Independent living

Rita Giovannoni

Chief Executive Officer of Independent Living Inc.

Age: 56

Family: Husband, Kevin Bartrom

Born and raised: Kenosha

Education: Bachelor's degree in English from UW-Parkside; associate's degree in respiratory therapy from Madison Area Technical College; master's in health-care fiscal management from UW-Madison.

Professional experience: Respiratory therapist and regional services at UW Hospital; joined Independent Living as executive director in 1987, position has since become chief executive officer.

About Independent Living: With 120 employees and about 600 volunteers, the nonprofit provides services for 5,000 to 6,000 people each year in three areas:

1. Independent living services.

2. Medicare certified home health agency services.

3. Senior/assisted living housing.

Q. How have the needs of your clients changed in the past 20 years?

A. I think the needs -- the help with housekeeping or getting to the grocery store or getting bathed and dressed in the morning -- haven't changed.

What has changed is the demographic. We've been experiencing this huge drift upward on the numbers of people in their 80s and 90s living in a community that really didn't exist in the 1970s and early 80s. So what we're seeing is this explosion of the 80-plus population unlike anything that has been experienced in this country. We're seeing tremendous growth, not so much in what people need, but more people needing assistance.

Q. How do you keep up with that boom?

A. It's very difficult because what we're seeing is flattening and a slight drop in being able to recruit a work force to provide the services that this bigger population is needing. ... It's a difficult place to be. On the employee side, probably one of our biggest challenges is being able to, as a small business, to offer our work force affordable health insurance. It's a huge issue for us. Because we're not state government. We're not a school system. We're not a larger employer. The ability to access affordable health insurance for our work force is extremely challenging.

Q. Why does Madison need Independent Living?

A. I think the community needs Independent Living and its network of senior providers because we're going toward -- and are in -- uncharted waters of this tremendous growth of folks in their late 70s, 80s and 90s. It's not unusual to be introduced to folks who have passed the 100-year mark. This is totally a new world of what they call the "old old." People have lived that long because of advances in health care and lifestyle. So we're learning a great deal about what it is to live a good life in those age brackets. What we're also learning is that the cohort of older adults in the 55 to 75 (range) is a very different group of individuals from the group in that age bracket when I started in this business 20 years ago. And we're learning that some of the needs are different, some of the skill sets of those individuals are different in terms of their access to technology and actual use of technology. I think people in their 50s to late 70s are healthier and still active in the community while they might be retired. They are people we are very interested in in terms of our work force needs.

Q. Why is retention of younger staff members so difficult?

A. I think the pool is smaller from the get-go. For younger people we often compete and don't do as well against the larger health-care systems in the community. For a certified nursing assistant to come and work in a home setting one-on-one in Middleton with an older adult, it sometimes isn't as appealing as working full shifts at a hospital where their opportunity for higher income and better benefits exists.

Q. How do you deal with that?

A. We're able to be pretty effective in hiring the younger person who wants and needs a more flexible schedule than they might get working full shifts in a larger organization.

Q. How many employees and volunteers do you need?

A. This time next year I would like for us to have 25 new full-time equivalents. I would like to see our volunteer work force grow by 100 new volunteers.

Q. Is it becoming harder to raise money as a nonprofit?

A. I've always thought it was hard to raise funds. I don't know if its harder. I think a lot of it has to do with being connected and having friends in the community, both individuals and the corporate kinds of givers. Oftentimes, older adults may not be quite the visibly needy that might exist in other constituent groups.

Q. Why do you think the needy elderly are under represented?

A. Perhaps the industry doesn't do a very good job of dramatizing the (daily needs). It isn't any less dramatic I suppose. ... It's very difficult to ask an elder to come forward and tell their story because of cultural biases where many elderly are very reluctant to the point of self neglect to take assistance. So you have that sort of cultural bias of "I don't want to take welfare." So we find ourselves, at times, having to talk an older person who we know needs the service into taking the service.

Q. How do you deal with that reluctance to accept services on a daily basis?

A. Come around a day or two after Christmas or Thanksgiving. We get the phone call from the adult child who has flown in from L.A. or New York and hasn't seen Mom since the last Thanksgiving. "I don't know what to do. The house is filthy. The refrigerator looks like a science project." And mom is in the back saying "I don't want any help. I don't need any help." The child has obviously observed some decline. So what you do is kind of jump into the mix and try to ferret out how might we be helpful in a respectful way that doesn't put the parent in a position that "Oh, my God. They're going to put me in a nursing home." Because that's the biggest fear. So how can you get a delivery of some of the services, maybe not all the services she needs, but maybe just a housekeeper once a week to start the process of helping that person stay independent.

Q. So there is a real need for the children of the people you serve to help communicate their parents' needs?

A. It really helps a lot. Because another thing we see quite a bit are people who have no one. It's unbelievable.

Q. What do you do in those situations?

A. It's very difficult. Right now we're working with an older woman who has beginning dementia. She has no one. She has no friends. No family. She's still competent. But her dementia is worsening and she has no one to be her power of attorney for health care or her financial affairs. She walks around with substantial sums of money in her purse. She will tip a cab equivalent what she pays in fare. She'll tip anyone who does anything for her. And there is no way our systems of support in our state can help her until she is in need of a guardian. So with her, nervously, we watch. I've talked to the cab companies and they were quite gracious.

Q. How do you think the elderly are treated here? Is it changing?

A. I think that it is shifting. I think what was elderly 10 years ago is not elderly any longer. When you think about it, say we all live to 100. The first quarter of our lives is spent being a baby, toddler, an adolescent and starting our process of becoming adults. The second quarter is in the work environment, building a career. And the third quarter, this used to be the fourth quarter. This is a wonderful dynamic that has a huge opportunity to reinvent and rethink and stretch other ways we can live in a community with each other. The fourth group is really our most frail people. And how we support that group, how we engage them in the world of the other three quarters will really be the test of we as a community and a culture that has never had an experience with folks of that age. I hope our organization gets to be a part of some of the dreaming for what's possible for people in their 80s and 90s and 100s. So that we really are thoughtful in terms of how we serve and love and support those individuals in that fourth group. It isn't about dying, it's about living.