7ab39fadaa11453abca45af0e7138c43

Special Delivery

Sun, 07 Dec 2025 19:13:19 GMT

Special Delivery

A letter from WWII is finally delivered

Blaine Briggs was raised in a preacher’s family. It was his father’s work that brought him to Columbus, Ohio, in the late 1930’s, where he attended North High School and met Gwen Campbell, a year his senior. They were debate partners and won the State championship. Gwen was his campaign manager when he ran for and won the election for senior class president. He viewed her as a mentor.

Following high school graduation in 1941, Blaine like so many young men of the time, joined the Army Air Corps and became a Lieutenant. Gwen attended college. He was stationed in Italy, she stayed in Columbus, as a biology major at the Ohio State University.

Sometime around July, 1944, Blaine sent Gwen a letter to let her know of his where abouts. Gwen, happy to hear from him, responded with a lengthy letter of the happenings in Columbus, in particular, updates on their mutual friends and the sports events at North High.

Her letter made its way to Italy. Unfortunately, Blaine was shot down and became a POW before he could receive it. It seemed the letter with a 3 cent stamp, postmarked September 26, 1944, would never make it to its recipient.

Blaine spent the duration of the war in the POW camp, Sagan, while Gwen attended college. After the war he married his lovely wife LaVerne, had two sons, and became a highly successful businessman. Gwen completed medical school, married Andre’ Trudeau and gave birth to nine children as she maintained her medical career. Blaine and Gwen went on with their personal and professional lives, seeing each other on rare occasions at class reunions. Gwen’s letter was long forgotten.

In April, 2009, Blaine, then 84 years old, received an e-mail from a librarian in Ohio, asking if he was Lt. Blaine Briggs, previously stationed in Italy. Perplexed, he responded that indeed he was, or at least had been years ago and queried why she was asking. She responded that she had come into possession of an unopened letter for him and asked if she might send it. Still puzzled yet also intrigued he agreed to receive it.

Within a couple days the letter arrived. It was the correspondence that Gwen Campbell had sent him with the latest news from Columbus, Ohio. Well, that which was the latest news in September, 1944. It produced a flood of memories and emotions.

Blaine contacted the librarian to thank her, and she told him that she had received the letter anonymously from a person who said he had purchased a stack of WWII letters at a flea market. He gave them to the librarian, having heard she was interested in WWII memorabilia. Due to Blaine’s distinct name, she was able to find him on the internet.

Blaine and Gwen had last seen each other over 35 years earlier at a class reunion. He didn’t know where she lived so he contacted her through a mutual friend. Gwen, at 86 years old, was a long retired anesthesiologist living contentedly at a retirement community. Because she was more than a bit confused by Blaine’s phone call, her daughter, Marie, also in Ohio, took over the correspondence with Blaine.

Marie’s enthusiasm over the long lost letter spread to the rest of the family. In Ohio and from Washington to New Jersey, Oregon to Pennsylvania news of the letter spread. The fact that the letter found its recipient 65 years after it was sent seemed incredible. Through a few degrees of separation, the story was picked up by the San Diego news and once on the news wire, it was picked up on the national news by Brian Williams.

Showing the letter to the news reporter and sharing the story was fun and heartwarming for Blaine. Gwen, her family, and everyone in the retirement community laughed when they saw Gwen’s high school picture shown on national news. All who hear the story find it to be warm and wonderful.

In September, 2009, Blaine and LaVerne were traveling near Ohio and decided to make a detour to Columbus to see Gwen and her family members, some of whom he had come to know over e-mail. Marie helped him plan a dinner for everyone and great excitement surrounded the day of the event. The dinner with Blaine and LaVerne included Gwen and some of her children and grandchildren, as well as some mutual friends from North High School. When the group came together, some meeting for the first time, it was as if it was a reunion of a group of old friends. All felt a deep connection even though most of the attendees were not even born at the time the letter was written.

Many questions were asked that evening, yet never answered: Who found the letter? Why did he want to remain anonymous? Where had the letter been for 65 years? Why did it surface at this time? All remain mysteries, making the story even more captivating.

