"They make sure the dietitian meets with me and I see the doctor probably a couple of times a month," Hanson says. "The diabetes is under control. I can't say enough about the medical service I get."
And when Hanson had to spend another week in a nursing home after an angina episode, he wasn't afraid that he'd never get out. He knew Gaughan had a plan for returning him home.
"Our goal is to prevent people from staying in nursing homes any longer than they need to," Gaughan says. With Hanson, "we set up additional home care services for him once he went back home, so we knew he'd be taken care of. That really helped the transition happen a lot quicker than it would usually."
Housing a huge obstacle
NewCourtland, where Thomas Smallwood lives, provides accessible housing to people who otherwise would have to remain in long-term care. Often, someone suffering an injury or stroke is sent to a nursing home for rehabilitation. Then a social worker determines that the person's home — Philadelphia is famous for its narrow, multilevel row houses — is no longer safe.
This is a common scenario, according to Beth Cwiklinski, director of the NewCourtland Life Program. "Accessible, affordable, safe housing is the biggest issue, because they couldn't return to that row home that had 13 steps to get into the house," Cwiklinski says.
Or even worse, after an extended hospital and nursing home stay, an older person cannot return home because there is simply no more home. The patient hasn't, or was unable to, pay the rent and is evicted — a harsh reality considering people want to spend their twilight years in their own homes. A recent AARP poll of people age 45 and older shows that nearly three-quarters of respondents want to remain in their own homes as they age, and that desire increases as people age.
"I've had plenty of people say that they would simply just rather be dead then be in a nursing home," says Gaughan. "It's very sad. Most of our people have developed a real routine in their lives. They know where everything is in their home and they know their neighbors. To be taken out of that routine — it's more difficult for an elder person to handle that kind of change."
Fortunately, a movement is afoot to keep older people independent as long as possible. NewCourtland and St. Paul's are two independent examples, but there's also political momentum based on the theory that paying for community supports could be cheaper than paying for nursing home care.