those aged 8 to 24 use a social networking site), its clear that older adults continue to flock to social networking. And by all accounts, it seems that seniors are more frequent users of social networking. Probably if you were to look at the average younger persons facebook page, youd find a lot of frivolity, whereas the area maintained by older adults are pretty much all about learning about whats going on with their families, especially grandchildren, and their friends. Email and social networking sites have also proven to be a godsend for adult children living distantly from their aging parents, helping them stay connected on a regular basis, Most of all, however, social networking on the Internet is a way to compensate for the loss of a social network based on face-to-face relationships. that loss commonly happens as persons age, especially for those living alone and those who have difficulty getting out into the world. Its true, too, that the longer one lives, the smaller the circle of long-time friends gets. Making new friends isnt always easy, and the opportunities arent always there. social networking on the web changes that for older adults.
33
VillageCare 154 Christopher Street New York, NY 10014
Looking for doctors who care?
HealtH Center
Open Monday - Friday. Early evening and weekend appointments available.
(Between Sixth and Seventh Avenues)
121A West 20th Street
We accept Medicare, Medicaid and most insurances.
212.337.9290
Walk-ins are Welcome
PRIMARY CARE
Diabetes Cholesterol Preventive Medicine Infectious Disease Immunizations Nutrition Womens Health
MENTAL HEALTH SERVICES DENTAL SERVICES

Dental Examination Prophylaxis 34 vi l la ge Ca r e t O dAy Restorations X-Rays
| s p ri ng 2011

VillageCare Today - Spring 2011

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Spring 2011

An Important New Residential Care Offering for the Community

12 An Emphatic Exclamation Point

20 shawn thorne Is Moving forward with Momentum

22 gatekeepers: looking Out for One senior at a time

24 fifteen years of Rivington house

the last word

Baby Boomers turn 65 and Face a Doctor shortage

north shore-LiJ and VillageCare open urgent Care Center

rivington House HiV Conference

Russian visitors Come to Rivington house

Participant Art Exhibited

HiV/aiDs in nyC: a snapshot

107,177 New York City residents are living with HIV/AIDS,

new HiV/aiDs Diagnoses

1,823 people were newly diagnosed with HIV/AIDS in New

40% of new HIV/AIDS diagnoses were among men who

world AIds day

Mirikitani Painting showcased at the smithsonian

New Rehabilitation and Nursing Center Ribbon-Cutting

white house director of AIds Policy visits Rivington

An Emphatic Exclamation Point

Looking Out for Seniors,

serving AIds Patients since 95

Rivington House Looks Back, and Ahead to the Future

At Village, we say, Whats our mission?

Whats our purpose?

We will be there until there is a

cure for AIDS.

More pay, better work relationships, being appreciated, listened to and

treated with respect.

You can be in control

VillageCare 154 Christopher Street New York, NY 10014

Looking for doctors who care?

(Between Sixth and Seventh Avenues)

121A West 20th Street

We accept Medicare, Medicaid and most insurances.

Walk-ins are Welcome

MENTAL HEALTH SERVICES DENTAL SERVICES

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