AN UNPAID DEBT

SHE HAD EATEN EVERYTHING BUT THE paint on the walls days ago and was weak with hunger. Her normally clean bedroom and kitchen were a mess: piles of dirty clothes, dishes unwashed, half-filled trash bags already too heavy for this seventy-seven-year-old woman to carry down the rickety back stairs. She still felt the effects of the stroke she had suffered ten months back, the speech impediment that appeared without warning, the electrical sort of pain that skittered up and down her bones. But on this stifling August morning it was the heat that got her. For fifteen years she had been a good tenant, but the landlord had never provided an air conditioner. Her one oscillating fan barely rippled the curtains. The humidity and hot air squeezed around her like the rank coils of an unseen snake, pressing the good air out and leaving her covered in a body stocking of salt and smell and moisture.

Sometimes Olive Mosley felt beaten, up against something as vast and permanent as death itself, because nothing stopped the old. You live a full life: raise a family, bury one husband and put another in a nursing home, work honorably most of your years, and all that means something, doesn’t it? But it doesn’t stop the old. Doesn’t stop deafness, or back miseries, or, worse, thinking your life has about as much relevance as the snout of an Edsel. And it doesn’t stop the loneliness. Lines have converged. Spheres have shrunk. Life has been noosed into a very small circle.

Olive Mosley doesn’t remember how long she lay baking in her bed, her mouth dry, her lungs like paper sacks. She barely remembers the telephone ringing. She learned later that she had faded in and out like a radio with no antenna, talking incoherent jabberwocky to the one old friend who periodically checked on her. What she does remember clearly about Baylor University Medical Center is the cool air. There, her eyes weren’t drip-fed with sweat for a change; there, people still cared enough about a lonely old woman to feed her and treat her heatstroke and dehydration.

Mosley had come to a crossroads. She could no longer sustain herself in her old life. But she would need help to forge a new life. And she would find, as too many of our elderly do each year, that Dallas has few solutions for her problems.



The Network



WHEN THE SOCIAL WORKER learned the range of problems facing Olive Mosley, she called the Access Center for the Elderly. ACE coordinates a network of forty-five local health and human services agencies, from the Aging Information Office to the Visiting Nurse Association, to provide physical, social, and economic help to Dallas County’s 220,000 residents age sixty or over, according to ACE director Patti Daniel.

Mosley became one of the twenty-five to thirty new clients assigned each month to ACE caseworker Del White. The month before she met Mosley, White worked with fifty-five clients (thirty new cases, twelve reopened cases, thirteen continuing ones), handling only three by telephone. The hospital social worker explained Mosley’s food situation, so White picked up a basket of staples from the Trinity Ministry to the Poor on the way over for the first visit with her new client.

Mosley was living in an upstairs duplex in East Dallas-house number missing, doorbell broken-roomy, but musty and old and deteriorating. Flaps of wallpaper hung from the walls and ceiling, torn screens, worn linoleum. The place had been closed up like a fist for years. When her new caseworker came to call. Mosley was very cooperative. A lively, interesting woman with a sharp mind, she still felt weak but was recovering nicely. As White gathered the facts, she uncovered once again the familiar vulnerabilities and dilemmas that plague the last years of so many of her clients.

Mosley was living on a monthly Social Security check of $448, nineteen dollars less than the average beneficiary. After paying $375 a month for rent and $45 to $50 for utilities, she had $25 to $30 left for food and other necessities. Clearly she would have to move, probably to a Dallas Housing Authority (DHA) complex for the elderly. But she did not want to move. She rejected White’s suggestion that she use the Meals on Wheels service, saying she could still cook for herself. Nor did she want to apply for food stamps: that was for welfare cheats. She did accept a fan that the Zonta Club, an organization that helps elderly women, had given to ACE. (In nine years of operation, ACE has never received a donated air conditioner.)

Intermittent home health care and custodial services for the elderly do exist, but those who don’t qualify under one of the state programs must pay. Del White did arrange for one of the nurses from the city’s geriatric crisis intervention program to check on Olive Mosley. To get the house cleaned, she called the Beckley Avenue Outreach Foundation, the city’s only agency providing short-term chore maintenance-for those who are indigent, sixty or over, and living near a bus line-for an optional five-dollar donation. To combat Mosley’s loneliness, White offered to contact the Visiting Nurse Association’s Friendly Visitor program, but Mosley declined. After so much solitude for so long, she felt a bit overwhelmed.

