At The Golden West Foundation, we seek to lead the industry in services for fixed and low income seniors

of Boulder County. A partnership with the Colorado Commission for the Deaf and Hard of Hearing will mean a brighter and more productive future for aging adults.

Golden West Senior Living 1055 Adams Circle Boulder, CO 80303 303.444.3967

Improving the Lives of Seniors with Hearing Loss

Brianna Westlake

2013

April 25, 2013 Reginald Jefferson Executive Director Colorado Department of Human Services 1575 Sherman Street Denver, CO 80203 Mr. Jefferson, Golden West Senior Living in Boulder, CO is home to over 368 residents, many of whom suffer from hearing impairments. We are a nonprofit organization serving low income elders. As the hearing decline progresses, residents are faced with daily challenges to remain active and healthy individuals. As a result, their function as human beings is reduced and they are often left to navigate the extensive yet overwhelming number of services offered to them in the community. Their hearing loss will often lead to isolation, which often exacerbates depression. Failure to thrive is a common diagnosis in the elderly and we feel strongly that providing carefully mapped resources, education, and technology to these individuals will create a strong feeling of community involvement and connection to the world. Our building was constructed in 1965 when technologies for the hearing impaired were limited and costly. Now that technologies have been invented and implemented, they are becoming widely available at affordable prices. The benefit of these technologies far outweighs their expense. In a large senior apartment complex such as ours, we feel strongly that we could provide the quality of life that is so deserved by our constituents. As a nonprofit organization, however, we are left with limited resources to make these improvements to the construction of our building. These items would include the installation of a telecoil loop system, wireless flashing doorbells and telephones, video capable communications, and various apartment amenity upgrades to suit those with hearing loss. In addition, we wish to train our staff and the families of the residents on the complex issues that hearing loss can create. We have learned of these available products through Namati Katungu, a community outreach representative from the Colorado Commission for the Deaf and Hard of Hearing. As a deaf individual, Mr. Katungu was able to make us aware of several deficiencies for those with hearing loss. This included a lapse in safety due to our current door entry system which requires the ability to hear the receptionist as well as communicate the necessity of your visit to Golden West. Namati had only one option of waving down a resident who was passing by the front door. The resident gladly opened the door for him, but this poses a risk to our security as door entry screening is one of our first security measures. Our level of welcome to guests and residents with hearing disabilities is not up to par with our hospitality standards. Namati met with several staff representatives, myself included, to develop an action plan to identify the primary areas of concern, the solutions to these problems, and a structured plan to reach our

goal of being associated with the best aging services in Boulder county. This pilot program was suggested to our facility by the Colorado Commission for the Deaf and Hard of Hearing and all staff were immediately receptive to advancing our skill set to include the needs of the low income seniors with hearing deficits. The staff of Golden West is a highly qualified group of people. Most are educated at a bachelors level, several at the masters level. Our executive director has been with the organization for almost twenty years, and our associate director for 19 years. The dedication to our cause is evident in the average length of employment which is quite high. We have staff to serve emergency needs, welfare needs including service coordinators, and we offer front desk concierge service. To be competitive with other caring and compassionate individuals, we must continue education for staff in all areas of elder care, but especially the causes of depression and isolation. To make our facility a friendly and welcoming environment to all who choose us as their home, staff should be aware of the causes of hearing loss, measure the loss of hearing acuity, and recognize practical solutions to these real world problems. The residents must also possess the autonomy to recognize their hearing loss and be willing to accept the guidance of family and staff. Family and residents should also be trained in the same areas that staff will be, as all play a key role in alleviating the pain and discomfort that hearing loss can cause. By hosting wellness clinics which will be guided by professionals, all could be invited to learn the process together. Giving the residents the gift of free knowledge will contribute to their overall confidence in the health care system and in their own right to pursue hearing care. In order to see this plan through successfully, we are requesting a grant of $15,545 to cover the cost of a hearing improvement program at Golden West. Over the course of several months in the year of 2013, we will complete the process of hiring the necessary contractors for the installation of the telecoil loop in our large public areas. Following the installation of this new and innovative technology, we will install the necessary cameras to make our door security system not only audio capable, but also visually accessible for all who require that option. Consultants from the Colorado Commission for the Deaf and Hard of Hearing will also be invited to return to Golden West to pursue community members who may prove themselves qualified and willing to instruct small workshops on all topics of hearing loss. Thank you for considering a partnership with Golden West. Improving the lives of low income seniors has been our mission for the past 48 years. Being granted the funding to improve our accessibility will create the new standard by which Colorado executes our willingness to diversify and serve the senior population. Please review the attached proposal. We look forward to collaborating with you in the near future.
Sincerely,

