Elder Services of the Merrimack Valley Medical Advocacy Program
Based on analysis of the “Needs Assessment of People Aged 60+ in Massachusetts” that was conducted in 2001 and again in 2005 and which is one component used to evaluate how well current services are meeting community needs, “transportation to medical appointments” and “relief for caregivers” were both ranked has high unmet needs for elders in Massachusetts and in the Merrimack Valley. Transportation is one resource that allows the elderly to remain independent, and relief and flexibility for family caregivers is another resource that allows caregivers to help keep elders in the community for as long as possible. Further, many caregivers are unable to always consistently accompany elders to these appointments because of work or other responsibilities such as childcare. In order to address these issues and meet these needs in our community, Elder Services of the Merrimack Valley developed and implemented the Medical Advocacy program in November 2002.
Based on recent demographic information, there are close to 45 million caregivers in the US today; nearly 60% of caregivers are currently employed. Another recent study of caregivers concluded that reducing caregiver stress would reduce the number of nursing home admissions, which is especially crucial in an aging society where elders and adults with disabilities increasingly demand the desire to remain in the community for as long as possible.
About You
Location
Project Street Address
Project City
Project Province/State
Project Postal/Zip Code
Project Country
Your idea
Focus of activity
Advocacy
Year the initiative began (yyyy)
2002
Positioning of your initiative on the mosaic diagram
Which of these barriers is the primary focus of your work?
Patients not empowered
Which of the principles is the primary focus of your work?
Democratize access
If you believe some other barrier or principle should be included in the mosaic, please describe it and how it would affect the positioning of your initiative in the mosaic:
Providing caregiver releief and advocacy for elders in an aging society, particularly for elders who often may find the health care system intimidating and overwhelming.
Name Your Project
Elder Services of the Merrimack Valley Medical Advocacy Program
Describe Your Idea
Based on analysis of the “Needs Assessment of People Aged 60+ in Massachusetts” that was conducted in 2001 and again in 2005 and which is one component used to evaluate how well current services are meeting community needs, “transportation to medical appointments” and “relief for caregivers” were both ranked has high unmet needs for elders in Massachusetts and in the Merrimack Valley. Transportation is one resource that allows the elderly to remain independent, and relief and flexibility for family caregivers is another resource that allows caregivers to help keep elders in the community for as long as possible. Further, many caregivers are unable to always consistently accompany elders to these appointments because of work or other responsibilities such as childcare. In order to address these issues and meet these needs in our community, Elder Services of the Merrimack Valley developed and implemented the Medical Advocacy program in November 2002.
Based on recent demographic information, there are close to 45 million caregivers in the US today; nearly 60% of caregivers are currently employed. Another recent study of caregivers concluded that reducing caregiver stress would reduce the number of nursing home admissions, which is especially crucial in an aging society where elders and adults with disabilities increasingly demand the desire to remain in the community for as long as possible.
Innovation
Define the innovation
Based on analysis of the “Needs Assessment of People Aged 60+ in Massachusetts” that was conducted in 2001 and again in 2005 and which is one component used to evaluate how well current services are meeting community needs, “transportation to medical appointments” and “relief for caregivers” were both ranked has high unmet needs for elders in Massachusetts and in the Merrimack Valley. Transportation is one resource that allows the elderly to remain independent, and relief and flexibility for family caregivers is another resource that allows caregivers to help keep elders in the community for as long as possible. Further, many caregivers are unable to always consistently accompany elders to these appointments because of work or other responsibilities such as childcare. In order to address these issues and meet these needs in our community, Elder Services of the Merrimack Valley developed and implemented the Medical Advocacy program in November 2002.
Based on recent demographic information, there are close to 45 million caregivers in the US today; nearly 60% of caregivers are currently employed. Another recent study of caregivers concluded that reducing caregiver stress would reduce the number of nursing home admissions, which is especially crucial in an aging society where elders and adults with disabilities increasingly demand the desire to remain in the community for as long as possible.