Blaine fondly made a toast to Gwen, who enjoyed the attention. The conversation flowed easily, again, as if everyone had known each other for years. As the evening wore on and the revelers fatigued there was a sense of just how special this gathering was. It was 65 years in the making and nobody wanted it to end. Given the age of the honorees, it was clear that they may not see one another again and they wanted to make the most of it. For the younger participants it was a step into the past and at the same time it was the creation of a special memory with their aging mother or grandmother who within a few short years would be gone.

The real guest of honor was the letter that had brought them all together. The letter had bridged the generations. It reminded all, that they do make ripples as they cast themselves into the ocean of life. It made everybody feel important and that they had experienced something very special. There was also a certain sense of relief that both the writer and the recipient lived long enough to see the letter delivered.

As the letter was pulled out of its protective plastic for a viewing, a surprised gasp went throughout the room as all were reminded of the postmark on the envelope. The date of that magical evening was September 26, 2009. Sixty-five years to the day from when Gwen dropped the letter in the mailbox.

Deciphering Lyme Disease

Mon, 19 Feb 2024 20:20:51 GMT

This is a Synopsis of: Shaw, J. (2024, Jan-Feb). Deciphering Lyme Disease. Harvard Magazine, pp. 12-13.

This is an article about the reasons for the varied symptomatology found with Lyme Disease, and interestingly, COVID. Lyme disease is the most prevalent vector-borne disease in North America and Europe and one of the fastest growing infectious diseases in the US.

Vector-borne means there is a living organism that can transmit infections between humans or from animals to humans. For example the mosquito is the vector that transmits malaria or the tick is the vector that transmits Lyme disease. Vectors can transmit parasites, viruses, or bacteria. (WHO/home/newsroom/fact sheets/detail/vector-born diseases, accessed 19 Feb 2024.)

This synopsis is based on the research of Jacob Lemieux who, in 2017 with colleague Pardis Sadbeti, spearheaded the DNA sequencing of Lyme Disease. Because of the genetic diversity of Lyme disease, the sequencing which they thought would take 6 months took 6 years. This complexity is associated with the diverse symptoms seen in people with Lyme disease. The array of symptoms may include arthritis, fatigue, neurological and cardiovascular problems, that may continue for years.

The genome of the Lyme disease causing Borrelia spirochete has the double stranded DNA found in most living things. Additionally, there are around 20 plasmids which are small, circular strands of DNA attached to the double strands that can replicate independently of the main DNA strands. These hard-to-sequence plasmids, were found to be critical in understanding the variations in disease severity and symptoms among different people. The plasmids occur only in certain strains.

The researchers noted that because of the similarities between Lyme disease and COVID, the wide-ranging and lasting symptoms of Lyme disease have become more familiar to the public in the aftermath of COVID.

Different plasmids are associated with different rates of dissemination in the body – rapid dissemination equals more severe symptoms. With this knowledge, it is hoped that new treatments and dissemination suppression may be developed to help mitigate symptoms. This may also involve improved understanding of how diseases, more generally, develop, spread, evolve, and develop drug resistance. Lemieux expressed his understanding that his work is an incremental step that hopefully lays the groundwork for future understanding of complex diseases.

As a person experiencing Long COVID (personally, I call it chronic COVID at this point), articles like this are a form of bibliotherapy, as they provide reasons for the unremitting symptoms I have experienced since 2020. I will not begin to describe my symptoms because, as the article notes, they are many and varied. I know I am far from the only person in this situation (there are long covid clinics in some medical centers) and I hope this description provides some form of comfort to others and promotes understanding to those interacting with people experiencing long-term symptoms.