Some of Mosley’s troubles are self-induced. Older folks often have their own strong ways. When a twig hardens it’s hard to twist it. No doubt, if opportunity is laid before a person and she fails to reach for it, that’s her problem. But if she cannot grasp it because of society’s shortcomings, that’s society’s problem.

In helping Olive Mosley, Del White encountered gaps in services and facilities needed by older adults, problems a city could overcome: few low-income housing units, minimal affordable home health/custodial care or publicly financed adult day care centers, no escort services to hospitals, medical offices, nutrition sites, or food banks. And Dallas has done little to aid seniors with problems that, luckily, Olive Mosley has so far avoided: abuse of the elderly, mental illness, a need for rehabilitation and therapy. And for those needing affordable nursing homes and medical equipment not covered by federal insurance programs. Dallas can be an inhospitable place.

Seeking to address these and other issues affecting many of the city’s seniors, and faced with demographic forecasts indicating that within the next three decades one in four Dallas residents will be over sixty-five, Mayor Annette Strauss last May appointed the forty-five-member Mayor’s Committee on Senior Services, headed by Harry Tanner, former executive director of the Community Council of Greater Dallas. This month the recommendations of the five subcommittees on victimization, housing, communication, transportation, and health services will be released.

Early on, the committee studied and updated a 1985 Senior Citizens Issue Paper prepared by the city’s Department of Park and Recreation. That study concluded that the eight most critical needs of Dallas’s senior citizens were income, crime protection, health care, in-home support services, transportation, housing alternatives, and access to services and leisure activities. If anything has changed in three years, it’s that housing needs may now be more critical. Priorities varied with each member in this new group, but after seven months of study, the most pressing problems seemed to fall into three general categories: crime and elderly abuse; health and mental health services; and housing.



The Fight



EMERGENCY ROOMS ARE THE doctor’s offices of the poor, regardless of age. Walter Scott, seventy-six, an indigent black widower living alone, was treated at Parkland Memorial Hospital’s emergency room the night of July 14 for bruises and welts on his neck and throat. When he told a social worker someone had tried to strangle him, she called Jacqueline Mosley (no relation to Olive), an Adult Protective Services specialist at the Texas Department of Human Services. The alleged assailant was the half brother of Walter Scott’s son. Because of his frail condition and uncertain home situation, Jacqueline Mosley suggested that Scott be temporarily placed in the Bryan Manor Nursing Home. He agreed.

In 1984. Texas, with 8,000 reported adult abuse cases, ranked second in the country. Eighty-four percent of these cases involved elderly victims. Since 1984, reports of elderly abuse have increased five-fold. In September the Dallas County Elder Abuse Task Force Report showed that the 465 valid elderly abuse cases investigated here constituted the highest rate in the state. Forty percent of these cases, however, were caused by self-neglect; the rest were various kinds of abuse (physical, sexual, psy-chological) or a combination of maltreatment such as abuse and exploitation. Nationally, surveys indicate that nearly six of sever (86 percent) of the abused aged are mistreated by their own families. Mosley says the Dallas rates are a bit lower but not much.

For investigators like Jacqueline Mosley, helping the elderly in abuse cases can be a legal and ethical nightmare. The biggest problem is the victim’s lack of cooperation. Almost one-fourth of the local confirmed cases in the September report refused all intervention efforts. They often are ashamed to admit their children or loved ones abuse them; many are confused and contradict their stories or forget altogether. Even in immediate life-threatening situations, an elderly abuse victim has the right to refuse any services and can choose to remain in the abusive environment.

Sitting in his wheelchair near his bed in the neat room at Bryan Manor, Walter Scott gums his chewing tobacco, his face working like an accordion. He lives on a monthly $530 Social Security check, paying $90 rent for his place in a dangerous South Dallas neighborhood where the bloods will steal the cream out of your coffee.

“The trouble come about because I didn’t want the young man drinking in my home at two in the morning,” Scott says. “He’s a bad man, always asking me for money. I gave him $175 to get my son out of jail but he spent it drinking. I ordered him to leave. Next thing I knew he was on me. First he tried to smother me, put a wet towel over my face. Then he put his hands around my neck. I started hollering, ’They trying to kill me.’” Finally somebody called an ambulance, but not the police.

