Keswick’s Carmel Roques: Helping seniors find ‘purpose and meaning’

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As a nonprofit organization focused on the health and well-being of older adults, Keswick has been serving the Baltimore community for 130 years.

Keswick offers inpatient and outpatient rehabilitation as well as community health services, long-term care and adult day services at its Wise and Well Center opened last year. These services aim to help individuals find purpose in their life, stay engaged with others and manage their chronic illnesses and be healthier.

The Daily Record reached out to Keswick CEO Carmel Roques to discuss senior health care and aging at home.

(This interview has been condensed and edited.)

The Daily Record (TDR): The mission of Keswick has been to improve quality of life for older people. How do you do that every day?

Carmel Roques (CR): So the way we do that every day is by focusing on what older people tell us makes a good quality of life, and I stress that because one of the tendencies organizations tend to have is to decide they already know what is good for people or what people want and they don’t bother to find out.

So what Keswick has done through the years is to really listen carefully to the people that we serve. What they have told us is that a good quality of life for them as an older person generally means being able to live in their home of choice in their neighborhood doing the things they enjoy doing and engaging and interacting with the people that they love and care about.

The overarching philosophy that we use for individuals, older people, is that what makes for a good quality of life is being able to be connected to other people, have a purpose that you do with your time and being able to be as well as possible.

Being well means a lot of different things later in life because you can have multiple chronic illnesses but if they are well managed and you are able to afford your medicine and you are able to have proper nutrition, you are able to have physical activity, you can be quite well having multiple chronic illnesses. That is something we try to help older people that we serve understand. It is having the best possible life you can have given the circumstances you are in.

TDR: Most older adults want to age at home. What are some of the programs that you offer to help people with their goal?

CR: For Maryland and for the country, we are facing an unprecedented circumstance, which is the longevity bonus years. We now have the expectation in Maryland that 1 in 5 people by 2030 will be over the age of 65, and a majority of those people will be living in the community somewhere. So the issue begins to be, in a circumstance where all across the country but also in Maryland, there is a severe shortage of affordable housing and housing that is accommodating for older people. Only about 3% of the housing in America is actually suitable for a person with any kind of mobility issues.

What we looked at is how can we help people under those circumstances with the social-economic barriers that are facing them, how can we help them stay home. We work with … providers that do what is called housing upgrades for seniors and that is for homeowners who meet low-income eligibility requirements. There is a mechanism for being able to assess their home and to help them do the renovations in their home and the remodeling to make it continue to be livable for them.

When we do that, we also look at everything else going on so it isn’t just ‘do you need guardrails in your bathroom and your handrail on your stairs to be repaired so that you can stay in your home, but also are you eligible for benefits that you are not enrolled in? Are you able to get proper nutrition and if not what would help you be able to do that? Do you have a way to get to your doctor’s office? Do you have a doctor? Are you struggling to pay for your medications?’

We do a full assessment while we are there so that we are looking at not just the built environment through the program but also the other kinds of needs and opportunities that an older person might have.

Then we also have programming that really looks at older adults through the Wise and Well Center and says we know that what you want to be able to do is to live your best life and to be as healthy as you can be and that means that from an individual point of view you need to be engaged in how can I stay connected to others, how do I continue to have purpose and meaning in my life and pursue that and how can I stay as healthy as possible which includes being as physically active as possible.

The Wise and Well Center has all kinds of programs and services and supports plus a beautiful environment that is structured to make that happen.

We also do things like when people come for a short stay in the skilled nursing center, frequently they need help managing setting up things at home that will allow them to have a successful return to home and not end up back in the hospital or not end up back in the nursing home. We do our Home and Healthy program which is geared around helping people leave the skilled nursing facility and go home and stay well over the course of being at home.

Part of what is really unique about what the approach Keswick takes is we are not a senior center. Senior centers in this country got started under the Office on Aging primarily to help address nutritional needs of vulnerable older people. … That is not what the Wise and Well center is about. The Wise and Well center is about older people finding the ways to become engaged in doing the things that will ensure (between the ages) 60 to 95 they are able to be at home, they are able to be engaged and they are as well as possible.

It is a very intentional programmatic focus that is different from a gym and from a senior center. It is much more structured toward what is it you are going to be doing to make sure that these next 30 years go the way you hope they will and how can we support you in that.

TDR: What are some of the most popular classes at your Wise and Well Center and why are they crowd pleasers?

CR: We do a really wide range because our strategy is we know no one gets up in the morning and says, ‘I just can’t wait to go over there and take a six-week boot camp course on controlling my diabetes.’ Our brains don’t work that way. Our hearts don’t work that way.

What we do is we think what might interest someone? How about a Cooking with the Doc series where you can come over and we will have one of the local docs help you cook a nutritious meal. That is very popular. We have a course that runs over the summer — Healthy Eating Active Living — where it is a whole range of things. It is planting an herb garden and then learning how to use the herbs. Then discovering how to at home maybe begin doing some (plant) pot gardening at home.

Why would we want to teach people about planting and eating herbs? Because it is a great way to introduce people to lower their salt intake and using spices instead of salt in their food which helps them manage their hypertension and other related diseases. It gets them into a conversation about nutrition that is fun and then you start to talk about more specific issues.

The other classes that are really popular are Zumba, yoga, Tai chi. Those classes are really popular and people seem to enjoy the fact that they are specifically geared toward older people. It is a lot different than going to the gym and you are basically in a class with 20-year-olds in spandex. These are classes focused very much on older adults.

TDR: How do the adult day services help caregivers for those who are living at home?

CR: Long before I came to Keswick, one of the things I did was start and run an adult day service program. I am an incredibly firm believer in that particular service for people who are trying to stay home and not require either living in an assisted living or a nursing home.

What the adult day service program does is it creates a place that a person can come and have engaging activities and have other people they can spend the day with but very importantly actually have their health care very carefully managed and overseen by a nurse who is following physician’s orders.

… All of these things can occur during the day and then the person can return home in the evening and most people who are involved in adult day programs have a family caregiver who is at home with them who is either working during the day or doing the things they need to do to maintain the household. (The program) provides a structured, dignified safe comprehensive approach to their loved ones care.

I think it gets way underutilized. It is a service that is covered by medical assistance for people who qualify medically and financially but it is also a less expensive alternative to moving into an assisted living. For most people, it meets their desire to be at home.

TDR: Many seniors develop friendships through the programs at Keswick. Why is the social aspect so important to seniors?

CR: There is lots of great research being done on that right now … on how isolation becomes more of an issue as we get older for a variety of reasons and how social isolation can lead to deterioration in our health.

At any age, being socially isolated can cause poor health outcomes but in later life, being socially isolated becomes more of a problem because many older people live alone, don’t have transportation and don’t have ready access to opportunities for social interaction and engagement so they become more isolated. Some of the health reporting has said that being socially isolated is as bad for your health as smoking cigarettes.

We know that people who are socially isolated are much more likely to become ill and have a harder time recovering from illness so it can actually be deadly for an older adult. So finding ways to help people not just have superficial contact but actually make new friends can be really critical for their well-being and their health outcomes over time.