2006-07 Broadcast Season
Broadcast Program Transcripts
Episode #2215
In the Best Interest of Seniors

Lewis: Mitchell Lewis, Host
Sullivan:  Rick Sullivan, Producer
Darkes:  Dr. Leroy Darkes
Murray: Mrs. Margaret Rose Murray
Smith: Brian Smith, Rex Laboratory
Pressley: Maja-Lisa Pressley, Rex Senior Health Center
Barnes: Ethel Barnes, Social Security Administration

Lewis: Rising prescription drug costs have created financial challenges as well as confusion for our state’s senior population.  We will take a look at what two organizations in North Carolina are doing to ensure seniors get the assistance they need next on Black Issues Forum.

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Lewis: Welcome to Black Issues Forum.  I am Mitchell Lewis.  In spite of efforts by the federal government to assist seniors with prescription drug coverage there are still many seniors who are falling through the cracks merely because they don’t understand the numerous prescription drug plans that are out there or even with the assistance their incomes are still too low to afford the medications they need.  On this edition of Black Issues Forum we will talk with two people who are the ground-roots level in finding ways to make sure the best interests of seniors are served.

But first, producer Rick Sullivan profiles a center in Raleigh that is working to make sure that the health needs of seniors are being met.

Sullivan: The Rex Senior Health Center is a doctor’s office for any and every person age 65 or older.  It is located near downtown Raleigh.  It accepts new Medicare and Medicaid patients.  In fact more than half of its patients qualify for both.  But what sets the center apart from other doctors’ offices are not the patients that come in the door as much as the patience shown by the staff.

Darkes: The primary issue is that you are dealing with someone who has been around for 65, 75, 80, even longer.  And just getting to know them, just getting to understand them, just getting to have a chance to hear what they have to say takes longer.

Murray:This health center has really been something that was truly needed in southwest Raleigh, in our larger community of African-Americans especially.  But you know this center being here would not be the center it is without the leadership that it has with Dr. Leroy Darkes.

Smith: Not only is he a top-notch physician that does wonderful care with his patients and knows them up and down, but obviously he is very involved in the community and all the things that go on, not only in southeast Raleigh but state-wide and maybe nationwide.

Sullivan: Dr. Leroy Darkes opened with the center in 1997.  He has put together a staff that has more than credentials; passion is a word you hear tossed around a lot in this workplace.  Passion not only for the work this team does but for who they do it for.

Pressley: I had, I grew up with a great grandmother and she, well she was a second mom to me.  She worked hard for our family.  If we needed her she was there and she modeled to me what running a family should be like.  She modeled to me what being a good person in the community is like.

Darkes: It gets to the mission.  People we are taking here through their blood, sweat, tears and sacrifice, made it possible for the lifestyle, for the privileges, for the answers that we all have.  So they earned the very best, they earned the right to get the very best we have to offer.  And so having a chance to do that is—it is not even exciting, it surpasses everything you imagine doing when you became a physician, to be able to give back in that capacity.

Pressley: He is just different.  He is different.  I haven’t worked in any other doctors’ offices but I call them all day, I go to the hospital.  You know he, he comes to work to do something important.  He is not collecting a paycheck.

Sullivan: Dr. Darkes and his team have put together a treatment package that includes regular visits from a podiatrist and a psychiatrist.  This mobile mammography van is here at regular intervals and prostate screenings are, too.  If needed patients can catch a cab ride to the office free-of-charge.  It is not uncommon for home delivery of medicines.  And the cost of expensive prescriptions is reduced with just a little extra effort.

Darkes: We could not do what we do without samples.  Thank goodness for the pharmaceutical company that generates them because a lot of people wouldn’t be able to get what they need, even with Medicare Part D, if we couldn’t supplement them with samples.

Sullivan: Seniors get a lot for their money here.  In fact they get a lot in spite of the money.  At the Rex Senior Health Center being heard and treated like family goes hand-in-hand with healing.

Lewis: So let’s meet today’s guest.  Dr. Leroy Darkes is the medical director of the Rex Senior Health Center that was featured earlier.  And we have Ethel Barnes who is the public affairs specialist of the Social Security Administration in Goldsboro, North Carolina.  And to the two of you welcome to Black Issues Forum.

Barnes: Thank you.