Context for Disruption:
The Medical Advocacy Program consists of a group of volunteers that provide transportation and accompany an elder to a physician appointment, treatment or other medical event, and act as an advocate and/or surrogate family member for that elder. Their role is to assist the elder in asking appropriate questions, record and organize information that the physician gives them, report to caregivers, and coach, support and empower the elder to be in charge of his/her health care during the visits and treatments. What is unique about this program is that it is “through the door” assistance. If an elder needs assistance putting on their coat or shoes, ambulating down the stairs to the curb, or carry oxygen our Medical Advocate can assist them. Medical Advocates meet with the elder, and a caregiver when possible, at least a half-hour before they are to leave for the appointment. At this time, the Medical Advocate reviews with the elder and caregiver any questions or concerns the elder may have and makes note of them in the elder’s Medical Advocacy record. This record becomes a reference and a health record for the elder. The Advocate provides transportation to the appointment and accompanies the elder throughout the office visit. During the visit, the Advocate will take notes for the elder and prompt and redirect the elder if necessary about any of the concerns that they had discussed earlier. The Medical Advocate will also take the elder to the pharmacy if there are any prescriptions that need to be filled. At the conclusion of each visit, the Advocate leaves the completed record with the elder so that they can review on his or her own or with the caregiver what transpired during the appointment. The Advocate is also able to provide relief for working caregivers who would otherwise need to take time off from work for medical appointments. The Medical Advocate can be another trusted voice in the care of the elder.
Delivery Model
To date we have trained close to 50 volunteers as Medical Advocates, including Advocates who are bilingual, speaking such languages as Spanish, Greek and Italian. Elder Services Medical Advocates receive specialized orientation training as well as other ongoing support and training during their tenure as Medical Advocates. Orientation training topics cover the following areas: “Overview of the Aging Process and Related Health Changes and Challenges”; “Infection Control and Hand Washing”; “The Role of the Volunteer Support Caregiver”; “Guidelines for Building Positive Relationships/Listening Skills”; “Assertiveness Training”; “Guidelines for Reducing Risk on Volunteer Assignments”; “Ambulating with an Elder and Preventing Falls”; “Transportation Safety”; “Emergency Guidelines”; “Confidentiality and Ethics”; and, “Procedures for Medical Advocacy”. Medical Advocates meet with the elder, and a caregiver when possible, at least a half-hour before they are to leave for the appointment. At this time, the Medical Advocate reviews with the elder and caregiver any questions or concerns the elder may have and makes note of them in the elder’s Medical Advocacy record. This record becomes a reference and a health record for the elder. The Advocate provides transportation to the appointment and accompanies the elder throughout the office visit. During the visit, the Advocate will take notes for the elder and prompt and redirect the elder if necessary about any of the concerns that they had discussed earlier. The Medical Advocate will also take the elder to the pharmacy if there are any prescriptions that need to be filled. From December 2002 through December 2005, the Medical Advocates have filled approximately 1076 requests and completed almost 3500 hours of medical advocacy time. Approximately 35% of those visits were primarily to provide caregiver relief. Currently, the program provides an average of 25-30 rides per month for elders throughout the Merrimack Valley.
Key Operational Partnerships
The essential partnerships that make this program so effective are the caregivers and the Medical Advocates, who work together to assist the elder in a health care system that may be intimidating and in which the elder may not feel empowered. The other key partners in this program are the primary care physicians and other health care providers who are supportive of the Medical Advoacte and her/his role with the elder.
Impact
Financial Model
The annual cost of the program is approximately $40,000 a year (Medical Advocacy budget attached). Most of the cost would go toward the salaries and fringe of 5 hours/week of the Volunteer Services Program Manager and a part-time Program Coordinator (20 hours/week). The remaining expenses are for mileage reimbursement for the Medical Advocates and other program support costs such as printing, copying, postage, telephone, etc.
When Elder Services implemented Medical Advocacy in November 2002 we were able to secure funding through the National Family Caregiver Support Program. Due to budget constraints Medical Advocacy is no longer funded through this program and is supported by other corporate funds and is coordinated by existing Elder Services staff and a Senior Aide assigned to the agency.
What is your annual operating budget?
$26M
What are your current sources of revenue? (please list any sources that are foundation grants)
Elder Services manages a range of programs and services that offer choices for older people and receives funds through various public and private funding sources including the state and federal government, foundations, corporations and individual contributions.
Effectiveness
From December 2002 through December 2005, the Medical Advocates have filled approximately 1076 requests and completed almost 3500 hours of medical advocacy time. Approximately 35% of those visits were primarily to provide caregiver relief. Currently, the program provides an average of 25-30 rides per month for elders throughout the Merrimack Valley. In federal fiscal year 2006 (October 1, 2005 - September 30, 2006) Medical Advocates provided 350 one-way trips for 62 elders in the Merrimack Valley.
