Goliath Joins David to Care for the Aging

“It’s the magic of risking everything for a dream that nobody sees but you.”

That line from the movie “Million Dollar Baby” – the last to screen at San Francisco’s Coronet Theater, now home to the city’s Institute on Aging – captures the dream of aging pioneer Dr. Lawrence Feigenbaum, who nearly 40 years ago envisioned comprehensive health services as an alternative to nursing home placement.

Modest beginnings as an adult day health center at Mount Zion Hospital eventually spawned today’s non-profit Institute which features an impressive array of wraparound health services for older adults – physical, mental and social – that annually treats 8,000 older adults.

Its evolution has been so successful that one of San Francisco’s mighty health Goliaths – the University of California San Francisco Medical Center – is moving a primary care practice that serves 1,000 patients inside the Institute’s Inner Richmond neighborhood headquarters.

So what does tiny David have that Goliath so admires?

“A proven record of offering programs that support the psychosocial care needs of older and disabled adults,” says Dr. Daniel Pound, a senior care specialist UCSF’s Lakeside Senior Medical Center.

Dr. Patrick Arbore, who heads the Institute’s behavioral health programs, puts it in directly human terms.

“They’re really wise to consider being at street level so that older people can find them in a setting that’s more hospitable,” says Arbore of UCSF. “It’s a labyrinth to find one’s way (there).”

Arbore proudly trumpets the Institute’s strengths, while pointedly noting differences in the two operations.

“We’ve got people here who are very sensitive to the needs of older people.”

At its adult day program, director Tracy McCloud often plays the piano for clients. Lifeways program director Erika Falk excitedly lectures on coping skills to members of PACE – the Program of All-Inclusive Care for the Elderly – a highly successful national program that provides high-needs patients with integrated health care as both health insurer and health services provider.

In other words, it’s a unique San Francisco vibe – as intimate as poetry and jazz.

A new headquarters opened in 2011 houses the Institute on its bottom two floors. The top four floors are 150 units of low-income housing, with many of its residents receiving health care downstairs.

Patricia Bentley was in a motorized wheelchair after 57 falls, several suicide attempts, and a variety of complex illnesses so debilitating her landlord threatened to evict her.

“Once I moved to the Coronet I have my health issues taken care of, my mental health issues taken care of, my lifestyle taken care of,” says Bentley.

The Institute also provides in-home assessments for older adults to provide everyday assistance such as bookkeeping, medication management, legal assistance, bill paying, and basic household tasks. It also makes physician referrals.

“Part of what we do is provide a safety net for wherever they are,” says Cindy Kaufman, chief operating officer. “We look at behaviors across the spectrum.”

“You want to keep them engaged on every level possible – physically, socially, creatively, cognitively – all of those,” says McCloud.

Maureen Morales says her father – veteran B-52 mechanic Al Patterson – would just sit at home if not for the Institute’s day care program.

“Since he’s been going, I’ve noticed a big change,” she says. “He’s just really happy when he gets home…. He’s more outgoing, less depressed.”

The second floor of the building is circled by a “Tree of Life” mural, one of many art projects at the Institute that draws artists from the surrounding art community.

The Institute has forged host of collaborations ranging from health centers to the Alzheimer’s Association. It acts as the lead organization for the city’s Community Living Fund to help the elderly and disabled remain in their homes. It operates a WellElder program for Northern California Presbyterian Homes & Services. It also participates with many other programs: the San Francisco Transitional Care Program, the Northern California Geriatric Education Center, and GRACE – Geriatric Resources for Assessment and Care of Elders.

Most impressively, the Institute has made behavioral health a top priority.

“It’s essential that we’re more thoughtful,” says Arbore, who in March received an award from the American Society on Aging for outstanding contributions to the field. “Especially in these days of incredible strain.”

For older adults, says Arbore, positive mental health can easily be disrupted by political diatribes or current events like the Boston Marathon bombing.

“What it does for a lot of people is reawaken old wounds, and issues of trust,” he says. “That’s one of the main themes since 2008 – ‘I’m going to run out of money before I die.’”

The Institute provides psychotherapy home visits to screen for depression, anxiety, substance abuse and pain management. Recommended treatment can include home psychotherapy by local psychology graduate students.

All employees – including non-therapeutic staff – are trained in behavioral health skills.

The Institute offers a Saturday morning grief group. It also operates a suicide prevention hotline and a “friendship line.” The institute fields about 3,000 incoming calls a month, while volunteers make 3,500 outgoing calls.

Funded by the city and county, as well as numerous grants, the Institute also operates a fee-for-service division, which screens and places workers in more affluent homes that can pay for elderly home care.

Although aging pioneer Dr. Feigenbaum passed away earlier this year, his magical vision for integrated, humane care lives on in the City by the Bay.

“We really believe connections bind us to life,” says Arbore.

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