“If police had been involved, Walter Scott’s case would be different,” says Jacqueline Mosley. He is one of the fifteen or so new cases she gets each month. Scott does want to press charges, but more than that he wants to go home. Although he is free to leave Bryan Manor. Mosley has convinced him to stay until his health improves, the investigation is completed, and his safety can be insured as much as possible. Bryan Manor has a contract with the state that allows Walter Scott and others like him to remain up to sixty days at no charge; after that, he would be charged $500 a month under a Medicaid formula.

Except for losing their life savings, the elderly worry about crime more than anything else. Everyone seems to have a story involving crime, and for good reason: last year the city showed increases in almost all categories of crime involving victims over sixty-five, according to Corporal Lonnie Cunigan of the Dallas Police Department. Offense reports from January through September of this year show 5,006 crimes against the aged, including nineteen murders, twelve rapes, and 419 robberies and assaults.

Corporal Cunigan was appointed last June as the Dallas Police Department’s senior citizens coordinator to oversee the DPD’s Senior Citizen Crime Prevention Program. Detroit has seventy-five to a hundred officers to work with the elderly; Dallas has Cpl. Cunigan, and he’s hoping to learn fast. Cunigan has been studying what police departments in other cities around the country have done to prevent crimes against the elderly. In that effort, Detroit clearly is a leader. They have a computer call system programmed to contact seniors twice a week asking if they have problems; they have developed an identification bracelet bearing a twenty-four-hour police station phone number and a code identifying the wearer and important medical information; and they have instituted a free lock installation program using police and community volunteers. New Orleans and San Francisco have an escort service for seniors. Other cities have Senior Citizens Advisory Councils that meet regularly with police officials at their area stations. The Dallas victimization subcommittee plans to recommend that police officials look into the feasibility of adopting these ideas and others, such as an identification letter to be used on the 911 emergency system to indicate a senior needs help.



The Nurse



EACH WEDNESDAY AFTER-noon, representatives of most of the forty-five agencies working with ACE meet to discuss cases that need special attention: a caseworker has smelled gas several times in Mary’s apartment in Oak Cliff; she’s sixty-four and has Parkinson’s disease, diabetes, and cataract problems. She needs a wheelchair so she can correctly light her oven, but how can she afford one when medicine, food, and rent eat up $300 of her $355 Social Security check? Martha, eighty, in South Dallas, lost her husband and sister last year; lives alone on $531 a month; needs $467 to turn her lights back on; she’s moved four times in the past year and forgets to pay her bills; she distrusts electrical appliances; the caseworker found her cooking fried chicken and spaghetti in her back yard over an open fire.

Sharon Buford, a public health nurse and supervisor of the city’s geriatric program nursing staff, tries to attend all the Wednesday ACE meetings. She is familiar with many of the cases because her nurses provide the city’s only no-cost home medical assessments. They also provide comprehensive physical exams, medication counseling, health screenings to check for diabetes, high blood pressure, colon cancer, and other problems; health education lectures, and nutritional advice. Today, as usual, Buford’s beeper sends her back to the streets before the discussion is finished.

This time the call is from an Adult Protective Services caseworker who had gotten a report that a ninety-two-year-old diabetic male had been out of insulin and food for several days. When no one answered at the Robert Deadmond residence, Buford called Deadmond using a neighbor’s phone. He told her to get the key from the home across the street, because it took him too long to get to the door. When they met she understood why: Robert Deadmond is a bilateral amputee, and he hadn’t been in his wheelchair.

The report on Deadmond proved to be a bit garbled. He had food, and it was not insulin but his oral hypoglycemic medication he had run out of four days ago. His blood sugar count was 349 when it should have been under 130. Sharon Buford counseled Deadmond about his medications and diet and made sure the medicine was on its way before leaving for her office on North Haskell.

Buford and her staff saw 451 people in August. “That’s about half the number we could see if we had our allotted eleven nurses instead of our five, including me,” she says. “We used to be the only place offenng attractive employment packages and flexible working days, but now all the hospitals do. And they offer higher salaries. Attracting murses is my biggest problem.” Dr. Herbert Shore, executive vice president of the Dallas Home for Jewish Aged and a member of the Mayor’s Committee on Senior Services, agrees. He has thirty slots for nurses at his facility He feels lucky if he can fill seventeen of them. The city’s starting salaries for public health nurses and practitioners are 521 200 and $25,900. respectively. Private hospitals in town offer S25,000 to $30,000.

