Senior Citizens in Rural Communities Need Help in
Finding Professional Assistance
Elderly adults often have unmet needs that can only
be identified in a home visit
Nov. 10, 2010 - A novel project set in a rural
community near Rochester, N.Y., to screen elderly people for unmet needs
found there is a need to help match senior citizens in living in rural
settings with the professional assistance they need.
The
University of Rochester Medical Center, Livingston County Department
of Health and Office for the Aging, and the Genesee Valley Health
Partnership collaborated to create this program, called Livingston Help
for Seniors. They describe this new model of care for rural-dwelling
adults in the November issue of the
Journal of the American Geriatrics Society.
Disabled senior
Americans could increase substantially with aging of baby boomers; more
aggressive efforts needed to prevent and manage illnesses and injuries
In one instance, a diabetic who did not own a
refrigerator to store insulin was provided a new appliance; other
examples included linking patients to professionals who could assist
them with paperwork, home weatherization, and unanswered medical
questions.
A unique aspect of the program was the use of
Emergency Medical Services (EMS) technicians to evaluate older people
who live at home for common problems such as falls, depression, or
management of medications, said the studys lead author Manish N. Shah,
M.D., M.P.H., an associate professor of
Emergency Medicine,
Geriatrics and
Community and Preventive Medicine at URMC.
Despite frequent contact with their primary
doctors, elderly adults often have unmet needs that can only be
identified in a home visit, Shah said. The EMS system has not
traditionally served a public health function, but we believe it has
significant potential, especially in rural areas where health care
resources are scarce.
"This innovative project clearly demonstrates what
can be accomplished to improve the quality of life for seniors and to
keep them safe and home, through successful, local collaboration of
primary care physicians, EMS, the health department, social services,
and aging services, added Kaaren Smith, director,
Livingston County Office for the Aging.
Approximately 7,300 people age 65 or older reside
in Livingston County, the center of which is located about 30 miles
south of Rochester. The EMS system in Livingston County cares for an
estimated 1,000 elderly people annually. The Genesee Valley Health
Partnership, a network of agencies and organizations, offered to act as
a hub for the program as part of its mission to develop new intake and
referral models to help local residents.
The study describes the experiences of the program
during its first 18 months of operation. It included 1,444 older adults,
all of whom sought emergency care. EMS technicians, who received special
training, would first deliver the appropriate medical care and then
would screen the patient for falls, depression and pill-taking
strategies, all areas of concern in geriatrics. Of the 1,444 people,
1,231 (85 percent) were screened. Average age was 80.
Two to four weeks after the EMS screening, the
program staff contacted each elderly patient to offer an additional home
visit by a case manager. During these visits, case managers would
evaluate patients and discuss issues such as vaccinations, advance
directives, nutrition, activities of daily living, alcohol and drug
abuse, cognition, and environmental safety. Based on the identified
needs and patients desires, the case manager would make referrals to
various agencies.
It is important to note that of the 1,231 people
initially screened, 73 percent refused a follow-up home visit, saying
they were not interested or denying that any problems existed, the study
said. However, the vast majority (92 percent) of the people who did
agree to the additional home visit reported satisfaction and received
important referrals for assistance.
The rate of refusal was related to a number of
issues, Shah said, including a belief by some elderly people that they
were already getting help from other sources. As the program has gained
acceptance, its value is more recognized.
We found out that sufficient community resources
exist to help elderly patients, but they are not always linked to those
people who need it most, said Paul Cypher, executive director of the
Genesee Valley Health Partnership. Our program created an organized
system that seems promising for future expansion.
Joan Ellison, R.N., M.P.H., public health director,
Livingston County Department of Health, agreed. This model practice
links service providers and those in need of services in a unique and
innovative way. We look forward to continuing this program in greater
depth and breadth in the future.
The study was funded by a Health Resources and
Services Administration Rural Health Outreach grant to Livingston
County.
Nov. 10, 2010 - A novel project set in a rural
community near Rochester, N.Y., to screen elderly people for unmet needs
found there is a need to help match senior citizens in living in rural
settings with the professional assistance they need.
