NEW SCOTLAND — Sue Weisz, the senior outreach liaison who has doubled this year as a town nurse, has resigned after two years on the job, to take a higher-paying position with the Visiting Nurses of Schenectady.

On Tuesday, her last day in Town Hall, she told The Enterprise that she is worried about the future of the town’s senior services, particularly the nursing aspects.
"Nursing is icing on the cake, but the town shouldn’t go for icing and give up the cake," Councilman Richard Reilly told The Enterprise this week.

The town board has funded the part-time post at $14.42 an hour, but some board members have been skeptical about the need for a nurse.

New Scotland started a senior program in 2001 with a one-year grant; Weisz is the program’s second director. The first director, Elizabeth Burvey, was not a nurse.

As a registered nurse, Weisz convinced the New Scotland Town Board, for 2005, to expand the senior-outreach position to include nursing, a service she says the elderly residents of the town really need.

Medicare, at most, covers six weeks of post-hospital nursing visits, and then patients are left completely on their own, Weisz said. She said three-fourths of the New Scotland elderly she has assisted are living on their own with no caregiver.
They need continued support, she said. There is still a lot of teaching and reviewing after the six weeks are up, Weisz said. The home-bound seniors need reminders about their medication and help with monitoring their blood sugar, blood pressure, health, and diet. It’s important "to let them know someone is checking in on them," Weisz said.

Some town-board members have questioned the town nurse position all along — the need for it, the additional cost, and the liability. Liability insurance for nursing has cost the town $268 annually, Weisz said. Councilwoman Deborah Baron said she is concerned about both the cost and the scope of the liability coverage.

Review

With Weisz leaving, the senior advisory committee and town board are reviewing the outreach position, and defining it more clearly.
"The ultimate goal of the board is to have an advocate for our seniors," Councilman Reilly told The Enterprise this week. "It’s important to keep focus on what the purpose of the program is," he said; being a nurse should not be a determining factor in finding Weisz’s replacement. "I would certainly hire an excellent advocate who might not have nursing skills," he said.

If nurses are interested in the position, he said, then most certainly the town should consider those candidates.

Councilwomen Baron shared a similar sentiment.
"I thought the nursing was only a small portion" of what Weisz was doing, Baron said. She said she is not sure how much nursing is really needed.

Weisz told The Enterprise that, everywhere she goes, her nurse and liaison responsibility follow; it’s not like she turns one on and off.

In finding a replacement, Baron is looking for a person to help the seniors and offer advice, she said. Baron doesn’t think the nursing aspect is necessarily needed and she doesn’t see being a registered nurse as a requirement for the job.
A liaison could "probably tie them into the right program," Baron said.
"There are bigger goals to the program than nursing," Baron said; it’s about reaching out and finding the elderly in need.
When Town volunteers this fall handed out referral guides, listing local services for the elderly, to 450 seniors who are 75 or older. For many of the elderly it was their first time seeing the guide, Baron said. "That was a little distressing," she said.

Senior outreach is about educating the elderly on the programs and options available to them, Baron said.
"The great role that the town can play would to be to inform seniors...improve their ability to access programs at other levels of government," Reilly said, such as programs from the county and assisting seniors with their new federal Medicare benefits.
"The most effective town program is one that doesn’t duplicate existing services, but increases access to those services," Reilly said.

Serving "the frail and fragile"
"The nursing aspect has really enriched the program," Weisz said. "It has gone from social work — not as well-defined program — to something that’s grown to something seniors trust for their day-in and day-out health concerns," Weisz said.
Now the town board needs to "back up the position with financial teeth," Weisz said.

The liaison position will lose its quality without a registered nurse who brings along assurance for heath status monitoring, Weisz said.
Her first year in New Scotland, Weisz was just a liaison, unable to serve as a nurse, and, she said, she wasn’t appreciated as much by the seniors then. "And, I’m the same person," she said.
Being a nurse, also helps while working with other agencies, Weisz said. When she is talking to a doctor’s office on behalf of a resident, or calling the Albany County Department of Aging, Weisz said, "speaking with a nurse validates the whole need and concern."

As a town nurse, Weisz has offered pre-and post-operative consultations, and care. For example, after a women had cataract surgery, Weisz helped her with her eye-drops.

She has administered vitamin B12 injections, regularly monitored home-bound senior’s blood pressure and blood sugars, offered referral services, acted as an advocate to physicians, held blood-pressure clinics, set up medication schedules and delivered medications, led caregiving family members through medical instructions, driven seniors to their last-minute doctor’s appointments, and transported seniors to meal sites, Weisz said.
"A lot of our efforts are to the frail and fragile," Weisz said, and the liaison has to uncover the need. Often a blood-pressure visit is just a way to get in the door, which leads to uncovering a more dire need, she said.

