HOW TO DIE YOUNG AT AN ADVANCED AGE
Pelican Press, December 7, 2000

Tyne Daly says the older woman she portrays in "Judging Amy" is no saccharin sweet little old lady. "She's difficult and prickly. That kind of older woman doesn't get investigated much except as a cartoon ... we marginalize old people as jokes..."

With that in mind, I asked the dynamic young president of Youthful Aging Home Health, Nicci Kobritz, what motivated her to delve into the care, feeding and pursuit of happiness for the old folks.

"As I was providing care to seniors, what I was most aware of was how frequently our seniors were unhealthy in their last years of life. So many are so unhappy and severely depressed. These are people who are very accomplished, male and female, mothers who have raised successful families, doctors, lawyers, CEOs — all miserable in their remaining years.

Kobritz felt there was a better way. It didn't happen overnight. Coming from Maine, a nurse practitioner (a registered nurse with an advanced degree), serving on the cabinet of Maine s governor, she had a wealth of experience from which to draw.

Having set up Maine's first Rural Pediatric Home Health Program, there is, she says, a distinct similarity in home health care for seniors.

"So I started my own company eight years ago here in Sarasota. We had been providing standard home health care up until four years ago."

She gave the mantra of standard home health care a hard cold look. In essence: keep you functioning independently in your home. No more, no less.

Kobritz decided there must be more, much more, and arrived at a concept called Youthful Aging Home Health Care.

The basis of this new approach is getting to know the client. What is his or her maximum capacity? What is he able to do? How can she be made functionally and cognitively independent? How can the quality of his life be improved? Summary: Get the client thinking, moving, excited, anticipating. Goal: Die young at an advanced age.

Otherwise, as Kobritz points out, "All you're buying is a very expensive adult sitter."

The Key to Maximum Functional Capacity
There are three components to get seniors to their maximum functional capacity in the Youthful Aging program: exercise, nutrition and interests and mental stimulation.

The first step is to be evaluated for physical fitness. "I may want them to have a personal trainer. If they have a beautiful pool, I may want the home health aide to take them into the pool and do some swimming exercises. Maybe just a good pair of shoes and do a lot of walking or stretching. Judgment is required. We are talking about seniors who have been de-conditioned."

The Youthful Aging representative explains to the client that in addition to exercise and nutrition components, quality of life is addressed— getting out and doing interesting things.

What are the things that once interested the client that he or she has not bothered to do for a long time? Shopping at the mall? Car trips? Theatre? Concerts? Walks on the beach? Visit a library? Youthful Aging never forgets that clients are intelligent adults capable of making their own choices.

In summary, Kobritz concludes, "Loneliness and depression break the spirit. When the spirit is broken, death ensues. My activity person lights a fire and gives a sense of purpose.

The theory is backed up by recent findings of the American Geriatrics Society: Feelings of happiness and well-being seem to protect individuals against physical decline in old age.

Staff-Training-Cost
Youthful Aging Home Health is staffed with 12 men and women who direct, assign and supervise the 200 male and female home health aides in the field.

By law, 72 hours of training is required to be certified as a home health aide. Screening is thorough: criminal background check, abuse checks, references and competency screenings. In addition, aides are continuously monitored.

Standard home health care cost today is $16 to $18 per hour. "What the home health agency bills," Kobritz explains, "is what we have to pay our caregivers and aides. Today, they have to have more money and we have to pay them well in order to get good people."

Making the Connection
When a prospective client (relative, friend) calls inquiring about Youthful Aging Home Health Care, a nurse goes into the home, together with a program director. After standard medical aspects are covered, the program director discusses activities with the client to unearth interests. If none surface, the program director is trained to dig for it.

"When my nurse and activities person get a feel for what's needed, there are two options. We can send someone out who we feel is appropriate or the client can interview that person. The person we feel is good, you may not like, so you may try as many as two or three in the course of a week until you find the right one."

Once the right person is found, continuity of care is very important. No revolving door; the aide stays as long as needed.

When asked if any of their clients are difficult and uncooperative, Kobritz responds, "Yes, but there's good reason that many are depressed, bitter and unhappy. We don't give up on them and we don't turn anyone down."

There are many ways to skin a cat and obviously many ways to tame a hostile client. In one instance, it was daisies. The family said the client liked them and when the aide arrived with an arm load, it triggered a small smile before the aide dashed into the kitchen and out of the combat zone.

"We tell our aides, give her space— don't get in her face— act like you're not there. Take your cues from the clients. In a few days they'll warm up a bit. Do your duty and keep him/her in your sights." Nicci says it works remarkably well.

Youthful Aging Growth
In business for eight years, this concept was fully implemented two years ago. Most of the rapid growth has been through word of mouth plus referral of satisfied clients and relatives.

In 1998 the company was selected as one of the five finalists for the Frank G. Berlin Sr. Chamber of Commerce Small Business of the Year Award.

They are about to embark on a major media marketing campaign to let more people know exactly what they do.

"I am hoping my colleagues follow suit because this is what home care is supposed to be like. We are supposed to be helping clients maintain their maximum functional capacity and make sure that we preserve the best they had and make them better.

The challenge is helping them to regain hope that, despite their disabilities, they can attain a quality of life that can be both productive and exciting. We are not supposed to be adult sitters."

-by Jean Reed