Role of Alaska Pioneers’ Homes Changes With Elderly’s Needs

Alaska’s first government-run old folks’ home was set up 81 years ago in the Sitka military barracks as a boardinghouse for indigent pioneers.

Today the state operates six modern “pioneers’ homes” across Alaska. They provide a range of low-cost services for the elderly, from a comfortable room and three meals a day to intensive nursing care.

But with Alaska’s elderly population growing rapidly, costs rising and the state no longer allowed to restrict admission to longtime Alaskans, the homes’ role in the health-care system is changing.

“We’ve been in a total regearing,” said Doug Holt, administrator of the Juneau pioneers’ home. “The evolution is from the old, comfortable residential environment to more of a specialized treatment facility.”

More emphasis is being placed on serving patients with Alzheimer’s disease and related dementia--the group of older Alaskans deemed most in need of help.

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An estimated 4,000 older Alaskans suffer some form of dementia, according to a recent report commissioned by the state. Of those, 11% are residing in the pioneers’ homes, 12% are in private nursing homes and 14% are served by community day- or home care programs.

That leaves 63% whose needs are not being met.

The problem, like most in the health care system, is money. Most Alzheimer’s patients and their families cannot afford to hire the kind of constant, costly care they need.

Medicaid pays the $8,000 to $10,000 monthly cost--about double what it costs elsewhere in the United States--of private nursing home care after a patient’s financial resources are exhausted. But because Alaska does not include care for Alzheimer’s patients under its Medicaid program, the state’s 20 private nursing homes are not a practical alternative for most families, said Shirley Hauck of the Alzheimer’s Assn. of Alaska.

The only other options for most families of Alzheimer’s patients are to move out of state or to get on the waiting list for a pioneers’ home bed.

The number of Alzheimer’s patients in the homes has increased sharply in recent years. Today, 40% of the nearly 600 residents suffer from a mental disability, ranging from serious forgetfulness to full-blown Alzheimer’s.

In response, special units have been set up in some of the homes and the staff has been trained to deal with the special needs of patients with “cognitive disabilities.”

The patients live in a common area designed for their needs. The emphasis is on making the surroundings, staff and activities familiar and to avoid unnecessary disruptions and disorientation.

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The pioneers’ homes also have been putting more effort into services for the semi-independent elderly who do not require expensive nursing care, but need some supervision and help with daily living--things such as bathing, taking medication and preparing meals.

“The whole idea is to keep them as independent as you can as long as you can,” said Jim Kohn, who runs the homes as deputy director of the state Senior Services Division.

Just two years ago, 45% of the homes’ residents were under nursing care. Today that number is down to 27%, with a corresponding increase in residents receiving “assisted living” care, Kohn said.

The homes’ original goal of providing “three hots and a cot” has less appeal to today’s elderly. Far fewer beds are being requested for simple residential care, as older Alaskans choose to live at home longer.

The expansion of community services such as home day care has helped decrease the demand for residential beds. That’s reflected in the rising average age of people entering the pioneers’ homes--82, up from the mid-70s several years ago.

Eventually, basic residential care probably will be phased out.

“It’s not the highest and best use of our resources,” Holt said. “There are other alternatives now that didn’t exist before. We should be using that space to deal with the people who have real problems.”

The reassessment of the homes’ role was prompted in part by a 1992 court ruling that struck down as unconstitutional the 15-year state residency requirement for admission. The state since has lowered the residency requirement to one year.

Lawmakers long justified the cost of the homes because they served pioneer Alaskans who helped build the young state.

“With the court decision, it’s no longer a pioneers’ home,” said state Sen. Bert Sharp. “Without establishing some kind of point system that leans in favor of long-term Alaskans, the original reason for the pioneers’ home has been eroded severely.”

The state still is trying to give some preference to longtime Alaskans. In June it established two waiting lists. One is an “inactive list” that Alaskans can sign when they turn 65 but before they are ready to enter the home. Once they are ready, they sign up on the active list and are given preference based on when they signed the inactive list.

The wait for a bed depends on the level of care requested and what space is available. It can range from weeks to years. As of late June, the list had one person who had been waiting since 1989; most had applied just last year.

Another issue facing the state is the homes’ cost, which has increased 4% a year since 1989 to $31 million last fiscal year. Resident fees provided only $4.6 million this year.

“The main issue is who’s going to get the subsidy and who’s going to pick up the tab,” said Joe Alter, a retiree who sits on the Pioneers’ Home Advisory Board and the Older Alaskans Commission.

Kohn said the state is hoping to reduce the subsidy by increasing rates over several years to cover the actual cost of care, by reducing operational costs and by better matching care to the residents’ needs.

Alter said the ultimate solution to the state’s dilemma over the cost of the pioneers’ homes is going to have to be a national program of universal health care that includes long-term care for the aged.