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Service Delivery Innovation Profile

Community-Based Volunteer Program Postpones or Avoids Nursing Home Admissions Among Neighborhood Seniors, Saving Millions of Dollars


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Snapshot

Summary

The Payne-Phalen Living at Home/Block Nurse Program is a community-based program that provides medical and social services to a culturally diverse group of more than 400 low- and moderate-income seniors living on the east side of St. Paul, MN. One of 44 such programs (43 in Minnesota and 1 in North Dakota), Payne-Phalen strives to allow seniors to remain at home through use of local professionals and volunteers who provide in-home nursing visits, medication management, coordination of medical care and social services, assistance with daily needs (e.g., transportation to medical appointments or grocery shopping), and social visits. In fiscal year 2006 to 2007, the program postponed or avoided an estimated 89 nursing home admissions, resulting in a cost savings of $4 million. Similar results have been achieved in 40 other sites that have implemented the program.

Evidence Rating (What is this?)

Suggestive: The evidence consists of estimates of the number of nursing home admissions avoided and their associated costs; these estimates are based on an assessment of each client's circumstances regarding health, support network, and services used, which is then used to make a determination as to whether the client would have required a nursing home admission in the absence of program services.
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Developing Organizations

Elderberry Institute; Payne-Phalen Living at Home/Block Nurse Program
Living at Home Network; Payne-Phalen Living at Home/Block Nurse Program St. Paul, MNend do

Date First Implemented

1999
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Patient Population

Age > Aged adult (80 + years); Vulnerable Populations > Frail elderly; Age > Senior adult (65-79 years)end pp

Problem Addressed

Seniors who need nursing care prefer to live at home, but many—particularly those with low or moderate incomes—lack access to the coordinated medical and social support services that can allow them to do so. With in-home medical care and social support, seniors can remain at home longer, preserving their quality of life and avoiding the high costs of nursing home care.
  • Preference for home living: According to a survey conducted by the American Association of Retired Persons, 82 percent of respondents would prefer not to move from their current home if they were to need help caring for themselves.1
  • Need for medical support to live independently: Despite a preference for living at home, many seniors live in nursing homes because they cannot navigate the medical care they need to remain independent.2
  • Need for social support: Loneliness late in life may be a risk factor for serious mental health conditions, such as depression; one study of adults aged 60 to 98 years found that the risk of depression is associated with the following social factors: grieving a recent loss, having few neighborhood visitors, reduced participation in organized social activities, and reduced church attendance.2

What They Did

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Description of the Innovative Activity

The program uses volunteers and small staffs—both professionals and community members—to provide a myriad of individual and group services geared toward maintaining the health and social connections of seniors living at home. Key elements of the program include the following:
  • Identification of needs and plan development: Staff consult with seniors and family members about their health and social requirements and then develop a plan that incorporates needed medical and social services. As part of plan development, the program performs assessments that address topics such as home safety, risk of falls and geriatric depression, and warning signs for Alzheimer's disease.
  • Nurse visits: If medical issues are identified, a block nurse makes skilled home visits to provide health education, medical services, medication management and assistance with care coordination. Other services provided by the block nurse include advocacy, which might include providing transportation to medical appointments as well as going into the doctor's visit with the client; providing caregiver support and education; facilitating family care conferences; running blood pressure clinics; providing foot care; and providing various assessments, nutritional support, long-term care planning, and referrals for chores and housekeeping.
  • Volunteer visits and services: If other issues are identified, the staff coordinates volunteers to provide any of a wide variety of services, including but not limited to rides to medical appointments, in-home social visits, grocery shopping, and respite services for caregivers. The program also has a volunteer matching program where seniors are paired with a nursing student. The program has an eclectic group of volunteers. They include nursing students from the University of Minnesota and Metropolitan State University, and partners with Century and St. Paul College. Many services are provided by community residents, and some participating seniors with minimal needs also serve as volunteers.
  • Weekly, monthly, and annual group activities: Organized group activities include four monthly blood pressure clinics, a summer picnic, a monthly active elders social group, monthly brown-bag grocery deliveries to low-income elders, an annual multicultural health fair, and an annual holiday gift distribution event in December.
  • Mostly free services: There is no charge for services, but donations are accepted. The Block Nurse program partners with Recover Health or refers to other Medicare-certified nursing agencies when medical needs are greater than can be met with volunteer nurses.

