Livingston County Help For Seniors

Description

With age comes higher disease burden, more disability risks, and increased difficulty accessing needed care — all of which are sometimes paired with limited financial resources. Especially in rural areas, research has shown that these demographics make older adults a population benefiting from home-based screening assessments to determine health needs.

In 2006, Livingston County, New York, was designated a medically low resource area with a growing population of older adults. The county's emergency medical service networks recognized that their Emergency Medical Technicians (EMTs) were, by default, providing care for this population. Wanting to properly meet this age group's needs, EMTs further raised awareness around the gaps in their profession's geriatric training. These issues resulted in a federal grant award allowing the Livingston County Office for the Aging to create the Help For Seniors (HFS) project that supported both the EMT training needs and a staff to follow-up on older adults' needs as identified by EMTs.

Grant funds specifically supported the development and dissemination of YouTube vodcast EMS trainings — many of which are still hosted on the Monroe-Livingston Regional EMS Council's website. The project's workflow formalized EMT screening opportunities for fall prevention, substance use, and depression when an EMS request came from the home of an older adult. Screening results and other needs assessment information were then transferred to the grant-dedicated case management team: a registered nurse and a social worker. This team contacted every referral to offer assistance.

With the grant's conclusion, the case management positions were eliminated. However, the project's capacity building in terms of county-wide networking, collaborations, and EMS training had established an integrated approach that was well-positioned to quickly implement a new state offering at the time, NY Connects, coming from the New York State Office for the Aging.

Although today no longer a designated medically underserved area, 2020 census data revealed that Livingston County still has an expanding number of older adults. Supported by NY Connects, the HFS program's service focus still continues under NY Connects: The county's EMS professionals are still strategically involved with assessments supported by a county-level funding arrangement and EMT referral follow-up is still completed, currently performed by the county's Office of the Aging staff supported by NY Connects. The latter agency provides varied resources for needs like eligibility screening for unrecognized benefits and "options" counseling – also known as " No Wrong Door"– all focused on helping the county's older adults to maintain their independent living.

Funding for the original HFS project was provided by a 2005-2008 Federal Office of Rural Health Policy Rural Health Care Services Outreach grant. In 2008, the federal Administration on Aging cited HFS as "Program Champion".

Services offered

The original federal grant-supported Help for Seniors program included training to prepare EMS professionals in completing field assessments for fall risks, substance use, and depression with referral follow-up done by the case management team's registered nurse and social worker.

Current services:

• Under a county-level funding agreement, EMS personnel still complete in-field health needs assessments during calls to homes of the area's older adults and make referrals to the Livingston County Office for the Aging following internal guidelines.
• Livingston County Office for the Aging personnel, supported by the NY Connects funding, mail special information packets to each EMS-referred individual that specifically includes an encouragement note to call the office for further information. An internal process also guides any needed direct outreach.

Results

Original 2005-2008 grant results:

1,231 older adult participants' evaluation results:

• 33% positive for depression
• 68% positive for fall risks
• 90% positive for medication management needs
• 90% program participation satisfaction

187 EMT participants' evaluation results:

• 6,000 views of "Vodcast" training
• Nearly 100% positive feedback on training

Current service results:

• EMS still makes about 20-25 referrals per month to the Livingston County Office on the Aging

Academic information and journal articles referencing the Help for Seniors program:

• Caprio, TV., Karuza, J., Katz, PR., Smith, K., Cypher, P., Shah, MN. (2008). Home-based screening of rural community dwelling older adults by Emergency Medical Services and referral to Transitional Case Management. Annual Meeting of the American Geriatrics Society Poster Presentation, May 2008.
• Shah, MN., Caprio, T., Swanson, P., Rajasekaran, K., Ellison, J., Smith, K., Frame, P., Cypher, P., Karuza, J., Katz, P. (2010). A Novel Internet-based Geriatric Education Program for Emergency Medical Services Providers. Journal of the American Geriatrics Society, 60(9), 1749-54.
• Shah, MN., Swanson, PA., Nobay, F., Peterson, LK., Caprio, TV., Karuza, J. (2012). A Novel Internet-based Geriatric Education Program for Emergency Medical Services Providers. Journal of the American Geriatrics Society, 60(9), 1749-54.

Challenges

During the original grant period, over 70% of seniors expressed varied reasons for their reluctance to allow follow-up home visits. However, with time and widespread use of the HFS program, the county's seniors became much more accepting of the multi-stage intervention process. Currently, this increasing community awareness and acceptance is represented by a reported quadrupling of calls to the Livingston County Office for the Aging.

Replication

Its original HFS work was considered "groundbreaking," with the vodcasts an effective method of EMT education. However, now, many similar rural programs across the country leverage HFS's original outcomes in their EMS and paramedicine outreach programs to address the unique needs of their specific area's older population.

Contact Information