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Connecting the Dots on Seniors' Health Care


Several years ago, Carol Woods President and CEO Patricia Sprigg, the Carol Woods Board of Directors and former board member William Friday approached The Duke Endowment to seek its support in developing community-based programs to address emerging healthcare problems for older adults.

The result was a three-year grant, funded by The Duke Endowment, known as the "Community Connections for Seniors" project.

The grant is designed to build connections to help integrate and coordinate services and supports in Orange and Chatham counties. Through the Community Connections project, now in its 10th month, new and more effective connections are being forged among existing organizations, programs, and people.

"Carol Woods is in a good position to help the community develop a collaborative model for an integrated service delivery system for older adults in transition," Sprigg said. "We believe in the care management model that has served our residents well and feel others could benefit from a coordinated and interdisciplinary approach."

According to the N.C. State Data Center, Orange County is one of 75 counties in North Carolina that will have more individuals over the age of 60 than under the age of 18 by the year 2030.

While many older adults will be able to have their needs met via retirement communities and other senior programs, the healthcare component of an aging population faces certain struggles unless solutions are found.

Numerous agencies and organizations help people with various aspects of healthcare, but often those resources work in relative isolation from each other. The grant is designed to help them work together in a more holistic way.

"There are organizations doing great work," said Heather Altman, a Carol Woods' employee and the grant's project director. "But many times they work in silos, and their initiatives are in silos; more collaboration is needed."

Friday, UNC System president emeritus, said the need for such collaboration is urgent.

"Everyone is searching for some type of answer, and this problem is going to overwhelm this state pretty quickly, service delivery-wise, healthcare-wise, manpower-wise," he said. "This is an exceptional opportunity."

One of the most critical problems is the lack of coordination and support in transitioning patients, especially older adults, from one healthcare provider or setting to another, such as following discharge from the hospital.

Older adults tend to have a high "bounceback" rate of seven-day and 30-day returns to the hospital after being discharged.

Community Connections will develop a multi-faceted approach to improving transitions from the hospital into the community by coordinating existing resources. This will help address people's desire to "age in place," while providing an economically feasible option for North Carolina.

"Carol Woods' residents are very concerned about what's happening to their friends who don't live in this sort of an environment," Altman said. "They want to make sure their cohorts, their peers who are not moving to Carol Woods or other retirement communities, also have access to good, coordinated care."

Mary Piepenbring, director of The Duke Endowment's health care program, said the Endowment was pleased to support the project.

"Through its health care grants, the Endowment seeks to enhance the quality of life for people in North Carolina and South Carolina, and we believe Community Connections will help do that for older adults," Piepenbring said.

Nancy Gustaveson, Carol Woods resident and chair of the Community Relations committee, is excited about the grant.

"[The grant] recognizes the need to bring healthcare into the community where people gather, and it stresses the need for more cost-effective services, particularly for those with greater limitations, physical or economic," Gustaveson said. "I like how the grant engages the volunteers of the community -- both faith-based and the neighbors."

Another facet of the Community Connections project addresses the issue of a shrinking workforce. According to the Task Force on the North Carolina Nursing Workforce, the state will face a shortage of registered nurses ranging from 9,000 in 2015 to 18,000 by 2020. In addition, less than 2 percent of physicians in training express interest in geriatrics.

The grant will focus on workforce development and increasing student exposure to aging services career opportunities.

Ultimately, the grant for Community Connections will enable participating resources connect with older adults earlier for greater health promotion, support them longer in their desired living arrangements, and improve outcomes during times of transition. Community Connections will also convene leaders in public policy, business, education and service delivery to identify areas of collaboration and innovation to address aging service needs.

"We believe the grant will have a positive impact in three areas: It will improve direct service delivery, provide positive professional training opportunities, and develop best practices while providing a foundation for public policy formulation," Sprigg said.

"Orange County has some wonderful resources for older adults, and it is just a matter of linking them. North Carolina is a huge retiree state and a wonderful place to retire. This is a real opportunity to be ahead of the game."