STEVE: The Agency on Aging is a private, non-profit corporation. We're owned by the older people of Aroostook County, which is the area that we serve. The mission of the Agency is to help people stay as independent as possible, for as long as possible.

There are a number of these agencies around the state. For lack of a better word, are you a franchise?

No. In the State of Maine, there are five Area Agencies on Aging. Each of those is an independent, non-profit organization. But we are all connected as part of a network. Across the country there are about 680 agencies similar to ours and we're connected to those agencies as part of the national network.

Since you're private and non-profit, how are you funded?

Well, we go for funding wherever we can find a resource. A primary source of funds for us is the federal government, through the Older Americans Act. We also have other grants and contracts with the federal government. The State of Maine provides us with funding through a number of different resources. Most federal and state grants come with strings attached, and one of those strings is that you have to have local matching funds in order to draw down the federal or state dollars. So we look for help from the towns and cities here in Aroostook County. About 94% of them do provide us with the money that we ask for, so we feel good about that. We have a lot of donations from people that we serve, and I think agencies like ours are unique in that respect. The Older Americans Act is a federal law that we operate under. [It] has a requirement that people who receive services from us be given the opportunity to make a donation toward the cost of those services. Those donations total almost as much now as some of the federal grants that we have. We get just a little bit over $300,000 a year in donations from people that we serve.

How many people do you serve in a year's time in Aroostook County?

About 5,000 people a year, we touch in some way with our services.

What percentage of our county population is elderly?

When we look at the population of 60 and over in The County, it's a little bit better than 13,000 people. So with the services that we provide, we hit a pretty good percentage, about 5,000 out of 13,000.

What's the total population of The County, do you know?

The last estimate that I saw, because of the closing of Loring, was going to be between 74,000 and 76,000.

That means about 17% of Aroostook's population is elderly. Is that a larger percentage than in other parts of the state served by similar agencies? Do you have a larger percentage of your population to serve than do other agencies?

Proportionately, what's happening in Aroostook County is that we do have a larger share of older people here to serve. But in actual numbers, Aroostook has about 8% of the state's over-60 population, so as a proportion of the total population, yes, it is higher. But you're going to find that in Washington County, and you're going to find it in Piscataquis County. The rural counties of Maine are pretty much the same in terms of what's happening with the population: a lot of out-migration of younger people, and the older people are staying.

What are the programs that your agency operates?

Probably one of the most important things that we do is provide information to people. We are an excellent resource for people simply to call if they have questions about aging. Last year we received just over 13,000 telephone calls. It could be on services, it could be about a benefit, it could be about a concern Ð cost of prescription drugs and people needing help Ð so information and assistance is probably one of the most important things that we do. We're the only agency in the State of Maine, as far as agencies on aging, that still maintains outreach workers to go out into people's homes. When you look at what's happened elsewhere, not just Maine but pretty much throughout the country, a lot of agencies have moved toward providing information and assistance to people through telephone calls. We do that, but we go a step further. We feel that because of the geography that we have, it's really important to maintain an outreach program of workers able to go into people's homes and sit with them around their kitchen tables and talk to them about problems that they might be having, help them with applications that might need filling out. That one-on-one service right in people's homes is a critical part of what we do.

The outreach service that you provide, is that something that individuals call and request, or is this a more proactive program on your part?

It can work both ways. People can call us, and if we're not able to answer the question over the telephone or we sense that there may be something else that may be going on or needs doing, we can dispatch an outreach worker to the person's home and work with them one-on-one. Most of our outreach workers are older people from [the same] communities that they're living in and working [in]. A lot of times the people that they're calling on are neighbors and friends and people that they've known over the years, so that's a big help. A lot of times the calls that go to the outreach workers don't come through this office, they come directly to the workers themselves.

What else does the agency do?

We have a really large "Meals on Wheels" component in this agency. Our Meals on Wheels program last year served 715 home-bound people, and we delivered 71,279 meals. That's a lot of meals going out. As important as the meal is the fact that that meal is being brought in by somebody that cares. Most of the clients that we have don't have a daily contact from somebody else from the outside. So that Meals on Wheels delivery person, they're making eye-to-eye contact with a person, they're greeting them, they're seeing that they're okay. Time and time again over the years workers have not been able to have somebody come to the door, and we've been able to summon emergency help for people. In some cases, it's been too late, but the fact that somebody is there making regular contact Monday through Friday is a big reassurance for a lot of these older people that are homebound. And unfortunately for some of them, that is the only human contact that they have, so that's critical for them.

