By Dr. Aruna Josyula and Dr. Oluwatoyin Thomas
Q: What is the name of this new program?
A: The Let’s Stay Home program is a collaborative pilot project of Senior Resources and the medical practice of Mercy Health Physician Partners (MHPP) Geriatrics. The program is focused on serving seniors with complex medical and social needs who have recently been hospitalized or had an Emergency Department visit and may not be able to stay in their own homes.
Q: Who is running the new Let’s Stay Home program?
A: Leading the pilot program are Senior Resources Community Services Director Amy Florea and Access Services Supervisor Kimberly Vazquez, along with MHPP Geriatrics physicians and staff led by Dr. Oluwatoyin Thomas and Dr. Aruna Josyula.
A: The project recently received the endorsement of the members of the Mercy Health Muskegon women’s giving club, Women for Health, who have awarded the Let’s Stay Home program a $34,000 grant. Due to the additional funding, the program will be provided to more seniors who without it would be at risk of placement in an assisted living facility or a nursing home.
Q: What is the primary purpose of Let’s Stay Home?
A: According to Dr. Oluwatoyin Thomas, the goal of the Let’s Stay Home program is to help seniors stay in their own homes as long as possible. In-home care services are not the focus. Rather, Let’s Stay Home seeks out gaps that, if not addressed, could place a senior at risk.
Q: What kinds of gaps?
A: “There are many times when seniors are admitted to the hospital because something fell through for them. For example, they may have been in need of food, medicine or housekeeping services. Medical care is just one of many factors that affect health,” said Dr. Aruna Josyula.
Other factors that affect a person’s health are social (income, education, employment, support and culture), physical (urban design, clean air and water), genetic and behavioral. “No single health-care organization can address all of these factors so partnerships like this, among health organizations and our community resources, are critical,” said Dr. Josyula.
Q: How will this program help to improve the health of seniors?
A: Amy Florea of Senior Resources anticipates the program will result in reduced Emergency Department visits and readmissions for seniors, eliminate missed medical appointments, increase program participants’ knowledge of their health condition and ensure that caregiver support is available.
“Experience has taught us that elders who are most likely to stay in their own homes have a support system to help them improve and manage their health conditions. The Let’s Stay Home program addresses these concerns,” said Florea.
Q: In what way does Let’s Stay Home go beyond in-home care?
A: The Let’s Stay Home program also provides case management services, health education, home-delivered meals, medical and non-medical transportation and other services that are provided during a period when the senior needs them most.
For example, after a discharge from the hospital, medications can be reconciled by a pharmacist, transportation to doctor appointments can be arranged, depression issues can be addressed and a social worker can be engaged to help with cognitive behavior therapy.
“We are we wrapping our arms around every aspect of the patient,” said Dr. Oluwatoyin Thomas. “If there are medication concerns or other issues to be addressed, they can be caught early. Concerns are brought to the physician’s attention and services that are already available can be deployed.”
Q: How does a senior qualify for this program?
A: Participants must be 60 years or older and have social barriers to care, such as caregiver burnout, lack of transportation, housing needs, in-home care needs or financial needs. In addition, participants must have had a recent hospitalization or Emergency Department visit. There is no cost to the participant and referrals can be made by requesting a consultation through MHPP Geriatrics by calling 231.672.6740.
Q: How long will these services be available for the average participant?
A: Once referred, a support coach will conduct a home visit and provide case management services for at least 30 days. With interventions in place, the participant will have weekly visits to monitor the progress of the interventions.
“This is only the beginning. We are always looking for ways to grow services to meet needs and improve life for seniors in our community,” said Dr. Thomas. “We are excited about this program because our seniors are correct; there is absolutely no place like home.”
Seniors are referred through the Mercy Health Physician Partners Geriatrics office and do not have to be a patient of that office to be referred. Call 231.672.6740 for more information.