For additional reading:

www.lemieuxlab.org/jacob-e-lemieux.html

www.sabetilab.org

www.massgeneral.org/medicine/ciid/research-labs/allen-steere

Hospitals are Not a Primary Source of Health

Thu, 14 Dec 2023 18:01:25 GMT

Nor of Social Determinant of Health Information

It is estimated that only 20% of health outcomes are related to clinical care impacts whereas from 50 – 80% of health is related to social determinants. Additionally, steadily increasing health care expenditures are not yielding positive results as outcomes continue to worsen. This trend will continue if unmet health related social needs (UHRSN) are not addressed. Hospitals may try to uncover these needs through manual medical record data abstraction but Navathe, et al. found natural language processing (NLP) to be a more efficient way to identify information in physician notes. It improved the recognition of fall risk, poor social support, and tobacco use. Further, risk factors associated with increased rates of hospital readmission were identified and included housing instability, depression, drug use, and poor social support. This information indicates that without expensive record review there are negative factors generally missed by hospital staff. Even if all UHRSN are identified, are hospitals in the position to successfully confirm and address those issues in a timely manner?

Navathe et al. further note that medical records were used to gather data because point-of-care surveys were not automated, nor scalable. This suggests that if such surveys are automated and scalable, they would be a better way to obtain relevant information. This would be particularly true if the point-of-care is the client’s home and electronic information transfer is available as it is through Medicaid mandated Electronic Visit Verification technology. Of importance, in home actions to resolve negative factors may be initiated promptly with information forwarded to supervisors for further follow-up, and for developing policies and procedures.

An additional disadvantage of hospitals managing UHRSN to avoid (re)admissions is that even hospitals supporting home care agencies experience an unavoidable conflict of interest because their business models include hospital services. Home care represents health systems existing in parallel with hospital health systems. It is appropriate to task the home care providers with keeping people at home. That is their business model.

Where you hang out counts.

183:770100068 (Martha Trudeau) — Wed, 06 Dec 2023 21:06:30 GMT

Health is not a healthcare issue.

Social determinants of health (SDH) are described by the World Health Organization as the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These elements represent from 50% to 80% of health yet funders and providers of healthcare often lack information about the burden of adverse SDH, also known as unmet health-related social needs (UHRSN). This void promotes consequential inaction. Without assurances that these needs are managed, funders and providers are failing to rescue people in vulnerable situations. Just as hospitals use Failure to Rescue as an indicator of quality, such an indicator should be in place in the community as well. In-home observation is an efficient and reliable way to fulfil the Community Failure to Rescue indicator which will either assure that needs are met or measure the burden of unmet needs which can inform immediate corrections &/or policies, procedures, and programs aimed at long- and short-term remediation activities. These actions may decrease health care utilization, but even if they do not, they will help close the health gap.

Home Care provides an option for identifying and remediating UHRSN. Services include routine visits from Direct Care Workers (DCWs, home health/personal care aides) who are predominantly women, and in many locations over-represented by women of color &/or Medicaid recipients as working poor parents. DCWs assist with activities of daily living and are currently not prepared to address HRSN. Community Health Workers (CHWs), on the other hand, can address HRSN but do not provide personal care and lack numbers to see all home care clients. The goal of this program is to provide training that adds CHW skills to the DCW skill set, creating a hybrid health services position, the Direct Care Community Worker (DCCW). These caregivers will provide personal care and address HRSN by routinely completing needs observations and initiating remediation activities or referrals as indicated. for non-medical needs Such an approach could help clients be healthier while reducing health resource utilization and cost. Additionally, the position provides potential career advancement for DCWs which could increase their current low-wage salaries to lift them out of poverty, decrease staff turnover, and bring other caregivers into this chronically understaffed yet essential field. Over time, data will inform the new quality indicator of Community Failure to Rescue. This program is motivated by the blended values of compassion, empowerment, and fiscal intelligence.

Information on this topic will be added weekly.

Community Failure to Rescue to Inform a Standard of Care

Sun, 09 Feb 2020 18:09:58 GMT

Are vulnerable people being left to fend for themselves?

