Novel program to help Fresno County’s chronically ill seniors

At 65, Linda Corbin struggles with so many ailments — diabetes, heart disease, eye and lung problems, the list goes on — she easily could find herself in a nursing home. And getting to her many medical appointments around Fresno isn’t easy since Corbin relies on a wheelchair and buses to get around.

Now Corbin and other medically frail seniors in the area can find the help and resources they need thanks to a novel health care program in Fresno County.

Called PACE — Program for All-Inclusive Care for the Elderly — the program provides a coordinated, one-stop shop for qualified Fresno County residents to get their medical and social needs addressed.

PACE will provide chronically ill seniors with comprehensive, coordinated medical care to help them manage their health needs and keep them in their homes and communities.

“We want to keep these seniors out of nursing homes and in their own communities,” said Abe Marouf, chief financial officer for nonprofit PACE Fresno County. “No one wants to be put into a nursing home.”

Fresno County’s program is one of nine in California, and the only one operating in the San Joaquin Valley. About 3,500 seniors in Fresno County fit the profile of a PACE patient, and the program hopes to serve up to 400 of them. Twenty are now enrolled.

To qualify for PACE, participants must be over 55, currently on Medicare (federal health insurance for the aged and disabled) or Medi-Cal (the state-federal health insurance for the poor) and must be living safely on their own. They also must live within one of the 51 designated zip codes. Most are in Fresno County, with a few spilling into Madera and Tulare counties.

The Fresno County PACE program was spearheaded by the Marouf family, who operate an adult day health-care facility in Orange County. They got some encouragement from Joanie Ballantyne, who owned her own adult day care facility in Fresno until 2009, and is friends with the Maroufs. Ballantyne now sits on PACE’s board.

“The Maroufs reached out to me because I had mentioned we needed a PACE program in the area,” Ballantyne said.

Ballantyne worked as a nurse for 40 years and heard about PACE through that work. She reviewed other PACE programs throughout California as well, researching them online and speaking with representatives on the phone.

“It was after I learned about the program through research that I realized how valuable it would be here in Fresno,” Ballantyne said. “We have so many eligible seniors here.”

Coming to the Valley was not easy. PACE Fresno County took out $3.5 million in loans to cover start-up costs, then sought out sponsors and donors who were interested in the organization.

“Our primary sponsors and donors are individuals. It was a very hard process,” Marouf said.

Many of these sponsors and individuals are from Orange County, home to the Maroufs.

PACE has agreements with Medicare and Medi-Cal in which PACE receives a flat monthly payment from the two entities for each patient who enrolls.

“It’s our job to manage that money for our patients,” Marouf said.

The concept began about 40 years ago in San Francisco as an alternative to building a nursing home in Chinatown. The model has gradually spread to 104 programs in 31 states.

The services and techniques behind PACE are what make it unique, said Peter Hansel, executive director of CalPace, an association that advocates for expansion of these types of programs.

“PACE programs have proven that they can significantly enhance the quality of life of frail elderly,” Hansel said. “No California PACE program has ever failed.”

Recent growth of the PACE programs has to do with the awareness of these programs growing all over the country, he said.

“People recognize these types of programs now, and areas that don’t already have them recognize their community could benefit from one,” Hansel said.

Fresno’s PACE facility, near Kern Street and Van Ness Avenue in downtown, includes both a recreational and daytime center, as well as a fully licensed medical clinic where patients can see doctors and specialists. Each patient meets with the staff and doctors to communicate any changes in their health status.

Seniors who sign on must give up their existing network of doctors. Instead, they use the physicians, hospitals and specialists that PACE contracts with through the clinic. PACE Fresno is currently contracted with roughly 100 medical personnel in the area. A head medical director, home care coordinator, activity director and many others check on patients daily, making sure they are receiving the care they need.

“This method of having lots of different people watching the patients works well because we get to observe them from all angles,” Marouf said.

Dr. Ara Soghomonian, an internal medicine doctor who is on staff at the Fresno PACE clinic, believes this system of health care is beneficial to chronically ill seniors.

“We as a staff can carefully oversee the medical aspect of a patient and there are others observing the social and emotional aspects,” Dr. Soghomonian said. “It keeps everyone on the same page and avoids long-term problems.”

Other benefits include unlimited access to the facilities, free transportation and nurses on-call at all times.

“If the patient is at home and believes they need medical attention, they can call us and we can send a nurse out to see them,” Marouf said. “The point is to keep them out of the ER if they don’t actually need to be there.”

That constant attention is what appealed to Corbin, who lives in downtown Fresno. She said she struggled with coordinating her own medical life before PACE, resulting in more problems than she started with.

