Vinalhaven Service List
As the largest island in Maine, Vinalhaven lacks neither a sizeable ageing population nor a variety of services. However, many Vinalhaven elders didn’t know whom to call to get their lawn mowed or get a ride to the grocery store. To bridge the gap, a group of volunteers created and distributed a list of available service providers.
How It Works
Residents have a name and phone number to call when they need assistance with common household tasks, including handyman work, lawn care, shoveling, personal care, paperwork, pet care, shopping, transportation, and social opportunities. It takes a burden off of families, and means that the older population can have more independence and stay in their homes much longer.
- Gather a group of community members.
- Meet with elders to figure out which needs are and aren’t being met. Ask which services they're unsure about.
- Check with service providers, then add them to the list.
- Distribute the list around the island.
- Check in periodically to update list and assess any service gaps.
Q & A with Kelsey Byrd, former Island Fellow on Vinalhaven
Q: How did this program fit into what’s already on the island?
A: There are already groups that help elders on the island, like meals on wheels once a week, Monday lunch and a fuel fund through the church, and the fire department calls people after storms to make sure things are cleared and shoveled. We wanted to pull those people together, and add more to the list. We tried to understand the network of support, and fill the gaps.
Q: What about Calderwood, the assisted living home?
A: Calderwood is successful, but it’s helping a small part of the community. There are over 100 adults over 65, and 80 over 70 years old, and they will need assisted living in the next 10 years. Calderwood is very important to the community, but getting in is like winning the lottery. We also need to create levels of care, not just more beds. It’s important to have different programs for different ages and abilities.
Q: What works well, and what doesn’t work as well?
A: People don’t want formal help. They need a balance of something that feels informal and friendly, but actually helps. We’re making this about gaining independence and control. The service list is important for that reason.
The volunteer group discovered that some services were either lacking or underused, such as transportation around the island. Part of their work was finding people to meet those stated needs, and then encouraging elders to actually use them.
Outcomes / Results
The first edition of the list has 37 phone numbers for services in eight categories: Handyman, Lawn & Garden Care, Plowing/Shoveling, Personal Care, Shopping/Errands, Paperwork, Pet Care, and Transportation. It also lists a number of ongoing social opportunities.
North Haven Outreach Worker
Aging islanders often don’t need full-time help, but when traveling to the mainland for a medical appointment or cleaning their house, an extra set of hands makes it easier and safer. When elders are still fairly mobile they often have a hard time admitting they need help, especially if they have to pay for it.
The North Haven Outreach Worker position has been around since the 1970s, and is funded almost entirely by the private Pulpit Harbor Foundation. It’s not only for elderly residents, but Lindsey Beverage, the outreach worker for the past nine years, mostly works with older islanders.
How It Works
Lindsey helps those in need with transportation to medical appointments, shopping, banking, and other errands off the island. She installs medical alert units in homes, and will act as liaison for medical appointments, relating the outcome to the patient’s family and getting prescriptions. She connects people with wheelchairs, walkers, and other equipment owned by the town. Sometimes, she just stops in for a visit, just bringing in the mail and saying hello.
- Locate funding, from individual donations, foundation support or the town.
- If there isn't a source of charitable funding for a position like this, consider starting an in-home care business, or recruit a very dedicated group of volunteers.
- Figure out which services are needed, and which ones can or can’t be met by the outreach worker. A series of interviews may be the best way to accomplish this.
- Spread the word to islanders about services offered and how to contact the outreach worker.
Q & A with Lindsey Beverage, North Haven Outreach Worker
Q: Do people pay for your services at all?
A: No. Probably the best part is that it is a fee-free service; otherwise, I think that it would dramatically reduce the number of people who even allow themselves to be okay with asking me to drive them to an appointment. There is a lot of pride to get around, so you really have to follow the individual’s lead. I have one person who doesn’t have family on the island, so it’s her only reliable option, and she would have to pay for it no matter what. Other people, if they had to pay for it, might not access it as quickly.
Q: How do people get in touch with you?