Community Failure to Rescue as a Standard of Care

The Direct Care Community Worker Observation Tool developed for this training program provides a focused look at key screening elements identified by Alley et al. (2016), including housing needs, food insecurity, utility needs, safety, and transportation difficulties. The immediate purpose is to identify elements that negatively impact health in order to inform remediation activities. It will subsequently gauge Community Failure to Rescue (CFTR). Failure to Rescue (FTR) was developed for use in hospitals and is being modified for home care. A premise of FTR as it was originally framed is that Medicare-aged people come into hospitals ready to have complications, so the measure of hospital quality is not an inevitable patient complication, but whether staff members are prepared and handle it (Silber et al., 2007). If someone has a complication and dies, then Failure to Rescue has occurred. FTR events are predicted and preparations are based on statistics about the frequency of complications (Silber et al., 2007). In the home care setting, older Medicaid consumers may be equally complicated, fragile, and vulnerable, and additionally, their lives may be riddled with basic needs insecurities which make them prone to adverse events.

CFTR represents people at home, an environment that lacks regulations and supports found in hospitals. Knowing up-front that these clients receive Medicaid services because of long term conditions and lack of financial resources should be sufficient data to prompt observation and remediation efforts. Care providers should observe for and be ready to handle the same inevitable complications found in hospitals, in addition to the unpredictable and possibly profound complications of life that consumers experience and that impact health care utilization, morbidity, and mortality. DCWs will continue to report clinical problems and will additionally be prepared to observe, report and resolve social issues.

Without assurances that social determinants of health are being addressed, then we must assume we are failing to rescue people in vulnerable home care situations. Individualized, on-site data collection for home care clients is the most efficient way to either confirm that needs are met or identify unmet needs. Uncovering the status of SDH in home care does not require high-tech methods if there is a trained caregiver in the home. For most health determinants, the observation tool will be self-validating; if one sees the air conditioner does not work, then it does not work. Similar observations will be completed for food availability, heat, running water and other SDH. A person with limited training can observe and help to resolve many social issues which fulfills the program values of compassion and fiscal intelligence.

References

Alley, D.E., Asomugha, C.N., Conway, P.H., & Sanghavi, D.M. (2016). Accountable health communities – Addressing social needs through Medicare and Medicaid. New England Journal of Medicine, 374(1), 9-11. DOI: 10.1056/NEJMp1512532.

Silber, J.H., Romano, P.S., Rosen, A.K. (2007). Failure-to-Rescue: Comparing Definitions to Measure Quality of Care, Medical Care, 45(10), 918-925.

A new canvas

Sat, 08 Feb 2020 16:27:45 GMT

MET-Healthcare-Innovations.com

MET Healthcare Innovations is a start-up company with the goal of enhancing home care services to address Social Determinants of Health (SDH) which are factors of normal life that can impact health. Those who fund and provide home care services often lack information about the burden of these factors in the homes of people receiving personal care services. The Direct Care Community Worker (DCCW) program adds skills of a community health worker to those of a direct care worker (home health aide) so social problems and personal care will be addressed. The funding and implementation of this program will have a significant impact on client morbidity and quality of life resulting in cost savings from more appropriate healthcare utilization. The initial focus of the DCCW program is on Philadelphia's older Medicaid consumers who are receiving home care services due to long term disabling conditions. As the poorest large city in the U.S., Philadelphia has well documented social problems. This is seen in clear indicators of poverty. Food insecurity effects more than 20% of the population. The average life span for those living in the highest poverty areas is 20 years less than those in wealthier areas. The Medicaid population is more than twice the size of the entire population of Pittsburgh. Addressing these inequalities will take a multi-prong approach and the DCCW program is one prong. Although an up-front investment in this solution will be necessary, projects throughout the U.S. have shown significant returns on investment from resolving negative social determinants of health. Please return to this site to find out more about how this program evolves.

The Basis for the Direct Care Community Worker Training Program

Thu, 26 Dec 2019 18:09:55 GMT

Program Motto, Mission, Vision, Values

Motto: Think straight, plan carefully, act boldly. – Clara Barton

Mission To provide Medicaid consumers who are >60 and receiving home care services, with the opportunity to live healthier lives by relieving them of at least some of the burden of negative social elements in their environment.

