Study clarifies needs of rural-dwelling elderly

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.

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 study's 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 patient's 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.