Are the Meals on Wheels workers volunteers or employees of the agency?

We use a mix of paid staff in some communities, and our Meals on Wheels program in other communities is totally volunteer run and operated. The difference is in larger towns. For example, Presque Isle: we may have 75 home deliveries in the course of one day and that's a heck of a lot of work to ask volunteers to do. So the Rotary Club has supported us by buying us a delivery van, and we have a paid staff person that makes the delivery run in Presque Isle. In Caribou, we have a large number of meals there and we use a paid staff person. Up in Madawaska we use a paid staff person. But in most of the smaller communities, the program is operated by volunteers.

Where are the meals prepared?

Whatever works!

You don't go to the drive-through?!

No, no. We have a number of partners, it depends on the town. In the Presque Isle area, and Mars Hill and Fort Fairfield, the Aroostook Medical Center provides us with meals; they're able even to do the special diet meals that a lot of people require. In Caribou, the Caribou School Department, through the Adult Learning Center, had a kitchen in an old school that closed down. They contract with us, we buy food from them and they're able to keep their kitchen going on a year round basis. That helps out some of the other programs that work there in that building, so everybody benefits. We buy meals from a nursing home in Van Buren, Borderview Manor. In Madawaska, we have a kitchen that we operate. We do our meals for Madawaska, Frenchville, down into Ste-Agathe and up into Fort Kent out of our Madawaska kitchen. We use the boarding home in Eagle Lake to buy meals. [In] Limestone, we use Kelly's Restaurant. [In] Mapleton, we use Mapleton Lunch. Down in Oakfield we have a new program that's opened down there. The Dyer Brook Community School does a program for seniors and we've been buying Meals on Wheels from a restaurant. In Ashland, we use a restaurant. So, it's whatever works in whatever communities. I think it's a boon to some of the economies to see us buying meals from a local restaurant, and I know the older people that receive those meals really like them, and the volunteers like to deliver them, and the business owners like to see us involved in their communities, so it's win-win for everybody.

Your main office is here in Presque Isle. Do you maintain satellite offices, too?

No, we don't use any satellite offices. This Presque Isle office is primarily an administrative office. People come here to receive services, too, but our philosophy on operating is rather than put money into office structures, we'll put our money into our services. Wherever we have a senior dining center, people have access to information and educational programs right there. We have partners that work with us in providing for the senior dining centers in communities. Our outreach workers, they all work out of their own home, they don't need to work out of an office. That works out well for them, and we don't have much overhead for administration.

Do you serve people in every corner of The County?

From Allagash to Danforth and over into Patten. Something that's unique that we do is each year we provide every municipality with a service report, what it is that we did for their citizens. The towns, we're asking them for money, but we're also accountable to them for the services that we provide. Oftentimes, especially in small towns, selectmen and the town clerk tend to be an excellent resource for us in terms of making referrals. By doing these kinds of reports for towns, we're keeping them up-to-date on what it is that we're doing. But more important than that [is] calling to their attention that we're there, and if they know of a person who has a need, let us know. We'll get in there and do something about it.

You have a lot of work to do in a very large geographic area. How many employees does the agency have?

[We have] regular staff, and we also have a home care division. Home care division works a bit differently. But on our regular staffing side, we've got 64 employees. On our home care side, it varies anywhere between 90 and 120 employees.

How do you define "home care" and what does that division provide?

We're not a licensed home health agency. We don't provide home health service. We provide personal care attendants that can help people with needs such as bathing, grooming, dressing, feeding, toileting, those kinds of basic activities of daily living that people may not be able to do on their own. They don't require the skills of a registered nurse, they don't require the skills of a home health aide that may require over 200 hours of training. But they are things that can be done by a person that does have some training. So we do employ a lot of personal care attendants to provide for those services for people. We have a number of people that do housekeeping, light and heavy housecleaning services for people who can no longer do those things for themselves. So there are some people that just require some real basic things, like a daily visit for reassurance, some help in getting groceries, maybe somebody to pick up prescriptions and those kinds of things. That would be a really expensive service for a nurse or a professional to provide for, but the staff that we have can do that at a reasonable cost and it meets a need that people have.

