Washington County CARES...Creating Solutions for our Aging Community

Washington County CARES
...Creating Solutions for our Aging Community
by Dawn Johns
Community Relations Director for Hospice of Washington

Washington County is really not that different from other rural communities across America when it comes to the increase in aging residents. The difference in Washington County is that the issues surrounding aging, caregiving, and end of life care are not going unnoticed and are being addressed. Actually the exact opposite is happening due to the efforts of a "grassroots" coalition that has formed and aimed their attention on improving life for the elderly and those associated with their care.
Washington County CARES began in October 2002 as a small group of committed healthcare providers wishing to unite their energies toward discussing and strategizing on the future care of older residents and their care providers in Washington County. Many agencies within the county offer specific services for the elderly, some services overlap, but the reality is, many gaps are still present. The coalition's primary goal, in its early conception, was to bring many of those services together in an attempt to close the gap. The three key areas of concentration focused on advance care planning, caregiving, and end of life care.

Advance Care Planning Workshops
The coalition members have successfully presented advance care planning information to civic groups and organizations seeking further education. Both, Marie Thompson and Susan Lyons, nurses at Washington County Hospital, are experts in the field of advance care planning and have shared their expertise by offering advance care planning workshops to the general community. They have also helped with training other coalition members on how to do advance care planning presentations.
When people have not given thought to their wishes and goals of care their health becomes compromised. Because of this, the coalition focused part of its attention in this area with the hopes of decreasing the overwhelming stress created in the midst of crisis.
Too often we find people not considering options for how they want to spend their days when they enter into a medical crisis or the last phase of life. The planning ahead allows individuals to think about what they want before a crisis begins. Additionally, advance care planning allows family members and health care providers to know exactly what steps of care are appropriate--given the patient's wishes. It can be a blessing for family members to know in advance their loved ones' wishes and honor those wishes at the time.
Getting started on advance care planning may be one of the hardest things to begin. This really needs to start through conversation with those who may be acting for you. Individuals need to initiate important conversations that express their wishes or goals with those closest to them and then share that with the primary care physician. Writing it down is the next step. This can be relatively simple and many organizations, such as Hospice of Washington County, Inc. and Washington County Hospital Palliative Care Services, offer assistance for anyone having questions regarding the forms or advance directive. Next, share a copy with your physician and the person(s) that will represent you as your medical agent or power of attorney. The last step in advance care planning is to review your plan periodically. Some states ask residents upon renewing their driver's license if they wish to make changes to their advance directive.
In Maryland, we currently do not have a formal registry for completed advance directives, however, House Bill 236 has passed and is awaiting the Governor's signature. Bill 236 establishes an advance directive registry in the Department of Health and Mental Hygiene; authorizes the Secretary to adopt regulations; requires the Department to carry out educational and outreach efforts about the registry; authorizes an individual to register an advance directive with the Department; provides for the placement of a notation on a driver's license or identification card that a person has made a registered advance directive; etc.
The CARES sub-committee on Caregiving and End of Life Care will continue to follow the progress of this very important.

Researchers have found that those providing care for their ill or elderly loved ones are likely to suffer from their own decline in health or mental status. Often an individual becomes a caregiver overnight without instruction or knowledge on how to do so.
The CARES coalition recognizes that caregivers need support to perform the arduous task of caregiving. Through offering support to the local community, the coalition has supported Washington County Hospital's Annual Caregiver Conference. In 2005, CARES produced its first annual Caregiver's Calendar that serves as a monthly information and support guide to caregivers. It also has information on a monthly Caregiver's Support Group facilitated by Sheri Evans at Somerford Assisted Living.

End of Life Care
Choosing comprehensive care from birth to death is the "norm" in today's health driven society. Typically, through modern technologies and advances, patients receive high tech procedures, medications, and options. The concern that members of the coalition have expressed is that health care has become challenging, both for the patient and the provider. It is important that both have a common ground to express both the patient's wishes and the provider's expertise on care options. Education is the vital link in trying to understand the medical maze--knowing when treatments may be futile and comfort care is the optimal choice.
Washington County CARES has supported community events such as "Stranger in a Strange Land" that Hospice of Washington County, Inc. and the Washington County Hospital sponsored. The five week educational program provided participants with information on the broad spectrum of planning for and experiencing complicated medical conditions. They have also supported the Annual Palliative Care Conference and the Retirement and Beyond Fair held each fall at the Valley Mall in an attempt to provide education to the community on navigating the rigors of today's complex health care system.

Reorganization of Cares
Since October 2005, Washington County CARES has had a major organizational change, for the better. Originally, about a dozen individuals from local agencies were the worker-bees of the coalition with another handful of associate members that did not provide help with hands-on activities. From October 2002 to 2005, the coalition busily worked on projects and the summer of 2005 seized the opportunity to participate at the local level on President Bush's 2005 White House Conference on Aging (WHCoA).
The WHCoA convenes once a decade to make aging-policy recommendations to the President and Congress, highlighting some of the pressing issues related to aging. In the past, from WHCoA conferences programs have emerged and policies have dramatically changed aging services. The Older Americans Act of 1965, which established the federal Administration on Aging and many state commissions on aging, was a direct result of the 1961 WHCoA. In 1971, the WHCoA resulted in a national nutrition program for older adults. Again in 1995, the WHCoA, reaffirmed support for existing programs, especially those constituting the social safety net for older Americans.
Although it is too early to know what results may occur from the 2005 WHCoA on a national level, we know that at the local level the impact can be measured by the positive outcomes seen since the public address in October. It has been since that time that the CARES coalition reorganized and captured the attention of many local agencies that had not been previously involved.
Today, the coalition has a board of 22 with representation from area agencies and community members. Officers for the Board are: Dawn Johns of Hospice of Washington County, Inc., President Rev. David Baker of Western Maryland Hospital Center, Vice President Mindy Propst of Easter Seals Adult Day Services, Secretary and Treasurer Sheri Evans of Somerford Assisted Living. The Board meets on a monthly basis and provides public forums 2-3 times yearly for up-to-date information on the work of the coalition.

As part of the reorganization, the CARES mission statement changed to reflect the new direction and vision for which the organization will direct their activities. The mission statement now says, "Through a shared and mutual commitment, we strive to enhance awareness, provide education, and improve the quality of life for the Washington County community."

To better serve the mission of CARES and the community needs, six sub-committees have formed. The committees are: Aging Well, chaired by Susan MacDonald, executive director at Commission on Aging, Caregiving and End of Life Care, chaired by Dawn Johns, community relations director at Hospice of Washington County, Inc., and Events, co-chaired by Terri Baker, executive director at REACH, and Emily McFarland, communications director at Williamsport Retirement Village, Mental Health, chaired by Mindy Propst at Easter Seals Adult Day Services, Resource Planning, chaired by John Kenney, adult services director at the Department of Social Services, and Transportation, co-chaired by Peggy Martin and Bill Beard of Many Individuals Helping Individuals.

To Learn More
Washington County CARES intends to remain abreast of the needs of our elderly residents while working collaboratively with local agencies to produce positive outcomes for the county's residents. Caring for the elderly and their caregivers is important to all of the agencies involved, as may be the situation with other agencies not currently involved. Anyone with interest in CARES or the work of a sub-committee is welcome to contact Dawn Johns at drjohns@hospiceofwc.org or call her at 301-791-6360.