Which element of the program proved itself most effective?
The most effective element of the Medical Advocacy Program is the relief that is provided to the family caregiver of the elder. The value to the community with this program is almost immeasurable. The support of medical advocates has helped many of our elders live safely in their homes longer. This lengthening of time in the community has decreased the dollars spent in a nursing facility. Elders have less confusion about medications ordered and their purpose, assistance with picking up prescriptions, getting to treatments and better communication with their physician and health care provider. Further, this program model can be easily replicated by any agency working with elders, people with disabilities or other groups in need of long-term supports in the community.
Number of clients in the last year?
In federal fiscal year 2006 (October 1, 2005 - September 30, 2006) Medical Advocates provided 350 one-way trips for 62 elders in the Merrimack Valley.
What is the potential demand?
In a society where people are living longer and the numbers of people aged 65 and older is ever-increasing, and where the numbers of family caregivers and the demands are also ever-growing, the demand for the Medical Advocacy program model is expected to grow in the Merrimack Valley and across the state of Massachusetts. The potentail for the demand of this program model in other parts of the United States is also great given the growing needs and demands of our aging society.
Scaling up Strategy
To better meet the needs of a society that is now seeing the youngest "Baby Boomers" turn 65 and currently has close to 45 million family caregivers, our main priority is to increase the Medical Advocacy Program in the Merrimack Valley and expand and replicate the program across the state of Massachusetts. This will involve increasing our volunteer recruitment and training efforts and increasing the outreach and awareness of the program to elders and ceregivers.
Stage of the initiative:
1
Expansion plan:
Working in partnership with the other 26 Aging Services Access Points (ASAPs) agencies in Massachusetts and with Mass Home Care, the statewide association for the state ASAPs, Elder Services plans to replicate the Medical Advocacy Program across the state. We will work together on volunteer recruitment and training strategies, and develop concerted efforts for outreach and awareness.
Origin of the Initiative
The Medical Advocacy Program was started in December 2002 to fill the need many of our elders have with transportation and advocacy. As our elders’ age increases, many of them become too frail to descend a stairway alone or ambulate to the curbside independently in order to access other modes of transportation. The case managers and nurses in our agency would express this as the number one unmet need with our elders. We utilized one of our own nurses to develop this program. She started the first training with 8 volunteers from the community who expressed an interest in assisting elders to doctor’s appointments.
This Entry is about (Issues)
Sustainability
What are your two main challenges to finance the growth of your initiative
The annual cost of the program is approximately $40,000 a year. Most of the cost would go toward the salaries and fringe of 5 hours/week of the Volunteer Services Program Manager and a part-time Program Coordinator (20 hours/week). The remaining expenses are for mileage reimbursement for the Medical Advocates and other program support costs such as printing, copying, postage, telephone, etc. The primary challenge is in securing guaranteed funding for the personnel and operational costs associated with the program.
How did you hear about this contest and what is your main incentive to participate?
Elder Services was made aware of the competition by one of our colleagues at one of the other Aging Services Access Point agencies in Massachusetts.
The Story
Do you have an annual financial statement?
Yes. This may be made available upon request.
Do you currently have an annual financial statement that tracks profit/loss?
Year 1: $40,000
Year 5: $1.08M
Please describe the amount (and/or type) of funding you need to implement your initiative, at year 1 and at year 5.
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Comments
Most consumers are overwhelmed by their own medical information. They rarely do research on their own health encounters beforehand, and often leave doctor's office unsure of what they have been directed to do and why. We have not been trained to ask health care professsionals the questions we have, and to keep asking questions until we understand the answers. We would not buy even a cellphone on such skimpy information as we seek for our own critical health care decisions. This is especially true for many older consumers, who accept the "doctor knows best" attitude, and accept what they are told based on faith, rather than knowledge. For this reason, compliance with medical advice is often weak because older consumers don't grasp why it is they are doing what they are doing in the first place. Medication noncompliance is a major concern, because seniors believe its not a big deal to skip a medicine, or to cutback to lower monthly costs.
