Clinicians are starting to look at the role that poverty, race, and other social determinants play in a person’s health, but what about social connectedness — how do friendship, family, and loneliness play into a person’s medical needs?
Large health care systems have yet to take up the fight in a meaningful way, but that could be changing. On Monday, CareMore, a unit of Anthem Insurance that offers coverage and health care to more than 100,000 members across seven states, is introducing a campaign to help some of the US population’s most socially isolated people: seniors.
CareMore’s “Be in the Circle: Be Connected” program is the brainchild of Dr. Sachin Jain, the company’s president. As a college junior at Harvard in 2001, Jain studied under Robert Putnam, author of the seminal book “Bowling Alone,” about America’s fraying social fabric, and Dr. Donald Berwick, a health care policy guru who, at the time, was studying the impact of “group visits” for diabetics, among other things.
Jain continued tracking the issue in his career as a physician and researcher, and when he joined CareMore, he saw how seniors, in particular, suffer from loneliness. “A lot of times their major social interaction comes from medical appointments,” he said. “And I thought, is there a way for us to actually serve them better than we have?”
Jain spoke by phone with STAT last week as he readied for the rollout of the new program. This interview has been condensed and edited.
How do loneliness and physical health intersect for seniors?
Getting old in America isn’t easy for many people. Things like the death of one’s spouse, your family getting dispersed across a broad geography, people’s friends passing away — even folks who are very social or connected gradually begin to lose those connections with others in their life. Oftentimes that leads to a decline in people’s self-care, so they’re not taking medicines regularly, not exercising with any regularity, not participating in social activities, and health outcomes suffer. So we see loneliness as both being a result of medical problems, and a cause of medical problems.
We’re trying to reframe loneliness as a treatable medical condition that can be treated. As physicians, we typically only ask patients about things we feel we can help them with. A lot of times, loneliness is staring us in the face, but we don’t ask patients about it because we don’t have anything to offer to solve their problem. So our clinicians are now offering interventions to make patients less lonely.
Such as?
We have about 1,100 members who’ve self-identified as being either lonely or socially isolated. So, we’ve got an initial team of three outreach workers led by a social worker who will connect with folks regularly by phone to offer consistent and positive support. And we’ll soon launch a “friendly visitor” program, where some of our seniors will get home visits.
We’re redesigning our care centers, so the waiting areas will be repositioned as social spaces where seniors can drop in and just be there. We believe this may improve health outcomes. If you’re a patient with chronic disease and you’re going to the care center for social interaction, you’re more likely to ask for your blood sugar or weight to be checked.
And we also have senior-focused gyms called “Nifty After Fifty” at most of our care centers, and a lot of the programs there are focused on creating social connection for seniors, as well as helping them with exercise. At CareMore we have a saying: “If exercise and social interaction were a drug, we think it’d be a blockbuster.” I met a couple yesterday who are CareMore members — both were widowed and they met at a “Nifty After Fifty” and got married there.
What’s the business case for this?
We’re a pre-paid health care system — a Medicare Advantage plan and delivery system, like the VA or any system that both insures and delivers care. So if our patients are healthier and less socially isolated, they’ll get admitted to the hospital less, take better care of themselves, and their overall costs will be lower.
In a fee-for-service world, you wouldn’t necessarily see the savings because your revenue comes from delivering more services. But we have to manage all our expenditures within a fixed budget. And we expect significant savings as a result of this model.
How do you get your physicians into this mix?
We appointed the health care industry’s first Chief Togetherness Officer, Robin Caruso, to oversee all aspects of this initiative. It’s about supporting every one of our 700 clinical staff in taking this on as an issue, and making it something they assess, and look for, and treat. We just had our all-team meeting, and there wasn’t a moment of greater applause than when we announced this. Everyone intuitively recognizes this as an issue for the seniors we care for. It’s about as real as it gets.
How replicable is this for other systems that are set up like yours?
It’s very replicable. And from my perspective, the goal isn’t just to do it at CareMore — it’s frankly to create a social movement around loneliness as a medical problem that can be treated. We’re trying to create national momentum around the issue, where more health care providers and organizations see addressing senior loneliness as their responsibility. Lots of people have tried to solve this problem by writing about it, and calling attention to it. We need to demonstrate that we can build and scale interventions that work to solve it. So we’ll be tracking outcomes very closely for these first 1,100 members, and the proof will be in the data and the results.
I view this akin to smoking. One of the things that Robin says is that loneliness is the new smoking. That’s how we have to think about senior loneliness in 2017.
About the Author Reprints
This is a fabulous idea and I want to be part of your dream team to make it happen! My mother fits your model; she’s healthy and lonely. She needs more mental stimulation and friends who can and will participate in activities.
Where are your models to intervene located? I want to be part of the solution. I am not in the healthcare business but am a human who enjoys other humans, especially older ones.
