For care, it's the small things that matter

Mrs. M is a very typical Senior Helpers client.

She’s in her early 80s, diagnosed with Parkinson’s disease, still living in her home just outside a major metropolitan area. For Mrs. M, aging in her home is a big priority; she does not want to live in an assisted living facility. It’s important to her to have control over her daily routines. She wants to see the things she’s spent a lifetime enjoying. She wants to relax with a glass of wine in her basement media room at the end of the day. 

But Mrs. M does need support. She knows she has limitations; she can’t drive, and she’s facing further decline in her day to day function with what she calls ‘the Parkinson’s’. So, when she sought help from Senior Helpers we did something new. We took a scientific approach to assessing her needs - one that delivers the data and insights we needed to give her the support she deserves, support that can measurably improve her quality of life. 

Telescope, versus microscope

The approach we took had everything to do with Ms. M’s Social Determinants of Health (SDOH).  We know that social, behavioral, environmental, and other non-clinical factors influence about 70% of health outcomes (more than genetics and clinical care, combined!). But which matter the most to Ms. M?  

To be able to impact Mrs. M’s care, we need to be able to assess her SDOH factors in detail, and within the context of her motivations and goals. We call these ‘Micro” Social Determinants of Health. This is different from SDOH that are “Macro” in nature - ones that originate within communities and patient populations. 

This is not to say that ‘Macro’ level issues - like access to transportation and the quality of primary care in her neighborhood - are not important. But to truly understand the influence of SDOH on her health and quality of life, we need to look through a microscope and a telescope. 

This is more challenging than you might expect. There are dozens of factors that influence your health, and each weighs differently from person to person. What truly qualifies as a ‘micro’ level SDOH, and why? Even if we identify them all, how do we know which are most important? 

This is the challenge we took at Senior Helpers. We wanted to develop a comprehensive framework to describe Micro SDOH and a methodology to measure their influence on the health of our clients. We believed that, by doing so, we could significantly improve quality of life.  

Another benefit? We’ve now unlocked the potential to significantly reduce unnecessary healthcare spending. 

Examining SDOH through patient function

We found the roots of our solution in the examination of an individual’s function and associated functional limitations. By this, we mean a person’s ability (or inability) to comfortably and reliably perform activities of daily living like walking, dressing, bathing, preparing meals, running errands and paying bills.  

Functional limitation correlates strongly with mood and motivation. You’re much more likely to report a lower quality of life if you’re dealing with loss of motion, range, grip strength and balance. 

Functional limitation also correlates strongly with healthcare spending. According to the Commonwealth Fund, patients with three or more chronic conditions spend about 55 percent more on healthcare than the average U.S. patient. If you add just one functional limitation to that patient profile (defined as a ‘high-need patient’) spending balloons to over 330 percent.   

One big reason has to do with hospitalization. On average, high-need patients are over twice as likely to visit the emergency room, have four times the number of hospital discharges, and use 25 times the amount of home health days. 

The opportunity here is significant. It’s estimated that lack of support for functional limitation cost Medicare more than $4 billion in 2015 alone. 

Smarter, more effective care

The solution we arrived at applies over 18 years of observational study on the root causes of hospital readmission within a 5-factor framework driven from best practice in geriatric occupational and physical therapy. 

1. Medical Condition Management 
2. Independence
3. Safety
4. Burden of Care
5. Quality of Life

The result - the Senior Helpers LIFE Profile - represents the most comprehensive, data driven methodology for identifying and measuring health and lifestyle risks associated with Micro Social Determinants of Health. 

The insights and data generated by LIFE Profile allow us to identify Micro SDOH related health risks that can then be remediated through a combination of physical, social, educational and community supports.  

Importantly, because LIFE Profile is consistent and measurable, we can now see how effective we are in reducing these risks. If we reduce the risk, we reduce the likelihood of a future hospitalization. If we deliver the right kind of support in a manner that is patient centered and goal-driven, we improve quality of life .

Supporting Ms. M. 

When Mrs. M was assessed, we saw some red flags. She wasn’t showering regularly. She had stopped going to the gym and stopped doing her recommended exercises. While she was calling family members and friends daily, no one lived nearby enough to help. With a decline in her range of motion and few assistive rails in her home, she was having difficulty doing laundry, cooking for herself, and taking care of her day to day needs. 

Plus, there was the issue of her daily glass of wine. It’s something she looks forward to and she’s been doing it every day for years. This means taking a glass down steep stairs with poor assistive handrails. It means doing this with ‘The Parkinson’s’. 

Ms. M. needs support, and she knows it. But her motivation is low and she’s embarrassed about her condition. To give her the help she needs we need to win her trust. To do so, we need to build her sense of ‘autonomy’. We want her to feel independent and in control, even if she needs outside help.  

The right sort of care

Winning Ms. M’s trust comes by applying a model of care that is responsive and empowering. We start by understanding her interests, preferences and ‘likes’ and then tying this to a meaningful goal. For Ms. M. we connected ‘doing her exercises every day’ to ‘ making a trip to see a gallery show before it closes’’ - something she really wanted to do. 

We then matched a caregiver to her based on her personality, her needs, and our caregiver’s training. All our caregivers receive our Senior Gems dementia training program with additional specialized training on Parkinson’s. We made sure to understand her exercises and help her keep a journal which tracked her progress. 

We also ‘graduated’ our support based on her level of function. For instance, she was fine dressing her upper body but needed help with her lower body. Rather than doing this for her we encouraged her to do it herself and provided her with a clothes hook to give her a hand. When she walked down her stairs we went down first - keeping an eye on her but not being overly ‘parental’ in our support. 

We also made a few changes in Ms. M’s home. Secure handrails were put in on both sides of every stairway. A tub bench and grip tape was added to her shower, along with a handheld shower so it's easier for her to bathe on her own. A small fridge in her basement kept her wine cold, ready for her television time. We took the glass up the next day to be cleaned. 

30 days later we reassessed Ms. M. using LIFE Profile. Her safety risk score went down, her ‘autonomy score’ went up. There was less chance she’d fall down her basement stairs although the risk is always there. Most importantly, Mrs. M told us that she felt more comfortable and confident - and ready to do more outside visits and host in her home. 

It’s all in the details

Since the beginning of this year, we have trained over a quarter of our 300+ SeniorHelpers locations on LIFE Profile - with more joining every month. We are finding that LIFE Profile provides an invaluable tool for families trying to understand the care needs of their loved ones. 

For a stressed family caregiver, just knowing the universe of what ‘could be’ important can be reassuring. Even more helpful: identifying the Micro SDOH that are most relevant to their loved one’s quality of life and applying care that can measurably improve it.

Most importantly, LIFE Profile facilitates a model of care that is truly client/patient centered, one that recognizes the need for autonomy. We want to know a client’s motivations for accepting care; we want to understand who they are in terms of their beliefs, their interests, and their relationships. It formalizes the ‘soft skills’ that allows any home care provider of quality to be in it for the long haul. 

For more information about LIFE Profile and Senior Helpers’ model of care, download our white paper “Decoding the Impact of Micro Social Determinants of Health” here.