“Sometimes, the buses I take to appointments wouldn’t have room for my wheelchair and I would miss my appointment,” Corbin said, who is currently enrolled in PACE.”It was extremely stressful.”

Corbin is excited about the benefits she will receive through PACE.

“They have everything here,” Corbin said. “It’s amazing how much stress is off my shoulders now that I have this program.”

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For more information

For more information about PACE or to schedule a tour of the facility, call (855) 630-7223.


Pressure chambers help Valley farmers save water during drought

SELMA — Tom Chandler, a fourth-generation farmer, is using a sophisticated suitcase-sized tool to do what farmers used to do largely by guesswork: Size up how much water to give his almond trees.

The device is a pressure chamber, and it squeezes water from leaves to measure how thirsty his trees are.

“Using the pressure chambers is like having a fuel gauge for your plants,” Chandler said.

With the Valley in the third year of a severe drought, farmers are turning more to such devices to help them more carefully calibrate their watering schedules — giving orchards more water some days, less on others.

“Before we started using these, we had no idea when the plants really needed water,” Chandler said. “Now we can figure out exactly when we’re running out.”

Chandler and his family have farmed for more than 100 years and are excited to see the improvements pressure chambers make in their orchards.

“They have helped us save water and we are more confident about what we’re doing,” Chandler said. “We irrigate more frequently but use much less water each time.”

Allan Fulton, an irrigation and water farm adviser, has worked with pressure chambers since 2000. Fulton has conducted research on calibrating what the chamber readings mean.

“Understanding what the chamber is trying to tell you helps farmers concentrate water in the areas that need it the most,” Fulton said. “This means more production while using the same amount of water.”

Fulton said he believes pressure chambers teach farmers one of two things — your crop needs more water, or you could be getting by using less water.

“These are unquestionably helpful in a time like this,” said professor Ken Shackel of the University of California at Davis. “You can save tons of water thanks to the chambers.”

Shackel has heavily influenced pressure chambers through his research. These were invented in the 1960s, but Shackel began studying them in the early 1980s.

“It wasn’t that pressure chambers were my new idea, but no one had ever tested them in the field,” Shackel said. “It was through researching with the plants that we realized dry soil doesn’t mean the plant is suffering.”

Thanks to his research, Shackel was able to create a smaller, simpler model that used less pressure and was portable. This model increased pressure chamber use among farmers.

“I developed a bicycle-pump model that didn’t require a big pressure gauge,” Shackel said. “A lot of farmers are using that model now as opposed to the other one.”

Pressure chambers are manufactured by Plant Moisture Status Instrument Co. in Oregon. The company says they’re used by 25% of California farmers.

“The chamber gives us a way to see our watering patterns from the tree’s point of view,” Chandler said.

Chandler has worked mostly as the financial manager for his parents’ farm. However, he has his own orchards and does much of the work on his farm by himself. This includes going out once or twice a week to check on the almond orchards using pressure chambers.

Typically between 1 and 3 p.m., Chandler will take samples from the trees and test them. He does this by taking a leaf from a tree and placing the stem into a hole in the chamber. Then, pressure is applied to the leaf and water will seep out of the stem.

“It’s important to do the readings around the same time every day,” Chandler said. “The readings are calibrated for that specific time frame.”

Chandler loads his pressure chamber into the back of his ATV and can complete his tasks in about an hour.

“We haven’t been using this technology for long at all,” Chandler said. “But it’s really great to see a difference already being made. Hopefully that progress will just keep getting better and better.”

Reedley residents organize to save historic building

REEDLEY — In a small apartment complex, Georgia Linscheid and Pat Bergthold have called a meeting of seniors. They have one mission: prevent one of the city’s most historic buildings from being demolished.

“Never underestimate an old lady in tennis shoes,” said Linscheid, Reedley senior and a preservationist.

Without their intervention, they say, the abandoned Granger warehouse in downtown could be knocked down and replaced by new school district offices.

The building — 62 feet by 351 feet — sits on a dirt lot across from Reedley’s historic water towers and opera house. From the outside, it doesn’t look like something worth saving. The ground is decorated with weeds and brush. What’s left of old paint clings to dusty 12-inch-thick brick walls. The simple, boxy building doesn’t have visual appeal.

But the Granger building represents Reedley’s deep agricultural roots, the women say. And they add that history within the building’s walls makes this pile of bricks significant.

“If that building goes, so does 100 years of history,” said Bergthold, a 77-year-old former Reedley High School teacher and preservation activist.