Do the people who receive the Meals on Wheels and home care services pay you for these services?

Many of the people that receive the home care services are clients of the State of Maine, and they qualify for Maine Home-Based Care Program or Medicaid waiver program that can help pay for in-home services for people that otherwise would have to be relocated to a boarding home or into a nursing home; they've chosen to stay at home. The State of Maine does provide financial help to them, so that we then get paid for providing them with care. There are people who don't qualify for state assistance and who can purchase those services from us on a private pay basis. We are in competition with some other agencies that are out there that provide for that kind of service. Our feeling on that is that competition isn't a bad thing Ð we're not duplicating in effect what other people do, but because there is competition in that sector, if you want to buy that service on a private pay basis you do have a choice. You get a choice of agencies, and you have a choice in terms of the person who comes into you home to provide you with that care. There are competitive rates between agencies, which tends to keep the cost for the consumer down. Because there's competition, we also compete not just on price, but on quality of service, so that's to benefit the consumer, too. But the home care division is only a part of what we do. People do pay on a private pay basis. People who receive Meals on Wheels can make a donation towards the cost of that service. People that come to our dining centers, they can make a contribution towards the cost of service, also.

Are you the only agency that provides the Meals on Wheels program?

Yes, we are.

Are there other services that only you provide?

We have what we call congregate dining centers. These are senior dining centers in communities where people can come in, enjoy a meal, enjoy the companionship of other people being around them. We use a lot of volunteers in that service, and we have a lot of community partners that help us out with that program. But last year there were 886 people that came to senior dining centers, most of them on a pretty regular basis. We served just over 44,000 meals there. For a lot of people [it's] the importance of those senior dining centers Ð a lot of the people who use those are people who live by themselves. It gives them a good reason to get up in the morning, to get themselves cleaned up, to dress up a little bit, to get out, and to enjoy that meal with friends and neighbors. For those that live alone, [it's] the fact that they have someplace to go, and it's a social occasion for a lot of them; it does have an effect on their health. They're not just getting their nutrition, that's important, but it's pulling them out of isolation. They're seeing other people and talking with other people, and that's an important thing for most folks. We also have educational programs for people [at the dining centers]. We'll do programs on, "What is it that you can expect from the Medicare program?" "What kind of changes are coming in Medicare?""What about supplemental health insurance to go along with Medicare?" "How much should you be paying for a supplemental Medicare policy?"

In the dining centers, people pay for their meals?

They make a donation. In most cases the donation doesn't cover the cost of the meal, but without their donations, instead of having nine dining centers we'd probably be operating two or three. And the same thing holds on our Meals on Wheels program. Instead of serving over 800 people, if we didn't have donations, it would probably be between 300 and 400. So, donations are a critical part of it.

You mentioned competition on the home care side; what are the other agencies that offer home care programs?

Aroostook Home Health Services provides for personal care attendants and homemakers; they also have home health aides available. They also provide for registered nurses. An agency in Presque Isle, a private agency called Seniors Domestics, they're a licensed home health agency. They provide for registered nurses and home health aides and certified nurse attendants. Madigan Home Health in Houlton serves down in that area, providing a lot of skilled care. [There's] Visiting Nurses of Aroostook and Professional Home Nursing. In The Valley we also have Valley Home Health Services. So there's a variety of agencies out there, and all of those agencies provide for a skilled level of care, and they also get into the personal care attendants, and some of them into the homemaker services, too. Catholic Charities of Maine operates a homemaker program. They receive government subsidies. So there's a number of agencies out there. Are we competing? Yes, we are. But what we find is that what's happened in the labor market, especially this past year, and I think we're going to see more of it in the future, if you've got a good employee, you're really fortunate. I think we're all trying to meet the referrals that we have for care, and we're all struggling to find employees willing to work and that are qualified to provide for care. So, competition works in a number of different ways.

How many agencies that you've mentioned operate county-wide?

The Valley Home Health Service and Madigan Health, they're pretty much regional, but the other agencies are county-wide.

Is there anything we haven't discussed that the agency provides?

