According to researchers at Columbia University, one in 10 Americans age 65 and older have dementia — cognitive difficulties affecting their ability to engage independently in daily activities. In the past year, the Pike Market Senior Center has seen a growing number of isolated older adults with memory loss and cognitive challenges. These vulnerable seniors have no reliable path to an appropriate level of care.
PMSC is accustomed to challenges. We serve a population of wonderful, charming seniors. Most live on very little money, and many are homeless. We are experts at helping homeless seniors find more stability. But when memory loss is involved, we struggle.
There is a gap between too little specialized assistance and what can feel like a heavy-handed response. Our staff occupies that gap, trying very hard but with very little success to find help for these seniors.
For example, consider the case of Mr. B.
Mr. B lived in a low-income apartment downtown and visited PMSC for meals. This spring, he accidentally flooded his apartment, causing thousands of dollars in damage. The building manager arranged a hotel stay during repairs. We learned that Mr. B had memory loss when he could not remember to go to the hotel at night, even with regular reminders and notes. He couldn’t track conversations and would hover around the PMSC entrance on the rare days we were closed. We know that he spent at least one night wandering around downtown Seattle. Mr. B is 75 years old.
When PMSC staff tried to get Adult Protective Services to assess Mr. B, it took weeks because he missed appointments. During this period, his behavior deteriorated. After seven long weeks, we finally got Mr. B assessed. It was determined that he lacked decisional capacity to continue living independently. When designated crisis responders came to hospitalize Mr. B, seven police officers accompanied them. This 75-year-old man left PMSC in handcuffs as protocol required.
There are no villains in this story. All the agencies involved were doing their best with limited resources and strict protocols intended to protect seniors’ autonomy. This troubling encounter was an alarming solution to moving a cognitively impaired client to a higher level of care.
Unlike Mr. B, most of the seniors with memory issues who we encounter at PMSC are homeless. While they have the survival instincts to walk into our senior center, they are unable to follow up on our resources. Because we don’t know when we’ll see them, we can’t set up appointments with outside agencies.
We often lose contact with these vulnerable seniors because they stop coming in or their behavior becomes so disruptive to others that we are compelled to bar them — something we do very reluctantly. And for homeless seniors with memory issues and good behavior, we still feel terrible sending them back out into the city at the close of each day.
For the last year, PMSC has been tracking 10 to 15 vulnerable seniors with memory loss, head injuries or other cognitive issues who are not getting the care they need. This relatively small population has a huge impact on our senior center. We are working hard on their behalf but are struggling.
There are no simple solutions to the challenge that these vulnerable seniors present, but there are steps that we can take as a community.
First, we need better data about how many isolated seniors face memory and cognition challenges. This will determine what kind of response is warranted. Senior centers and homeless shelters are the natural venues for this census.
With that information in hand, providers and advocates could develop faster, flexible engagement protocols to fill the gap between no assistance and involuntary hospitalization involving law enforcement. Currently, it appears that seniors need to instigate a crisis like flooding an apartment before services will engage.
Finally, King County needs a dedicated shelter where isolated elders with memory loss can stay and be assessed by trained staff.
These older adults have done nothing wrong. They are experiencing cognitive decline. For all of us who are fortunate to have long lives, Mr. B’s experience could be our own.