A: People are sometimes referred to me by the clinic, if it’s an immediate medical thing, but by and large it’s a culturally known position, and people just call me at home.
Q: Do you have a list of services you do and don’t provide?
A: It’s case by case, person by person, and I’ve learned where their boundaries are. It’s important for someone in my position to be aware of good personal boundaries, but there’s nothing on my job description that says I can’t do XYZ. People either want you do everything, which eats up all your time, or nothing, and they’re isolating themselves. You have to recognize when someone is really capable, and where that line crosses into an unsafe situation.
I think one of the most relatable trainings is the PSS (personal support specialist), and I have done that for an unrelated position. I have resisted some of that training, because it will tell you, "You can do XYZ, but you can’t do this." The curricula isn’t derived from rural island communities. They tell you, "If you take money from someone to do shopping, you have to get a receipt signed, etc." In the real world, people rip other people off, especially elders, so there are lots of rules. Here, there’s a lady who gets the same 14 things every time, and if I’m in Rockland, I’ll give her a call and ask if there’s anything I can get for her. I’ll pay for them separately, and then she reimburses me. But according to that training, it would not be okay. On an island, you have to be able to think outside that box.
Q: What’s the biggest roadblock for other communities who want a position like this?
A: When I talk about my role as an outreach worker, everyone says, “Oh that’s so great! How do you get paid?” Then when I explain, “Oh…” Clearly there aren’t foundations with a similar commitment in their own community, so there isn’t any lightbulb going off. Funding is definitely a roadblock.
- Anyone in need of assistance can call Lindsey on the phone. Usually, she explains, folks tell her “I have an appointment on this date, and I need you to come.” Sometimes, that can lead to conflicting appointments, but usually she’s able to accommodate their needs.
- It would be difficult to muster volunteers with the same dedication or availability as a paid staff person. For islands without an obvious funding source, paying for an outreach worker is the biggest challenge.
- Individuals require different amounts of help and work well in different styles. Lindsey stressed the importance of listening carefully, getting to know individuals, and adjusting care and services accordingly.
Outcomes / Results
This is a very successful program. Lindsey receives funding for eight hours a week, often works 15, and says this could easily become a part time job if the funding were available. However, she also stressed that the program’s success, if measured by its ability to reach those in need, is dependent on not requiring any payment. While similar programs who charge for care may turn a profit, they reach fewer people and a smaller portion of the aging population.
On Swan’s Island, Donna Wiegle runs an informal program called Eldercare Outreach of Swan’s Island. She generally doesn’t charge for services, and is able to help the island elders with everything from transportation to paying bills. She also runs the island’s medical center, so unlike many island eldercare services, Donna can help with some medical issues and act as a liaison between residents and their mainland doctors. Swan’s residents appreciate the neighborly and informal care that Donna provides. The program is a 501(c)(3) non-profit funded by individual donations, and Donna recently began receiving a small stipend of compensation.
Many island elders need help with daily tasks but aren’t ready to leave their homes. For example, they can get up from a chair by themselves or with the help of one person, but need assistance to bathe or cook three meals a day. They may not need to move to an assisted living home, but can benefit from regular visits from an in-home care provider.
Chebeague Island’s residential care facility, Island Commons, has been open for 16 years, and they’ve recently launched an in-home care program called Chebeague Cares.
How It Works
The staff do just about everything, from “rise and shine” services and medication reminders to light housekeeping and laundry. There are a few exceptions: as a “non-skilled” Personal Care Agency, they can’t provide medical services like injections or wound care. And if the elder needs more than one person to help them stand up from a chair (a “two-person assist”), then they are beyond the level of care that Chebeague Cares can provide.
They also offer “in-home” hospice care at the assisted living facility, meaning that coordinator Amy Rich can hire a caregiver to work with that single resident nearly full time during the end of their life. Families are happy to have that option and avoid having to move their loved one in the last months of life. Chebeague Cares has done the same thing for patients who didn’t want to remain isolated in rehab after surgery.
- Conduct one-on-one surveys with potential participants to determine need, willingness to pay, and desired services.