Yes, the services we provide for families caring for people with Alzheimer's disease.

I know that hospitals have Alzheimer's support groups. Do you work with them?

Yes, we staff their support groups! Through Cary Medical Center, Pines Health Services, we have a support group that meets at Pines on a regular basis. Sharon Berz is our Alzheimer's specialist; she heads that support group, she staffs it. The Aroostook Medical Center and their support group, Sharon staffs that one and heads it up. There's another support group in Van Buren, Pat Cyr's involved with that. Pat's a volunteer with us, she's not a paid staffer. [There's] one down in Houlton that's operated out of Madigan Estates, and we provide them with support by material, and that kind of thing, speakers occasionally, but we don't staff that one. We've got one in Fort Kent; we're up there on a regular basis, and that's pretty much a volunteer one Ð when they need us, we come in, provide them with the programs. We mentioned competition, but really it isn't. Our Retired Senior Volunteer Program, we're the sponsor for RSVP. There's more than 700 volunteers there that are directly related to us, and those volunteers are assigned out to work for hospitals and nursing homes and agencies that we supposedly compete with. We may have volunteers and we support the volunteer activities for those volunteers there. There's a lot going on that we do. In Caribou and Presque Isle, we've got adult day care programs that haven't taken off the way they could, but we're as busy right now as we want to be with them. That's an important service, and nobody else is providing for that kind of thing. That works out well. Caribou is unique in that it's the only program we're aware of in the state that is a partnership between the city and a private non-profit in doing it, so the city provides us with the space and we run the program. We've got an adult day care program operating for people with Alzheimer's disease. [In] Presque Isle, the Presque Isle Congregational Church provides the facility and we provide the staff and the programs, so that works out well.

Are you helping with Alzheimer's programs in other parts of The County?

We're hoping, if we can get the funding for it, to get one off the ground up in Fort Kent. We've been working on it for two years, but haven't been successful yet. We're going to try again. There's the Brookdale Foundation out of New York City, and basically what they do is give you start-up funds for your first year, $15,000. The second year they cut it to $7,500. And the third year you're on your own. They're the ones that were instrumental in Caribou and Presque Isle, in getting us started up. We haven't been successful yet in getting them to fund a third venture for the Fort Kent area, but we've applied for two years now; we're going to apply again. It takes two years, really, to get the program to support itself because there's very little in government funds available to subsidize the cost, so the people that come there are pretty much on a private-pay basis, and it takes a while to build the knowledge of the program up and then to establish a regular clientele, to keep the thing going.

Are there more programs that you offer here at the agency?

We've got an eyeglass frame program that I think is really neat. We have an arrangement with a company that makes eyeglass frames who provides us with their surplus inventory, and what we have are free eyeglass frames to give out; if you've bought eyeglasses lately, you know that the cost of frames can go up to $100 or better. What we've found is that most of the eye care facilities in Aroostook County don't mind using our free frames with people who otherwise wouldn't be able to afford a new set of eyeglasses. They've been real reasonable in putting people's prescription lenses into these new eyeglass frames. So that's a neat thing, and we give these frames out to people who can't afford the cost of eyeglasses. We also make loans to people. We, in partnership with the Maine Community Foundation [who] gave us a basic grant several years ago, set up a revolving loan fund so we could get dental care for people who otherwise couldn't afford it. Since that time we've given out, I think it's now up to around 46 loans, so people can get dentures, or get their teeth taken care of. Most of the people that we've given money out to have paid us back, and we've been able to sustain [the fund] now for a four-year period. We also give out loans to people for hearing aids, and again that's on a revolving loan fund. We don't charge people any interest. Medicare and Medicaid don't pay for eyeglasses, hearing aids, dentures, dental care, none of that.

So you take up the slack on those.

Yes, if people can't afford it, we do make a loan available. People make payments back to us, anywhere from $10 to $15 a month until it gets paid off. That opens up a health care service to them that otherwise they wouldn't be able to get. We've also been doing some emergency loans for people who have household problems. For example, we had a lady this past winter, her sewer line into her home had broke off underneath her trailer. In that instance, we were able to get her an emergency loan to get a plumber in there to hook her septic system back up. We're sort of people's last resort.

When there's no place else to turn.

