Full Circle America, INC 1.888.873.8817

Personal Member Advocate

Can be friend, family member, person who made referral, volunteer, another more experienced member, phone tree captain, staff person; Duties: Contact member as often as appropriate: emphasize flexible, natural relationship; 'Actionable' Information is reported to either the office manager/ a staff person for immediate follow up.

Telephone Checks

Depending upon the level of support requested, we have volunteers make telephone calls to each member. We recommend calls at least once a day, but often a follow-up call is needed. We have found our members prefer to ease into this. The relationship develops slowly, with either the new member calling us, or more commonly, one of our telephone captains initially calling a new member a few times a week. The content is meant to be fluid and friendly, and private unless the member seeks otherwise, or the phone captain detects some actionable information.

Video Spot Checking

We utilize web-enabled pan and tilt cameras that are ID and password protected, but accessible to authorized family and staff from wherever internet service is available, our members and their families have tremendous peace of mind that an elder is safe and secure, and that someone local and dedicated to their well being is assisting them.

Depending upon the level of support selected by the member, video spot-checks are performed on a schedule and as needed when there is concern about the member. The checks are performed by one of our paid or volunteer staff. With our current technology each check is logged and any 'actionable information' is conveyed to the office manager or health care professional on call. The phrases 'every picture tells a story' or 'a picture is worth a thousand words' absolutely convey the value of these cameras to the members of the network.

Since we monitor primarily the kitchen, dishes in the sink or not, newspaper or mail on the kitchen table or not, visitors at the kitchen table or the member getting something out of the refrigerator, with all the shots time-stamped, and able to have notations logged, tell a great deal about the day. As mentioned, all of this is also available to authorized family and friends and accessible over the Internet from anywhere.

These snapshots provide a body of work that surpasses anything most residential care facilities can offer. They rival and sometimes exceed the information provided by in-home caregivers since the information is unfiltered, and candid, not shaped by the interaction between member and caregiver. For many members, this surveillance is much less intrusive than agency caregivers being in their homes many hours a day.

Most members do not find these video spot-checks an invasion of privacy. As a matter of fact, many members find great comfort in knowing someone is looking out for them. Most cameras come with privacy buttons. All cameras can be easily draped with a napkin to afford immediate privacy. Moreover, the images are not being broadcast indiscriminately, but are only available to authorized individuals with the password. Most images are erased on a daily basis, with the only ones that are archived or saved representing that day in a members life, or confirming that a scheduled paid visit or service was performed. Compare this inconvenience to the far larger loss of privacy which results from moving into a double bedroom in a residential care facility, sharing a bathroom, bureau, and closet with a complete stranger, and being tended to by a constantly changing staff of caregivers. To challenge the contention that Big Brother is watching, I offer the following. Despite the Orwellian connotation, many big brothers historically have been a welcome protector. It is also key to remember that every level of support, and monitoring, is by the choice and consent of the member. A decision that can be reversed at their discretion.

So far, video care of members has detected falls, and led to prompt staff responses, averting many trips to a hospital. Other times, power outages and furnace failures have been detected and addressed. This tool also provides to us a well documented means of quality assurance. We can see for ourselves whether our staff member or volunteer has arrived when expected and how long they have remained. Substandard performers are easily weeded out. Once we identified a private caregiver (not one of ours thank goodness) stealing from a member, which led to the return of the stolen money.

Most importantly, the warmth and richness of the images immediately draw one into the lives of the members, and extend that same feeling to distant family members. They also give extraordinary detail that can often identify changes before a major problem develops. So, despite the initial reluctance of many older individuals to embrace such a new idea, it only takes one incident for a camera to prove its value. As the Maine Approach headlines choice, no member is required to have such a service. We are confident that with time, as a member's trust of us and our approach grow, they will see the wisdom of this feature.

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Home Visits

Home visits are an essential feature of the Maine Approach. No sophisticated technology can take the place of such personal interaction. What we call "touches". The home visit may be from a nurse, another staff person, the personal advocate, or a volunteer. Often the visitors are also members fulfilling their own desire to be helpful. All are selected because of their people skills, and dedication to the mission. Because of the uniqueness of our approach, we are able to attract the best from every community.