Lewis: Dr. Darkes I’ll start off with you, especially being there in the trenches, what are some of the challenges that you are seeing when it comes to African-American seniors or seniors for that fact, other minority seniors, getting or maintaining the healthcare that they need?

Darkes: You know I think most of it comes under the heading of access.  Just getting to a place that is there to provide care specifically for our seniors.  And when I mean that I mean recognizes the special needs, the special considerations that need to be made to provide the care.  There are practices that are designed to do that are few and far between if they exist at all.  Getting to the services, the referrals, getting around so that you can follow-up with the recommendations is a challenge for our seniors who are often dependent upon others for most of the kinds of logistics that would make that happen.

Lewis: When you look at even, when people get to that age of 65 and beyond, how does a relationship sometimes change between the patient and perhaps the doctor they had leading up to that time?

Darkes: Well that’s interesting, you know oftentimes at the 61st birthday when patients graduate into Medicare, they no longer are able to continue seeing the physicians who have been providing care for them oftentimes 20 or 30 years.  There are many practices, I would almost say the overwhelming majority of practices taking care of adult patients do not accept new Medicare patients and many of them are not taking care of their patients when they reach the age of 65 and age into Medicare.  So that leaves our seniors really scrambling.

Lewis: Ms. Barnes, we’ve talked about Medicare and Medicaid, just to give our audience an idea of what is going on here, what is the difference between Medicare and Medicaid?

Barnes: Medicare is a federal program and it is nationwide.  And Medicaid is a state-administered program and it can vary from state-to-state.

Lewis: And Dr. Darkes of course you are in charge of the Rex Senior Health Center.  Tell us how did this center begin, what lead you to get involved with this?

Darkes: Well we’ve been there for 10 years.  It was Rex Healthcare’s acknowledgement of the need to provide care to individuals in southeast Raleigh and specifically the need to provide a facility to provide care to address the needs of our senior population.  I think it is very insightful in that there is going to be a demand and there is a demand, an increasing demand, for centers like ours that provide a comprehensive care package designed specifically to address the unique needs of our seniors.  As I said many times you have someone who has been, the average age of our patient, 75, and they’ve been on the earth for 75, 80-plus years, their needs cannot be met in the typical seven-and-a-half minute visit that occurs in a busy internal medicine or family practice setting.

Lewis: What types of services do you offer?

Darkes: We have made an effort to identify those services that we traditionally have been sending patients out of our facility to receive and to try to internalize as many of them as possible.  We have a full-service laboratory.  We have access to the mobile mammography unit, we have on-site podiatry, we have a full-time medical social worker who helps coordinate all those resources that are available within the community for our patients in the center.  We also have a psychiatrist who has joined our practice in a sense, coming in several times a month to provide mental health services which are much needed and access to those services in a timely manner, much needed, just to name a few, and we are continuing to.  We have a urologist who comes in.  We’ve had cardiology and we will have cardiology again as part of our on-site services we provide to our seniors.

Lewis: Ms. Barnes, of course we talked about this earlier, prescription drug coverage seems to be a big issue, especially among seniors and especially the cost.  What is Social Security doing to try and help that situation?

Barnes: Our role as far as Social Security is concerned is to, with the new Medicare D prescription drug program, there is extra help available that will help one pay with the, pay the monthly premium, with the co-payment and the deductible.  So therefore our initiative is to make sure people understand this program and that they apply for this program because it will help them with the Medicare D prescription program itself because that is a separate issue.  There are two different issues; one is the extra help which you apply for with Social Security and then the Medicare D program itself you have to apply either through Medicare or using the internet.  But that is through the Healthcare Financing Administration.

Lewis: And I believe we have a graphic where we can take a quick look at the qualifications for Medicare D extra help.  If your annual income is below $15,315 and you are an individual or $20,535 and you are a married couple living together and your resources are below $11,710 for an individual and $23,410 for a married couple living together, you do qualify.

Barnes: For the extra help.  I want to make sure that people understand that if they do not meet those requirements then they do not qualify for the extra help, that they are still eligible to apply for a prescription drug plan which is so very important, not only to seniors but to individuals who have Medicare coverage.

Lewis: Dr. Darkes in your practice are you seeing more Hispanics come into the fold as well or, I know it is primarily African-Americans but are you seeing Hispanics?

