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May 27 / Thomas Jankowski

Innovation in Aging Services, Part 2

tom jankowski chair croppedIn my last blog post, I introduced the notion that innovation in aging services is more about collaboration and cooperation than about new technology. One program I discussed is Experience Corps, in which seniors volunteer to tutor children in local schools. This program brings many benefits to schools, students, and older adult volunteers. Here’s a similar program that works in the opposite direction: The TECH program developed by the Central Oregon Council on Aging. TECH stands for Teen Elder Computer Help. It’s an intergenerational training class that uses teenage volunteers to teach seniors how to use digital cameras, smartphones, e-mail, Skype, and social media such as Facebook. The seniors and teens all love it. The older people feel more connected to modern technology and popular culture while being able to stay in touch with their far-flung family members and friends. The teens come to better understand their elders and cultivate a sense of pride in volunteering and helping others. It’s another win-win.

Right here in Michigan, in places like Kalamazoo and Ferndale, Royal Oak and Ypsilanti, people are developing time banks. Time banks allow people to barter services, and they are a great vehicle for intergenerational exchange and mutual assistance. Using time banks, older adults can trade services they are able to provide for services they are unable to do for themselves. They can offer to provide after-school childcare in exchange for help with lawn mowing. They can bake a batch of cookies for their neighbor, who will clean out their gutters or rake their leaves in return. They can repair torn clothing or sew a popped button for the person who will take them grocery shopping. The possibilities are huge, the cost in dollars is small, and the potential for intergenerational learning and empathy and a stronger community is real.

One thing that these intergenerational programs have in common is that they capitalize on the understanding that while older adults often need our help and support, they also bring a lot to the table: A lifetime of experience and wisdom, a grounding in the community, a good amount of free time, and sometimes significant financial and physical resources. Our older population is growing, and plenty of its members will need help in maintaining their health and independence, but overall it is the healthiest, best educated, and most socially engaged older population we’ve ever had. My research shows that seniors are not only participating in the work force at higher rates than they have in many decades, but even those who are retired import billions of dollars into Michigan’s economy in the form of Social Security and pension benefits each year. This does not include their Medicare benefits, which largely fuel our healthcare system, currently the strongest economic sector in our state. Yes, let’s serve seniors, but let’s also give those who are able plenty of opportunity to serve others.

Finally, let’s remember that things change, and agencies that serve seniors in their communities need to keep up with the changes. They cannot continue business as usual and expect to survive. They need to find new ways to provide services and enhance the quality of life of our older adult population, all while reducing costs. New services that are well designed and competently delivered to serve unserved needs can ultimately reduce costs in the long run. A good example is the care transitions program of The Senior Alliance, Area Agency on Aging 1-C, another organization I work with in Southeast Michigan. The Senior Alliance developed a care transitions coaching program that is now funded by the Centers for Medicare and Medicaid Services. This program has helped to significantly lower Medicare costs arising from readmission and rehospitalization among high risk, frail elderly folks who are discharged from the hospital. The transition coach meets with each client in the hospital before they are discharged to help them assemble and review their personal medical record. They teach them and encourage them to properly manage their medications, to adhere to dietary guidelines prescribed by their doctors, and to follow up and advocate for themselves with their primary care physicians after they are discharged. They meet with them in their homes after discharge to review meds and offer information and support, and make sure they take proper steps to care for chronic conditions and get regular medical care. It costs several hundred dollars to coach each patient, which seems pretty expensive until you consider that by reducing readmission by nearly 30%, which this program does, each dollar spent reduces health care expenditures by many more dollars, not to mention reducing the human costs of unnecessary hospitalization. Now that hospitals are being penalized by Medicare for preventable readmissions, they have become eager partners in this enterprise.

But the larger point is that those who serve the older population must keep their ear to the ground. They must maintain a keen awareness of the broader environment in which seniors live. And they must be ready to adjust their programs and services to better fit those changing conditions. Program evaluation, needs assessment, and outcomes research are key to accomplishing these goals. In the aging services field, they have done a great job of measuring outputs—units of service delivered, clients served—but they have done a poor job of measuring outcomes and the end results of the services they have delivered. My colleagues at the Senior Regional Collaborative and I have developed a measurement tool called the Quality Aging Matrix which we hope will help us to gauge the effects of our services on the quality of life of older clients. It measures the conditions seniors face along several dimensions such as mental and physical health, housing, nutrition, and social engagement, each ranging from crisis, to stability, to thriving. It uses repeated measures taken at intake and each review by a caseworker to show the degree of movement from crisis to a thriving condition in order to evaluate the effectiveness of our programs. It’s still in its very early pilot stages, but we hope it will help service providers to better assess their services and convince funders that their programs are effective and that precious dollars are being well spent.

To those in the aging network, the message is this: Don’t be afraid to be creative, try new things, reach out, and work together. Older adults are our parents and grandparents, those we love, those upon whose legacy we have built our lives. We owe them a debt of gratitude, and we carry an obligation to offer a hand when they need help. And if we haven’t yet done so and we are lucky and take care of ourselves, some day sooner than many of us would like to admit, we will join their ranks. Wouldn’t it be nice to have an array of efficient and effective services to depend upon when we do?

 

To learn more about Dr. Tom Jankowski and his work visit http://www.iog.wayne.edu/profile/thomas.jankowski/

This essay was adapted from the keynote address by Thomas B. Jankowski, PhD, at the Midland County Council on Aging Annual Meeting and Senior Services 50th Anniversary Dinner, November 12, 2013.

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