Brianna L. Westlake

A New Age of Disability Accommodation

At Golden West, we serve the low income elderly of Boulder County through subsidized apartment rentals. The options for low income housing in Boulder are not extensive. In fact, we are one of only two facilities that accept Medicaid for assisted living residents in all of Boulder County. In order to supplement the cost of subsidized rent and Medicaid insurance, our founders, First Christian Church, established the Golden West Foundation in 1986. It is the intention of the Golden West Foundation to procure funding for a program to improve the lives of residents and visitors by installing new technologies and updating our education, training, and awareness of hearing loss. The Golden West Foundation is seeking funding from the Colorado Commission for the Deaf and Hard of Hearing to benefit the residents and visitors of our 365 apartment senior living facility. It is evident that our building lacks updates that would improve quality of life for hard of hearing individuals and we have identified key areas to be changed, improved, and implemented. We know that we will be a valuable asset to all those with hearing loss in Boulder County at the completion of our project. The following proposal will outline our goals including: A description of the organization Critical analysis of necessary infrastructural improvements Critical analysis of necessary education programs Roadblocks to progesss Plan for improvements

Our Organization
Since 1965, Golden West has been serving low income seniors in the Boulder County area. The Golden West Foundation was established in 1986 to subsidize rental fees and assist residents with costs of living. In March of 2012, Golden West was approached by a representative named Namati Katungu from the Deaf and Hard of Hearing Coalition. He visited the facility on several occasions and determined lapses in accessibility for residents who are either deaf or hard of hearing. A focus group was developed which incorporated a staff member from each department of the facility. In this focus group, staff determined where we lacked proper accommodation for deaf and hard of hearing residents which make up approximately 80% of our population. As a result, the focus group gave a presentation to the leadership team and made the group aware that we are working towards improving the lives of seniors with hearing loss at Golden West. Since the central tower of Golden West was constructed in 1965. This leaves room for cultural, sociological, and infrastructural changes in those 48 years. All of these changes impact the way that hearing loss must be addressed in a senior living facility.

Areas in Need of Improvement

The inspection of our building completed by the Colorado Commission for the Deaf and Hard of identified the top needs we currently face. These include the purchase and installation of new technological advances such as the telecoil loop system and an upgraded secure entry phone. Also, there is a great need for expanded education for residents and staff on the issues that surround hearing loss. Staff must become more aware of the causes of hearing loss and effective communication with those who have hearing loss. Residents must become aware of the resources they have available to them as a hard of hearing senior in the Boulder area. All of these changes require an important financial investment.

Accessing Our Building A primary concern we must address as an organization includes the ability to access our building as a visitor with hearing loss, or as a resident allowing someone else to access the building. The current system includes a phone which is mounted to the wall, and directory of numbers that correspond to a resident. The visitor must dial a three digit code, verbally announce themselves to either the front desk staff or to the resident they are calling. Then, the front desk staff or resident must determine if the individual can enter the building and open the door by pressing a digit on the telephone. A deaf visitor is unable to hear when a person has answered the phone, and is therefore unable to gain access to the building. A deaf resident will not hear that their phone is ringing, or if they do hear or see the phone, they may not be able to distinguish who they are letting into the building. This is cause for concern because it compromises the security measures in place to maintain a safe residence for our seniors. It is concerning that we may also be excluding deaf visitors by having an inaccessible system.

Autonomy and Education

With concerns such as hearing loss, it is essential for service care providers and individuals suffering from a disease to seek out current information. Individuals must be aware and willing to accept a deficit in their hearing capabilities. Hearing loss can be a difficult disease process which can lead senior citizens down a path of denial and grief. Unfortunately in our senior living setting we deal with a high level of hearing loss denial coupled with low income residents who frequently lack direct access to medical care. The issue of autonomy, or self-reliance in a healthcare setting, is one that leads to increased isolation, confusion, and depression. When a resident begins to change habits in their social patterns, staff must be trained to accurately determine the nature of their withdrawal from others. Since many disease processes caused by aging can have the same symptoms, there must be continued education for service providers to identify hearing loss in order to prevent unnecessary depression and isolation in a senior living setting.