As for mental and psychological help, “there is virtually no organized mental health care system for the city of Dallas,” according to the health services subcommittee’s final report. Dr. George Foelker, coordinator of geriatric service for the Dallas County Mental Health and Mental Retardation Center, estimates that two in ten persons sixty-five and over need treatment for mental illness disorders and that at least 80 percent of these are not being reached.

Another void examined by the health services subcommittee is the lack of affordable adult day care centers. There are four adult day care centers in Dallas but they charge an average of $30 a day; that includes transportation, meals, occupational therapy, social activities, and some nursing care. These are excellent facilities, but because of the cost, they often aren’t fully utilized. The Baylor Hospital Adult Day Care Center, for instance, averages ten patients a day but has a capacity for twenty. San Francisco’s seven adult day care centers, which do serve the low-income senior, have become a national model. Operating costs are met by a combination of state and city money and grants from United Way, local corporations, and foundations. In 1986. California’s legislature became the first to authorize Medicaid reimbursement for this type of care provided outside of an institution. Since then, twenty-four other states have followed California’s example, but not Texas.

More than any other committee, the health services group uncovered a long freight train of needs and problems: Medicaid doesn’t pay for hearing aids; the cheapest dentures are $175 a set for indigents, and more dental service sites are needed; eye care is extremely limited for indigents; more podiatric services are needed; bath rails and elevated toilet seats aren’t covered by Medicare or Medicaid. Most of these concerns are addressed in the final report.



The Partnership



AFTER CRIME AND MONEY, THE BIG-gest concern for many elderly citizens is housing. Its well known that even many two-income families have a hard time buying a house. A family earning the nation’s median income of about $28,000 falls short of the money needed to carry the mortgage on today’s median-price home. Data from an income survey of the 1984 Census reveals that those over sixty-five had an average household income of $18,279. Two years ago another mayor’s task force, this one studying low- to moderate-income housing needs, documented the fact that Dallas needed more than 45.000 additional units for its less affluent citizens.

For the elderly who can’t afford their own apartment or home, what does Dallas offer? There are eighteen retirement homes, fourteen government-subsidized apartment complexes, and 1,314 apartment units in eight Dallas Housing Authority buildings, for those who are at least sixty-two and whose annual income, with few exceptions, doesn’t exceed $13,150. Among these 1,314 units, 135 vacancies exist for the 170 families on the DHA’s waiting list.

Allan Block, chair of the housing subcommittee, has had experience in creating low-income housing for seniors elsewhere. He worked as an engineering project manager in St. Paul, Minnesota, for The Housing and Redevelopment Authority, an independent nonprofit corporation that has built 4,000 units for low-income seniors. He looks to the Boston Housing Partnership (BHP) as the model in creating low-income housing units independent of federal government programs and subsidies.

The BHP is a centralized and citywide nonprofit corporation whose members include the city of Boston, major banks and insurance companies, community housing and development corporations, neighborhood leaders, and the Commonwealth of Massachusetts. It facilitates the planning and financing of housing projects by coordinating funds for community development corporations (CDCs) to use in the construction and rehabilitation of low- and moderate-income rental housing.

The thrust of Block’s subcommittee’s report will be to recommend the use of the Center for Housing Resources, Inc. (CHR) as the local model of the Boston-style CDC. The report will also say that advocating and providing affordable housing for seniors should become a specified priority in the CHR programs. CHR just completed Jeffrey Square, a twenty-unit townhouse co-op in Oak Cliff for low- to moderate-income residents. So far, the CHR board has only agreed to study the proposal from Block’s committee.



The Future



IT USED TO BE THAT PEOPLE DIDN’T AGE. They died. In 1950. people sixty-five and over made up just 7.7 percent of the population. Today the number is up to 12 percent and expected to almost double by 2020. The fastest-growing figure of all is the “old old” (seventy-five and over), who are increasing five times more rapidly than the “young old” (sixty-five to seventy-five). Texans are staying alive longer, and more elderly people are moving into the state. A recent National Institute on Aging study showed that Texas experienced a 191 percent increase in the number of older persons moving here from 1960 to 1980, second only to Arizona. That trend has continued.