When there's no place else for them to turn, we usually hear from them. We do try to patch something together to make it work for them. There is government assistance to help pay for some things, but a lot of people are surprised when they need eyeglasses or a hearing aid or dentures, that there just is no resource out there, even on an emergency basis. Here in Aroostook County you get an older person, and it's the middle of the winter, and all of a sudden they don't have any septic system; what do they do? That's a real emergency need and we've been able to respond to that Ð in some cases, not all. But if it's reasonable, we try to do something.

What are the requirements for someone to receive services from the Aroostook Agency on Aging?

We don't have any income criteria. The only age criteria that we have is by federal law, the Older Americans Act, and that's that a person be aged 60. People that are disabled under age 60, we'll provide them with information. If they're homebound, we may look at things like home delivered meals, if there's some state funds there to help support it. We work closely with the Department of Human Services with Adult Protective Service in providing assistance to people that they refer to us.

So you only have to be 60 years old.

Basically, yes. Or under 60 and disabled.

Have we covered everything, Steve; is there anything we've missed?

Legislative advocacy, because it's a critical part of what we do.

Explain your involvement in legislative advocacy.

Back when I first came here, one of the major issues that we identified was the percentage of income that property tax takes. We worked with the legislature back in the late 1970s to put in place the Elderly Householder's Property Tax Refund Program, and that's returned millions of dollars over the years to people. That makes a big difference in terms of the lives of people being able to maintain and keep their own home. That was a piece of legislative advocacy that was identified by the Agencies on Aging, and we worked with the legislature to put in place a program to help take care of that. The cost of prescription medications has been a major issue for us. We worked with the legislature to get them to understand that there was a problem and we worked toward a legislative solution, which is the low-cost drugs for the elderly program.

Is that the legislation that was recently passed in Augusta?

No, that's another piece. But the low-cost drugs for the elderly program, that's also expanded to include the disabled population. It is income-based, but that's been a critical service and I think it's an important thing that, had we not been there, the legislature wouldn't have done. The Maine Rx Program, which is a new Maine prescription program for people that don't have any prescription coverage, we've fought hard in this past legislative session; it was the elder advocates I think that fought probably the hardest to see something done about the cost of prescription drugs. The result of that was the passage of the program. I'm not saying we instituted that, because we didn't; it was Senator Shelley Pengree, but she required a lot of support to see that program through the legislature. In the end it took some bipartisan work with the governor's support to put a program into place that was acceptable to everybody, and I think we're going to see the fruits of that in the coming years. Those are three things. Maine is one of the first states in the nation to ban mandatory retirement. That battle was back in 1975 and again it was the agency's sort of older people that were in the forefront on that issue. So over the years we've been involved in a lot of things. The Maine home-based care program, which has helped thousands and thousands of people delay being placed in a nursing home. Aroostook County spearheaded that effort back in 1981. We put together a pilot project as a demonstration for the state to show that with some fairly intensive care management and a little bit of resources Ð we provide things like personal care attendants and housekeeping help Ð people that were destined to go to a nursing home could stay at home. We were the first agency to do that as a demonstration and since then, the program did take off, and the legislature funded it and increased it over the years.

Are you personally involved in these legislative movements? Do you go to Augusta and talk to the legislators?

Yes. To some of them I say too much! The Aroostook County legislative delegation I think is aware of us, and they listen, and they work together on our behalf. It is for Aroostook County and they know it is going to benefit people from Aroostook County. We don't see all the partisan bickering over the issue. I think our county legislators work hard, and when they see something that is truly for The County's people, they'll support it.

Do you work with other directors in similar positions around the state on these common pieces of legislation?