To develop training, tools, and a career trajectory for Direct Care Workers which will enable them to take on the new hybrid role of Direct Care Community Worker.

To provide financially engaged stakeholders with the opportunity to act compassionately and with fiscal intelligence.

Vision

Medicaid consumers will have fewer illnesses, appropriate use of healthcare resources, and will be highly satisfied with their in-home care providers, health plans, and other service providers.

Funders will have a 100% return on Negative Social Determinants of Health remediation investment because of decreased resource use.

The new Direct Care Community Workers will receive a living wage. This position will serve as a step on a career trajectory.

Values

This program maintains the blended values of Compassion and Fiscal Intelligence, with Compassion focusing on Medicaid consumers and caregivers, and Fiscal Intelligence focusing on service providing agencies and Medicaid health plans.

Home Care is the most basic form of health care delivery, presents the most reliable information about the presence or absence of negative social determinants of health, and allows immediate remediation opportunities.

Empowerment is a key aspect of this program. Direct Care Workers will be empowered with enhanced knowledge and the redefined role of Direct Care Community Worker. They will, in turn, empower their clients to live healthier lives.

Thinking like a Community Health Worker to help resolve Negative Social Determinants of Health.

Fri, 13 Dec 2019 16:15:11 GMT

Developing a hybrid caregiver position: Direct Care Community Worker

A training manual has been developed for experienced Direct Care Workers (DCWs, aka Home Health Aides) which will be used to instruct them on the duties generally identified with Community Health Workers (CHWs). Upon successful completion of this program, participants will be prepared to serve in the hybrid position of Direct Care Community Worker (DCCW). In addition to providing personal care to older clients, the DCCW will be equipped to recognize and address negative social determinants of health (NSDH), while enhancing their clients’ abilities to resolve such issues and to self-advocate. The aim is to improve clients’ quality of life and decrease preventable health care utilization and cost. This training provides the knowledge, skills, and tools to observe, resolve, and report negative social elements found in clients’ homes and to identify when additional help is needed for complex or clinical issues. This new position will provide a career trajectory for DCWs that could provide a living wage and may also draw people into the field of direct caregiving. Funders will realize cost savings from decreased health care utilization which will offset a higher reimbursement rate for these specialized caregivers.

Because they know their clients and are with them regularly, DCWs are in a trusted position to help resolve NSDH. This type of assistance is within their abilities and standards of practice which include observing, reporting and documenting; and maintaining a clean, safe, and healthy environment (Legal Information Institute, 2019; Pennsylvania Department of Health, 2019). This training will provide resources to immediately address many social problems. Given the importance of resolving NSDH, it is sensible to utilize the potential of this workforce which until now has been an untapped resource.

In Pennsylvania, the Department of Health identifies core competencies for CHWs as communication skills, interpersonal skills, knowledge of the community/specific health issues/health and social service systems; service coordination skills, capacity building skills, advocacy skills; teaching skills and organizational skills (National Academy for State Health Policy (NASHP), 2015 ). The PA DoH further defines in-home services provided by CHWs to include nutrition education, home health and safety assessments, and prevention education (NASHP, 2015). Combining these skills with those of DCWs will most efficiently provide a well-rounded care experience for in-home clients.

This project is driven by the values and key strategies of Compassion, Fiscal Intelligence, and Empowerment. Compassion focuses on Medicaid consumers and DCWs while Fiscal Intelligence focuses on service providers and funders. All stakeholders may be empowered by the activities, outcomes, and impacts. This blended strategy leads to remediation efforts that will improve quality of life and reduce costs. Stephen Trzeciak, MD, of Cooper University Health Care in Camden, N.J., uses the term “compassionomics” to depict the economic element of compassion (Trzeciak, 2018). He points out that client-focused, compassionate care is associated with lower resource use and higher quality, fewer errors, and better compliance, as well as positive physiologic changes like stress and pain reduction for patients, and less burn-out for care providers (2018). More recently he found that compassionate care can help prevent post-traumatic stress disorder (Burling, 2019). In brief, compassion promotes fiscal intelligence.

