FEATURE STORY — November/December 2004

UIC's Central West Case Management Unit helps the elderly live independently

By Lisa Stodder

It's 9 a.m. and Jonessa Cannon BSW '02, MSW '04, is in Chicago's Austin neighborhood, making her rounds as a case manager with UIC's Central West Case Management Unit, a community-based organization that offers programs designed to help older adults live as independently as possible.

Professionally attired in a black-and-white shirt and black slacks, Cannon sits at the dining room table in her client's comfortable but modest apartment. Her client, Evelyn (the names of some individuals in this article have been changed to protect their identity), has just given Cannon a tour of the flat. The worn green rug, piano with an open hymnbook and lamps with dusty globes suggest little has changed in the 30 years that she's lived here.

Evelyn sits at the table wearing a lightweight dressing gown, eating oatmeal from a cup. "I'm 84-years-old and haven't had no health problems, thank the lord," she says.

Cannon, age 32, shuffles through papers, sorting out Evelyn's financial affairs and income. Cannon grew up in the community, and her easy manner meshes well with Evelyn's. With the preliminaries out of the way, she asks Evelyn for a bank statement.

"You can check it, but there's nothing in it. When you're living on a pension, you've got to stretch every dime." Evelyn, slightly slope-shouldered and slow on her feet, gets up to find her bank book.

Evelyn's assets and annual pension of $8,000 meet the program's financial criterion. (To qualify, total assets must not exceed $12,500.)

Next, Cannon must take an inventory of Evelyn's needs, health and resources. If the outcome is in her favor, she could be provided with home-delivered meals, transportation, homemaker services, respite care and other needed services.

During the interview, Evelyn gets up to show Cannon a decorative plate commemorating the Baptist church her father founded, a photo of her husband (who died in 1980) and the kindhearted note someone sent after finding her stolen wallet in an alley.

While it's easy to be lured into the stories and histories of her clients, Cannon is actively observing. Evelyn can still get up and sit down, feed herself, pay bills and remember things. She plays piano and attends church. She drives on occasion. Two stepchildren visit and help out financially, and her nephew takes her to the grocery store.

Although the effects of age have slowed her down (she recently had a cataract operation), Evelyn functions without major impairments or infirmities.

Cannon gently breaks the news to her that she's doing all right and doesn't qualify for home services.

Evelyn's head tilts a little to the side, and her face grows somber. Good news but not the news she wanted to hear.

The Graying of America

Next year, when Evelyn turns 85, she will join the ranks of what the Census Bureau refers to as the "oldest old," adults 85 and older, considered to be the fastest growing age segment in many countries worldwide. In the United States, this population has doubled in the last 20 years.

According to the 2000 U.S. Census, nearly 13 percent of the population was 65 and older. By 2030, that segment is expected to increase to 20 percent, the result of the baby boom generation (those born from 1946 to 1964) reaching the age of 65, starting in 2011.

In 1965, the Older Americans Act was signed into law to create the Administration on Aging, and states began to receive funding to provide services for people over 60 years of age. In 2000, the act was amended to provide funds for more services.

According to Government Spending in an Older America, a report published by Population Reference, "Public finances must be adapted to deal with a new demographic situation ... Nearly 70 percent of nursing home residents are covered by Medicaid" and represent "35 percent of overall spending" in the program.

Helping older adults stay independent—and out of costly nursing home care—is part of a growing nationwide civic initiative. The term "aging in place" describes the process of growing older without having to move from one's home and community, with support services provided as they become needed. The aging-in-place agenda promotes "elder-friendly" programs in communities. The term has also been appropriated by those marketing senior lifestyle housing.

"It's about creating options. Why shouldn't the consumer decide?" asks Paul Bennett, program director of the Central West Case Management Unit. "Ask any senior. Your goal is not to retire to a nursing home. Several bills are pending in the state legislature ... to move more state dollars from institutional care to community-based care."

Incorporating Research and Teaching

UIC's Central West Case Management Unit provides community-based assessments to help older adults stay independent in the community. Through its contracts with the Illinois and Chicago Departments on Aging, the unit administers to adults 60 years and older on Chicago's central West Side. In addition to home visits, the unit provides assessments at 15 West Side medical facilities, offering hospitalized clients a choice prior to admission to nursing homes.

Sixty-five case coordination units operate statewide, but UIC's is the only community service agency to have a research, teaching and learning component. The university context for the service agency encourages staff to continue their education, which allows them to become better service providers.

In addition, the unit is gaining prominence in the field. "We've helped raise the bar in what is considered case management statewide," says Bennett. "And we've emerged as a leader."

"There were many service providers available for the elderly, but there wasn't [one devoted to] integrating research and teaching with the service," says Creasie Finney Hairston, dean of the Jane Addams College of Social Work. "Our unit is unique in that way, and the only one connected to a university." (Since 1999, the college has provided administrative leadership for the unit.)

Two years ago, the college received a grant from the Hartford Foundation, which sponsors curriculum development in gerontology and recruitment of social workers.

Elizabeth Essex, a Hartford Geriatric Social Worker Scholar and an assistant professor at the College of Social Work, drew on the unit's work with older adults to gain insight into "care-giving patterns in increasingly complex households." In addition, Essex and the unit worked together and developed a care-giving form to enhance information collection for assessments.

"Only 5 percent of master's-level students specialize in aging," says Essex. "So I think it's a real asset to have this program at the college. It's a lab for research and learning. Older adults have not had enough attention from social work schools."

Although social work is reported to have a high attrition rate, Bennett says he has no problem retaining his staff. He attributes the unit's success to "the positive atmosphere and educational opportunities."

Photography: Andrew Campbell