We do. We work with the AARP, [with] the Maine Council of Senior Citizens; there's a group called the Senior Legislative Advocacy Coalition, we work with them. The Agencies on Aging together identify what our priority needs are for the legislature. We try to identify why these needs exist and what kind of legislative solutions might there be to resolve these issues. Sometimes it's not a need for more money, but it's a need to look at a state policy. An example of that would be the issue of safety and older drivers. We've had some major incidents with older drivers that got a lot of media attention. A lady crashed through a restaurant. There was another lady that was killed, she was a pedestrian walking across the street and walked into the path of a vehicle. There was a backlash that all of a sudden we need more laws to restrict the rights of older drivers, and that was sort of a knee-jerk reaction. I think we kind of moderated that a bit. Looking at the issue of older driver safety is something that the State of Maine has to pay some attention to, and what we did is we met with the Department of Transportation to talk about what are they doing to make the roads more user-friendly for older drivers. There are simple things that the state could do that don't cost a lot of money, such as putting white lines down the right hand side of the highway. That doesn't seem like very much, but for those people with night vision problems, that's a critical thing. There's things that the State of Maine can do, other than taking people's rights away. But there are people that may need their rights taken away, because they're no longer safe on the road, and for us, that's a major issue. Who should be involved in making that decision? It should be the people who are responsible for public safety. Do we need driver's tests? Yeah, and we have them. Do we need vision tests? Yes we do, and we have them. Should it be every two years, or should it be every year? That's open for debate, but those are issues we'll be looking at on an on-going basis.

What are your goals and challenges for the future?

The prescription drug issue is going to be a continuing issue. I think we're going to see an effort by drug companies to be more restrictive in the State of Maine because of Maine's new prescription pricing law. So that's an area that needs attention. A need in Aroostook County that we're seeing that has been a continuing need, and it's a tough one to deal with, are people living in their own homes [and] having real difficulty paying for or finding somebody to do basic home repairs. That's an area that we know we need to tackle. We've got some community volunteers that have expressed an interest in doing volunteer work in home repair for the elderly, so we're looking at developing a service around that. Medical transportation is a big need. We do a lot of medical transportation in cooperation with Aroostook Regional Transportation System, but we also have 120 volunteers that work for us, who transfer people who don't fit in with the bus schedule. As medical services get more and more regionalized, specialized, we're finding that there's a greater demand to bring people in to Presque Isle and Caribou from outlying areas for cancer treatment, and to Bangor for cardiac care, or down to Portland for cardiac care. We've got a fairly large older population, and they just don't have access to other kinds of support for transportation service. Somebody has to do it.

Is it a problem now to provide these kinds of transportation services?

Yes. We've got nine volunteer transportation groups throughout The County. All of them are community-based. Most of them have five, six, seven, eight, 10 volunteers that work for them. Basically, we try to coordinate that service for them. We provide them with financial support to help pay for gas for the volunteers.

They use their own vehicles?

They use their own vehicles. Volunteer services are always a challenge. Volunteers move on and we have to find people to replace them. A lot of the volunteers that we use are older people themselves, and we're at a point with this agency where some of the volunteers that are really active for us are in a position of needing the support that we provide, and we have to find new volunteers to serve them, so that's always a challenge.

If someone has questions about services, or if they want to be a volunteer, how do they get in touch with this agency?

The easiest way would be to call us.

And your phone number is . . .?

764-3396. Toll free 800-439-1789. E-mail is arooage@ainop.com. And there's a new thing, too; I think it's really neat, because we were told we couldn't do it. With the other four Agencies on Aging [in Maine], we set this toll-free number up this past year. We call it Elders One. Wherever your calling area that you're calling from, for example, if you're in Caribou, you dial this number 877-353-3771, it will ring in here. If you lived down in Westbrook, you dial that number and it's going to ring into the agency in Portland. If you're in Brewer, it's going to ring into the agency in Bangor. So it's a toll-free statewide number that, based on the calling area, it's going to ring in the appropriate agency. Technically we were told that that couldn't work, but it's worked now since January, and it's cheap.

The five agencies in the state share this?

Yes.

Are you receiving a lot of calls through this number?

Statewide, a lot of calls, yes. Most of the calls that we're seeing on that number are people who didn't know about us. We've been running some ads in the Bangor Daily [News]. We do a thing on public radio; a lot of public service announcements have been using this. A call this morning [was] from a lady named Heidi down in New Hampshire [who was] concerned about her parents in Fort Fairfield. She listened to Maine Public Radio and heard that tag line. Calls from out-of-state all come into the Eastern Agency on Aging, so we have one-button transfer for that call to us so we don't have to tell the person you have to call the Aroostook Agency on Aging. It's seamless.

So these five agencies, even though each is independent, work cooperatively with programs such as this Elders One phone service?

Yes; legislative advocacy, we're all together.

Have we covered just about everything?

Just about, yes.

Thank you, Steve.