The frequency of visits is partially determined by the package chosen. The length of the visit is not predetermined but generally lasts from 15 minutes to an hour depending upon the situation. The content of the visit is similarly unscripted. But the goal is primarily to see that each member is getting what they expect and need, and helping to problem solve together with the member around any unmet need or desire. Often the need is as simple as taking out the trash or getting the mail. Simple things.

Home visits can be used to teach a member a new skill. They can be used to initiate a video call to a family member or friend. They are used to share video highlights from a recent event on the Elder TV site or further explain the social networking features.

Together with the errand and transportation services, the visits provide opportunities to grow the relationship, and to reduce the loneliness and isolation of members. Sometimes including another member in a home visit provides mutual benefit. Several members of our community have known each other from their earlier days, but due to declining health or other reasons, have lost touch. They now welcome the opportunity to be reconnected by our staff person or a volunteer. Carol and Janet have helped orchestrate and execute several small dinner parties and small group outings.

Transportation & Errand Services

Elders often cite transportation as their most challenging obstacle to home living. Whether it is getting to doctor appointments, grocery shopping, or running necessary errands, the tasks associated with getting out of the house become formidable when declining vision, balance, and strength interfere. Difficulties dealing with such basic needs preclude rekindling any interest in other community events such as movies, theater, music, sports, church and service organizations. Combating rampant loneliness and isolation among elders in our community mandates addressing transportation. It is an essential piece of any effort to help elders stay in their own homes and to renew their involvement with family, friends, and community.

We have included a basic level of transportation service within our packages and more extensive services are available to meet the needs of members who are required to make multiple trips or appointments each week. Ideally family, church groups, and friends will meet the transportation needs related to health care so our focus can be to get the member out of the house for some fun. We feel philosophically that a disproportionate amount of transportation resource in most communities is devoted to medical issues.

Volunteer Opportunities

We need to see our elders as a hidden resource for both affordable labor and volunteer effort. Once recognized as capable of making a difference in so many ways in their community, it is only natural to design a program around the abilities of our elders. The arithmetic is compelling. If just 10-15% of the over 65 population will contribute four hours a week to a meaningful activity, the resultant labor force would meet all of the needs of every elder.

We are not talking about token busy work here. We have identified the individual triggers that cause elders and their families to seek residential care options for their loved ones. Then we defined the ways in which many other elders and community members can address these triggers. We continue to implement the process. But it is abundantly clear that if we identify the specific tasks that need doing, we can then delegate these to the appropriate members of the elder community thereby fundamentally changing the outcome of residential care placement in many cases.

Most seniors desire to continue to make meaningful contributions to the communities around them. When I spoke to the Pemaquid Cooperative Ministry's Community Outreach forum in March, 2010, more than a dozen 90-plus year-olds in attendance signed up to volunteer to help their neighbors in the approach we outlined. It was truly remarkable to see so many elders who are not commonly sought out, commit to participate. Clearly our approach resonated loudly with their sense of what needs to be done.

Emergency Call Buttons

We use LogicMark products called Guardian 911 and Freedom Alert. The advantages are that these buttons has no recurring monthly fees. They are purchased outright with a one-time cost and then is owned by the customer. We have chosen to include it in every Freedom package we offer.

Guardian 911 and Freedom Alert systems have several other advantages. The speaker is on the device you carry rather than back at the base station. This allows the wearer to talk directly to the call center representative rather than trying to talk from a separate room or even through a closed door. Their latest product, the Freedom Alert button, has three modes on the back of the base station: direct 911 notification, sequential dialing of four programmable numbers, or the programmable sequence followed by an automatic 911 call. This button fits many circumstances where a frail elder cannot get to nor use a telephone easily. It can become their version of a cordless receiver, albeit limited to one specific number or sequence. So we have incorporated their features into our packages, knowing that they play a role. With the passive monitoring available with our webcams and motion sensors, they make our packages the most comprehensive available.