Recent successful efforts to resolve NSDH are found in various locations around the U.S. (Morse, 2018; Sandburg et al., 2014; Shah, Rogers, & Kanter, 2016). Such efforts should be appreciated for what they have accomplished, and a home care focus should be added to the array of options to impact social problems at their core. The CHW role has been identified as an essential element of a broad health promotion campaign and is described as, “…community members who are trained to bridge the gap between healthcare providers and patients.” (Kangovi, Grande &Trinh-Shevrin, 2015, p. 2277). With this training, DCWs, who are trained to provide personal care, will add CHW duties to become DCCWs with the skills to bridge the gaps between consumers and health systems, society, and better health. DCCWs will be trained as observers who strive to understand consumers and their environments in order to appreciate how to help them be happy and healthy. This information will help pinpoint problems, identify them as relevant to the consumer, and develop remediation actions.

Check back for periodic updates.

References

Burling, S. (2019, March 19). Pa.’s new rules for low-income seniors: For those on Medicare and Medicaid, it’s complicated. The Philadelphia Inquirer, A9 & A11.

Kangovi, S., Grande, D., & Trinh-Shevrin, C. (2015, June 11). From rhetoric to reality – Community health workers in post-reform U.S. health care. The New England Journal of Medicine Perspective. DOI: 10.1056/NEJMp1502569

Legal Information Institute. (2019). 42 CFR 484.36 – Condition of participation: Direct Care Worker services. Retrieved from https://www.law.cornell.edu/cfr/text/42/484.36

Morse, S. (2018, July 5). What Montefiore's 300% ROI from social determinants investments means for the future of other hospitals. Healthcare Finance. Retrieved from https://www.healthcarefinancenews.com/news/what-montefiores-300-roi-social- determinants-investments-means-future-other-hospitals#

National Academy for State Health Policy. (2015). State community health worker models: Pennsylvania. Retrieved from https://nashp.org/state-community-health-worker-models/

Pennsylvania Department of Health. (2019). Home care agencies regulations. Retrieved from https://www.health.pa.gov/topics/facilities/home-care/Pages/Home-Care-Regulations.aspx

Sandberg, S. F., Erikson, C., Owen, R., Vickery, K. D., Shimotsu, S.T., Linzer, M., … DeCubellis, J. (2014). Hennepin health: A safety-net accountable care organization for the expanded Medicaid population. Health Affairs, https://doi.org/10.1377/hlthaff. 2014.0648

Shah, N. R., Rogers, A. J., & Kanter, M. H. (2016, April 13). Health Care that targets unmet social needs. New England Journal of Medicine Catalyst, Retrieved from https://catalyst.nejm.org/health-care-that-targets-unmet-social-needs/

Trzeciak, S. (2018). Can 40 seconds of compassion make a difference in health care? Knowledge @ Wharton, Aug.6. Retrieved from http://knowledge.wharton.upenn.edu/ article/the-compassion-crisis-one-doctors-crusade-for- caring/?utm_source=kw_ newsletter&utm_medium=email&utm_campaign=2018-08-09

Think like a Community Health Worker

Fri, 29 Nov 2019 16:33:34 GMT

What does a Community Health Worker do?

Community Health Workers (CHWs) have distinct qualifications like communication skills, interpersonal skills, knowledge of community services; advocacy, service coordination, and client empowerment; teaching and organizational skills. They are often connected to hospitals or health systems and are familiar with and part of the community. Their goal is to help their clients live healthy lives.

CHWs help their clients resolve negative social determinants of health; negative aspects of where people live, learn, work, and play that impact their health. Social Determinants of health (SDH) may be positive or negative. Positive determinants are things like food in the kitchen, ability to pay for needed medications, and transportation to the doctor's office. Negative determinants would be the opposite of the positive elements and may also include lacking air conditioning in the summer, living in an unsafe structure, or having utilities turned off.

