Marilyn Pace Maxwell, MSW, is the Executive Director of the Mountain Empire Older Citizens, Inc. (MEOC), an Area Agency on Aging serving far Southwest Virginia.  MEOC has provided services to citizens of all ages since 1974 and is a private, non-profit 501-C(3) Corporation.  In addition to serving as an area agency on aging, MEOC is also its region's public transit provider, the host agency for Healthy Families of Southwest Virginia, the location of the Mountain Laurel Cancer Resource and Support Center and houses and administers The Southwest Virginia Children's Advocacy Center.  MEOC's Family Caregiver Family Services has been honored by the National Council on Aging as one of the top five programs in the nation.

Marilyn is a VERY active member of three of AlzPossible's initiatives: Training & Education, Info & Referral, and Services.

What is your role (or, better, what are your ROLES) at MEOC?

My roles are many at MEOC. I serve as Executive Director and thus perform the administrative responsibilities that generally accompany that position. However, one of the joys of working at MEOC is that we function as a real team and have worked really hard since our beginning days thirty-one years ago to avoid departmentalism, specialization, and unnecessary bureaucracy. We remind ourselves regularly of our mission and purpose and have tried to maintain a very consumer-centered, community based organization. I have been so fortunate to work for a Board and Advisory Councils that have willingly given me and our staff the flexibility and encouragement to be creative and to be real advocates for the people of our region. Advocacy is one of my favorite roles and our organization puts major emphasis on our legislative mandate to serve as an advocate for the people in our region.

The development, maintenance, and nurturing of partnerships is a central focus of my work. Partnerships are a major, major key to the day-to-day operations of MEOC and are the primary reason for which we are able to serve and interact daily with the thousands of people connected to the work and mission of MEOC.  

What do you feel are the most challenging aspects of your work?

The most challenging aspect of my work is the never ending need to locate and develop new and additional revenue sources to respond to the tremendous need that is present in our Central Appalachian area.  I always feel like I’m trying to work a jigsaw puzzle and never have all the pieces and that the pieces keep changing. For example, we presently have put together 60 different revenue sources to provide the myriad of services we now provide. However, even with that effort, we have some of the highest numbers on waiting lists of any area in the state. If you examine the Virginia Department for the Aging’s latest Unmet Demand Report, you will see that a whooping 34% of persons identified as in need of homemaker services and who presently are un-served live in our service area.  At the same time, 28% of those identified as in need of home-delivered meals (and are not serviced) live in our service  area.  Our region’s unmet need is over- represented in all six of the services tracked by VDA—Adult Day Care, Home Delivered Meals, Homemaker, Personal care, Residential Repair, and Transportation.

Each year we serve more and more people, but each year the unmet need increases.  We live and serve in a very mountainous area with great geographical beauty. The geography itself represents a challenge in reaching our older citizens. 

As we celebrate our 31^st year of service to southwest Virginia, we are facing a major challenge. We have been so fortunate to have very little staff turnover. Once people join our team, they seldom leave. That organizational loyalty and memory are absolutely invaluable to our success. However, we are facing the reality that most of our management team and program directors will be hitting retirement at the same time. We need to begin preparing for that and begin training younger people for management positions. However, we are caught in a Catch 22 situation because these demographic challenges are occurring at a time when revenues to the world of private non-profits have decreased and are continuing to decrease while unmet needs of area seniors are soaring. In order to find funds to bring in new staff, we would have to dramatically cut services. Our Board is beginning a yearlong discussion, at my request, of this issue. We are concerned with maintaining the organization and reconfiguring it to serve the needs of our area for the coming decades.  

What are some of the projects we could find today in your "laboratory"?