- If there are willing clients, get licensed as a personal care agency.
- Create business plan, contracts, etc.
- Find staff
- Fundraise to subsidize prices and reach low-income clients.
- Create advertising materials and launch programs.
Q & A with Amy Rich, Coordinator at Island Commons
Q: How did you decide how much to charge?
A: We charge $26/hour, and people of an older generation think it’s an enormous amount of money. But we’re fully insured, with workers comp, and I pay my workers well. Staffing here is an adventure, and I had to make it attractive for people who want to do eldercare. After all expenses, we make about $1.50/hour. I would tell anyone who wants to do this, “Unless you can figure out something that I have missed, you’re doing this to offer another wonderful program to your community, because you know that it’s needed. Not because you want to make money.” We’re not MaineCare approved, because last time I checked the reimbursement was about $10/hour. I couldn’t even pay someone.
Q: How about other business planning?
A: We started with an old-fashioned business plan and figured that we have to have a two-hour minimum. We have some people who would call and say, “Can you just help mom come to the car?” We are a business, and I can’t get someone to go get 20 minutes of pay and blow their whole morning.
We also have 2 different contracts, one of which is a sliding scale. We’re lucky that someone has donated $10,000 to enable a sliding scale based on Maine’s 2015 poverty rates. I can’t waiver my prices, but I can change the client’s, and that $10,000 has been invaluable to offer services to my lower income residents.
Right now, we’re breaking even. We’re working with two or three users at a time, usually. We usually have the same staff that work at the assisted living facility, but it’s challenging because I can’t let them go into overtime.
Q: How do you decide who you can work with?
A: We decided that we need to have an assessment meeting and fee. A client is above our level of care if they’re a two-person assist. I can’t, in good conscience, send a worker out to someone who can’t get up with just one person assisting them. There are people on Chebeague who are way above our level of care. So the assessment, just a brief conversation and checklist, is invaluable. The assessment fee is hard for people, but $150 just covers our time and footwork.
Q: Can people use long-term care insurance?
A: Some people do, and it depends on what kind of insurance they have. Usually, they will ask me for a Quickbooks printout that they submit. I’ll submit how much it all costs for the year, or summer, and they’ll get reimbursements. I’ll fill out any paperwork that is necessary.
Q: How do you get past resistance to signing up?
A: The elder’s caregivers (usually family) will say, “They need this!” But it’s tricky. Sometimes we’ll say to the elder, "Marianne is just going to come in, and you let her know what cleaning you need done, what you can’t get to today, and she’ll go with you to get the mail since you love getting the mail,” and we kind of empower them with the program, until they’re comfortable with it. When you say, “This is our in-home care program, and we’re going to help you get off the toilet,” you lose a lot of people who have been taking care of themselves for 90 years.
Q: What is going well?
A: The three people that we’ve been servicing for the past few months are so thankful. They’ve told us that they’ve had a bit of their summer back, that they have safety, and though they weren’t sure at the beginning, they love having a companion. I work hard to match people up based on personality. I’m proud of how we’re taking care of these people, and I can stand behind our work. Everyone who uses it is very satisfied, both the caregivers and the clients.
Q: What advice would you offer someone who wants to start an in-home care program?
A: How well you know your population, and what they truly want (not what they’re telling you they want), will determine your end success in launching an in-home care program. You need a group of dedicated people (not just one!) who are going to sign up. You need to sit down with potential clients and ask, “What would you love to have done for you that would make your day easier? Is it something you can see yourself spending $20/hour on, or is that out of your reach?” You also can’t underestimate the administrative time it takes to field calls and do assessments.
- Finding enough clients. Especially among the year-round population, there is a surprising gap between what many island elders say they would like available, and what they are actually willing to pay for. Amy recommends doing in-person meetings before launching a program to find a group of elders who will be your dedicated clientele and make sure that prices will be acceptable.
- Finding staff. There is a small pool to choose from, and Amy has to pay well to make jobs attractive. Because of the limited staff available, many full time staff from Island Commons also work for the Chebeague Cares program, and they must be paid overtime (see below), adding another financial burden.
