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Last May, over 100 hundred people in ten small Vermont towns got together in four weekly study circles to learn about long term care issues, reflect upon their own experiences, and suggest ways to make life better for people who need long term care. By the end of the month, many participants were ready to move beyond studying and talking and into local action.
The study circles were organized by the Champlain Valley Long Term Care Coalition, a group of health care providers, consumers, advocates, and caregivers committed to ensuring quality care. Coalition leaders saw the study circle approach as a way to get "informed input" from a broad range of concerned citizens. They recruited people from the business, academic, religious, political and health-care communities to describe local issues such as staffing shortages and housing needs and elicit ideas about how to address them. The group worked with study circles expert Susan McCormack of the Study Circles Resource Center. She said the difference between study circles and the more traditional focus groups is that the circles call for more than just dialogue about the issue—they require real action.
"We learned that the study circle model also empowers people," says coalition member Beverly Boget of the Visiting Nurses Association. "You have to be prepared that people are going to come out of the process ready to do something." The Champlain coalition plans to use the study circle model again as it works to broaden its constituency. To assure greater economic and ethnic diversity, the coaltion will organize discussion groups in places where certain groups already meet, such as refugee resettlement offices.
John Cushing, the Town Clerk in Milton, Vermont for the past 34 years, says, "A clerk gets to know people—over the counter at the town office, in the store, on the street. They get to know me as a person, and they become comfortable talking about issues." One issue that comes up often is long term care.
In May, Cushing's feel for the town's pulse and his belief in the power of local governance were fused by the study circle presentation of statistics about long term care. According to the Vermont Department of Aging and Disabilities, almost twenty percent of Chittenden County’s senior citizens are in need of long term care, but help is becoming harder to come by. In 1990 there were 11 potential caregivers for every one person needing care. In 2050, that number is expected to drop to 4-to-1, according to the Chronic Care in America Institute for Health and Aging.
At the series of meetings in Milton, Cushing joined a dozen other people who live or work in town to talk about aging and the need for care. "I know that long term care is a problem," Cushing says. "I see it in my own family, and I hear about it from many others. But I didn't know that the number of retirees will increase by 50 percent in Chittenden and Grand Isle counties by 2014. And I didn't know about the growing number of younger people who need care."
The discussions convinced Cushing that long term care can best be addressed as a local issue. He looks back to the old "overseer of the poor" system as a model because it was based on people in communities helping each other. "Communities know who the people in need are," he says. "Our people need personal connections to services, help from their neighbors, not a computerized voice over a distant 800 number."
Each of the circles was charged with authoring three action steps that the members thought would help prepare their community for the coming challenges. The Milton group came up with four action items. The first action step was to maximize people’s ability to live independently. “We felt it was important to help keep these people in their homes,” Cushing said. The Milton group also proposed hiring a resource director, who would, among other things, centralize the community’s resources so that people in need would at least become aware of what services and agencies existed to assist them.
Kathy Printon, Youth Services Coordinator for the Milton Family Center, also came out of the study circle ready to tackle long term care issues locally. "The state supports outreach people who visit every family with a new baby. Why don't we have the same kind of outreach for elderly people? We can find out who is living alone, who needs services. When a developer plans to build 40 condos, town regulations can encourage him to use universal design, so homes can be accessible for everyone."
Both Printon and Cushing believe that connections between elders and young people are essential—improving both services and understanding. The Milton group called for the creation of an intergenerational community center. Cushing reflects back on how much he learned as a new, young 22 year-old clerk from his 76 year-old predecessor. Printon sees Milton High School's community service requirement for graduation as a resource for providing simple chores and errands.
Now that the study circle process is over, the Milton group is meeting on its own. "I'm hoping that we can make a presentation to the Select Board," Cushing says. Study circles in other towns also focused on local approaches to improving long term care. The group in the town of Jericho listed family, neighbors, churches, schools, and the community's tradition of pulling together as prime resources. They called for a town coordinator "who could help the community take care of itself."
At a time when elder care issues seem bogged down in distant and complex discussions about Medicare, Medicaid, and Social Security, Vermont voices are asking for local control. "We should down-size state and federal programs and build local capacity," John Cushing says. "Local government is closest to the people."
By Barbara Leitenberg and Joseph Cote
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