CHWs provide much needed services, but what if a person in need does not have a CHW? There are many older people receiving Medicaid benefits for long term disabling conditions who have Direct Care Workers (DCWs) with them routinely to help with personal care like bathing, cooking, assistance with moving around, etc. These workers, also known as Home Health Aides, have never been trained to observe for or resolve the negative elements found in the homes of their clients and so are untapped resources for addressing them. Combining CHW skills with those of DCWs will most efficiently provide a well-rounded care experience for in-home clients.

This role is being developed and is called a Direct Care Community Worker (DCCW). Please return to this site to find out more.

For some, everything that could go wrong already did. So now what?

Sun, 20 Jan 2019 18:11:32 GMT

Bringing about change begins with painting the most colorful picture you can to describe why change is needed and why it is a good idea.

12 March 2019 I am working on a project to help close the health gap, which is one of the Social Work Grand Challenges (Fong, Lubben, & Barth, 2018).

By health gap I mean that some people have fewer opportunities to be healthy than other people.

There will always be inequities, but some inequalities involve basic needs. The basic needs I am talking about are called social determinants of health (SDH).

They are elements of where we live, learn, work, play that can positively or negatively impact health (HealthyPeople.gov, 2018). In other words, where you hang out impacts your health. My project focuses on negative social determinants of health and ways to resolve those issues.

"SDH" is a compact term to describe a very complex set of issues. Social determinants include things like air quality, housing, utilities, food, physical and emotional safety and other basic needs.

In the US we spend much more on health care than we do on SDH (Weiner, 2014). I would like to see this reverse because when basic needs are not met, they can lead to illness and expensive health care utilization.

There are pilot projects and research that suggest that spending on SDH will help decrease spending on expensive health care (Center for Health Care Strategies, Inc., 2018a, 2018b; Sandberg, Erikson, Owen, Vickery, Shimotsu, Linzer, M., …& DeCubellis, 2014; Morse, 2018).

The values motivating this project are compassion and fiscal intelligence. Stephen Trzeciak is a physician researcher in NJ who coined the term "compassionomics” (2018). He notes the impact of compassion on patients, cost, and providers and has found that compassion has a positive impact on all three. So you can see how compassion and fiscal intelligence go hand-in-hand.

The population I am working with includes older people living in Philadelphia who are Medicaid recipients. They are receiving home health aide services to help with personal care which is needed because of long term health problems and limited financial resources.

The problem I am trying to solve is that many of the Medicaid recipients are living with negative SDH (NSDH) but there is no formal way to know who is suffering and what the problems are. Inother words, who needs what. This information could help inform solutions. The Home Health Aides (HHAs) who routinely visit are not trained to observe for NSDH or to resolve them.

Connected with some health systems are Community Health Workers (CHWs). These are local residents who are trained to provide support tailored to the needs of individuals at high risk of hospitalization. They meet with the patients regularly to help resolve issues, encourage health-promoting behaviors, and to help set and realize realistic health goals (Kangovi, & Asch, 2018; Kangovi, Grande, & Trinh-Shevrin, 2015). Needs go unmet for those without the assistance of CHWs, even though they have home health aides in their homes on a regular basis.

My plan is to develop a home health aide training program entitled, "Think like a Community Health Worker." The home health aides currently working with these clients are very much like CHWs. They live in and understand the community. Because home health aides are on the bottom rung of the income ladder, they may also be Medicaid recipients as working poor parents. Those who receive training will work in a new hybrid position called the Home Care Community Worker or HCCW. They already possess personal care skills and the added training will provide them with the tools to recognize and resolve negative elements within the environments of their clients. For example, if the aide notices that a client with emphysema goes into the hospital every summer, consideration will be given to why that happens. Realizing that the client has breathing problems because it is hot in the house would prompt the HCCW to go through the process of getting an air conditioner for the client. If a $500 air conditioner prevents one $2,500 emergency room visit, then it is an excellent return on investment.

