Livingston County Help For Seniors

Evidence-level

Effective (About evidence-level criteria)

Description

In 2006, Livingston County, New York, was a designated medically underserved area with a growing elderly population. In general, older adults have a higher disease burden, higher risk for disability, limited financial resources, and difficulty accessing care, demographics making them an ideal population to screen in home and provide further care as needed.

Since Emergency Medical Technicians (EMTs) were providing the default care for the county's aging population, they raised awareness around their geriatric training gap.

In response, the Help For Seniors (HFS) project was developed, intervening at 2 points in the healthcare continuum: screening older adults for unmet healthcare needs and educating EMTs on geriatric care using vodcast trainings through YouTube videos.

The initial project lasted 18 months, but components have continued under the supervision of the Livingston County Office for Aging. Funding was provided by a 2005-2008 Federal Office of Rural Health Policy Rural Health Care Services Outreach grant.

Services offered

The Help for Seniors program utilized the Livingston EMS to implement basic assessments geared to improving the health of Livingston County seniors:

• Additional screening provided for older adults after EMS care for falls, depression, and medication management
• Referral of older adults with ongoing care needs to case managers
• Development and dissemination of a geriatric care training program for EMTs in order to better understand the specific needs of older adults

Results

The following results were found during the program's active screening of 1,231 patients:

• 33% screened positive for depression
• 68% screened positive for risk of falls
• 90% screened positive for medication management problems
• 90% of patients served were satisfied with the program

Another evaluation found the EMS "vodcast" training to be very successful as they received over 6,000 views. In all, 187 EMTs were trained and gave almost entirely positive feedback regarding the trainings' usefulness.

HFS was cited as a "Program Champion" by the Administration on Aging in 2008.

Journal articles that reference 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 Emergency Medical Services Based Program to Identify and Assist Older Adults in a Rural Community. Journal of the American Geriatrics Society, 58(11), 2205-2211.

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

After screening, some seniors expressed initial reluctance to agree to further follow-up visits. For instance, 73% of patients refused to have follow-up home visits for various reasons. However, with time and widespread use of the HFS program, the county's seniors became much more accepting of the multi-stage intervention process.

Since grant funding ended, there are reduced resources for follow-up, impacting engagement and effectiveness.

Replication

The Livingston County Help for Seniors program has many components that can be replicated or adapted, including the complete EMS online training.

Contact Information

Karen Dewar, Director
Livingston County Emergency Medical Services
Livingston County Office for the Aging
585.243.7596
kdewar@co.livingston.ny.us