- Small program size. Chebeague Cares is a program of the Island Commons Resource Center, and falls under the same tax ID. Amy Rich, who runs both, says that despite the fact that the current situation can lead to staffing challenges, Chebeague Cares is too small to justify the time it would take to create a separate 501(c)(3), and it would completely double the taxes every year.
- Creating clear boundaries. It’s helpful to have a contract that clarifies limits and exceptions, i.e. if the staff will provide care after 6:00pm, stay overnight, or charge more for a husband and wife than a single person in the same home.
- Competition with more casual arrangements. It can be easier and cheaper for some islanders to arrange for help on their own. A Personal Care Agency is registered, insured, and trained, but that also means higher prices.
Outcomes / Results
Chebeague Cares has been up and running since November 2014. They are breaking even and are able to offer many services, but they don’t have many clients yet; only 2 to 3 people at the time of the interview in August 2015. There are many islanders who are above the level of care that Chebeague Cares is able to provide, but they are unwilling to move into the Island Commons assisted living facility and are instead hiring skilled (i.e. medical) assistance or relying on their families. Other islanders whose income levels are too high to qualify for the “sliding scale” offered by Chebeague Cares are simply unwilling to pay for the service, and find other ways to manage.
Islesboro's Beacon Project and Vinalhaven Eldercare Services also offer in-home care. Many other islands provide more informal in-home care arrangements for residents or summer visitors.
SIDEBAR: TELEMEDICINE & ISLAND ELDERCARE CONFERENCE
Especially on the more remote islands, traveling to a medical appointment can be costly, time-consuming, or nearly impossible. The Maine Seacoast Mission provides telemedicine services through staff traveling on the Sunbeam V to Frenchboro, Isle au Haut, and Matinicus. It also provides land-based telemedicine units on Swan's Island and Islesford where locals have been trained as health aides to utilize the technology, and elderly island residents can meet with their doctor on screen—it’s like high quality Skyping. A handheld camera and other devices allow nurse Sharon Daley, who travels on the Sunbeam, to show doctors a sore throat, ear infection, and more.
Sharon and the Seacoast Mission also provide flu shots, bring audiologists and other specialists out for visits, and provide support for island elders in end-of-life planning, dealing with insurance, and more. The elders sign up for appointments when the Sunbeam is visiting, or call Sharon to make arrangements.
Sharon also helps organize an annual eldercare conference on Islesboro, gathering eldercare workers, and advocates from nearly every year-round island in Maine. They share updates, lessons, and discuss policy.
“Just getting people together from islands and talking about common problems and issues is a great support to each other," says Sharon. "You don’t need to reinvent the wheel. When a group has learned how to do something, they can share that with others.”
Boardman Cottage - Islesboro
Many elderly islanders eventually must move out of their homes and live with family or in an assisted living facility. If there is no such facility on their home island, they must move away from family, friends, and lifelong familiarity of their small island community.
Residential care facilities already operate on Vinalhaven, Chebeague, and Islesboro, and North Haven will soon join them. Though these homes serve a small number of residents on each island, they fill a crucial niche in the island community. Many islanders who would otherwise be forced to move to the mainland are able to stay in their home communities, surrounded by family and friends. Boardman Cottage on Islesboro is the residential portion of the Beacon Project, the center for eldercare on the island.
How It Works
When it was built in 2005, Boardman Cottage had six beds, and they’ve recently added two more. In addition to regular resident care, they offer respite care, hospice care, and short term stays if space is available.
- Identify administrative staff, a fundraising team, and a board of directors. You’ll need strong leadership.
- Conduct one-on-one surveys with potential residents. This is helpful when figuring out how many beds to create, and is also a good way to tell potential residents about the benefits and exciting prospect of the new facility without obviously trying to sell them something.
- Figure out size and type of facility. Adult family care home? There are guidelines around the level of care and number of beds.
- Get licensed
- Find staff
- Fundraise to subsidize prices and reach low-income clients
- Contruct or renovate facility
- Begin move-ins. Don’t expect everyone to knock down the doors at once. Although Boardman has been full for a while, the first residents moved in over many months.