Bergthold makes her way around the property in her pastel cardigan and tightly laced tennis shoes, sharing stories of the building’s past. She points out different aspects of the building that make it wonderful, eyes fixated on this seemingly ordinary structure.

Built in 1892, the building was commissioned by the Granger’s Bank in San Francisco, which was a group serving farmers. It was reputed to be the largest grain warehouse west of the Mississippi River.

When vineyards and orchards replaced wheat fields, the building transformed into a raisin packinghouse. This was the birthplace of Sun-Maid Raisins and became well-known throughout the West Coast.

Bergthold and Linscheid, 87, her longtime friend, have fought for many years to save Reedley’s history. During a walk around the property, Linscheid straightens out a sign she made that hangs on the front steps.

The sign reads “Granger Building. Built in 1892.”

She put it there so residents would recognize the building’s significance. Linscheid laughs as she wipes dirt off, and says she doubts the city would have given her permission to hang the sign had she asked. But in this case, the senior activists are taking on City Hall and the Kings Canyon Unified School District.

The city has condemned the building, which has been empty for nine years. The school district wants the site for new administrative offices, and the city supports the district.

Schools Superintendent Juan Garza sees the demolition as a positive thing. The district’s current offices are small and outdated. “We outgrew our current facility years ago,” Garza said.

Having the office in downtown would increase foot traffic and business. If the district can get its hands on the property, its new office could be opened in a year and a half.

“We would pay respect to the building and try to model ours off of the current structure,” Garza said. “It’s a win-win from our perspective.”

Reedley City Manager Nicole Zieba believes the Granger building has passed the point of saving. “We would have to take that building apart brick by brick in order to restore it,” she said.

But Zieba appreciates the seniors’ efforts to preserve the city’s history. “People like them make Reedley the unique city that it is. We really appreciate their work, but we wish they’d look at the facts.”

Bergthold and Linscheid say facts back them up.

They contacted Scott Vincent, a Fresno architect specializing in historic buildings. He and his team of engineers inspected the Granger warehouse about five years ago.

During his inspection, Vincent found the roof trusses needed reinforcement and the length-to-width ratio exceeded safety limits. However, he found it safe to be renovated.

He drew up a plan to have the building turned into a public library on one half, and a multipurpose meeting space on the other half. He estimated the cost at $7 million.

“Just because a building is condemned doesn’t mean it can’t be restored,” he said.

Bergthold has been down this path before. She’s had a hand in preserving old and historic Reedley buildings for decades. She and her late husband worked together in 1983 to save the historic Reedley Opera House.

“There were dead rats and stray cats in that building,” Bergthold said. “But now it’s beautiful and everyone loves it.”

Bergthold and her husband were able to buy the property with the help of two partners. When the opera house was renovated, the couple gave the building to the city. It is now used for local theater productions.

Bergthold remembers the process of saving the opera house from a Kentucky Fried Chicken restaurant that was pegged to fill the property.

“I didn’t want a bucket of chicken,” Bergthold said. “The whole experience was just very politically challenging.”

Bergthold was a schoolteacher in Reedley for many years, and her husband worked for the YMCA. Bergthold and her partners, Ruth Hase and David Matsurra, still own four of the older downtown buildings along Main Street, which are occupied by businesses. Due to her husband’s recent death, Bergthold hasn’t been able to acquire the Granger property.

“We need to work together with the city to make that building what it should be,” Bergthold said. “It would be a team effort — I couldn’t do it alone.”

The preservationists convinced LaVerne Youngberg, a former Reedley mayor, to join their movement. She said she always has been a fan of older buildings, but never had been an activist — until now.

“When I heard that building was going to come down, I had to say something,” Youngberg said.

She said it’s important for the city to see where the preservationists are coming from.

“We aren’t trying to stop progress, but rather integrate the present and past,” she said. “There’s nothing wrong with new things; I just don’t want people to lose sight of where we came from.”

Many of the preservationists have been around Reedley for decades. Linscheid has seen the Granger building go through many stages.

“Every generation has found a new use for that building,” Linscheid said. “Saving the building might not be the path of least resistance, but we have to step up and take action.”

Whichever side wins the argument, hurdles remain. The school district still needs to acquire the property from the state of California, which obtained control when Reedley’s redevelopment agency was dissolved.

The preservationists readily acknowledge they don’t have the money to finance the building’s rehabilitation. They’re hoping the city or school district will dig deep to save the building.

“We’ve never been the ones with the deep pockets. We’re the visionaries,” Bergthold said. “This town has tons of visionaries. We just need to keep their visions alive.”