Financially, the aged are somewhat better off, but the figures can be misleading. Yes, the percentage of the aged living below the poverty line has been cut from 20 percent in 1970 to 12 percent in 1984, but 8.3 percent of the elderly are also classified as “near poverty.” That brings the total of the elderly living near or below the poverty level to 20.9 percent compared with 18.7 percent for the nation. And the poorest are trie most vulnerable: elderly women living alone, as one-third of them do; those over eighty-five; elderly blacks, almost a third of them, who live on less than $5,300 per year. Old-age poverty now is not a problem of income but of distribution.

The Mayor’s Committee on Senior Services has produced a valuable study. There is some of the pattern of every high school valedictory address, with big questions melting into fatuous, wishful answers, but there are also specifics weighted with the ballast of reality: shameful gaps, hard-working, low-paid people, and outright voids.

But for the most part, silence has been the response of city leaders to the many studies produced by its citizenry. Since the Mayor’s Task Force on Low and Moderate Income Housing completed its report two years ago, exactly twenty-four units have been built as a result of the city’s revolving loans fund: CHR’s twenty-unit Jeffrey Square, and Trinity Presbyterian Church’s Project Oasis, four transitional units for the homeless. Public housing is not high on the city’s agenda. Last August 19, the members of this task force’s transportation subcommittee received a memo from chair Norman Moorehead that stated in part, “The 1980 study ’Transportation Services for the Elderly and Handicapped,’ done by the Community Council of Greater Dallas, is still current. No changes have occurred.”

The response to this new report, therefore, is predictable. The politicians and officials will listen with grave avidity, then talk like editorials and pursue publicity with the industry of coolies. Their collective smiles and attention will bloom and fade as quickly as an accelerated film of horticultural miracles. If they act at all, it will be very slowly and painfully, like elderly gentlemen with bowel problems. Still, the citizen effort must be made, for in cases of injustice, silence is consent.

In taking care of the poor and disadvan-taged, Texas and Dallas rank well down Mister Darwin’s artfully conceived tree, near ooze itself, barely protein and ruminating mud. Texas ranks 47th in mental health services. 48th in welfare payments, and 49th in Medicaid expenditures. On average, the nation spends $2.91 per elderly resident for elderly protective services; Texas spends $1.55. In this abysmally parsimonious state, Dallas ranks last among the six largest cities in per capita funding for health and human services: $42.49 compared to first-ranked Austin’s $273.13 for those under six and over sixty-five.

As a civic body, it is time we became more man than monkey. Certainly it is true that Dallas is experiencing hard times and no longer is feeling flush and splendid, but in hard times a city’s true character is revealed.

Pauline Kress is a longtime civic worker who served on this committee’s health services group. “There are three things city leaders can do when the economy goes bad,” she says. “One, aggressively seek public funds; two, work hard to forge alliances between public and private sectors to make things happen; three, raise taxes. I don’t see anyone doing anything.”

It is more than reasonable to ask why our public officials and leaders aren’t working to emulate imaginative projects like the Boston Housing Project. We learned in October that the Dallas area had the wealthiest collection of the super-rich in the entire country. Where is the Ross Perot, the Trammell Crow, the Harold Simmons who will lead the fight for the dignity of the old? Why aren’t our leaders pushing to create coalitions to provide affordable adult day care centers like San Francisco has done? Some elderly residents of Boston, Memphis, Los Angeles, Ann Arbor, Michigan, and Madison, Connecticut, live in so-called shared houses, single-family homes where an average of five seniors share rent, meals, and chores instead of living alone or in nursing homes. Why has no one contacted the National Shared Housing Resource Center in Philadelphia about making that possible here?

Last month, the nonprofit Local Initiatives Support Corporation (LISC) in New York announced that it had raised more than $50 million from corporate investors to create low-income housing in New York, California, Minnesota, Missouri, and other states. Why not here? “We are doing a low-income housing project in Houston but there hasn’t been an expression of interest from Dallas,” said Alfred E. Prettyman, director of communications for LISC.

“It’s a question of priorities. Fancy symphony halls and ape habitats at the zoo are more important than affordable houses and day care centers for the old,” says Pauline Kress. She knows something about priorities, persistence, and the glacial movement of Dallas government on social and health issues. Fifteen years ago, as a member of the Martin Luther King Center Board (she still serves on the MLK Family Clinic Board), Pauline Kress and others developed a position paper and campaign to build a senior citizens activity building and adult day care center on vacant land next to the MLK Center. Nothing happened. This month, construction finally began on the still-empty lot. No, it won’t be an adult day care center, but an extension to the recreation facility for seniors. Progress.