AGING
November 25, 2010

Care for Rural Elders

In much of rural America medical and geriatric care may be minimal. A new program that tightens the safety net may help.

A rural community in New York may have found a better way to get medical and social help to elderly individuals who need them. It starts by giving EMS workers a larger role in identifying these needs.

Livingston County began giving additional training in geriatrics to its EMS workers a few years ago. After being called to an elderly person's home and medically stabilizing them, EMS workers now speak with the person about common problems of the elderly, such as falls, difficulties with taking medication and depression.

One person, a diabetic with no refrigerator in which to store insulin, received a new refrigerator. More common was simply linking people with existing individuals and organizations that specialize in assisting with paperwork, unanswered medical questions, home weatherization or legal issues.

If the person is experiencing any of these problems, this is communicated to local social agencies. A few weeks later, the person is phoned by a case manager, who offers to make a home visit to help figure out the best way to deal with these problems.

During the home visit, the case manager and client discuss what the client needs help with and how to get it. So far, this has included a wide range of topics: vaccinations, nutrition, alcohol and drug abuse, cognition, activities of daily living and environmental safety.

Visits are made only to those who want them. Sometimes what a social worker sees as help, a client sees as intrusion. Nearly three-quarters (73%) of the people offered the home visit refused it. But among those who agreed to the visit, 91% reported satisfaction with it and received various types of referrals or assistance.

One person, a diabetic with no refrigerator in which to store insulin, received a new refrigerator. More common was simply linking people with existing individuals and organizations that specialize in assisting with paperwork, unanswered medical questions, home weatherization or legal issues. The network for helping these people already existed, it was mainly a question of getting both sides connected. The program is generally not about creating new programs or additional community resources; it's about getting existing resources to work better.

Livingston County, NY is located about 30 miles from Rochester. About 7,300 people over the age of 65 reside in the county. Over the first 18 months of the program, EMS was called by 1,444 elderly people, average age 80. After dealing with their immediate medical problem, EMS was able to screen 85% of these people. Of those who were screened, 45% had fall-related needs, 69% had medication management-related needs, and 20% depression-related needs identified. Approximately one-quarter of these people who could be contacted (171) later agreed to a home visit.

When called, EMS workers are in a unique position to evaluate much more than just the immediate medical needs of a patient. Simply being in a home that's too cold in the dead of winter identifies a need. Taking advantage of this ability of EMS workers makes a lot of sense, especially in rural areas where health care and social resources are often scarce.

An article detailing the program appears in the November 2010 issue of the Journal of the American Geriatrics Society.

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