Seniors CONNECT for Health: Training Elders as Community Health Workers in Detroit

By Denise White Perkins

A tale of two seniors:

Mrs. Wixom is a 75-year-old widow. Her children live out of state. She suffered a stroke last year, and was recently discharged from the hospital after a heart attack. She has all her medications and a list of doctors’ appointments, but no car. She feels overwhelmed. She sits in a chair and stares out the window all day until it’s time to eat or sleep. She feels upset about how much her neighborhood has declined in 30 years.

By contrast, Mr. Kentwood has lived in his own home for 30 years. He has a host of neighbors and friends. He was discharged from the hospital after a heart attack and attends a local, all-inclusive program where he has access to pharmacists, therapists, doctors, caregivers and transportation. He is active at the local Community Center learning a new language.

Some seniors may have challenges, while others thrive. Can we engage those in the latter group to help those in the former?

In 2015, supported by the Michigan Department of Health and Human Services, Henry Ford Health System’s (HFHS) Institute on Multicultural Health (IOMH) implemented the Seniors Collaborative Outreach Network Navigating and Educating Communities in Transformation (Seniors CONNECT) project. The project engaged community-dwelling elders identified at Detroit senior centers to serve as Community Health Workers (CHWs) and conduct outreach events to their peers. This intervention represents a promising practice for improving the support system for at-risk seniors and reducing disparities in health and well-being.

HFHS comprises six hospitals, 29 medical centers and the Henry Ford Medical Group, which includes 1,200 physicians practicing across metro Detroit. HFHS sees about 93,000 inpatients and completes 3.1 million physician visits annually, serving more than 1 million Southeast Michigan residents. We have a long history of research projects and community-based initiatives addressing health and healthcare disparities. Our Institute on Multicultural Health works to achieve health equity for underserved racial and ethnic minorities, as well as other marginalized populations, and to eliminate health inequities for all. Seniors CONNECT represents a step toward addressing health equity among older, higher-risk Detroiters.

The U.S. senior population is growing. In its Older Americans 2012 report, the NIH stated that in 2010, 40 million people age 65 and up accounted for 13% of the population; by 2030, this number will increase to 72 million, or 20% of the population. A 2012 article in the Detroit Free Press noted that in Detroit, seniors are more likely to be hospitalized, chronically ill, and die too soon.

The keys to healthy aging are well-established: 30 minutes of physical activity most days; a low-fat, high-fiber diet incorporating fish and 5 servings of fruits and vegetables daily; being mentally active and learning new things; having social support and engagement; reducing stress; and consistently taking medications as prescribed and attending doctor appointments.

Unfortunately, many seniors find themselves socially isolated, especially in Detroit, which lacks reliable public transit. Research shows that isolation can be detrimental to seniors’ health and well-being. As noted in the United States of Aging Survey, social isolation affects 8% of seniors in the U.S. Socially isolated seniors express more concern about aging in place and may need help with transportation, health management and home maintenance.

CHW Competencies

  1. Outreach Methods and Strategies
  2. Individual and Community Assessment
  3. Effective Communication
  4. Cultural Responsiveness and Mediation
  5. Education to Promote Healthy Behavior Change
  6. Care Coordination and System Navigation
  7. Use of Public Health Concepts and Approaches
  8. Advocacy and Community Capacity Building
  9. Documentation
  10. Professional Skills and Conduct

—Massachusetts Board of Certification of Community Health Workers (www.mass.gov) 2014]

 

Through Seniors CONNECT, we strived to engage, train and support a diverse team of community-dwelling senior citizens as Community Health Workers (CHWs), who could then provide education, navigation and support for underserved or vulnerable older adults in metro Detroit. Community Health Workers are trusted, knowledgeable frontline health personnel who typically come from the communities they serve. CHWs bridge cultural and linguistic barriers, expand access to coverage and care, and improve health outcomes. The project’s goals were to increase knowledge, skills and efficacy of senior CHWs in addressing individual, social and health services-related determinants of health for other seniors. We aimed to leverage the shared life experience among seniors of the same generation to overcome barriers to help-seeking such as lack of awareness of resources, mistrust of service providers, and fear of losing independence. The project sought to improve quality of life and sense of empowerment of both CHWs and seniors they serve.

The project began by recruiting 7 community-dwelling seniors above age 55 from partnering Senior Centers to become CHWs and serve as independent contractors in June 2015. Candidates completed an application and informal interview which assessed their interpersonal skills and experience in community service. They underwent approximately 126 hours of training covering such topics as social determinants of health and disparities; listening skills; engaging patients in research; program planning; finding health information; linking individuals with community resources and assets; outreach and advocacy; basic CPR skills; healthy aging; motivational interviewing; and site visits with programs serving seniors. Training methods included role plays, case discussions, journaling, video review, readings, community surveys, site visits and workshops with interactive exercises. CHWs received binders of resource and referral information, planning tools for wellness events, and data collection tools to track progress. Following this training, they conducted 24 community wellness sessions targeting underserved seniors over the course of 3 months at various locations, resulting in a total of 288 participant encounter hours. In addition, they conducted social needs assessments and provided referrals and resources to 120 Metro Detroit seniors. The project has generated support and interest from insurers, universities, and national organizations. Senior CHWs report high levels of engagement with the program; participants respond well to it; and senior centers have been enthusiastic about the results. However, funding and staffing to sustain the project remains challenging. We learned valuable lessons on effective approaches to training seniors as CHWs, including the importance of allocating additional time and support for computer-based trainings and the need to ensure the CHWs themselves remain engaged in their local senior center so that they also feel supported. Nevertheless, Seniors CONNECT represents a promising practice for empowering seniors to help their peers find the resources they need.

Denise White Perkins, M.D., (dwhite2@hfhs.org) is a Senior Staff Physician and Faculty in the Department of Family Medicine at Henry Ford Health System, where she enjoys a busy clinical practice and teaches medical students and residents. She also serves as Director of the HFHS Institute on Multicultural Health and is a Clinical Associate Professor at Wayne State University School of Medicine, Department of Family Medicine and Public Health Sciences.