One resident who has dementia was, on occasion, found wandering in a field near her home. Her son worked full time outside of the home. The woman’s husband is in Hospice, and the family’s Medicaid and Medicare had been spent on services for the father who had been in a nursing home, Weisz said.

In hard situations like these, Weisz said, she finds assistance, through such groups as Community Caregivers or the Albany County Caregiver Connection.

Before coming to work for the town, Weisz had been the director of Community Caregivers, a Guilderland-based not-for-profit organization that organizes volunteers to help seniors and others in surrounding communities.

Sometimes the New Scotland senior outreach involves just making a five-minute phone call to ask an elderly resident how things are going in their life, Weisz said. Or, in a quick home visit, she can pick up on something like the individual now has a shake in his hand when he didn’t before.

Often people don’t even recognize when something has changed, Weisz said, or they are in denial.

Sometimes it is just a matter of contacting the doctor to take away a prescription or add another, or other times, as a nurse, she alters a patient’s diet or introduces a new exercise, she said.

Ninety percent of the people the senior service program has helped are on fixed incomes, Weisz said, and almost all of them are seniors, but she has also helped disabled people and families who are down to their last penny, she said.

Although she has enjoyed her job and grown close to some residents for whom she cared, Weisz decided to leave for her own economic stability.
"It has been an honor to serve the town," Weisz said, but she only has 14 years left until retirement and, "the benefits of a 401k are appealing."

Weisz was finishing her yearly report for the town board on Tuesday. From January to November, she had visited 138 seniors in their homes, revisited 48 of them, referred 204 to outside services, and spoken to 262 on the phone. She said that there wasn’t overlap in the categories and that each senior she worked with was designated to just one category, and not counted twice.

Advisory committee

Reilly and Baron both said that they are going to look toward the advisory panel for direction.

The committee members have spent several years defining the program and have a better sense of what the need is, Baron said.
"I personally would like to see more at-home visits with seniors...calls to ask ‘How’s your arthritis doing today"" Baron said. She would like to rally neighbors to be that friendly face.

Weisz brought great attributes to the program, Baron said, and she likes the way Weisz developed it, but Baron said she still sees the program as being in its infancy stages.

Elizabeth Kormos, the chair of the senior services advisory committee, told The Enterprise that the committee doesn’t want to change anything, except build up a volunteer core to provide additional services.

The liaison’s job is to connect seniors to existing services, Kormos said. The committee is not looking for someone to do direct-care nursing, but instead to provide education and screenings. The advisory board wants the senior liaison to be a nurse because nurses have the knowledge of health care to best assess a person’s needs, Kormos said. The outreach should be one of wellness service rather than one of health-care though, Kormos said.

The liaison is really the connector. For example, she helps someone in need get them food from the food banks — some residents didn’t even know that the town has food bank. Also the liaison can connect a senior with the Home Energy Assistance Program (HEAP). A lot of elders are unaware of the programs, and the liaison closes that gap, Kormos said.
"We haven’t been able to build up volunteers," Kormos said, so the committee would like the new liaison, "to put a little more emphasis on marketing volunteers," Kormos said.

Volunteers could really be doing the companionship visits, Kormos said, and transportation.

Part of the objective of senior services is to offer family caregivers reprieve, Kormos said.

But, Kormos said, the committee doesn’t want the liaison position to be reduced because of volunteers, but rather it wants to expand the services.

Pay
Weisz is concerned that the town won’t be able to keep a registered nurse unless the board continues to raise the salary over time, and she said she was "shuddering" when she heard that Baron wanted to reduce the salary.

Baron said she would like the senior liaison compensation to go back to what Weisz was being paid when she first started two years ago.
It’s insulting in a job "to hire a new person exactly where they left off," Baron said. She would like for the first six months, to go back to the original position’s hours and salary which was about 14 hours a week at $13.50, and then reevaluate how things are going at the advisory committees lead.
The new person should start slowly and "give everyone breathing space," Baron said.

Kormos said the committee wants the new person to be paid what Weisz had been receiving when she left, and keep the position at the same hours as well.
"We realize the salary is not at the level of a nursing job, but it’s not a nursing job, it’s a liaison job," Kormos said.

Weisz told The Enterprise with the cost-of-living increases that all town employees get, the hourly wage for the liaison for 2006 is budgeted to be $14.85. Weisz worked in 2005 20 to 22 hours a week over the course of three days.

The third day of her salary was being paid by a grant from Albany County Department of Aging because of the town-nurse duties. This grant runs from April of 2005 to March of 2006.