Weekly Planner

This simple tool came out of our experience where home health agencies routinely scheduled their visits around their availability not that of the customer. It not only was insensitive to the client's life but also many elders would not do anything else that day other than wait for their visitor. The form we use allows us to have a pretty good read at a glance of the individual elders life and routine. We can help them plan an outing or tailor a volunteer visit to fill in a slow part of their week. We can remind them of upcoming events or appointments. We can share this information with the phone tree captain, our nurse, and the video spot-checker to coordinate their roles.

Monthly Activity Calendar

A Monthly Activity Calendar is compiled at least a week in advance of the start of every month. It merges the community calendar provided by the local newspaper with that provided by the senior center, the residential care homes, and public radio. It attempts to highlight those activities that may interest our members.

This calendar is more than a bulletin. We seek to have every member attend at least one and preferably two non-medical events outside of their homes each month. We have found that the positive impact of attendance at such events can last weeks. We call this afterglow effect a "bounce", and it can make all the difference.

Our personal advocates, phone captain, home visitors, and other volunteers are all charged with helping identify events that each member would like to participate in. Next, it is their follow-up task to help implement that member's attendance at their selected events. We will help with tickets and transportation. We offer reminders. It is in keeping with our mission to engage elders in events going on in their community.

Full Circle Activity Outline

Go Out For Lunch: Monday at the Elementary School / Tuesday at the High School / Wednesday at Senior Center/ Thursday at Area Churches / Friday at Area Restaurants

Join and Host A Supper Club: Socialize Monthly for the Fun of It. You are the host once a year. Help with preparation and clean-up provided.

Take A Class / Attend A Lecture: Senior College/ Adult Ed / Area Speakers

Take In A Movie Locally: Monday at Skidompha Library in the evening / Thursday afternoon at someone's home.

Help Someone With Easy Repairs: From repairing a lamp or a picture frame to a storm window project.

Baby Sit: Help give a Young Mother a Break.

Host A Young Student A Few Hours A Week: Provide a Quiet Place To Do Homework

Be A Buddy To An Older Neighbor A Few Hours A Week

Hire A Youth To Do Some Yard Work

Teach A Youth To Bake, Or Sew

Join A Volunteer Event Crew: Help Local Non-Profits Host Their Occasional Events

Offer A Ride To Someone Else / Pick Up An Order While You Are Already Out

Join A Catering Service: Dig Out a Favorite Recipe to Make a Home-Cooked Meal for Someone Else

Join The Community Call Center: Make a Few Phone Calls to Remind Someone to Take their Medicine, or Encourage Them to Join a Local Activity, or Just Chat.

Mental Health Assessment

This Maine Approach feature grew out of our desire to demonstrate the value and power of what we were doing. Empirically, it made sense that if we could improve the rest of an older individual's life they would be happier, need less medical care, and be healthier longer. But we needed to find a way to track such data in a way that was not too cumbersome. The ASEBA scoring system pioneered by Dr. Achenbach and the Vermont Center for Children, Youth, and Family provided the tool we were looking for. It has an Older Adult Behavioral Checklist that can be scored by our members or their families. It scores each member in the domains of depression, anxiety, cognition, attention, behavior, and physical functioning. We have chosen to offer it twice a year.

Monthly Summary

In keeping with our desire to regular prove ourselves to our customers, we send a brief summary, on request, to the individual, a family member, or the individual's primary care physician. It is a simple summary of the monthly highlights of that member and the service package they have received.

Respite Opportunities

Respite care is a concept whereby individuals, while desiring to stay in their own homes or with extended family members in their homes, often need temporary room and board when their primary care-giving family member is unavailable due to work, illness, hobbies, children, or vacation. As a concept, respite care is gaining traction, but capacity is lacking in most communities. We have successfully tested a 'Home Away From Home' Program whereby older homeowners may contribute spare rooms to our network pool for respite care, day care, and additional social networking.