Context of the Innovation

The Block Nurse Program was established in 1981 when a group of friends realized that the seniors in their neighborhood could live at home longer if a nurse was available "on every block" to check on them. After operating for several years, developers of the Block Nurse Program learned of a program with a similar mission, called Living at Home. In the mid-1980s, the programs merged, becoming the Living at Home/Block Nurse Program. Each program is geographically defined and operates with a small paid staff and a cadre of volunteers. The Elderberry Institute was created to serve as a nonprofit umbrella organization to act as a fiscal agent for most of the programs. In August 2010, the Elderberry Institute was renamed the Living at Home Network. The Payne-Phalen program is housed in First Covenant Church in St. Paul; it was established in 1999 by members of the church and the local community and became a 501(c)(3) nonprofit organization in 2004. Currently, the program serves more than 400 low- and moderate-income elders who are 65 and older (and their families), including about 300 white, 88 Latino, and 15 African-American elders.

Did It Work?

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Results

An evaluation of the Payne-Phalen program and similar programs in 40 other sites show that the Living at Home/Block Nurse initiative has postponed or averted many nursing home admissions, saving millions of dollars in Medicaid funding.

Results From the Payne-Phalen Program
  • Substantial cost savings: In fiscal year 2006–2007, the program served 408 clients, providing 1,345 volunteer hours to them. Analysis estimates that the program delayed or averted 89 nursing home admissions (representing 865 months of nursing home care) during this fiscal year, resulting in a cost savings of $4 million to the Medicaid program.
  • Positive return on investment: For every dollar granted to the program by the state of Minnesota, the program saves an estimated $3.50.
  • Services utilized: In fiscal year 2006–2007, 88 volunteers spent 1,345 hours providing services to program participants. In 2010, volunteers provided program participants with more than 1,000 rides to medical appointments and grocery stores.
Results From 40 Other Sites

During fiscal year 2006 to 2007, these 40 programs served 11,578 clients, providing them with 108,614 volunteer hours. Analysis suggests that these 40 programs delayed or averted 1,138 nursing home admissions (representing 8,238 months of nursing home care), resulting in cost savings of $36.8 million to the taxpayer-funded Medicaid program.

Evidence Rating (What is this?)

Suggestive: The evidence consists of estimates of the number of nursing home admissions avoided and their associated costs; these estimates are based on an assessment of each client's circumstances regarding health, support network, and services used, which is then used to make a determination as to whether the client would have required a nursing home admission in the absence of program services.

How They Did It

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Planning and Development Process

Key steps in the planning and development process included the following:
  • Agreement with the Living At Home Network: The Living at Home Network supported program startup by offering an array of tools and personal assistance. In addition, the Elderberry Institute acted on the new program’s behalf until Payne-Phelan could obtain its own 501(c)(3) designation approximately 4 years after its inception.
  • Recruitment of initial set of volunteers: The program identified a group of committed volunteers who agreed to provide program services.
  • Design of services: The Payne-Phelan program identified the type and frequency of services that it would initially offer based on available staffing. At first, program offerings were fairly limited, but they have grown over time as volunteer support has increased.
  • Partnership with church to provide space: The program collaborated with a local church that agreed to rent space in the basement to serve as the program's headquarters.
  • Creation of board of directors: The Payne-Phelan program created a diverse board of directors, including an individual who works for the Minnesota Department of Human Services, a retired real estate agent, an attorney, a retired businessman, a professor of social work from a local university, a retired military man, and a human services program coordinator. The board helps to identify needs in the community and to prioritize program services. Board members also serve as advocates and fundraisers for the program.
  • Recruitment of additional volunteers: Program staff distributed flyers throughout the area, placed notices in local church bulletins, and solicited newspaper articles to generate interest in volunteering (and to encourage program referrals). Program staff collaborates with area colleges and universities to enroll nursing, social work, and medical Spanish service learning students to act as the programs "eyes and ears" in the community. They are matched one-on-one with seniors and provide a social outlet for many of them who are isolated.
  • Pursuit of funding: The program solicits foundation and government grants and donations from the community to fund program services from various sources.

Resources Used and Skills Needed

  • Paid and volunteer staffing: Due to funding cuts in 2008, positions were cut in the program. The program now has two paid staff members, one full time and one 3/4 time, and there is no longer a nurse on staff. Originally, the program had two full-time paid staff members (an executive director and a manager of elder and volunteer services) and five part-time paid staff members. In fiscal year 2006 to 2007, 88 volunteers spent 1,345 hours providing services to program participants. In addition to managing the program, the staff members work on medical advocacy and chronic disease management issues.
  • Costs: The cost of program operation were $237,448 in fiscal year 2006 to 2007; this figure includes staff salaries, health promotion and outreach services, volunteer/service coordination, and in-home nursing services. The projected annual budget for 2008 to 2009 was $393,000. However, due to recent decline in State funding, the program estimates the budget will be reduced by 60 percent. The impact on the program is that rather than expanding services and increasing staff time to provide needed services, the program is forced to decrease hours and services.
  • Space: The program has two offices, three telephone lines, space for case management meetings, family care conferences and use of a larger hall for educational programs, and weekly gathering for Latino clients with memory loss.
  • Reimbursement: Although the Payne-Phalen Block Nurse Program is not a Medicare-certified agency, many Block Nurse Programs do use the nursing services of Medicare-certified agencies for which they receive reimbursement. Payne-Phalen is working with a payer to receive reimbursement for Independent Living Skills provided by staff. The rate is $7.24 per 15-minute unit ($28.96 for an hour) with a limit of 12 hours per client per year.
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Funding Sources