Thank you for giving this huge need in our society attention.
Melanie Parmelee
Beginning in facility hallways where there are hanging portraits of treating physicians all with their arms folded across their chest. Not exactly welcoming body language.
Yes, overcome isolation and loneliness, just start by initiating Integrative Medicine.
When your practitioners give the patient a sense of caring, many positives fall into place.
That is not happening for me now at all. Oncology is the last place to present a cold clinical attitude.
I have worked on changing this unsuccessfully since October 2011!
Now June 2019, traditional uncaring, unfeeling, Oncology is once again holding me hostage. Line dancing, card games, concerts will not erase the callous treatment I know all too well.
Thanks
Terrie
How are the waiting rooms designed to be more like meeting spaces? I’m brainstorming and thought…round tables instead of rows of chairs?
Lost my husband 5 years ago, no friends no hobbies I am lonely I do need advice and some help. I don’t engoy the things I use to. Not much excersize It is the new smoking! I quit 25 years ago. But this being idle is horrible. It feels like I don’t have anything to live for just waiting to die.
I have been divorced over 30 yrs. I lost my job 5 yrs ago a lay off, then developed various medical issues. My kids live far away, grandkids thousands of miles away, no other family. They have no clue how hard it is being a woman alone. I am involved in various groups, but nighttime is the worse. I try to keep busy, but their is an ache, esp. for my family. Linda Duke maybe you could try volunteering, at least you wouldn’t be idle. Anyway, you do have something to live for, you just may still be grieving. I pray a lot, I know it helps, it’s so hard but I know God is there.
Thanks for touching this very real issue that has perhaps got larger with urbanization .
Many community are starting Village to Village movement, senior helping senior, and that help is not limited to some one changing a light bulb or driving one another, but also social connectivity. Locally I am helping one such movement. Another movement is the young generation(high school/ colleges) reaching out to local senior communities . My son is working on one such project of encouraging the middle school kids having senior pen pals, and this weekend the kids are going to visit them in person.
Again, pulling the community to address this very important issue of social isolation in senior will be a wholistic approach, in addition to the Payors encouraging it from cost perspective.
Most medical events traces back to social detriments.
I am very happy to know that Care Mote is addressing this issue holistically.
Thanks.
Bravo! I really hope this initiative goes well for CareMore and others in order to bring more connectivity into seniors’ lives.
At Chapel Hill Community in Canal Fulton, Ohio, connectivity is a huge plus for our independent living residents. They come to our community and discover a whole new chapter of abundant life amongst other seniors.
If their health declines to where they need assisted living or long-term care, they move into the main building, but still have friends nearby with whom they have a camaraderie. Our corporate mission at United Church Homes is to transform aging by building a culture of community, wholeness, and peace. It is refreshing to read about others embracing like-minded initiatives.
Duh….This isn’t news CareMore is another solution for isolated lonely seniors. Virginia Anderson
This is fine, but don’t forget that there are people who like to be by themselves. For example, some Buddhist monks (who spend a great deal of time alone) are some of the happiest in the world (check out Matthieu Ricard: http://www.businessinsider.com/how-to-be-happier-according-to-matthieu-ricard-the-worlds-happiest-man-2016-1 )
Perhaps people need to learn their techniques on ‘how to be happy.’
Yes, there’s a difference between “being alone” and “being lonely.” The U.S. is a nation of extroverts and we often get judgy about what we think the norm should be.
That said, my respiratory problems (late effect of radiation to the mediastinum) might have been noticed and dealt with sooner if someone had seen what a daily struggle it had become for me to just get up and down the stairs. There are benefits to having someone else plugged into what’s going on.
As a member of the “Sandwich Generation,” we are always torn between our own family obligations and meeting the needs of our aging parents and grandparents (74-94) who live alone, quite far from us. I want to share a great communication tool that is now available to seniors and their family members. My wife and I did quite a bit of research and just got her parents a grandPad tablet (www.grandpad.net). The tablet was designed just for seniors, primarily for them to be able to connect with their loved ones safely and it has changed my in-laws lives almost overnight. It is a remarkable service that comes with 24 hour support and is very simple to use. They don’t have to worry about passwords or many different fees from different providers. It’s a one stop package deal. The day their tablet arrived, my father-in-law was able to do a video chat with his son in Europe and it was the 1st time he had seen him “live” in over 4 years! Neither of my in-laws are very tech savvy, so the grandPad is a perfect way for them to email people, listen to music, do memory games, etc. We can all communicate with them frequently and send them real-time photos of what is happening in our lives. When we are traveling or find something we think they would like (old trains, unique fashions, etc.) we snap a picture and send it to them. If we are not available to visit them, we can have a video call and it’s like being right in the same room. We can’t say enough great things about this product!
Where can I get a Gran Pad??
Where can I get a Gran Pad??