When Raisa Otero-Cesario's mother, Ana Otero, was hospitalized in February after a fall, she turned down the doctors' suggestions that she leave her mother overnight.
"No way I'm leaving her," was her response.
For Otero-Cesario, family is a priority. She has cared for Otero, 88, since 2000, when she brought her parents from their homeland of Puerto Rico to live with her and husband, Mike Cesario, in Columbia. Her father died of cancer in September 2001.
Otero's dementia, discovered last fall, can make life unpredictable. The illness has its ups and downs, and reactions to medication have caused serious complications for her. Some days, she is up and walking for hours. Others, she does not walk at all.
But Otero-Cesario firmly believes that her mother is happiest at home — with her family — and she is willing to make every effort to keep her there.
Since last December, she has received assistance through Howard County's Opting For Independence pilot program. The program is a joint venture between the county Office on Aging; and the Coordinating Center, a statewide nonprofit organization that assists people of all ages with complex medical needs, to help seniors, 65 and older, stay in their communities rather than move into nursing homes.
The program is one of 14 across the nation to get funding from the Administration on Aging, the branch of the U.S. Department of Health and Human Services responsible for the addressing the concerns of senior citizens and their caregivers. The $441,290 grant lasts through September 2012.
Opting For Independence has three components, according to Peggy Rightnour, manager of client services for the Office on Aging. The first is the bedrock of the program: helping seniors stay in their communities through consultations and advice.
Rather than providing new services, Opting For Independence serves as a liaison that links senior citizens with services that are already in place that can help improve their quality of life — programs such as Living Well, a county program that teaches seniors how to manage diabetes and other diseases, and caretaker training for their families.
Phyllis Madachy, project director for the Coordinating Center, likened the program's role to that of a general contractor.
"The general contractor is not going in and pounding the nails," Madachy said. "What we want to leave people with is a good, strong plan."
Project coordinators are also interviewing people not served by the program to find out their strategies for staying at home and will publish case studies in November.
The program's third component is creative. In conjunction with the Howard County Arts Council, coordinators are planning a project for seniors to develop their life stories into scripts, which eventually could be presented as a performance.
Since its official launch in October 2009, about 120 people have enrolled in Opting For Independence. So far, it is only available to Howard County residents living in Columbia and Ellicott City, in Zip codes 21043, 21044 and 21045 — areas with the county's largest population of senior citizens. Coordinators hope to expand the program in the future.
Irene Closson and her father, Archibald Jones, joined in April. Jones, 91, has lived with Closson since 2008. Because of mobility problems, he spends most of his time on the ground-floor level of their Columbia home.
One of the first suggestions program coordinators had for Closson and Jones was to build a ramp at the threshold between their living room and the room leading out to the backyard, so Jones can glide smoothly out the door in his wheelchair. Next, they plan on building a pathway through the backyard to the front driveway, so Jones' wheelchair will not get stuck in mulch on the way to doctor's appointments, as it did recently.
"There's so many things that you need that you don't realize you need," Closson said.
Seniors enrolled in the program are visited by a program therapist, who takes stock of their living situation and needs, then comes up with recommendations and a plan to improve their quality of life. Visits are comprehensive; often, they can last for a hour and a half.
After the initial visit, some program clients don't need any more assistance. Others receive periodic visits from occupational therapists.
Since Closson and Jones joined the program, therapists have helped them make multiple improvements to their home. They have suggested a rail next to Jones' bed to help him sit up in the morning, grab bars in the bathroom and orthopedic shoes for Closson.
Most of all, Closson cherishes the time she has with Jones at home. "I want to spend every moment that I can spend with him," she said.
Otero-Cesario has been doing the same. She and Cesario said the Opting For Independence coordinators have been a great resource.
"We're new at this. We kind of do it by the seat of our pants," said Otero-Cesario. "I think it's just important for us to know we're not by ourselves."
The program found a "tough but fair" therapist who had Otero running after weeks of being bedridden. For the Fourth of July, Otero's family brought her to a condo in Ocean City. Their suite was three floors up, without an elevator, but she climbed the 36 steps with no problem.
Although Otero might not have that same energy level every day, moments like those mean a lot to her family.
"There's been a lot of priceless moments that I don't believe in my heart we would have had if she weren't home," Cesario said.