Two of the agencies-the Housing and Development Department and the Environmental Health Department-make inspections only upon receipt of a complaint.

And such complaints are few and far between, so those agencies seldom visit boarding homes.

Another reason for the lack of official action is that for all the boarding homes in the state, some 100 of them, as well as every sheltered-care home, nursing home, hospital, 24-hour child care center, day-care center and foster home in New Mexico-more than 2,000 facilities-there are only three HSSD licensings inspectors.

Then there is the matter of the efficiency of that HSSD licensing department For example, the most recent list of licensed boarding homes released by Robert Frankalucci, head of the department, does not contain the names of several boarding homes his own department has licensed.

A striking example of the department's operations came just a few weeks ago when a licensing inspector revoked the license of Mi Casa Su Casa, a South Valley boarding home whose proprietor, Mrs. Laura Andrade, had been arrested the night before on a charge of beating an 82-year-old resident of the home.

Under the state Boarding Home Licensure Act, a boarding home cannot operate without a license, and all welfare clients living in the home should be removed immediately.

A week later, however, the more than half a dozen private-pay residents of the home were still there.

Questioned about the situation, state workers talked vaguely about not being sure of their legal authority.

The point became moot a few days later, however, when the HSSD legal department decreed that the very licensing regulation under which the home had been closed was in direct conflict with state law requiring a hearing before any such action is taken.

The Boarding Home Licensure Act, passed by the State Legislature in 1972, does represent an attempt on the part of the state to improve conditions in its boarding homes.

It provided for the first licensing of the homes and subsequent regulations to govern them.

And some things in the homes may have gotten better since then.

"If you think they're bad now, you should have seen them two years ago. There were people living in chicken houses, on mats in basements," said Larry Brown, state director of the HSSD Social Services Agency.

But Adelina Hill, a former adult specialist with HSSD and now a professor of social work at Highlands University in Las Vegas, said, "There has been no significant change because the regulations aren't enforced."

And others agree with her.

Joan Tefft, county supervisor for adult services with the Social Services Agency, commented only that it would be "hard to say" whether things had improved.

Even if the regulations were fully enforced, however, there is a question raised by many as to their real worth.

For with the exception of a few token phrases, the regulations totally ignore an area in which many of the bad conditions in boarding homes exist: care. They deal almost entirely with physical plant requirements such as bathroom facilities or heating and water systems.

Perhaps the developers of the regulations covered themselves by implying that no care should be needed in a boarding home, defining such a place as one which provides only "a combination of rooming and eating . . . and which does not provide nursing care or assistance in daily living."

Those needing assistance in daily living, theoretically, would be taken care of in sheltered-care homes, which are defined under separate regulations as places providing that care.

But even state officials are aware that there are not enough sheltered-care homes to house all the people needing assistance.

"We've had the problem for many years. Perhaps who should be in shelteredcare homes, people with a chronic ailment, are in boarding homes," said Thomas Shinus, deputy director for the HSSD State Health Agency.

Mrs. Connie Padilla, who runs a highly reputed boarding home in the South Valley, says that she must bathe seven of her nine boarders, that they are physically unable to bathe themselves.

And the majority of the aged people living in boarding homes require similar

care.

The main reason they are in such homes is because they cannot get along by themselves, they do need assistance.

Many of the old ones cannot bathe themselves, or clip their own toenails, or even find their way to the bathroom.

The retarded or mentally ill ones may need guidance, or transportation, or other kinds of help.

If they are in a home run by someone like Mrs. Padilla, who provides far more than is required by state regulations, they are lucky.

But an operator is perfectly within his legal rights to provide only bed and board.

Mr. Shinus suggested an HSSD program, the Homemakers, as "a real glimmer of hope" for helping residents of boarding homes.

The Homemakers do, indeed, provide services such as giving bed baths, preparing special diets, and the like.

But they go only into private homes, Mary Vaughn, county director of the program, said.

What of the people in boarding homes?

"That's the visiting nurses' problem," she said.

The visiting nurses, however, provide medical, not "custodial" care, according to Muriel James, director of one of the organizations, Visiting Nursing Service, a non-profit United Community Fund agency which tends to people who need occasional medical attention in private or boarding homes after their release from the hospital.

Mrs. James, who has been complaining about boarding homes to state and local officials for several years, says she always gets the run-around, the "there'sno-place-to-put-them" line.

"HSSD has totally abdicated responsibility in this," she said.

Anne Beckman, Albuquerque director of the American Association of Retired Persons Job Placement for the Elderly, said she, too, has run into a brick wall in trying to make someone take responsibility for the boarding-home situation. "I've tried talking to state legislators about boarding homes time and again. They'll talk about anything else but that."

Midway through 1973, HSSD did begin a massive survey to determine whether welfare clients living in room-and-board arrangements actually were in need of a higher level of care.

The survey offered foster care, sheltered care, day care, nursing homes and other situations as alternatives.

The results of the survey are still being tabulated, but the State Health Agency's Shinus said he estimated that by the time results were in, it would be revealed that 50 to 60 per cent of the people need a higher level of care.