Kormos said one of the reasons the committee wants to hire a registered nurse or a licensed practical nurse is because it is required to maintain the grant. Additionally, the advisory group is applying for the same grant to extend it for a year.

So far, Kormos said, the advisory group has received at least three résumés from registered nurses who want the job.

The committee has started the interview process. One of the candidates is a registered nurse and a friend of Weisz who heard about the opening before the town started advertising, Kormos said. But the committee has made no decision yet, and placed an advertisement in The Enterprise last week. They are opening the pool up to everyone, but are advertising locally, hoping to attract someone from within town.

Weisz lives in Guilderland Center.

Board members divided

Supervisor Clark said that he wants another nurse to continue the program as it is, and expand it.
He has asked the town board to allow the advisory committee to do the interviewing and make recommendations because he is "very firmly confident in the advisory committee’s ability," he said.

Clark thinks the town will have a new employee hired by mid-December.

Weisz offered a tremendous commitment, and, as a nurse, she was able to better evaluate the needs of seniors, Clark said.

It doesn’t concern him that the liaison position has had a two-year turnover rate. The town has limited money and he is not looking to increase the wage to pay a nurse the going rate, he said.
The town is not "trying to get someone to sit in a position for years," he said. Instead he wants someone who is determined, creative, innovative, and going to bring a commitment for the short term. He said he welcomes a new person every several years to bring her skills and a new eye to the program. He’s not expecting a nurse to make a career of it, because he is aware the pay the town is offering to a registered nurse is very little, Clark said.

Just as long as the person is dedicated while she is here, to care and move the program forward, he said.

Weisz said that nurses, on average, get $20 an hour in the region.

Letters

At a senior advisory meeting on Nov. 21, which Baron attended, Weisz became aware of Baron’s hesitation about the necessity for a town nurse and Baron’s desire to reduce the salary. Weisz said this is also when she learned that Baron was interested in replacing Councilwoman Andrea Gleason’s position as the town board liaison to the senior citizens; Gleason was not re-elected.
Weisz immediately wrote a letter to the Enterprise editor. (See letters page.) "If Mrs. Baron’s philosophy is to cut quality to our senior citizens, this not someone we want on the town board to represent our elderly and disabled," Weisz writes.

Weisz told The Enterprise this week that board members use the budget as a reason to reduce the senior-services liaison position. "They say the budget is one thing, I think politics is always something, too," she said. They don’t want one group to get the credit, she said. "I don’t want to see it as a political football...I want seniors to win in this situation."

At the same time that Weisz sent her letter to The Enterprise , she sent copies of it to some of the advisory committee members.

After an advisory committee meeting this Monday, Kormos, the committee’s chair, submitted a letter to The Enterprise Tuesday morning.
"Sue’s concerns are premature," Kormos wrote. She also wrote that the board is in support of Baron’s joining their meetings.

Chad Hemphill, a member of the senior advisory committee and pastor at Moutainview Church, spoke with The Enterprise on Tuesday evening.

With letters to the editor that have been submitted recently and run in the past regarding the town’s senior services, politics have entered in at various times, he said.
In Weisz’s most recent letter, she interjected "basically politically energized comments," against Baron, Hemphill said. So, in response, on Monday, the advisory board voted unanimously to recommend that Baron be appointed as the town board’s liaison to the committee, he said.

It is not customary for a citizens’ group to make a recommendation of which town board member it wants to be its liaison.
"What the [advisory] board was seeking to do was to have a strong relationship to the town board," Hemphill said, "Express our partnership...and affirm that Mrs. Baron is being welcomed."

Committee members Kormos and Hemphill both told The Enterprise they are interested in the nursing aspect of the senior liaison position continuing. When Hemphill was asked if he had any concern about Baron’s being the town-board liaison when she is not convinced of the importance of the nursing aspect, Hemphill said that the committee’s relationship with Baron as a board member has just begun, and that he believes they will come to an understanding down the road.

While some initial thoughts may conflict, Hemphill said, they are not going to let differences get in the way of doing what’s best for the town.

Kormos said that Baron was the only town board member who expressed an interest to them in joining their committee, so their vote represented supporting her.

Kormos said if another town board member were interested, the committee would welcome him or her as well.

Baron said she was surprised that it had gotten out that she was interested in being the liaison to senior citizens. She said she wasn’t even the one that threw her name into the pot.

All the town-board members and board members-elect received an e-mail from Clark in which he recommended who he thought would be good for which board liaison appointments, and he had named Baron for the seniors, Baron said.

She said that she hadn’t even responded to Clark’s e-mail yet, and that, while she would like to be the town board’s liaison to the senior citizens’ advisory committee, she is up for doing almost anything.

She said the liaison spots are really just decided on amongst the board members based on their interest and strengths.