We are involved in a regional partnership studying and planning for a P.A.C.E. program for our area. PACE is an acronym for an exciting model of care for the frailest and poorest of our citizens 55 years of age and older who are nursing home eligible. PACE stands for Program of All Inclusive Care for The Elderly, a program centered on the belief that it is better for seniors with chronic care needs and their families to be served in the community whenever possible.  The PACE approach offers a comprehensive set of long term care services (including medical care) that keep people attached to their communities. The model prevents unnecessary hospitalizations and nursing home admissions and is a true one-stop service for the older person and their caregiver. We have had a dream of a PACE Program in our part of rural Appalachia for over 10 years. We have all the needed ingredients in our partnership, but lack the startup cash needed to make it a success. That is our only barrier. We are meeting with all sorts of people to see how we might solve that problem.

We are also looking at taking the model developed for our ARDRAF proposal and applying it to other populations.  We want to do everything that we can to see that today’s technology does not bypass our rural area and its people.  Technology should be accessible to all and should be available to all segments of the population. We want to make sure that the elderly and their caregivers are connected to the world of technology and provide them the support they need to become part of this world. Our ARDRAF grant is concerned with Alzheimer’s caregivers. We have written a proposal to other sources to look next at our KinCare Program. KinCare is a program for grandparents raising grandchildren, an increasing arrangement in our area, and one in which there are special needs of both the young and the old in this situation.

We recently received a grant from The National Library of Medicine to develop a distance learning and training center at MEOC. Our eventual goal is to link technologically all of our senior wellness centers, community group respite centers and proposed PACE centers with our MEOC office center. This would present unbelievable opportunities for new and better ways to serve people in more comprehensive and holistic ways.  We would like to connect our 15 Pharmacy Connect sites so that area pharmacists could do pro bono mediation monitoring and counseling while the applicant was at the site enrolling in the free medication program.

What do you consider to be your greatest accomplishment?

Marilyn accepting the HOPE Award on behalf of The Mountain Laurel Cancer Center of MEOC. The award was presented at The Inter-Cultural Cancer Center's (ICC) Ninth Biennial Symposium on Minorities, the Medically Underserved, and Cancer held in Washington, D.C. in April, 2004. The HOPE (Helping Other People Endure) Award recognizes "exceptional service in the area of cancer prevention, cancer patient support, and survivorship in minority and/or medically underserved communities in the U.S. and its associated territories."

That is a very difficult question for me to even attempt to answer. Professionally, I have not individually accomplished anything; all my efforts have been as part of a great team of folks. I learned a long time ago that smart people make you look smart and dumb people make you look dumb!!! I have never understood those administrators who feel threatened by having quality people around them and who prefer to surround themselves with "yes" people and sycophants. My management philosophy is to never hire anyone dumber than me!

As a team, MEOC has received national attention and we are all very proud of our organization. Thus, my biggest accomplishment professionally is being a part of this team of people—all of whom remain committed to mission and service and who never try to hide behind a bureaucracy when faced with human need. I love the quote by Margaret Mead that goes something like, “Never doubt that a small group of thoughtful committed people can change the world. Indeed, it is the only thing that ever has.”  I have been blessed to work with thoughtful committed people going on four decades and that has made the difference for me.

Personally, my biggest challenge has been surviving breast cancer on two different occasions. Thus, I guess that my greatest personal accomplishment is being a cancer survivor.  From those experiences, I learned not to sweat the small stuff and that just about everything is small stuff.

Have any of your initiatives failed and if so, which  ones and why?  Any learning advice/lesson drawn from this experience?

I believe that the Japanese proverb “Fall seven times, get up eight” is something that I have learned over the years. If you have a dream and it is a dream that if realized will make a positive difference in the lives of others, then you should never let go of it. If you hold to it long enough, then the “stars” will ultimately align themselves for the dream to become reality.

I have learned that some people are a whole lot more fun to partner with than others and that I would rather play with them than those who don’t know how to play with others.

I have learned that when a door closes that it is much more productive to go find other open doors than to try to knock the closed door open. I have learned that truly when a door closes that several more and better doors open and that’s where I choose to put my energy.

What are the benefits of being part of AlzPossible, Virginia's Comprehensive Alzheimer's Disease Virtual Center?

