His housing dilemma is the most common problem facing senior citizens displaced by Katrina. It is, however, not their only obstacle -- medical services, transportation and a lost sense of community are also high on the list. Seniors want to remain independent and live at home for as long as possible, and Katrina has forced some of them to decide between independence and returning to New Orleans. For some seniors, the problems are too overwhelming and, as Fulton says, many will never make it back.
"I've talked to four or five people in Atlanta, and they say they ain't coming back," he says. "I talked to a friend staying in Minnesota, and I said, 'What you doing about the cold?' He said he don't worry about it. They have clothes, apartments and transportation, and that's more than they have here."
Fulton commutes to New Orleans daily so he can continue the rebuilding process. He stops every day at the Central City Senior Citizens' Center and eats a meal, one of the few services the center is still able to offer. Howard Rogers, director of the Orleans Parish Council on Aging, which oversees the center and a wide range of federally funded programs for seniors in the city, says the lack of housing has become a desperate situation for the elderly. Many of these displaced seniors call Rogers daily asking if he can find them a place to live. He feels that some of them just want to make a final journey home -- to be at peace.
"I hate to put it this way," says Rogers, "but a lot of them want to come home to die."
Rogers laments not only the loss of the many services his office provided seniors pre-Katrina, but also the senior citizens themselves. Before the storm, Rogers says there were approximately 75,000 senior citizens living in Orleans Parish, and now roughly 25,000 to 30,000 have returned to the area. His office was in charge of 18 senior centers and 32 meal centers throughout the city, and they served 2,000 meals per day. Now, Rogers reports, there are only four senior centers and one meal center, and they serve 250 meals per day. Other programs that were critical in order for many of the elderly to remain independent -- "Meals on Wheels," Senior Companion Program, RSVP (a volunteer program, which had more than 1,000 senior citizens working in hospitals, and centers), home health care, homemaking services, transportation and "Grandparents Raising Grandkids" (a national family caregiver's support program) -- are no longer available to seniors living in Orleans Parish through the Council on Aging.
What Rogers and his staff can provide are meals for those seniors who can get to a center, dental care and informational counseling so seniors can find new doctors, navigate insurance claims, and find housing. Since the meals are transported from Mississippi and are not prepared at the centers, Rogers has to depend on transportation for meal service. A simple traffic accident could translate into many senior citizens not eating for a day. Rogers says this dearth of existing senior assistance means the aged must have better survival skills than in the past.
"We just don't have the social services we used to have for the frail elderly living at home," admits Rogers. "We have a support system, but it's not strong enough."
He wants additional funding to expand current services; Rogers' staff was reduced from a pre-storm level of 65 employees to a present staff of 15. Part of this can be attributed to displaced workers, and fewer services in the area dictates a smaller staff. But a greater impact is that Rogers' budget still has to accommodate seniors who used to reside in New Orleans and are now living elsewhere in the state; his office will pay for these displaced seniors' needs until June 1. Most of them have relocated to either Lafayette or Baton Rouge. For example, Rogers says there are 80 seniors living in one trailer park in Baton Rouge, and they are all Orleans Parish Council on Aging clients.
Since the elderly were not only evacuated throughout the state but also across the country, the Governor's Office on Elderly Affairs attempted to contact them to ensure their needs were being met. Godfrey White, director of the Office on Elderly Affairs, says he arranged for three case managers to work with elderly Houston evacuees. These seniors were separated from the general population of the Houston evacuation centers so they could be, as White puts it, "provided with a socializing reality, now that it's missing."
Even with efforts from the state and other agencies, Rogers believes some seniors who had lived at home with a caregiver prior to Katrina ended up in nursing homes because they were evacuated to shelters without their caregivers. Because staff at the shelters decided the seniors had exceptional needs, they were first sent to special-needs shelters and eventually to nursing homes.
Joe Donchess, executive director of the Louisiana Nursing Home Association, a trade organization, doesn't dispute Rogers' assertion, but feels blame should rest with the caregivers. Donchess thinks the affected seniors might have been living independently, but in "ill circumstances," and that the medical staff at the evacuation shelters determined that institutionalization was necessary.
