As Daniel Drake makes his way through the halls of the Living Independently For Elders (LIFE) program headquarters, almost every person he passes shakes his hand, nods “hello,” greets him by name. And despite having a jam-packed itinerary as the CEO of the all-inclusive elder care center, Drake knows their names as well.

“We have 422 members, and I’ve gotten to know a great majority of them,” says Drake, who took the helm of the School of Nursing’s LIFE program four years ago. “I have lunch with them. And when I see them, believe me, they tell you the positives of the program.”

And for the members of the program, who are able to spend time at home and avoid round-the-clock nursing home care thanks to LIFE, the positives are aplenty. Since 1998, LIFE’s innovative program has been providing all necessary preventative, primary health, acute, and long-term care and transportation during the day so that eligible senior residents of West Philadelphia can remain in their communities.

“If you talk to most of the elderly people in the community, they’ll tell you they’d like to stay in their homes,” Drake says. “They have nothing against nursing homes, they don’t mind going for a short stay to rehab, but often, they like to go home and be in community-based living, and that’s our goal—to keep people at their highest functioning level in the community.”
For Drake, who has an MBA and a master’s degree in health science administration, and has been working in the long-term nursing care industry since 1993, that mission—and his passion for working with the elderly—were what drew him to Penn.

The Current visited Drake at the LIFE program headquarters at 4508 Chestnut St. to talk with him about the challenges of running a unique health care system, new problems facing today’s elderly populations and their caregivers, and the joys of spending time with some of the elder residents of West Philadelphia.

Q. When you first joined the LIFE program team, what were some of your main initiatives, and how have they evolved?
A. A lot of them were and still are geriatric initiatives with reducing the amount of emergency room visits, reducing hospitalizations, keeping people in the community, keeping them out of the nursing home environment, because that’s what most people want.
I always believed Penn had the best nursing school, and I believe that because of that, LIFE is the No. 1 PACE [Program of All-inclusive Care for the Elderly] program, which is the national model that successfully helps older people remain in their homes.
You can look at the LIFE program like it’s an inside-out nursing home. We provide all the services someone would get in a nursing home, but in their home. They can come [to the center] Monday through Friday, and they can see their nurse practitioner, a podiatrist, a dentist, an eye doctor, the medical director, physical therapy, or just come here and socialize for the day. So they really enjoy the program.

Q. Who is an ideal candidate to participate in the program?
A. Everyone who is in the program has to be nursing-home eligible with a diagnosis, so we have a very frail population. In fact, we have the No. 2 highest acuity among the PACE programs, which presents its own challenges. Potential members have to be over 55 years old, live in one of our 13 zip codes—10 across West Philadelphia, North Philadelphia, Southwest Philadelphia, and three in Delaware County—and who would rather be in our program than in a nursing home so they can stay at home.

Q. What made you want to do this kind of work?
A. I just liked working with the geriatric population. I started as a nurse and working in nursing homes, and really enjoyed it, but always thought, like a lot of nurses, I wanted to try working in a hospital. I worked in the ER, I worked in oncology, and after I did that for two years, I thought I really missed the contact with the geriatric population. Caring for them, they can tell you so many stories about what they’ve done and where they’ve been. I felt it was more fulfilling.

Q. You seem to have good relationships with many of the members of the program. What do people tell you they like about LIFE?
A. I think that they like that it’s all inclusive—members can come here and get everything instead of having to go from their house to a doctor’s appointment, then to a senior center. They’ll come here and they can socialize for part of the day, see their physician—it’s all under one roof, and they enjoy that.
One of the other great benefits we offer is home care. So during the past few weeks, as it was snowing and temperatures were dropping, if they need to stay home and need care, we come out to them so they didn’t have to get bundled up and onto our bus to come in and get cared for.
When it snowed two years ago for about six straight days, we had people begging to come back in to socialize. This is their home away from home. They come here and have a light breakfast, but at lunchtime, they’re talking away. These are people who have had similar lives and similar experiences, and they just really like it.

Q. What about the employees?
A. I think that the people [who work] here are very passionate about what they do. If you talk to any of the nurse practitioners here, you’ll hear that we’re proud of the fact that we are the only owned and operated PACE program with the School of Nursing. We’re proud that we’re the only PACE program that is Magnet-certified through [American Nurses Credentialing Center’s] Pathway to Excellence Program, and we were on President Obama’s Higher Education Community Service Honor Roll with Distinction in 2009. That was a big honor, and the proposal wasn’t written by an administrative person—it was one of the employees here who thought of the idea and wrote it because he believed it was such a great program. In general, the employees support it and really believe in it, which is nice.

Q. In what ways is the LIFE program beneficial to family members and caregivers of older individuals?
A. Think about it this way—when you have a loved one who is debilitated at home, it’s pretty much a 24/7 job. Even when you go to work, you’re worried about that loved one. They can come here Monday through Friday, and you know where they are and that they’re being cared for. It’s a respite for the family—a break. The six to eight hours a day they’re here is time that family members can go food shopping, go to work—time that they might not have had before programs like this existed.
One of the other benefits is we do give respite care. We’re not here 24/7, and people don’t live here. But say your grandmother was in the program, and you and your family wanted to go down the shore. We will find her a respite place for a week. We’ve offered that to all of our families, because we don’t want them to burn out. We want to be here for the assistance, but again, it’s really a partnership.

Q. Do you think the challenges for caregivers and the older population have changed in recent years?
A. I think that since the economy’s been worse, it has really changed, because you have a lot of people who are unemployed or underemployed, working second and third jobs to make ends meet, and it makes it that much more difficult for them to care for their loved one. This program is a lifesaver because somebody might have to drop their loved one off at 6 a.m. because they recently changed jobs and have to commute farther now—we accommodate that for our members. And we do it because we want to do what it takes for our members to stay in their community.

Q. How do you think programs like LIFE benefit the communities they serve?
A. It keeps people in their homes so that they can continue to go to the same church that they’ve been going to since they were 10, 12 years old. This is an area where a lot of the membership here owns their homes, and they’ve been in those homes for 30, 40 years. Taking them out and putting them into a nursing home or sending them somewhere to a different zip code, it starts to erode the community. People want to stay where they’ve been. And in this community [surrounding] the University—Penn’s goal is to strengthen it, not to weaken it. This program, I think, definitely strengthens it.

Q. Could you speak about the research and education components of the LIFE program’s mission?
A. We have a tripartite mission: research, education, and the practice portion. A lot of research takes place here from the School of Nursing, as well as other schools within the University, such as the School of Dental Medicine, the School of Social Policy & Practice, and Wharton. We do a lot of clinical education; all the nurses go through one rotation here.
For research to be done here, [the researchers] must present to the Council of Elders, a group of the membership that has to approve any research project. They have a say in it here, which is important.
Recently, we’ve had studies about the relationship between incontinence and exercise, and hospitalizations among African Americans. The council approved both of them because they felt they were worthwhile for the community.

Q. What’s your favorite part of working with the LIFE program?
A. Seeing the satisfaction that the members get from being in the LIFE program. A lot of them know that if we didn’t have this program, there would be a lot of uncertainty in their lives. They don’t know if they would be living in a nursing home, in some other kind of placement, or in and out of a hospital.
I think when you see someone who comes in and they’re really not in good shape, you’re part of their life; you meet them, you hear in meetings that they’re not healthy and people are concerned. Then the whole team assesses them and we put them on a care plan, and you see them four months later, and they’re in arts and crafts or doing ceramics. You just say to yourself, ‘We’re doing the right thing.’