The MEDICAL ADVOCATES proposal submitted by Elder Services of Merrimack Valley in Massachusetts accomplishes several goals at once: 1) it makes sure that elders in the community actually get to their appointed doctor visits on time, 2) that they prepare for, and understand the content of what occurs with the doctor, and 3) they are coached in what to do in order to comply with their medical plan of care.
All of this is done with an easily replicable project that is predominately volunteer driven. This is far more than just a medical escort program. This is a medical coaching program, which has the intended effect of not only better preparing elders for their medical encounters, but puts their mind at ease and lowers anxiety about using health care services because their advocate is with them.
Every elder services agency should provide this basic coaching assistance, but few do. Part of the key is providing the resources needed to get the model up and running, and demonstrate its effectiveness. Here in Massachusetts, we have 27 non-profit Aging Services Access Points prepared to replicate this model in all 351 cities and towns in the Commonwealth.
This fundamentally empowers the consumer, and ensures that nothing will happen to them, without them.
Research indicates that taking an active role in your health care is critical to making informed decisions. One highly recommended way to do this is to "bring a friend or family member" to help you communicate your concerns and questions clearly and to help keep track of what the doctor tells you. Many older adults could benefit from a trained, impartial volunteer who can help them prepare for the visit, help facilitate communication during the visit, and review with the older consumer after the visit what was said, what the next steps are, and what follow up is needed. Not only is there the potential for improved health care outcomes for the older consumer, but family that is at a distance may be relieved of the stress and worry about an elderly loved one going to appointments alone and potentially learning difficult or confusing news. A primarily volunteer driven program that empowers older consumers to make informed decisions and improve their health is one worth replicating.
The Medical Advocates Program is a nationally recognized model for its innovative and creative use of senior volunteers to provide non-emergency medical transportation and valuable advocacy assistance to older persons who want to continuing living in their own home. The Community Transportation Association (CTAA) has a feature in two of its primary technical assistance manuals, the Senior Transportation Toolkit and Best Practices and its Medical Transportation Toolkit. A description of the program is also posted on CTAA's website. In May 2003 at CTAA's EXPO and pre-EXPO National Conference on Transportation for Elders in St. Louis, Missouri, Ms DeRoo presented on the program.
Every aspect of the ESMV program that I have examined -- planning, development, management, and supervision -- is outstanding. The program use volunteers to provide meaningful and demanding work. Their careful volunteer policies and procedures (recruitment and selection, training, and supervision) and overall excellent program management policies and procedures are the reasons why they can successfully use volunteers to perform such demanding work. When I have spoken with the leadership of the ESMV, I have been impressed by the agency's commitment to the program and its support of the Medical Advocates staff.
I frequently use ESMV in presentations at national and regional professional conferences as an example of a
program model that should be adapted in other communities.
I want to say that in my opinion, both personally and professionally, transportation is one of the major impediments in acccessing medical services. Many organizations, both private and governmental agencies only provide service to the curb which is not adequate for an elderly frail person. In addition to this major obstruction, the cost of the service, can reach into the hundreds of dollars. Recruiting and training quality volunteers will significantly increase the availability of the services and access to the service. We strongly support this application. Currently we have a tremendous availablitity of younger retirees who are available to assist their fellow seniors.
We learned about the program developed by Elder Services of the Merrimack Valley at a recent association conference. How intrigued we were to learn of the innovative ways that ESMV has utilized volunteers to provide much needed transporation services in conjunction with medical advocacy. So many elders are intimidated by medical professionals that they forget their questions, or if they do ask, may not understand the replies given. ESMV's volunteers can write down the questions ahead of time while talking with the elder in a more relaxed environment and then can also note answers so that elders and family members can refer to them later. The volunteers also assist with medical plan compliance by reminding elders to adhere to their specific medication schedules. We were impressed with ESMV's program planning and development. They took particular care in creating policies and procedures for the Medical Advocacy Program that enable it to grow successfully. We support ESMV's competition entry.
As the director for an Area Agency on Aging for over 20 years and a primary caregiver for my 88 year young mother, I have seen first hand the need for medical "advocacy" (someone who is a good listener and can take careful notes) and the transportation needed to get to and from health care appointments. Addressing the two needs via a volunteer model is not only effective, it is sustainable. The model proposed by ESMV has the potential for widespread replication and success in a vareity of geographic and cultural settings. It can work in urban as well as rural areas. Cultural and lingusitic differences can be addressed through careful screening and matching of volunteers. By offering staff support and backup through a formal system of recruiting, training and scheduling, volunteers and participants alike can be assured of a well run and stable program that will meet needs over the long term. I enthusiastically support the program and would like to be one of the agencies that replicates the model in our planning and service area.
