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Creating an ‘Ecosystem of Health and Wellness’ to Reach Underserved Older Adults

By Christina Reardon, MSW, LSW

As the number of older Americans continues to grow, so too do concerns about how to keep elders from overtaxing the nation’s healthcare system. In response, many technology-driven projects have emerged with the goal of keeping older adults out of hospitals and skilled nursing facilities and in their homes and communities. The aims of these programs have ranged from promoting health literacy to preventing cognitive decline to increasing coordination between care providers.

Now, a California organization is working to bring all these approaches together to improve health outcomes among older adults in Los Angeles. The Front Porch Center for Technology Innovation and Wellbeing recently launched its Model eHealth Community for Aging (MeHCA) project. The project brings together a network of organizations, including social service providers, healthcare organizations, and educational institutions, to use broadband-enabled technology to improve access to care for underserved and low-income older adults in LA’s Koreatown neighborhood. Project supporters believe that if their efforts are successful, the project could serve as a model for other such collaborative relationships nationwide.

“We wanted to create an ecosystem of health and wellness,” says Kari Olson, president of the Front Porch Center.  “If we can make it work here, we can help other organizations.”

A Multifaceted Approach
The Front Porch Center is part of Front Porch, a California-based nonprofit that operates active adult, retirement living, and affordable housing communities in several states. Formally established in 2009, the center focuses on deploying emerging technology that helps people manage their health and remain active and independent.

The MeHCA project is one of 15 projects in California that was named a recipient of the Broadband Adoption Model eHealth Communities Awards in 2011. The awards program, administered by the UC Davis Health System and the California Telehealth Network, provided more than $5 million in awards to community organizations to improve health outcomes among underserved populations through the use and integration of technology. As an award recipient, the Front Porch Center has been given approximately $225,000 in telehealth equipment and a $50,000 grant from UnitedHealthcare.

These resources will be used to support the MeHCA project’s multifaceted efforts in four activity areas:

“Self-Health Knowledge”: This part of the project will focus on improving older adults’ technology literacy skills through training sessions about using computers and the Internet as well as through in-language health resources and the Dakim BrainFitness program. The Dakim program uses brain exercises to help elders fight cognitive decline.

“Big Screen Health”: The project will develop health- and safety-related information workshops delivered through its partner organizations via videoconferencing.

“Know Your Health”: This part of the project involves using remote patient monitoring and video consultations to help older adults understand and manage their healthcare needs.

“Pass on the Paper”: The project will place five student interns from East Los Angeles College in community clinics to support the implementation of electronic health records.

The project is targeting about 500 to 600 residents in Koreatown. But the project’s impact could be much larger because of the scope and variety of partnerships involved, says Davis Park, director of the Front Porch Center.

“We wanted to address this as a holistic project that addresses issues on a number of fronts,” he says. “We want to increase capacity and leverage existing resources in the community.”

One partner organization that is hoping to expand its reach through the project is the KHEIR Center, which operates a community clinic and social services programs for underserved and uninsured residents of southern California. The center has offered health education workshops and presentations in the past, but the MeHCA project will give it the videoconferencing capabilities it needs to expand to new audiences, says Kirby Van Amburgh, project manager with the KHEIR Center.

“It’s an opportunity to increase our audience and get the information out there. It was a pretty easy decision to participate,” she says. “This really fits our mission to increase access to healthcare. In these times, we need to be creative in increasing access in ways that we wouldn’t be able to do before.”

The videoconferencing sessions also will promote beneficial socialization between older adults, says Gordon Gibb, director of social services at St. Barnabas Senior Services, a Los Angeles-based organization that provides transportation, social support, nutrition programs, health education, and other services. St. Barnabas will provide workshops via videoconferencing and also offer Dakim BrainFitness kiosks at three of its sites.

“It’s about giving [older adults] a chance to offer mutual support and build that network and follow up on one another,” Gibb says. “And knowing that the broadcasts are going across the city allows them to feel connected to [older adults] in other areas.”

The cooperation that the MeHCA project promotes among healthcare organizations, social service agencies, and behavioral health professionals will become more and more important as the healthcare landscape is increasingly shaped by federal healthcare reform and the push for person-centered healthcare homes, says Sajid Ahmed, director of health information technology and innovation for L.A. Care Health Plan, another project partner. L.A. Care is a public health plan serving residents of Los Angeles County. One of its projects is the Health Information Technology Extension Center for Los Angeles County, which is helping healthcare providers throughout the county implement electronic health records.

Technologically Forward, Culturally Competent
The cultural diversity of the Los Angeles area will provide both opportunities and challenges to the organizations involved in the MeHCA project, says Forrest Hong, PhD, LCSW, C-ASWCM, who works in the city as a social worker and geriatric care manager. The partnerships fostered through the project may be beneficial to the organizations involved, but some of the older adults involved may initially be wary due to cultural differences and language barriers.

“It needs to be done in a language sensitive and culturally competent way,” says Hong, who also is chairman of the NASW’s Aging Specialty Practice Section Committee. “It’s going to take time. It’s a matter of developing trust.”

Gibb says he understands that certain aspects of the MeHCA project may be more difficult to implement than others. For example, older adults with low English proficiency may face barriers in accessing the Dakim BrainFitness kiosks because the program’s exercises are offered only in English and have a western cultural perspective.  But that’s not a reason to reject such technological interventions, he says.

“With anything we try, there are going to be challenges. It’s something to keep on your radar, but it’s not a barrier,” he says. “It’s part of the learning process.”

— Christina Reardon, MSW, LSW, is a freelance writer based in Harrisburg, PA, and a contributing editor at Social Work Today.