"It's what we've always feared," says Donchess. "What we've seen with these folks who lived with personal-care service workers is that when the emergency arose, the personal-care workers were nowhere to be found."
Donchess says the nursing home bed- occupancy rates in other parts of the state did go up, and the occupancy rates in Baton Rouge and Lafayette are still close to 100 percent. However, he thinks the occupancy rate has "dropped to near normal in the northern part of the state." Louisiana has historically ranked low nationally in the bed-occupancy rate. In 2002, Louisiana was 37th in the nation with a rate of 78.7 percent, compared to the national average of 82.7 percent. Many experts consider money spent on empty beds to be problematic. In 2005, according to the Louisiana Department of Health and Hospitals (DHH), 87.7 percent of the state's budget for long-term care for the elderly went to nursing homes and their patients' care. Only 12.3 percent was paid to home- and community-based health care for the elderly.
Although resources are limited, there are still alternatives for older people who need home assistance but want their own place. Home Instead Senior Care offers non-medical companionship for seniors living at home. Caregivers go to the person's home and assist with daily activities such as meal preparation, housekeeping, medication management and transportation. Home Instead only accepts private insurance, but Synergy Home Health Care, which provides similar assistance, accepts Medicaid.
As for assisted living and senior housing in Orleans Parish, there aren't many vacancies. Catholic Charities runs two senior housing complexes, Christopher Inn and Mater De La Rosa, but both are full and have extensive waiting lists (Mater De La Rosa has closed its waiting list). Pratt-Stanton Manor and Lambeth House have vacancies but only accept private insurance.
For seniors who currently have housing available in New Orleans, Voris Vigee, vice president of program operations for Volunteers of America, urges them to make sure their homes are safe and of good quality. Vigee says it's necessary for seniors to assess their situation before deciding to return.
"[The decision] has to be based on their current needs structure," she says. "If there are community services there to meet their needs, then I would strongly urge them to return." Vigee says her office can help seniors make that decision by supplying them with information about their neighborhoods and available assistance.
Gordon Wadge, president of Catholic Charities of New Orleans, says his agency can still deliver meals to seniors through the "Food for Seniors" program, which is currently providing 4-lb. grocery bags, equivalent to 16 separate meals, to seniors in the New Orleans area. Along with other groups, including ACORN and Common Ground Collective, Catholic Charities also has a volunteer task force that can help seniors rebuild their damaged homes.
Wadge feels it is critical that seniors' mental-health needs be addressed as well as their physical needs. "These folks are shell-shocked, and frail," says Wadge. "One of our programs, Louisiana Spirit, is geared towards anyone, but seniors can benefit from it." The program sends counselors to households, offering emotional support and other aid.
Even the most self-reliant seniors could find counseling beneficial, says Sontra Carmouche, director of Social Services for Central City Senior Citizen's Center. They have been uprooted, and there are many unanswered questions. "They, like many of us, have lost their sense of community," she says. "We don't always put a lot of value on it, but it matters. You know, 'Where are my friends?' 'Where are my neighbors?'"
If necessary, Carmouche can refer seniors to Metropolitan Human Services District (MHSD), a mental-health agency funded through DHH. Psychiatrists are available, and patients can get prescriptions filled. MHSD also has a cadre of social workers and offers case management for senior citizens.
Still, it is housing that looms largest in Irving Fulton Jr.'s mind. It isn't just finding a home for himself, but also for his wife and his elderly mother. Many of his older friends and neighbors are going through the same ordeal and are scattered throughout the country. Fulton feels he can rebuild a house elsewhere in the city and eventually move into it, but his former neighbors aren't so fortunate and shouldn't have such worries at this time in their lives. Fulton believes their neighborhood has to be restored; losing it would mean leaving these lifelong residents alienated from New Orleans forever.
"It needs to come back, because that's all they have," says Fulton. "There's no other place for them to go."
Helpful numbers: Catholic Charities, 523-3755; Volunteers of America, 835-3005; Metropolitan Human Services District, 568-6686 and the after hours cope line, (800) 749-2673); Central City Senior Center, 524-7463.