Q & A with Maura Michael, Administrator at Boardman Cottage
Q: What has changed since Boardman Cottage opened?
A: With six beds and taking MaineCare, we had a deficit, so we added two more beds to try to bring in more income. The state changed the rules, so you can still be an adult family care home and have eight beds (the other models have cost reimbursement and a lot of paperwork), so we got to keep the same title, have eight beds, and hopefully increase the bottom line.
Q: How much do you get from MaineCare?
A: MaineCare gives you $30/day for room and board for all residents, regardless of care level. If someone needs minimal help besides, you receive another $20/day, and up from there. However, they cap that additional funding at $70/day for any level of care, so the maximum funding is $100/day. The private pay rate is $180/day, so that’s where we break even. Other facilities that use cost reimbursement can get $130-$150/ day from MaineCare, but it’s considerably more paperwork. The facilities on Chebeague and Vinalhaven are private nonmedical institutions, not adult family care homes. They also receive funding from MaineCare, but use cost reimbursement instead. They get reimbursed annually for their overall resident group, not for individuals.
Q: How many staff do you have?
A: We have three full-time and ten part-time. One of the challenges of being on the island is that everyone has another job, which usually takes priority over us. We’re only required to have one staff person per 12 residents, but we usually run with two people on during the day and an awake person overnight. We need more staff if we have to take someone to the doctor, on or off the island. The staff, unlike an assisted living home, do everything -- the cooking, the personal care, the laundry, and the housekeeping. They have a lot of roles.
Q: Do you have staff live on the island?
A: A lot of them do, but we’ve had to pull staff from away, which is more expensive due to ferry tickets and parking. They can stay in the apartment upstairs [at Boardman Cottage], but transportation is an issue.
Q: What would you do differently if starting from scratch?
A: It would be great to have more input into the design, in terms of closet size, room size, lower windows, outlets up higher. Little things you don’t think about -- like the towel rack in the bathroom should actually be a grab bar. We have a wonderful whirlpool bathtub, but no one can get into it. You have to think of practicality.
Q: What works well around here?
A: I like our staff-to-resident ratio. They get to sit at the table, eat together, and play Scrabble. The staff really get to know the residents. They’ll come on their day off and take someone to the rummage sale, or be at the library and grab a large print book for a resident. I like the feeling that you get when you come in. It’s a homey atmosphere.
Q: Any success stories?
A: A lot of our success stories deal with hospice. We had an in-home client who was really failing fast. We were full here, so she moved on the mainland, but she was born and raised here. Then one of our residents went home for a little while, so we were able to bring her in and hospice on the island with everyone here. We could bring families here to spend the night. People feel comfortable here.
- Finding staff. Turnover in direct care positions is extremely high, and island communities can quickly become tapped dry. Boardman has started hiring part-time staff from off-island, adding costs for ferry tickets and parking. Some island staff employed in the winter depart in the summer for higher-paying caretaking, cleaning, or fishing jobs. Boardman has had some success hiring college students who have returned to the island for the summer break.
- Filling the funding gap. Fundraising $100k per year is no small feat. The Beacon Project raises money through fundraising events, individual donations, furniture sales, and other odds and ends.
- Maintaining program integrity. With a changing board and tight finances, it’s easy to lose sight of the mission of the program.
Outcomes / Results
No elder wants to move out of their home until they’re practically forced. However, Boardman Cottage is doing well. They recently expanded from six to eight beds, and have six people on the waiting list. They fundraise another $100k per year, mostly to make up for lost revenue due to low reimbursements from residents relying on MaineCare. It’s never easy, but their staff and residents are content. Most importantly, elders from Islesboro are able to stay on the island as they grow old.
The eight-bed Ivan Calderwood Homestead operates on Vinalhaven Island, and the seven-bed Island Commons on Chebeague. North Haven Island's Southern Harbor Eldercare Services will soon open an adult family care home. On the mainland, ElderCare Network of Lincoln County runs seven small eldercare homes.