If his estimate proved true. Shinus said, he would move to encourage the development of more sheltered-care homes.

Henry Keck, adult specialist with the HSSD Social Services Agency, said, however, that more than half of the results have been tabulated, and only a meager two per cent have been shown to need more care.

Like Shinus, Mr. Keck had expected the percentage to be higher.
And, he said, "I have a lot of doubts about the results."

Questioned on the matter, county adult services supervisor Joan Tefft, whose department conducted the survey here, said she had interpreted the survey as offering only nursing homes and hospitals as alternatives, an interpretation she based on a cover memo that arrived with the survey questionnaires.

And obviously, she said, most of the people surveyed did not need such a drastic change in care.

And so, through misunderstanding and crossed wires, what might have proved an invaluable tool for defining the specific needs of a much-neglected group, and thereby establishing goals toward which to work, has been rendered meaningless, at least in Bernalillo County.

In true bureaucratic form, the agencies and officials in New Mexico have ignored the conditions in boarding homes or messed up whatever efforts they have made to correct them.

Adelina Hill at Highlands describes the situation as “a merry-go-round." And the old people, the old and helpless ones, will ride forever.

[Albuquerque Tribune, May 16, 1974]

RANGE OF PROPOSALS COULD GIVE HOPE TO ELDERLY

(Last in Series)

In the Santa Fe headquarters of the state Health and Social Services Department (HSSD) there exists a proposal for a statewide system of family foster homes for the elderly.

The proposal was developed by Adelina Hill, a former HSSD adult specialist, as an alternative to the boarding homes which currently provide the only place for hundreds of New Mexico's elderly to live.

The plan would cost relatively little, Ms. Hill said, because unlike the fosterhome program for children, under which the state pays foster families $70 to $100 a month for each child, the elderly themselves would pay for their care, as they do now in boarding homes.

The cost to the state would boil down mainly to salaries for about six staff members to select appropriate foster families and monitor whatever specific guidelines were established for the program.

Experts see a foster-family situation as ideal for the elderly, offering them a feeling of belonging and a chance to participate in a family routine.

Members of the HSSD Board seem to agree. They gave the go-ahead on the foster-home plan some seven months ago.

Since that time, however, the plan apparently has been just where it is today: "under study."

"We're working on the plan," said Larry Brown, state director of the HSSD Social Services Agency, "but it hasn't been implemented yet. And I couldn't give a target date."

Such seeming lack of urgency on programs for the elderly is not unusual, observers say.

"The main thrust of social work has been child welfare," explained Ms. Hill, who is now a social work professor at Highlands University in Las Vegas. "But the elderly population is growing," she said, “and something must be done."

As Anne Beckman, Albuquerque director of the American Association of Retired Persons Job Placement for the Elderly, put it: "People are going to keep living longer and longer, and it's about time someone started learning something about it. You can't just throw them into a pit."

With stories ranging from underfeeding to actual beatings, some of the boarding homes in which elderly people now are forced to live seem little better than pits.

But there are alternatives such as the family foster-care plan, and people who work with old people talk excitedly and longingly about them.

Dale Libby, an inspector with the HSSD Institutional Licensing Section, notes that there is an informal foster-care program already working in Truth or Consequences.

"With all of the older people in T or C, there is only one boarding home, because families take in one or two elderly persons. The town is full of individual homes which take in older people," Mr. Libby said.

As far as Libby is concerned, that situation is perfect.

But there is a range of other choices.

Some are preventive: efforts to keep old people out of boarding homes, active and independent in their own homes for as long as possible.

Such alternatives would entail massive expansion and coordination of programs such as Meals on Wheels, a Model Cities effort that delivers pre-cooked meals to elderly people's doorsteps.

Those are exactly the kinds of alternatives that Barbara Menzie, director of the Metro Areawide Aging Agency, is working toward.

Her agency has spent the last year developing an area plan for the elderly which, if approved by the state and funded locally, will draw more than $200,000 of federal funds in matching grants.

The plan for Bernalillo County, where 19,348 of the state's 70,611-strong, over65 population resides, according to 1970 census figures, would include such

programs as an outreach team to go into the homes of the elderly and do such odd jobs as fixing a light switch or a kitchen cabinet; a mini-bus transportation system to offer door-to-door service for the elderly; a preventive health project.

A 1973 Scripps-Howard article quoted the deputy chief of research and demonstration for the U.S. Health, Education and Welfare Department's division on aging as saying that 18 to 50 per cent of the elderly people in institutions would not be there if there were adequate services in the community.

For elderly persons who are not able to make their way alone with just periodic visits by community workers, however, there is another alternative to boarding homes day care.

The concept of day-care centers for the elderly is still fairly new.

As of March 1973, there were only about 50 such centers in the United States according to an article in U.S. News & World Report.

The concept has been heralded by some, however, as "the answer to a prayer," and Ms. Menzie said she hopes by next year she can convince the city to begin a program of day-care for the elderly.

The advantages of such care are plentiful. A center would offer working families who might otherwise be forced to place elderly relatives in a boarding home a chance to keep those relatives with them instead.

