Roberta B. Merkle is the executive vice president of strategic initiatives at St. Elizabeth Community, a nonprofit, nonsectarian charity providing care to older adults and people with disabilities.
Before her current job, Merkle served as president and CEO of Cornerstone Adult Services Inc., guiding the organization’s growth for 25 years. In that time, she took Cornerstone from a one-room adult day services facility to a multi-centered organization with five locations in Rhode Island. Merkle is co-founder of a women’s shelter in Massachusetts and a co-founder of the Rhode Island chapter of the national Alzheimer’s Association.
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The St. Elizabeth Community was the recent recipient of a $49,500 grant from the Tufts Health Plan Foundation, supporting its expansion of Support and Services at Home, or SASH, a service aiding older people in affordable housing coordinating their health and social service needs.
PBN: How did St. Elizabeth Community learn about the SASH model?
MERKLE: Seniors age 65-plus living in [U.S. Department of Housing and Urban Development-subsidized] housing are more likely to have multiple chronic conditions and higher health care utilization and payments than unassisted Medicare and Medicaid beneficiaries in the community.
Rhode Island’s population of elderly residents in public housing is more than twice the national average [35 percent in Rhode Island versus 16 percent nationally]. Therefore, a collaborative effort among health care providers, HUD-assisted senior housing, and community-based agencies and residents themselves serves as an ideal platform for efficiently managing the health of a large population of low-income older adults with significant levels of physical and mental health risk.
PBN: How will the $49,500 be used to launch the program specifically?
MERKLE: Tufts Health Plan Foundation funding will enable Saint Elizabeth Community to carry out the third year of its three-year SASH pilot program at the Saint Elizabeth Place senior community in Providence.
The SASH program leverages existing services to support an elder’s desire to live independently. The SASH model is managed by an interdisciplinary team led by a project director. Key team members include a bilingual SASH coordinator, bilingual SASH wellness nurse and a team of community service providers. The SASH coordinator, which is funded by the Tufts Health Plan Foundation, plays a critical team role in outreach and care planning for participants.
The SASH coordinator is responsible for coordinating a monthly team meeting with existing [local] providers such as a mental health agency and home care.
Under this grant, we will continue to utilize the consulting services of Cathedral Square Corp. and Nancy Rockett Eldridge in the third year of this project. The focus of our work will include the expansion of the pilot to additional sites.
PBN: Please explain how the program helps keep people healthy and independent
MERKLE: SASH staff creates an organized, person-centered presence in the community. The SASH staff embedded in the housing community includes a SASH coordinator and wellness nurse. Staff utilizes person-centered approaches to build strong and trusting relationships with SASH participants. SASH staff focuses their efforts around three areas of intervention that have proven most effective in reducing unnecessary Medicare expenditures: Transitions support after a hospital or rehab facility stay; self-management education and coaching, particularly relating to chronic health conditions such as diabetes, arthritis, etc.; care coordination.
Regular check-ins and coaching is made available to all participants. There is support in connecting effectively with doctors and health care providers. The SASH team is available to help in case of crisis and to provide support with transitions back home from a hospital or rehabilitation stay, significantly reducing miscommunications.
PBN: Where do you hope to focus your recruiting efforts among other communities?
MERKLE: It is our intention to extend the pilot to include two or three additional housing communities located in Rhode Island. Initially, we will identify potential sites based on specific criteria, including geographic location, readiness to adopt a new model of care and the number of seniors living in the housing facility. Once we have identified the two or three entities for the initial expansion of the pilot, we will begin the training program.
Rhode Island has a large and growing aging population. Seniors 65-plus comprise 16.5 percent of the population versus 15.2 percent for the nation, and Rhode Island ranks fourth in the nation for the largest percentage of people age 75-plus. The percentage of seniors in the state is projected to increase to nearly 25 percent by 2030.
The average 75-year-old has three chronic conditions and uses more than four prescription medications, and older women have greater overall health expenses than men. In Rhode Island, older women comprise 80 percent of Rhode Island Medicaid-funded nursing home days. HUD-assisted residents have a greater number of chronic diseases and use more health care services than other residents.
The 2013 America’s Health Rankings Senior Report gave Rhode Island low scores compared to other states in several key areas: hospital readmissions [No. 49], preventable hospitalizations [No. 36] and physical inactivity [No. 33]. The SASH program addresses many of the income-related health care disparities facing seniors in Rhode Island.
It is our desire to expand the SASH program statewide and Saint Elizabeth Community continues to work on long-term sustainability for the program. We will continue to work on the sustainability of the SASH program, so that it becomes a reality for 15,000 residents living in elderly housing in Rhode Island.
PBN: Can you share an anecdote or example of how this new program can aid Saint Elizabeth Community’s residents?
MERKLE: In the few short months since we launched the program, we have seen several real success stories of how the SASH program has had a positive impact on the participants who live at Saint Elizabeth Place in Providence.
A participant in their 60s had multiple health conditions, including hypertension, history of a stroke as well as pulmonary issues. The participant’s blood-pressure readings were spiking and through SASH’s communication with the primary care physician and various specialists, the medication was adjusted. This resulted in the participant’s blood pressure leveling off at a safer level.
We also worked with the participant to prepare for his next visit with a specialist and as a result, the participant understood for the first time the impact his disease has on his health. The participant has worked with a nutritionist and is exercising with a goal to lose weight. The participant is determined to make the necessary changes and the specialist is “shocked” to see such a marked improvement in the patient’s overall health and disease. The participant now understands how to manage their disease with the support of the SASH program.
And finally, at a recent event, SASH participants began to share stories of how SASH has helped them and impacted their lives. One woman raised her hand and asked to share her story. She stated that she was here in this country alone without any family. She said that she had been lonely until she enrolled in the SASH program. She stated that now she feels like she has a family again!
Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.