Aging in Place
A common term used to describe the challenges faced by senior living facilities which have been established for many years is called aging in place. At Golden West, very few residents used walkers in 1980 when they first moved into our facility. Now very few can walk without an assistive device. Their physical abilities have diminished over the years, and have left them with a reliance on a cane, walker, etc. The same principle can be applied to the concern of hearing loss. Many residents did not need the services of an audiologist when they first moved in and met with our resident service coordinator. Now many years later they may find themselves needing the help locating services to improve their hearing, but lack direction on who to speak with in order to arrange those services. Denial and low autonomy in our resident population considerably contributes to the issue of aging in place, adding a new layer to peel back in order to properly serve our aging population in Boulder County.

Achieving Our Goals

Funding is always a top concern with any nonprofit organization. Priorities must be made when dealing with a building that is rapidly approaching its 50th anniversary. Building infrastructure will take priority over resident services because a warm, dry apartment takes precedence over communication accessibility. All grant requests made in the past three years have been to contribute to improvements to our windows, roofing, and boiler systems. It is time again to focus on the

quality of life as the quantity of years increases for the population. In order to make the necessary improvements, the Golden West Foundation must secure $15,545 to begin addressing our causes for concern.

Creating the Future for Golden West

As a result of the concerns addressed in this current situation, Golden West is lacking the qualities necessary to make us a competitive agency for the aging in Boulder County. Newer facilities have greater accessibility to solutions for problems caused by hearing loss. To continue providing an outstanding service to our deserving senior population, we must be competitive with other senior living facilities in our area. A grant to Golden West is vital to promoting healthy seniors. Communication is a link to the outside world, and without it, we will see many seniors fall victim to isolation and depression as result of being misunderstood. We have established where our shortcomings lie, and we have developed a plan of action to see the future of elder care improve at Golden West.

Our Plan: Implementing Changes to Improve Lives

Managing the limited resources for hearing impaired residents at Golden West has become challenging. Therefore, we believe a successful solution must meet the following objectives: Begin working with an outreach consultant to receive professional guidance Invest in new technologies designed for residential use for individuals with hearing loss Create a space for residents and staff to become educated on the topic of hearing loss Coordinate employee training improvements, including educational training materials Acquire facility infrastructure technologies designed to accommodate hearing impairment To meet these objectives, we propose creating a program to improve our ability to handle hearing loss in both residents and building visitors. The program will be referred to as the Hearing Impaired Improvement Program, or HIIP. This program will include staff and resident representatives who collaborate on a regular basis to address our lapses in both training and infrastructural approaches to hearing loss. A representative from the Colorado Commission for the Deaf and Hard of Hearing will be invited to assist our focus group. In addition, a fund for these improvements will be established and overseen by this panel of concerned advocates. The plan will be implemented in steps, with emphasis on low budget items until funding can be secured for higher budget items like building infrastructure. The first action item to address is a meeting of staff and resident representatives with a professional educator from the Colorado Commission for the Deaf and Hard of Hearing. Fortunately, this step is already in motion as we were approached by Namati Katungu in 2012. It was this interaction that made our gaps in services apparent, and left our organization more aware of the changes we needed to make to better serve our population.
Opening: Golden West Senior Living is not accessible to deaf and hard of hearing residents Cause 1: Building is Outdated Cause 2: Low Resident Autonomy Cause 3: Low staff education on hearing issues Cause 4: Concerns with Aging in Place Cause 5: Low Budget for Improvements Effects: Golden West will lose opportunity to market to a larger range of people, quality of life for current residents will decrease

Addressing Group Structure

In order to overcome our lack of hearing accessibility, our challenges must be approached head on. We will create a functional home for our constituents by implementing a new program to improve the lives of residents with hearing loss. We are referring to our program as HIIP, or Hearing Impaired Improvement Group. The first step will be to organize a resident outreach and focus group. This group will serve as a liaison for our new program to the residents of our community. In order to have guidance from an individual well versed in deaf and hard of hearing programs, we will visit several times with Namati Katungu. Namati reached out to our community in 2012 to address areas in need of improvement, and to assist in the process of identifying and correcting these concerns.