It also would allow an old person who did not want to give up his own home the opportunity to retain it, returning to it each night.

As proposed by Ms. Menzie for Albuquerque, day-care centers would offer 10 or 11 hours of daily service. There would be a registered nurse on hand at all times, and part-time physical and speech therapists.

At least one nutritious meal a day would be served, and transportation would be provided.

A main goal would be to keep elderly citizens active through various rehabilitative programs in the centers.

Another alternative that would foster activity and independence in the aged is "group homes."

Like the foster-home proposal, a plan for group homes was developed under the direction of Adelina Hill and accepted by the HSSD Board in September, Ms. Hill said.

Group homes would provide a situation in which elderly people assembled by state agencies could rent a house of their own and hire whatever persons they might need to assist them-a cook, for example.

Such residences would be, in a sense, boarding homes without an operator. But the welcome burden of personal responsibility often spells the difference between senility and a full, purposeful life for the aged.

Another alternative to boarding homes that is often mentioned is multilevel-care facilities.

Joan Tefft, county supervisor for adult services with the HSSD Social Services Agency, envisions such facilities located in two or three places around the city.

"One level would have regular apartments with cooking facilities," she said. "Another level would contain one or two or three 'boarding-home' set-ups, little areas where residents would have their own rooms, but would come to central dining areas for their meals.

"Then there would be a level for those needing a little more physical care, and a top-notch nursing home."

Ms. Tefft said such facilities are common in the East.

Barbara Menzie said it was just the type of facility described by Ms. Tefft that she and other planners had in mind when they began working on Encino House, a low-to-moderate-income apartment building at 609 Encino Place NE. Various confrontations with the Department of Housing and Urban Development, which was financing the project with government loans, however, resulted in the elimination of the central kitchen and most of the other "frills" in their plan.

As a result, Encino House offers only pleasant, small apartments at reasonable rates for the "well-elderly," as manager Randy Parker described the residents. A last alternative is to improve the boarding home-sheltered-care home system that presently exists.

One possibility toward that end would be to grant food stamps to low-income persons who could receive them under federal regulations were they not living in boarding homes.

There are some who oppose that idea on the grounds that food stamps is a nonprofit program that should not be used in a profit-making venture such as a boarding home.

But several persons, including boarding home critics, say the idea would considerably ease the burden on boarding home operators with low-paying welfare boarders, and would at least help solve one of the chronic problems in boarding homes: underfeeding.

Another possibility suggested by some would be for the state or federal government to offer some sort of boarding home supplement.

J. Patrick Kneafsey, head of the city Environmental Health Department, said, for example, that he saw only two ways to improve the boarding home situation: "raise payments enough so the boarding homes can be decent and safe facilities," or "have the state operate homes."

Mela Anaya, operator of a well regarded boarding home in the South Valley, said she felt an operator today could barely break even charging $175 a month, let alone the less than $140 (the maximum welfare payment for the elderly) they now can charge.

A suggestion offered by Thomas Shinus, deputy director of the HSSD State Health Agency, proposes a system of "vendor" payments for boarding and sheltered-care homes, to work much in the same way as Medicaid works in nursing homes.

The system would pay the facilities certain amounts based on the level of care for each eligible person in the homes.

Most of the services needed in such homes are "custodial" in nature, but Shinus said in reality, many could be considered "low-level medical needs."

Because sheltered-care facilities by definition are supposed to offer greater care than boarding homes, but for roughly the same price a vendor system could offer more incentive for development of sheltered-care facilities.

When questioned about the possibility of such a system, Charles Lopez, state director of the HSSD Public Assistance Agency commented only that his agency was out of the business of helping the elderly, with the exception of Medicaid, since the federal government took over the states' financial assistance programs Jan. 1.

A federal government pamphlet on its new welfare program for the elderly, blind and disabled, however, notes that some states currently are supplementing the federal payments.

A vendor system might be one way New Mexico could follow suit.

The money, theoretically, exists, or could exist: Lopez said the federal takeover had saved the state $5 million to $6 million a year.

And Adelina Hill charges that by leaving conditions in boarding homes as they are, leaving people without rudimentary care until they actually become sick, the state ends up spending more money in the long run in expensive Medicaid payments.

"We are debilitating our old people," she said. "It costs more in the end."

YOU VISIT MANY HOMES OF ALL MOODS AND APPEARANCES ...

You cannot tell, in a brief visit to a boarding home, whether there are only two meals a day served, or whether the old people languish for days with illness or broken bones before a doctor is notified, or whether the boarding-home operator strikes the old people when they get on her nerves.

But you can see old people lining the walls, staring blankly with nothing to do; you can see torn sheets, and filth; you can see boarders, aged and mentally ill, who look so dirty you want to back away when they extend their hands in friendship; you can smell urine so strong it almost makes you retch.

And so these are the things you have to go on, these things and the warnings of operators you meet along the way whose homes are full, but who tell you to be careful of "some of these places."

Magdalen Urban may have an opening in her boarding home, Casa Maria, 1024 Lead SW, she tells you.