As a local service provider, AlzPossible provides me with the opportunity to develop partnerships outside of my region in our efforts to reach out to persons with Alzheimer’s disease and those who care for them. It will keep me up to date on all the initiatives going on throughout the Commonwealth and will give me new ideas to serve better the people in southwest Virginia. It will also give us the opportunity to share a lot of the innovative things going on in our neck of the woods, particularly in the areas of technology and caregiving, support services for caregivers, and the development of partnerships.

More importantly, AlzPossible provides means of putting together programs and partners in new and different ways and locating the funding to make them happen.

I am extremely excited about the construction of AlzPossible and am awed by Dr. Zaven Khachaturian, the other members of the Alzheimer’s and Related Disorders Commission and our Chair, Ian Kremer, for doing the hard work to make this vision reality. We are all particularly indebted to our Commission staff, Janet Honeycutt and Bill Peterson, for shepherding this through.

What would be one project which you have tackled within the Virtual Center?  Any results you could share with us? 

I have been privileged to serve on the Commission with Dr. Russ Swerdlow who serves as Chair of The Services Work Group. It has been exciting to be a part of the process to establish a Virtual Memory Disorders Consultative Clinic in the Commonwealth. I am pleased that the first two clinics were held in far southwest Virginia. We first got it off the ground in Scott County at Clinch River Health Services, a community health clinic. The second was held at Norton Community Hospital in Wise County.

I am sure that Dr. Swerdlow could speak more comprehensively about the success of the two clinics, but, from my local viewpoint, I have found through this experience that local physicians are hungry for input and support from memory disorder specialists in treating their patients with memory disorders. There has been great cooperation and eagerness in setting up the clinics with participants feeling the need to have a continuation of the clinics on a regularly scheduled basis.

It has been exciting to me to be a part of this groundbreaking endeavor and think that the evolution of this concept will result in better care for persons with memory disorders through out Virginia.  We are working on setting up additional clinics in the southwest and hope to have those pinned down shortly.

If resources would not be a concern, what would be the hottest, top three projects you would tackle tomorrow?

I can only answer this question from the vantage point of Director of MEOC and what I see and know to be true about our region and its people after living and working in southwest Virginia since 1972.

I would want everyone in our region (and our nation) to have running water and an indoor bathroom. Just imagine how much easier life would be for people, and particularly elderly people, if they had these basic “conveniences.”  It is sinful to me that resources are so disproportionately distributed that in the 21^st century, we still find pockets of people without running water and indoor plumbing in our nation and in our state.

I would want all people everywhere to have access to quality health care, including dental care, mental health care, and pharmaceutical coverage. Our region has the highest number of uninsured and underinsured people in the Commonwealth. I see way too many hardworking people, many of them working two jobs just to be able to pay their bills, who do not have health insurance as a benefit and who are too low-income to afford it. I see way too many people who fall between the cracks who die too early because of lack of basic health care. Receiving treatment in an emergency room is the norm for them. 

Lastly, I would invest in a true community based long term care system that would provide the full range of services needed to allow persons to age with dignity in their own homes in their own communities. It would be a system that would strengthen and support families while responding to the needs of those without family.

Who is someone you have looked to as a role model?

I have been fortunate to have so many people in my life who have been such positive influences and who have nurtured and nourished me along the way! It would be impossible to enumerate all of them here, but all of whom have been so instrumental in shaping my life.

Since the Paces and the Carters came to this country, they have been involved in public service so there was no way on earth that I could escape from having an interest in the needs of people around me and from believing that public service was an honorable calling. I still believe that—even though it is now, unfortunately, a minority viewpoint-- and am still motivated by the challenge issued by President Kennedy during my high school days for each of us to ask first what we can do for our country.

My father was a union supporter and organizer, served as business agent for the ironworkers local union, and set a great example for me to keep centered on what was basic to people and what was superfluous. I also learned from him that a healthy sense of humor was a necessity for those advocating in the public arena, particularly if you sided with those without power. I also learned from him the responsibility of separating issues from personalities, but I’m not nearly as good at it as he was.