Leading By Example
It will be a priority for us to outfit a model apartment which includes all amenities we plan to offer including, but not limited to, caption phones, doorbell alert system, phone alert system, and portable loop systems. It is important to offer these services to our residents because the occurrence of hearing loss in adults aged 85 and older is over 80.6% (Lin et al, 584). The average age of a resident living at Golden West is 84. That means that nearly 295 residents living at Golden West suffer from some degree of hearing loss. Our objective is to gather a stock of accessible items to share with our low income residents on a need to need basis. While creating a surplus for resident use will be important, it will be essential for staff to show our residents how to use these. By creating a safe learning environment which is equipped with modifications for hearing impairment, the HIIP will allow items to be tested before their purchase.

Continued Education
The staff of Golden West will be collaborating to plan a health and wellness campaign which includes education for current staff and residents. These low budget seminars will be another opportunity to share our new technologies with residents who may benefit from them. Education is the key to improving the lives of those who are deaf and hard of hearing in our community. A health and wellness lecture series is currently planned for the months of May through October 2013, with a special dedicated focus each month. The month of June has been selected to incorporate matters of hearing health into weekly lectures and presentations.

Updates to Building Security

Also, the largest investment to building infrastructure will be the installation of a secure door entry system that is video enabled. Because we are a secure community, the main doors will only open if a resident is contacted by door phone directly, or if the receptionist is dialed they can also open the door. Take for example a resident named David. Though he is a senior citizen, he was born deaf. When he came to tour Golden West, he had to wave his arms at the door until someone walked by to open it for him. Because he is deaf, he was unable to use the loudspeaker to dial the office to have the door remotely opened. He was unable to hear the receptionist respond to the telephone call. Now that he is a resident, he has a door card which will open the doors. When he has a visitor, however, they have to contact the office and are unable to notify David that they have arrived. With a two way video phone, David could regain his independence to open the main doors for guests who come to visit him. We must improve the way we think about hearing accessibility and our nations standards of living for those who suffer from hearing loss.

Improvements to Building Infrastructure

Determining the exact nature of our buildings deficiencies will take strategic coordination with Namati Katungu and his extensive list of resources. The list of items to be addressed will include a potentially costly assessment to be completed by contractors who specialize in the installation of telecommunications and telecoil communication technologies. This portion of our plan has been identified as one of the more costly investments, but it will be the most influential change in our environment. By installing a system known in the industry as a loop, residents with significant hearing loss who utilize hearing aids will be able to enjoy activities such as resident council, bingo, lecture series presentations, and other special events. Loop systems eliminate background noise and amplify the voice of the primary speaker with little to no feedback in the hearing aid. These systems are being used widely in Europe, found frequently in theaters, taxi cabs, and airports.

Summary of Plan
To ensure that Golden West is providing the best environment for aging seniors in Boulder County, our areas of improvement must be focused on. With an array of technological devices available for individuals with hearing loss, it is not acceptable to continue without progressing with technology. Now that our organization has observed our shortcomings, we are morally obligated to provide disability services to improve quality of life. Following recommendations from staff, resident, and professional collaboration, Golden West will begin acquiring devices to modify standard apartments. One apartment will be established as a model and used to educate staff and residents. Staff will begin a training effort and learn about the causes and ramifications of hearing loss. The Golden West Wellness Campaign will kick off a journey toward education and life improvement. After these low budget items have been successfully implemented, we will move forward with the installation of the loop system in our main dining room. In total, our requested budget amounts to $15,545. When we have addressed all of these shortcomings, we will be able to serve our existing population more effectively, and become the leaders in progressive aging. When the HIIP is implemented at Golden West, we will be on the forefront of senior care in Boulder County and provide desirable and sought after services.

Budget
Item Video Door Entry System Flashing Doorbell/Phone Combo Personal Portable Loop System Dining Room Loop System Model Apartment Modification Training Video Production Staff In-service TOTAL INVESTMENT Cost $2,500 $119.00 $295 $1,100 $1,500 $1,300 $11 p/p Quantity 2 10 4 1 2 1 125 Labor $1,000 $0 $0 $400 $0 $0 $1,375 Total $6,000 $1,190 $1,180 $1,500 $3,000 $1,300 $1,375

$15,545

Plan in Action
We need to implement these programs effectively or we face the reality of failing resident health and declining census numbers. Since our project has been underway since the spring of 2012, we have a solid foundation to implement a three month push for the improvement plan. We know that we can provide services to improve the quality of life for our residents who can no longer function normally due to their hearing loss with the creation of the HIIP. The following graphic illustrates our projected timeline:

November

December
Designate apartment to begin rennovations

January
Begin model apartment rennovations

Establish focus group

Deligate the creation of staff education materials

Begin planning wellness campaign

Schedule meeting with loop system installers

Begin ordering accesible devices

Revisit outreach representative and determine course of action

Re-evaluate proposed budget

These three months will be essential to the implementation of our plan. Following a January meeting with the focus group and representatives from the Department of Human Services, we will proceed as we see fit at the time. Construction for the loop system should begin in February.

