Bridging Elder Care Networks
of the Life: Act 2 Partnership

In Northeast Florida, the five county region which includes Baker, Clay, Duval, St. Johns and Nassau counties is expected to experience a 31% growth in the population over 60 years of age in five years time, from 2005 to 2010.  The United Way of Northeast Florida initiated a community planning process in 1999 to identify a major focus to become its Targeted Community Initiative for the next 15 years, and became the first United Way in the country to adopt “Aging” as a major priority; developing a long-term focus on “Senior Independent Living and Quality of Life”.  In April of 2002, United Way launched its senior initiative which became known as Life: Act 2 the following year.  The Bridging Elder Care Networks Life Act 2 Partnership (BECN) emerged directly out of this initiative.   The partnership’s three major goals are to: elicit a culture shift in the way the Northeast Florida community views and values seniors; to integrate medical admission and discharge processes with the community’s social service system; and to strengthen the continuum of services available to the community’s seniors.

Successes:

• Several area hospitals have partnered with the Bridging Elder Care Networks Partnership and have made a commitment to review how “elder friendly” their institution is by taking a self-assessment survey developed by the Partnership. The hospitals have also committed to forming task forces that will improve delivery of health services to older adult patients.
• As a result of the self-assessment, one hospital’s CEO for systems excellence created an internal ElderCare Committee with senior leadership and representation from all levels of staff to improve their practices.
• A recently launched Advocacy & Transitional Care Management program offers care coordination and volunteer support to older adults discharged from the hospital as they transition back to the community; in hopes of reducing unnecessary extensions of hospital stays or re-admissions among older adults.  Carefully trained volunteer Elder Advocates make contact with consenting  “at risk” discharged elders and their families to see if any assistance is needed with referrals to community agencies, to get resource information needed, to make follow up phone calls and to generally try to assure a seamless transition home.

Real Life Impact:

Recently, an older cancer patient who needed chemotherapy – with a very limited income and a big responsibility of parenting a grandchild – needed additional assistance after discharge from the hospital. The Elder Care Advocate visited the patient and offered assistance and referrals with unpaid bills, replacing an appliance that did not work, food stamp application, meals, and caregiver & babysitting services. In addition, the patient and grandchild were referred to the “Be a Santa to a Senior” program, and they were adopted by a service provider’s employee’s church that provided food and gifts for the holidays.