Dan O'Leary, Exec Dir, Mystic Valley Elder Services, Malden, MA
As director of an organization which provides services to elderly persons, I am very interested in the model for medical advocacy as proposed by Elder Services of Merrimack Valley. While our agency does assist in transporting some elders to doctor's appointments, we do not have the resources to take this a step further and provide the advocacy often needed during or following the appointment. Many of the elders we serve are quite frail, may have some hearing loss or diminished capacity to comprehend the medical information being given to them. Also, they may have no local family members or close friends that are willing to "interpret" medical jargon, intervene on their behalf, or advocate for them on issues or problems which may arise.
The model the ESMV has put forth appears to be both cost-efficient and effective. By using volunteers, resources are greatly expanded. Also, the type of volunteer that would be interested in participating in such a program would probably also be very motivated in improving the quality of life of an older person. By helping someone make better, more informed decisions about their health care and life care, everyone wins.
Last year volunteers for Somerville-Cambridge Elder Services escorted frail elders to 777 medical appointments. While the primary purpose of our escort transportation service is to ensure that frail, disabled or cognitively impaired elders are able to get safely to and from their medical appointments, a critically important second purpose has emerged. Many of our clients will informally seek the assistance of our volunteers at their medical appointments. This assistance can take the form of interpreting for non-English speakers, acting as a recorder of vital health information, or explaining the instructions of the health care provider.
Elder Services of Merrimack Valley has developed an excellent program that should be replicated throughout Massachusetts. Somerville-Cambridge Elder Services would like to expand the scope of its escort transportation service to include a formal medical advocacy component, and we hope that we will be able to learn from the experience of ESMV.
I am pleased to have the opportunity to comment on the “Medical Advocates” program developed by Elder Services of the Merrimack Valley. I represent the Beverly Foundation which undertakes research related to transportation options for older adults, and I believe that the “Medical Advocates” program includes some of the most innovative ideas found in any of the more than 400 volunteer driver programs in our data base. After hearing about the program and meeting its founder, Mary DeRoo, I had the opportunity to make a personal visit to this extraordinary program to meet with Ms. DeRoo, program staff, and volunteers; and came away from my visit even more impressed with the important contribution the program makes to the patients, the caregivers, and the community.
And now about my impressions regarding the “Medical Advocates” program innovations. Indeed it is an innovation in the transportation sector, for while many transportation programs around the country provide escorts who stay with passengers at the destination, I know of no other transportation program that trains the drivers (in this case the medical advocates) to act as an advocate and/or surrogate family member for the elder. The involvement of volunteers as volunteer drivers/medical and the assistance they provide enable members of the community to take major responsibility in providing assistance by asking appropriate questions, by recording information provided by the physician, by reporting to caregivers, and by empowering the elder during health care visits. Indeed the “Medical Advocacy” program is an innovative way to involve the community in helping older adults through patient support, as well as transportation services. While their social contribution is important, their economic contribution of $63,875 in volunteer hours is what makes it possible for such a program to flourish.
Indeed, I believe that the “Medical Advocates” program should be replicated or adapted throughout Massachusetts. And, as a next step, I hope that the program will be shared with the rest of the country.
Helen K. Kerschner, Ph.D.
President & CEO
The Beverly Foundation
Pasadena, CA
At Ethos we have a number of medical escort volunteers who help frail elders go to medical appointments. As the Volunteer Coordinator, I hear a lot of reports from the volunteers, that the clients, who have limited family involvement or other informal support, need a lot more than just a shoulder to lean on during their medical visits. Many elders that we provide with medical escort services are very frail and disabled, with diminished ability to understand the medical information they receive, as well as follow doctors’ orders. I am very interested in the medical advocacy model that the Elder Services of Merrimack Valley developed. I strongly believe that this is an excellent program. It is designed to make a significant difference in the lives of many of our most frail clients. I fully support the ESMV’s application, and I look forward to being able to replicate the Medical Advocacy Program at Ethos.
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