Alone and Invisible No More: How Grassroots Community Action and 21st Century Technologies Can Empower Elders to Stay in their Homes and Lead Healthier, Happier Lives (review)

Written for a mixed professional and public audience concerned about current long-term care approaches, this book provides a detailed overview of a community-initiated alternative, "the Maine Approach". The Maine Approach is designed to achieve a grassroots community network of coordinated volunteer and skilled provider support services to enable frail older people to age at home. Building beyond this local infrastructure, the author also introduces the reader to a national movement, "Full Circle America", which acts as an umbrella and support infrastructure for other communities wishing to adopt the Maine Approach. Both the approach and the national infrastructure for promoting its uptake and application have been motivated by unsustainable escalating costs, growing needs for health and social services for an aging population, and the segregation, isolation, and marginalization of older people associated with current long-term care alternatives. The thesis underpinning this book is that the Maine Approach affords a cost-effective long-term care alternative comprised of the right amount of technology, organization, volunteer support, skilled care, and additionally, a "secret sauce" that ultimately enables frail older people to remain in their own homes, chart their own paths, and contribute meaningfully to their communities. The "secret sauce" missing from current models of long-term care is the approach's emphasis on finding ways for older people to become involved in helping others enrolled in the program, thereby optimizing their sense of purpose, independence, and quality of life.

The book is clearly written. In a step-by-step fashion, the author explicates the problems of our current system: its disregard of both the human potential and the psychosocial needs of older people; its inadequacy for the growing demands of an aging population; its overly bureaucratized operation; its fostering of unhealthy dependencies, and its untenable cost to both public and private purses. This is followed by a full disclosure of the history of the Maine Approach, its three different service bundles, and in-depth real-life qualitative data that illustrate this strategy in action. The risks associated with optimizing the independence of frail older people are acknowledged and addressed. Illustrations of real-life incidents support the argument that there is dignity in accommodating the risk-taking that accompanies living alone at home, identified by frail older people with multiple chronic medical problems as essential to their quality of life.

With due respect for readers who might consider adopting the Maine Approach (in its fifth year at the time of this publication), the author then provides an analysis of the "slow response" to its adoption. The insights shared are premised upon his first-hand experiential knowledge as a family physician and as the leader of this movement, both of which have encompassed care for numerous older persons in Damariscotta Maine The challenges identified are associated with humanity's natural inclination to deny physical and mental decline until the onset of a crisis that triggers action; to take a short-term, ad hoc, rather than a long-term, planned approach to deploying financial resources to address these crises; and to circumvent the real-life challenge of deciding and agreeing who, ultimately, is the decision maker about an older person's life. The author concludes that such challenges mean that long-term care directions are driven more by concerns about finances and liability than quality of life. He also notes impediments to change, including current institutional norms, such as public sector resistance to innovation and risk-taking, existing government regulations, long-term care insurance policies, threats to the residential care industry, and the misfit of the democratic, liberal nature of the Maine Approach with the current political climate in the United States.

In subsequent chapters, these challenges are countered with several reasons why a community might adopt the Maine Approach: (a) the Eldercare Network costs...