Here's how a collaboration in Southwest Michigan helped older adults avoid hospitalization for COVID

Health care providers repackaged existing community services that enabled older adults to stay in their homes if they came down with COVID, or return home more quickly if they were hospitalized.
This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

As primary caregiver for her husband, Alan*, Arlene* has her hands full. When the COVID-19 pandemic began, one of her greatest fears was what would she do if she or Alan came down with COVID. Fortunately, this older couple lives in the Region IV Area Agency on Aging (AAA) service area, encompassing Berrien, Cass, and Van Buren counties in Southwest Michigan. When Arlene tested positive for COVID, she discovered she could access in-home help to get herself and her husband through the ordeal. 
Guy Miller.
“I was the [Berrien County Health Department] epidemiologist at the time. I let her know that she was positive for COVID-19,” says Guy Miller, Berrien County health officer. “They were living together independently at home, which is great. I think that everybody should strive for that. She was really concerned about how she was going to take care of her husband if she's got COVID. So, I asked her if we could refer her over to the Area Agency on Aging.”

Early in the pandemic, Region IV AAA pulled together a collaborative initiative, the Rapid COVID-19 Home-Based Community Service Response. Through partnerships with health departments, medical systems, and other agencies throughout the AAA's service area, the AAA put together a package of existing community services that enabled older adults to stay in their homes and avoid hospitalization if they came down with COVID, or return home more quickly if they were hospitalized. The initiative provided Alan with a home care assistant who helped him with getting out of bed, bathing, dressing, and feeding — and allowed Arlene to rest and recover from the virus at home.

“When you get COVID-19, you get really, really tired and exhausted,” Miller says. “[Arlene] just couldn’t do what she used to do. It was just phenomenal to have this help because the default would have been she goes into the hospital and he's got to go, too, because he can't stay at home anymore.”

Helping hospitals by helping patients

In addition to creating the best possible quality-of-life scenario for this couple and other older adults like them, the initiative also addressed the hospital bed shortages that occurred during the first year of the pandemic.

“We know the burden COVID had on the hospitals during this time,” Miller says. “We were really trying to make sure that we had enough beds for those people who were critically ill. If somebody could be taken care of at home, that was the ideal solution. Region IV AAA was able to alleviate the burdens on hospitals by providing care at home.”

Since its inception, the initiative has served 241 older adults. The first service offered to older adults who are referred to the program is care management and care coordination. A nurse or a social worker meets with the older adult and chats with them to determine their unique barriers, specific goals, and challenges to either staying home or returning home after hospitalization.
Christine Vanlandingham.
“Beyond that, we tap into services to meet those specific needs and goals,” says Christine Vanlandingham, CEO of Region IV AAA. “We provide whatever personal care might be needed, medication management, and make sure that nutrition is available — home-delivered meals or liquid supplements. It’s meals for the caregiver, too, so they can keep caregiving. Caregiver supportive services are a really important component.”

Other services include help with cooking, household chores, and grocery shopping. Durable medical equipment, such as grab bars, walkers, and hospital beds, make staying at home or coming home sooner after a hospitalization safer and more manageable. Vanlandingham recalls a patient who could not make it upstairs to their bedroom. By providing them a hospital bed on the main floor of the house, the patient was able to come home and the loved one caring for them was better able to provide care. 

In addition, Region IV AAA offers a personal emergency response system that summons emergency services with the push of a button.

“Folks know if they need help, someone will be there right away,” Vanlandingham says. “It's very much a more robust package of services. Each is as unique as all of those 241 individuals. We still get referrals on a routine basis. Certainly, they're not anywhere near what it was a year ago. But again, COVID is still in our community.”

Of the patients diagnosed with COVID, 35% received support at home and avoided hospitalization. The 65% of patients who were hospitalized were able to be discharged and go home sooner.

“We were able to do that assessment while they were at the hospital, get that support package arranged, and have it in place so that they could get home quicker with all those supportive services,” Vanlandingham says. “Making sure that package of services that met their individualized needs just as importantly reduced their risk of hospital readmission.”

Building a more collaborative future

Melinda Gruber.Also serving Berrien, Cass, and Van Buren counties, Corewell Health South collaborated on and helped fund the initiative. For Dr. Melinda Gruber, vice president of Corewell Health South Medical Group and Continued Care, the initiative is personal. COVID took Gruber’s mother’s life while she was hospitalized in another area of Michigan, isolated from family. Gruber's mother caught COVID at the hospital and never came home.

“Her husband of 67 years dropped her off at the emergency room and that was the last time he ever saw her,” Gruber says. “I would say the benefit of the initiative is really to avoid hospitalization and to have a successful recovery at home. Or, with additional support services in the home, potentially they can be discharged from a hospital sooner.”

Gruber believes the best lesson learned from the initiative’s success is that health systems can quickly partner with community-based organizations to better support older adults and patients of all ages.

“I have to give so much credit to the leadership of the Area Agency on Aging,” Gruber says. “I mean, like for all of us, the world turned upside down. They quickly assessed what the new needs were and pivoted their services to meet those needs.”

While the initiative's future post-COVID remains unknown, its success will certainly be a benchmark for future services that seek to help older adults remain in their homes, where they want to live out their years.
Guy Miller, Melinda Gruber, and Christine Vanlandingham.
“A huge benefit of this program is —and will continue to be — the collaboration and streamlined referral process for clinicians to get older adults and caregivers connected to home and community-based services,” Vanlandingham says. “That is a huge win for our community going forward.”

*Alan and Arlene's names changed for privacy.

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Photos by Taylor Scamehorn.