Metropolitan Area Agency on Aging
The program is funded in large part through grants from the city, county, and state, as well as from other foundations, individuals, organizations, and fundraising events. One example is a $44,000 grant from the Metropolitan Area Agency on Aging for participation in a statewide Alzheimer's disease demonstration project. In 2010, two dinner events and two sales with proceeds benefiting the program were held.end fs

Tools and Other Resources

The Living at Home Network (http://www.elderberry.org) has developed a manual on how to start a Living at Home/Block Nurse Program; this manual, Forming A Community-Based Network, is available free of charge at http://www.elderberry.org/content/Documents/FormingACommunityBasedNetwork.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat ReaderĀ® software External Web Site Policy.).

Adoption Considerations

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Getting Started with This Innovation

  • Find committed volunteers: The initial set of volunteers should be highly committed to the program. Volunteers should be passionate about serving the needs of seniors and supporting the program's mission of helping them remain in their homes. A minimum of 10 volunteers are needed to support a basic set of services.
  • Create a diverse board: Board members should be from different professional backgrounds. When recruiting board members, clearly explain their responsibilities and expectations related to raising funds for the program.
  • Find a place to serve as headquarters: Possible locations include churches, senior living centers, and community centers.
  • Pursue funding: Funds should be pursued aggressively from a wide variety of possible sources, including State and local governments, foundations, corporations, and individuals. It is recommended that no one source exceed 25 percent of the program's funding.
  • Advertise aggressively: Be bold and creative in marketing the program, as this will generate volunteers, clients, and donations. Consider activities such as approaching television and radio stations, putting information in church bulletins, and passing out flyers.

Sustaining This Innovation

  • Be proactive in identifying clients: Too often, programs do not get client referrals until clients are in crisis and close to needing a nursing home admission. The program is more likely to be able to delay nursing home placement if clients are referred when they are still relatively healthy and can therefore derive a greater benefit from program services. Payne-Phalen encourages seniors to volunteer for the program to build a relationship with staff before they are in need of services themselves. Whether they provide rides to medical appointments for other seniors or come in the office to help with a mailing, there are always volunteer opportunities to make a difference.
  • Recruit volunteers on an ongoing basis: Continue to actively identify volunteers from the community as well as from local institutions such as nursing schools.
  • Add nursing services gradually: Most programs begin with community-based assistance and coordination and then add skilled nursing services after 4 or 5 years in operation.
  • Identify reimbursable services: Payne-Phalen is actively attempting to identify services for which insurer reimbursement can be obtained.

Additional Considerations

  • Payne-Phalen is the only program or agency on the east side of St. Paul working with Latino clients with memory loss. The program was cited in 2007 for its work by the National Alliance for Hispanic Health.
  • Although no one is turned away from services for inability to pay, there is a cost for Block Nurse Programs services: the cost of paying personnel, rent, phones, computers, etc. With more and more nonprofits being impacted by funding cuts, more programs are asking their seniors for a donation for rides to the doctor. Another trend is to ask seniors and their families to commit to making a monthly contribution to support the services of $10, $15, $25, or $50. Some Block Nurse Program newsletters are carrying stories about how to leave a legacy to the programs.

More Information

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Contact the Innovator

Mary Gallagher
Director, Payne-Phalen Living at Home/Block Nurse Program
1280 Arcade St.
St Paul, MN 55106
(651) 774-7078
E-mail: Mary@blocknurse.org

Innovator Disclosures

Ms. Gallagher has not indicated whether she has financial interests or business/professional affiliations relevant to the work described in this profile; however, information on funders is available in the Funding Sources section.

References/Related Articles

Payne-Phalen Living at Home/Block Nurse Program. Available at: http://www.blocknurse.org/payne

Footnotes

1 Stevenson K. Americans Modifying Homes To Remain Independent. ElderWeb 2000 June 6. Accessed May 14, 2009.
2 Adams KB, Sanders S, Auth EA. Loneliness and depression in independent living retirement communities: risk and resilience factors. Aging Ment Health. 2004;8(6):475-85. [PubMed]
Comment on this Innovation

Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read more.

Original publication: August 18, 2008.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: July 31, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: October 22, 2009.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.