As noted previously, there are organizations realizing excellent returns on investment and improved patient outcomes from social determinant remediation. This information will be shared with potential collaborators. Developing these collaborative relationships will be part the program implementation and will include the Medicaid health plans and other community agencies who will provide up front services and funds to pay for resolution pathways.

At this time, CHWs make significantly more money than home health aides (Glassdoor 2018a, 2018b). When the health plans begin seeing a cost savings through decreased resource utilization, they will be asked for a higher reimbursement rate for the HCCWs. This will help improve the income of these low wage yet essential workers.

Philadelphia Salaries

CHW $38,000-$65,000 (Glassdoor, 2018a)

HHA $23,000-$34,000 (Glassdoor, 2018b)

The first step in all of this is identifying the burden of the problem and this will be accomplished by the HCCWs, newly trained to "Think like CHW." They will observe and report what they see. Resolution pathways will be developed based on their findings. This projects helps the clients by resolving negative social issues and the caregivers by increasing their responsibilities and their salaries.

References

Center for Health Care Strategies, Inc. (2018a). Transforming complex care profile: Redwood

Community Health Coalition. Retrieved from http://www.chcs.org/media/TCC- Profile-RCHC_022217.pdf

Center for Health Care Strategies, Inc. (2018b). Transforming complex care profile:

AccessHealth Spartanburg. Retrieved from http://www.chcs.org/media/TCC-Profile- AccessHealth_022217.pdf

Fong, R., Lubben, J.E., & Barth, R.P. (2018). Grand challenges for social work and society. New York, NY: Oxford University Press.

Glassdoor. (2018a). Retrieved from https://www.glassdoor.com/Salaries/community-health-worker-salary-SRCH_KO0,23.htm

Glassdoor. (2018b). Retrieved from https://www.glassdoor.com/Salaries/philadelphia-home-health-aide-salary-CH_IL.0,12_IM676_KO13,29.htm

HealthyPeople.gov. (2018). 2020 Topics & objectives, social determinants of health. HealthyPeople.gov, Retrieved from

https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

Kangovi, S., & Asch, D.A. (2018, Aug. 29). The Community health worker boom. New England Journal of Medicine Catalyst. Retrieved from

https://catalyst.nejm.org/community-health-workers-boom/

Kangovi, S., Grande, D., & Trinh-Shevrin, C. (2015, June 11). From rhetoric to reality –Communty health workers in post-reform U.S. health care.

The New England Journal of Medicine Perspective. DOI: 10.1056/NEJMp1502569

Morse, S. (2018, July 5). What Montefiore's 300% ROI from social determinants investments means for the future of other hospitals. Healthcare

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Many people are experiencing poor outcomes because of negative social determinants of health [SDH]. These SDH are a heavy burden for those experiencing them and a heavy financial burden for those paying for the poor outcomes. The values of Compassion and Fiscal Intelligence when blended can ease the effort of resolving negative SD. Many people think they are too expensive to fix and they must be convinced otherwise. I aim to do that.

There are many ways to influence what people are talking about which in turn may impact what people do. There are technology platforms like TV, radio, Facebook, blogs, email, and YouTube, yet nothing beats a face-to-face sit down talk as a platform for telling a story. This situation allows you to express your passion and to confirm understanding as you sit eye-to-eye even though all participants’ thoughts may not be eye-to-eye. Technology is great when there is no other option although it should never replace in-person contact when it is possible. I plan to sit down with change agents like government officials and corporate heads to use my influence to direct theirs.

A blog like this might be a helpful way to formulate my thoughts as I prepare. I might get ideas from others to strengthen my presentation so I can create a colorful and descriptive picture. SD are like colors of paint; some are wonderful, some not so good. It is most important to remember, though, that colors can always be changed.

My First Blog Post

Sun, 20 Jan 2019 17:34:00 GMT

It's official, I have a blog and I'm not afraid to use it.

I have finally decided to take the plunge and add a blog to my site. I always wanted an easy way to share information with visitors and super excited to start this journey. Keep coming back to check for updates.