Costs and Benefits

The items listed in our budget fulfill all of our goals of making our facility accessible and marketable to those with hearing loss. The video door entry system will be our greatest improvement to our visitors who are hard of hearing because they will have the ability to be seen to let in our doors. Additionally, the loop system will increase our profits by encouraging prospective residents to choose Golden West over another facility, thereby supporting the foundation for a successful future. Adjusting our services to a new market will be essential in increasing our census. If Golden west can successfully solicit an addition ten hard of hearing or deaf residents in 2014, we will regain a profit of approximately $108,000. The benefits of the HIIP are numerous, both to the quality of life, and to the success and prosperity of the foundation.

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Experience and Qualifications

John Torres- Executive Director John has served in the aging services field for more than 30 years, including 16 years as Golden Wests executive director. A native of Boulder County, John is involved with the Colorado Association of Homes and Services for the Aging (former executive director, 2002, John was awarded the Pacesetter Award by the Boulder president, board member and mentor) and the American Association of Homes and Services for the Aging (AAHSA). In Daily Camera for his leadership in aging services in Boulder County. Despite a busy schedule, John takes time to help nurture future leaders through mentoring, and in 2005, he was awarded the Dr. Herbert Shore Outstanding Mentor Award by AAHSA. Donna Ruske- Associate Director of Administration Donna began her career with Golden West in 1993. She has remained with Golden West because she is proud to be part of a mission-driven nonprofit organization that provides such a needed service to the community. During her tenure Donna has held several positions, but since 1998, her passion and primary responsibility has been with human resources. Today, Donna also manages the assisted living and independent living department staff, who provide the direct services to the residents of Golden West. Donna has a bachelors degree from Willamette University in Salem, Ore. Jill Moore- Director of Resident Programs Originally from Kansas, Jill moved to Colorado in 1977. After living in Wyoming for 15 years, Jill moved back to Colorado. Jill has nearly 20 years of experience in senior recreation, having worked for other senior living communities and several senior recreation centers in the past. Jill has degrees in human rehabilitative service and recreation administration with an emphasis in gerontology.

Brianna Westlake- Staff Representative Brianna has worked for Golden West for over four years. She received her bachelors degree in Communication Studies with a minor in Sociology from the University of Colorado Denver. She began as a caregiver, and has worked as receptionist and Foundation Representative. She interacts with residents on a daily basis and is familiar with the difficulties faced by elders with hearing loss.

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A Brighter Future for Disability Accommodation

The Golden West Foundation is seeking to provide funding to make improvements to our facility in order to better serve residents and guests that are deaf or hard of hearing. These improvements need to be made as a result of an audit completed by the Colorado Commission for the Deaf and Hard of Hearing. Following this audit, a team of staff members and residents collaborated and came to an agreement on the best plan of action to improve the quality of life of our hard of hearing and deaf residents, friends, and visitors. With a grant of $15,545 from the Colorado Department of Human Services, we will improve the lives of hundreds of low income seniors. The building will be outfitted with state of the art technologies that will shed light on the options that are available to assist in the hearing and perception process. No longer will our residents need to feel isolated at large events because they will have the ability to hear the speaker through their t-coil devices. Guests will no longer feel uninvited because they will be able to independently reach the person they are attempting to visit. With a partnership between the Colorado Commission for the Deaf and Hard of Hearing and the Department of Human Services, Golden West can improve the lives of those who live here. We will be on the forefront of innovation, leading the way for other facilities to adopt the same practices and create open communication for those who face hearing loss. We welcome the opportunity to improve the pilot program in which we participated, and expand the knowledge of hearing loss in the elderly into other facilities. Our foundation representative can be reached at 303-939-0828 or by email at bwestlake@gwboulder.org . We look forward to communicating with you soon.

Lin, F. R., Thorpe, R., Gordon-Salant, S., & Ferrucci, L. (2011). Hearing Loss Prevalence and Risk Factors Among Older Adults in the United States. Journals Of Gerontology Series A: Biological Sciences & Medical Sciences, 66A(5), 582-590.