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# Client Services

The AL-CARE Program has successfully served live-alone clients in the
District of Columbia for over six years. For example, live-alone clients
sometimes forget what to do when a meal arrives from Meals on Wheels,
and the Home Care Aide can prompt them to eat. At other times adult day
care is available but live-alone clients may need someone to remind them
when to go and where the day care is located.

Currently, the average live-alone client uses approximately \$3,000 per
year of AL-CARE services. This can be compared to \$165 per day for
nursing home care, which is the only other option available for
live-alone clients with dementia in the District of Columbia.

In the later stages of Alzheimer\'s disease, the need for care becomes
extensive. Clients who require more care than can be subsidized by this
program may purchase additional services at private pay rates. Home care
is provided until the Case Manager, the family, or a guardian decides
that it is unsafe for the client with dementia to continue living alone.
That decision may result from excessive wandering by the client, a
deterioration of physical health, or extreme problems with home hygiene.

# Finding Live-Alones who Need Services

When the District of Columbia Office on Aging asked the service network
providers to identify an underserved dementia population in the District
of Columbia, it was discovered that there were numerous persons with
dementia living alone. At the time, AL-CARE was the only home care
program exclusively serving clients with dementia. Because of AL-CARE\'s
focus on caregiver respite, individuals without live in caregivers had
not been eligible for the services. With the advice of the Senior
Network, the District of Columbia Office on Aging proposed to use
Alzheimer\'s Demonstration funds to target the live-alone population.
Currently, more than half of AL-CARE\'s clients are live-alones.

# How the Program Works

As a member of the active Senior Network in the District of Columbia
since 1986, AL-CARE has provided services to families of persons with
dementia. The Senior Network includes over 30 agencies funded by the
Office on Aging. Service is provided at over 100 sites.

Because AL-CARE was already a trusted and participating member of the
provider community, issues of trust building and awareness did not
warrant special attention. Most service providers in the District of
Columbia area were well aware that there was a large, unserved
population of elderly persons with dementia who were living alone in the
District. Following a survey sponsored by the District of Columbia
Office on Aging, providers merely needed to acknowledge that the
population existed and to make the commitment to serve them.

AL-CARE initially expanded its base by beginning to serve individuals
with live-in caregivers who were at work or otherwise out of the home
during the day. AL-CARE distributed a brochure in the community that
described its services to live-alone clients. Using the Senior Network
communication structures (newsletters, quarterly meetings, etc.)
providers were notified of AL-CARE\'s new focus. Referrals began as soon
as providers became aware of the service availability. Thus, AL-CARE had
very little start-up time and was at capacity soon after the
Alzheimer\'s Demonstration grant was awarded.

The next initiative for AL-CARE and the District of Columbia Office on
Aging is to work with other providers in the Senior Network to encourage
them to begin providing services to the live-alone population.

# Barriers and Obstacles 

Among the barriers to providing services to the live-alone population
was skepticism within the community at large that individuals with
dementia could or should live alone in the community.

Additionally, liability and service agreement issues had to be handled
differently because there were no live-in caregivers to give consent.
For example, it was necessary for AL-CARE to change consent forms that
had been geared toward a population that lived with a caregiver. It was
sometimes necessary to find relatives or other persons responsible for
live-alones to obtain consent to serve the client. Access to homes had
to be negotiated in different ways because live-alone clients may not
remember to be home for, or to let in, their respite aides. Safety
issues were more prevalent in this population and thus also needed more
attention. Home care aides must be constantly vigilant about safety
issues because there is no caregiver at home to assist the individual
with dementia.

# Benefits of Service to Live Alones 

In addition to offering a low-cost service to a segment of the
population that previously had few options, the AL-CARE live-alone
project broadened awareness about dementia and helped alleviate the
misconception that persons with dementia cannot live alone.

# Generating New Funding

The agency has received contributions of over \$40,000 from relatives or
financial guardians of live-alone clients. Stories of live-alone
situations are effective for fundraising. AL-CARE regularly applies for
grants from foundations and other organizations with interests in
supporting programs for live-alone persons with dementia.

# The Costs of the Program

The costs for expanding the program included additional training for
home care aides, increased professional staff support, and flexible
scheduling.

Increased training and supervisory costs are minimal and can be
incorporated into existing training protocols with existing staff.
However, flexible scheduling may lead to more significant costs,
depending upon how an agency compensates its home care aides. There are
occasions when a home care aide may go to a client\'s home only to find
the client absent or unwilling to let the home care aide into the home.
Provided the home care aide makes every effort to find the client or
gain access to the home, the AL-CARE home care aide is paid for the
whole visit, regardless of whether the aide got into the home or not.
These paid visits can become expensive because this situation occurs
about three times a month with live-alone clients served by the District
of Columbia program.

# Keys to Success

1.  Make a commitment to serve clients with dementia who live alone.

2.  Hire and train appropriate aides.

3.  Insure that aides are absolutely honest, sensitive, and caring.

4.  Emphasize the importance of good communication skills in training
    aides.

5.  Insure that everyone is flexible and creative in meeting various
    needs.

# Contacts:

Administration on Aging: (202) 401-4547

330 Independence Ave.

Washington, DC 20201

Karyn Barquin: (202) 724-5622

District of Columbia Office on Aging

9th Fl. S., 441 Fourth Str., NW

Washington, DC 20001

Marla Lahat: (202) 726-8870

AL-CARE

6000 New Hampshire Ave NE

West Building

Washington, DC 20011

The Administration on Aging is the official Federal agency dedicated to
policy development, planning and the delivery of supportive home and
community‑based services to older persons and their caregivers through
the national aging network of state and local agencies on aging, tribal
organizations, service providers and volunteers.