Darkes:There is a little trickle.  I think that as the population ages they are becoming more and more aware and as the community enlarges, becoming aware of our practice and the services we provide, we are seeing more.  A very light trickle at this point.

Lewis: When you look at senior citizens as a whole, what are some of the primary health concerns you see?

Darkes: Well our seniors they want good care just like anyone else.  And I think that our seniors have grown accustomed to receiving what they would even recognize as less-than-good care.  They want to be heard.  They want their issues to be validated.  They want to continue to receive the same high-quality of care that they know exists other places and that other individuals are receiving.  And that is not just geographically, that is other places like other physicians’ offices and younger patients.  I think that many seniors notice that as they age up they tend to get less and less consideration and less and less validation of the fact that their issues are real to them and they need to be addressed.  And that’s one of the things that we place great emphasis on in our practice is to acknowledge the fact that there is no reason to stop providing the same level of high-quality aggressive comprehensive care that people have come to expect in this country and certainly deserve.

Lewis:  Let’s get a little personal for a moment because we look at the piece and I saw where you got very emotional when you were talking about why you do what you do.  Is there someone in your life that was perhaps going through your mind when you were doing that interview?  Who are some of the people you think of when you start thinking of senior healthcare?

Darkes:  Well, I think of over the years, all of the individuals who have opened up doors, who have stopped to lend a helping hand, who have offered advice, who have paid with their blood, sweat, and tears so that we could have the opportunity to help.  And they deserve, they earned, our very best.  And it is just, it is hard to accept when you see them receiving less-than.  We wouldn’t have what we have if it wasn’t for them.

Lewis: Ms. Barnes, when you talk about the extra help and the benefits, how does someone go about applying for these benefits?  What type of information is needed?

Barnes: To apply for the extra help, an individual can go on the internet and of course we know a lot of seniors and people with Medicare and African-Americans sometimes do not have the access that they need to the internet, but they can call the 1-800 number, 1-800-772-1213.  They can go into any local Social Security office and apply.  Or they can call their local Social Security office on the telephone to apply for the extra help.  And it is so important that people apply for the extra help because right now if an individual does not have a prescription plan they cannot enroll in Medicare D unless they are in their initial enrollment period for Medicare or unless they are eligible for the extra help that is available.  So there is a time period that you have to enroll in the Medicare D.  Therefore people who do not have it should consider enrolling in the extra help.  Plus the savings to enroll in the extra help, the benefit of it, is about $3,700 per year one could save.

Lewis: Now are there any other benefits associated with the extra help plan?

Barnes: Other than the, paying the monthly premium, the co-payment, and the deductible no.

Lewis: Now of course Social Security is working on another project, it seems to be targeted towards women but it is for everyone to become more aware of their healthcare.  Talk about that.

Barnes: That is still the extra help that you are talking about.  Some people refer to it as low-income subsidy because it is a needs-based program.  But this year around Mother’s Day we have an initiative that is nationwide and we are reaching out to people to reach out to others, show someone you love during this Mother’s Day that you care about them by talking about the extra help.  They may have it, they may not have it, but it certainly is a good time to talk about extra help, Medicare, and find out if someone needs to enroll in this program because if you really love someone, if you care about someone, then you want to make sure that they take advantage of all the programs that are available.  And Social Security has this program that is available to people who are in a low-income category.

Lewis: Dr. Darkes sometimes in dealing with the senior patient, do you find like a reluctance of folks coming in to get care?

Darkes:  I do.  It, it takes building a rapport and a relationship to really un-do the years of growing accustomed to not really receiving the type of care that is appropriate.  Patients are often surprised that you actually stop and listen and do not talk until they stop talking.  Patients are also surprised, and I’m surprised, when I ask them about routine care that should have been provided long ago that they are totally unfamiliar with.  And it takes a while to get someone comfortable with the fact that I am asking them to do things that they have never been asked to do before.  And why now, you know.  You mentioned about the extra help, I have patients who average five and six medications.  That extra help to them is worth approximately $2,300, $2,400 a year towards their prescription drug medications.  That is an invaluable resource.

Lewis: And Ms. Barnes, what can people do to find out more about services that are available through Social Security?

Barnes: Contact Social Security.  And of course we have an excellent website that is www.socialsecurity.gov.  Excellent website.  Or they can call Social Security or they can come in and visit any local Social Security office.

