
Small & Gutsy Features Home Care Partners, Filling the Gap for Elders in Need
There is a gap in elder care that almost nobody knows about until they land in it: too much income to qualify for public assistance, not enough to pay roughly $40 an hour for private help. Host Dr. Laura Scherck Wittcoff sits down with Marla Lahat, who has spent nearly four decades in that gap — building an Alzheimer's home care program in 1986 when people told her adults with dementia could not possibly live on their own, and running Home Care Partners since 1999. It is a conversation about what Medicare actually covers and doesn't, about aides who walked through a frozen city to reach their clients, about the private-pay division this nonprofit's own staff refused to run, and about a question Laura is living through herself while her mother sits in a memory care unit several states away. Marla Lahat, MSW, LICSW, Executive Director, Home Care Partners. Marla has been a leader in the field of aging and caregiving for decades. She began her career in nursing homes — work most people don't enjoy, and she loved, particularly engaging residents with Alzheimer's and other dementias at a time when, as she puts it, staff simply weren't taught how to communicate with them. She joined Home Care Partners in 1986 to develop its Alzheimer's home care programs, which were then essentially unheard of, and became executive director in 1999. She has authored articles and presented seminars on Alzheimer's disease, caregiving, and home care services, and serves on several community-based committees working to improve care for older adults and their families. In 2013, she received the EXCEL Award for Excellence in Nonprofit Leadership. What is Home Care Partners? A private nonprofit serving vulnerable adults across the Washington, D.C. metropolitan area — D.C., Maryland, and Virginia — so they can remain safely and comfortably in their own homes. The mission is to preserve dignity, independence, and quality of life through home care services, support for family caregivers, and home modifications that make aging in place possible. Critically, it is built for people who cannot afford essential home care and do not meet the threshold for public assistance. The home health aide program is the core of the work — help with activities of daily living: bathing, dressing, light housekeeping, and the smaller tasks that quietly determine whether someone can stay home. Safe at Home does home modifications and fall prevention. The logic is that you can't fix one part of a person's life in isolation: providing an aide doesn't help much if the client can no longer manage the stairs and is effectively stranded on one floor. One fall can be devastating for an older person. The D.C. Caregivers Institute , funded through the D.C. Department of Aging, supports and trains family caregivers — who are still providing the bulk of care in this country. Social workers and nurses on staff , which is unusual in home care, carry out the assessments that determine what level of support someone actually needs. Funding comes from donations and grants alongside public support in the region, including the D.C. Department of Aging, agencies on aging and human services departments in Arlington, Montgomery and Prince George's counties, and the Veterans Administration. A graduated model. One of the areas they've expanded most is care for people who need only a little help — not daily assistance, but someone to do the laundry, take out the trash, or wash the hair they can no longer reach. Key Topics Covered "They can't possibly live on their own." When Marla began building an Alzheimer's home care program in 1986, the condition barely had a usable name — people were still saying senility, organic brain syndrome, old age forgetfulness. The program eventually specialized in something people told her was impossible: supporting adults with dementia who were living alone. Her answer then and now is flat. Yes, they do. They can. They need support. She's still proud of it. How you know it worked: The measure of success came years later and in an unexpected form: the separate Alzheimer's program stopped being necessary. Every aide — both licensed home health aides and certified nursing assistants — was trained and supported well enough to work with that population, so dementia care was folded into regular home care. She's quick to add that it isn't all they do: plenty of their clients, in her words, are sharper than she is. The gap almost nobody knows about: Most people assume Medicare covers home care. It covers a small portion of it, tied to very specific nursing needs. It does not cover the help people actually need — bathing, dressing, light housekeeping. Nor, as Marla points out, will a private insurer. The result is a large population of older adults who need daily support, can't get public assistance, and can't afford roughly $40 an hour. That's who Home Care Partners was built for. Easing into being helped. Nobody likes change, and accepting help is a particularly hard change to accept. So rather than waiting for a crisis, they offer a smaller tier of service — someone who comes twice or three times a week. Marla puts it in the client's own voice: I have a wonderful aide, Miss Mary, who comes to see me. Maybe she can come a little more often now, because I really do need a bit more help. And I trust Miss Mary. The point is that trust gets built before dependence arrives, not after. Why the training is in person: Being a home health aide is isolating work. You leave your house in the morning, you go to your client, you come home at the end of the day, and you've seen no one else. Aides in the D.C. area need 12 hours of continuing education a year, and it could be done online or through packets. Home Care Partners insists on doing it in person anyway — partly for the quality of the training, mostly so the aides actually see their peers. They never shut down. Through COVID, the office stayed open. Aides were going out into an extremely confusing situation and needed somewhere to pick up personal protective equipment, which in the early days Marla describes as gold — unobtainable, and ruinously expensive if you found it. Clients who canceled at the start were calling back within weeks. Training moved temporarily online and to printed packets, and went back in person as soon as it safely could. "Without our aides, we don't exist," Marla says she's focused on two groups: the people receiving care, and the people providing it. The organization fundraises specifically so it can offer better pay and benefits to aides, on the straightforward logic that quality staff produces quality service and people who aren't treated well don't stay. It isn't a program; it runs through everything, and it's written into the mission statement. The policy argument: Marla's broader wish is for greater public support and for insurers to cover far more of this than they currently do, on the obvious preventive logic — a fall and the rehabilitation that follows cost far more than the help that would have prevented it. Her diagnosis of why they don't: a trap of medicalizing everything. The services she provides aren't medical in nature. They support health and wellbeing, but they don't require a physician's order. What matters is what people need day to day in order to go on living well. Learn about services, programs, and ways to give: HomeCarePartners.org Connect with Small & Gutsy Website: SmallandGutsy.org Email: Laura@SmallandGutsy.org Do you know a nonprofit or social enterprise doing incredible work? Send them our way!