My two wonderful Pace aunts in Tishomingo County, Mississippi were a major influence in my life. Some of my favorite childhood memories involve the two of them in one way or another. It was only when I got to college that I realized it was atypical for a child to spend her week-ends “working” alongside her aunt in the Clerk’s office of the Tishomingo County courthouse issuing marriage licenses and often times serving as witness for those wishing to marry that same day! I soon learned that finding the niche as the Marriage Capital of the South was a darn good way to finance local government! I’ve been crying at weddings ever since I was 5 years old!

I grew up in a small town in Alabama—Sheffield--and attended the Methodist Church there that fortunately was peopled with a large number of folks that we refer to as “the saints” of the church. Their surrogate parenting of all of the children in the congregation provided a wonderful security and confidence that is hard to find these days.  They functioned as “family support workers” before there was a societal need to develop such programs and to coin such a phrase.

I have shared more than anyone would ever want to know, but I must add that my choice of community organizing as the type of social work that I wished to pursue was influenced by the work and writings of Saul Alinsky, a true champion of the disenfranchised. Although I disagreed with some tactics, I was attracted to his passion for the need for systemic change. I had the opportunity to meet him shortly before his death while I was a student in graduate school at UNC-Chapel Hill.

During my professional life in the field of aging, I have been honored to host and spend time in our area with both Dr. Arthur Flemming and Maggie Kuhn, both real heroes of mine.  Among Dr. Flemming’s many outstanding contributions to public service in government was his creation of what became the federal office on aging during his tenure as Secretary of Health Education and Welfare during the Eisenhower Administration. Dr. Flemming was the most impassioned voice for the elderly and for the call to action that I have ever heard. When he stood at the microphone in the National Guard Armory in Big Stone Gap, Virginia, in the early 1970’s at one of the earliest gatherings of MEOC and exhorted all of us to make the Constitution of the United States a living document and forcefully proclaimed that older people need a dream, not just a memory, we were all transfixed and wanted to join him immediately.

Maggie Kuhn, founder of the Gray Panthers, spoke to us of discrimination in the workplace against the older worker and how forced retirement resulted in our country losing the talents and skills of our aging people as they were tossed to the junk heap at a mandatory retirement age. She was a pioneer who was stressing the need for intergenerational actions before it became the norm to suggest such an approach.

We have had some real giants in the aging field to spend time and share their knowledge with us in far southwest Virginia. It is a tribute to their deeply held value of inclusiveness that they graciously took the road less traveled—literally and figuratively—to visit southwest Virginia. By their presence, they affirmed their commitment to ALL elderly people, a commitment that empowered those of us in rural Virginia.

Finally, I am deeply indebted to Dr. Helen M. Lewis, founder of the Appalachian Studies movement, who gave me my first job in southwest Virginia when she hired me as an Assistant Professor of Social Work at what is now The University of Virginia’s College at Wise and served as my mentor and Department Chair. She has been my friend and role model for the last 35 years and continues to teach me the importance of maintaining organizations as  community-based ones, the necessity for true community education and that participatory research is the way to arrive at the truth of communities.

Can you give us your definition of courage?

Courage is one of those virtues that is hard to define, but you know it when you see it. Courage is more than the mice agreeing that the cat needs to be belled, but someone taking the action to bell the cat! Courage is taking the unpopular position because it is the right position. I remember Maggie Kuhn saying that we must speak up even if our voice shakes. So, being courageous does not mean that we are unafraid, but that we take the right and just action despite our fears.

One of my favorite stories since childhood is the Biblical story of David and Goliath. David’s faith was so great that he was able to beat the unbeatable.  I believe that people who display courage have a confidence that comes from trust in a higher power.

If you were ruler of the world for a day, what would you do?

I have absolutely no idea! It is so farfetched that I can’t even embrace it.  But, then again, maybe, I could destroy all the weapons in the world and issue a decree that no more weapons could be manufactured by anyone. Think I could get that accomplished in a day?  Then I would order all bumper stickers on all vehicles to be removed and replaced with bumper stickers that read, “Peace on earth, the whole earth, no exceptions” and would also issue tee-shirts and school uniforms emblazoned with our newly adopted world slogan!