Lewis: Dr. Darkes you were talking about the cost.  How is the center that you are operating, how is it funded?

Darkes: We have the good fortune, and I guess I have the good fortune, of being associated/affiliated with Rex Healthcare who supplements our center.  Without Rex Healthcare we would not exist.  With the reimbursement as it is, providing services primarily to a Medicare population is a losing proposition.  Without the supplementation we would, we wouldn’t be able to exist.  So we are able to exist because we are Rex Healthcare, because Rex Healthcare has made this commitment, and because they continue to make the commitment.  We have gotten very good at being efficient and cost-effective but even that doesn’t bridge the gap between what we actually generate in terms of revenue and what it actually costs to run a practice like that.

Lewis: Now is your center unique, especially compared to other facilities perhaps in the state or perhaps in this region, in this Triangle?

Darkes: I would dare say this, I am unaware of another facility such as our in the Triangle or beyond.  I will not say that we are unique on a national level, but I am certain that within an hour’s drive of here, two hours’ drive of here, there is nothing that comes close to comparing to what we provide.  We are a model.  I dare say that in the not-too-distant future there will be demand for centers such as ours and that is kind of what keeps me going is that I know that we are going to be so far ahead of the curve that we will be teaching individuals how to do what we do in a few years.

Lewis: A question to both of you and I’ll ask you, Ms. Barnes, what advice do you have for children or caregivers of seniors to make sure that seniors get the care they need?

Barnes: To actually take some time with them, look at the mail that they receive, talk to them about benefits that they receive, and insure that they understand what they have and to inquire as to whether or not there are other services available and if so to actually help make the contact to reach those available resources.

Lewis: Any other advice Dr. Darkes?

Darkes: Well I think of course, our children, my contemporaries, your contemporaries, need to be aware that this is something that we need to deal with, we are dealing with, and to be very proactive.  If you are not helping your parents you should be helping your neighbors.  If you are not helping your neighbors you should be helping your friends.  Again as I said before, they deserve the very best we have to offer.  If you have access to this information, access to the internet, etcetera, you should help them to take advantage of every resource that can be brought to bear to support their health.

Lewis: And of course you stay very busy.  You also have your own radio show.  Talk about the advice you give on the show.

Darkes: Well again I am fortunate, very fortunate, to have that venue because each week I do have a chance to reinforce, to put information out there in regards to how to actively participate in improving the health circumstances in our community.  That includes our seniors but includes the whole community.  I always like to say that to those who are listening you now have this information but the expectation is that you share it or you put it to good use.  It is not just entertainment; it is information with the expectation that there be action.

Lewis: And of course in talking about this particular subject, as you, you were talking about that the center will serve as you know a monument if you will of the future, or a model that is—how would you like to see your center evolve, even from where it is now as far as services are concerned?

Darkes:  I would like to see us continue to internalize as many of the services that we refer out.  I would like us to be a one-stop shop.  We have transportation; if we can get our seniors to our center then we can provide them with everything they need.  One of the barriers to care for our seniors is access, as I said in the beginning, and that access is not only to a center such as ours but access to the services that we utilize as referral and as consultant, resources to help provide care.  So I would love to see us continue to be able to internalize those services.  I would love to see us be able to begin to take this model and begin to propagate it.  I would like to see a senior center in every community.  And I think there is going to be.

Lewis: We’ve got about 30 seconds left and Ms. Barnes, especially in your efforts to try to bring other organizations into what you are doing, any pleas out there for assistance from other groups that you would like to be involved in your efforts in terms of education in the community?

Barnes: Yes.  I would like to say during this Mother’s Day initiative and any time during the course of the year that we are available to go out and talk to organizations, churches, any group concerning Social Security extra help because we do understand that we have to get the information out.  And you can call us and request a speaker.  You can go on the website and request a speaker.  And regarding the extra help, if you have Medicare D and you do not have assistance paying for it, contact Social Security to see if you are eligible for the extra help because it certainly will help.

Lewis: And we will have to stop it there.  Dr. Darkes, Ms. Barnes, thank you so much for being here.  If you would like to get in touch with our guests or obtain a copy or transcript of this show, visit us online at unctv.org/bif.  When you visit be sure to give us your comments and program suggestions.  You can also call us on the BIF line at 919-549-7167.  For Black Issues Forum I’m Mitchell Lewis.  Thanks for watching.

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