In my July 7 column, "Sharing learning opportunities has come full circle," I mentioned that I couldn't fit into that column all the information I had learned at the Maryland Gerontological Association's spring conference. One of the topics I didn't have room to discuss concerns medical-religious partnerships as a model of caring and how these connections can address the health needs of an aging society.
I decided that this subject matter is worth two columns; this one will provide background and details on this model of caring from an expert, Dr. W. Daniel Hale, a psychologist and national leader in health ministries; and the next column will cover the practical application of this care model through health care ministries at Howard County churches.
At the MGA conference, Hale was part of a panel addressing the topic "Reaching Out to the Community." As the conference agenda stated, "creative community collaborations are necessary in the current economic climate and outreach programs that incorporate innovation and outside the box thinking to effectively meet the needs of older adults were discussed. Hale's presentation was on "New Models of Caring." The information in this article is based on his conference presentation and my phone interview with him.
As of June 27, Hale is a special adviser in the Office of the President at Johns Hopkins Bayview Medical Center, in Baltimore. He is on leave from his position as professor of psychology at Stetson University, in DeLand, Fla., and expects to be in Baltimore for at least two years to further the work he started in Florida. He is also an adjunct associate professor of medicine at Johns Hopkins School of Medicine.
Health care solutions
Hale's work in Florida centered on solutions to deal with the health care challenges that need to be addressed in our aging society, and especially the high incidence of chronic conditions in that population. In the United States population in 1992 the percentage of people 65 years of age or older was 12-13 percent. It is projected that in 2030, the year that the baby boomers reach Medicare age, the percentage will grow to 19-20 percent.
Not only is the aging population increasing, but chronic illnesses in the adult population are increasing. Hale cited in his presentation that 87 percent of people, age 65 and older, has at least one chronic condition and 67 percent of that population has two or more chronic conditions. These statistics translate to the fact that more than 133 million Americans live with at least one chronic condition and approximately half of these have multiple chronic conditions.
These numbers are expected to grow to 160 million by 2020 and 170 million by 2030. Hale said that we are facing a major health care crisis around the challenge of chronic illness. Hale further explained that people with chronic conditions account for 90 percent of all prescription drugs used; 80 percent of all inpatient hospital stays; 75 percent of all visits to physicians; and 85 percent of all health care expenditures. Chronic conditions are also the leading cause of mortality, accounting for seven out of every 10 deaths.
Glaucoma and diabetes
I was surprised to find out from Hale that health care for chronic conditions is mostly provided in the home by the patients themselves and their family members. He cited two examples: glaucoma and diabetes mellitus.
For glaucoma, he said that a patient with this eye disease goes to the ophthalmologist every four months for a pressure check, a visual field exam, or a complete eye exam, but most of the time, the patient is managing the disease by applying eye drops to reduce the eye pressure. It is the same with a person who has diabetes mellitus.
The patient monitors blood sugar levels and injects insulin, or takes the appropriate medication, thus the majority of the care management is in the patient's hands, and the patient only goes to the doctor for regular checkups or if a special need arises.
According to Hale, data suggest "care provided in the current acute, episodic model is not cost-effective and often leads to poor outcomes for patients with chronic conditions; that these conditions require continuous care and coordination across health care settings and providers. We can find solutions by developing better connections between supportive and clinical care delivery systems and by encouraging and supporting patient self-management and family caregiving."
One solution is for medical leaders to partner with religious congregations of all denominations. In his book, "Bowling Alone: The Collapse and Revival of American Community," Dr. Robert Putnam states, "Faith communities in which people worship together are arguably the single most important repository of social capital in America."
Putnam goes on to say "In one survey of 22 types of voluntary associations, from hobby groups to professional associations to veterans groups to self-help groups to sports clubs to service clubs, it was membership in religious groups that was most closely associated with other forms of civic involvement, like voting, jury service, community projects, talking with neighbors, and giving to charity.
Religiously involved people seem simply to know more people." He cited a survey that found that "religious attendance was the most powerful predictor of the number of one's daily personal encounters," and that "regular church attendees reported talking with 40 percent more people in the course of the day."
In 1992 the population of Volusia County, Fla., was 375,000, of which 20 percent of that population was already 65 years of age or older. Based on the fact that this was 50 percent higher than the rest of the country, Hale and his associates, Drs. Richard Bennett, Neil Oslos and C. Dwaine Cochran, started researching and developing a project to help address the medical needs of this aging population.
After consulting at length in Baltimore and Florida with Dr. John Burton, then professor of medicine and director of the Division of Geriatric Medicine and Gerontology at Johns Hopkins, Hale and his associates got the green light to pursue Project REACH: A program to train community-based lay health educators. From the beginning, he had 'buy-in' from the local community hospitals and physicians. Clergy welcomed congregation-based health education. The program required committed, energetic lay leaders who could be identified and trained.
The plan for Project REACH was to train 12 lay health educators, starting with 20 to 25 people because of projected attrition. The volunteers would be recruited from religious congregations. Medical professionals would provide instruction and materials. Then lay health educators and medical professionals would conduct subsequent programs.
Recruitment started in 1994 with 22 in the first set of classes, which were held at Halifax Medical Center, in Daytona Beach, Fla. They ended with 25 volunteers, 'reverse attrition.' Two more sets of classes were offered and a total of 59 volunteers were trained as lay health educators.
Dr. Richard Bennett, who now serves as president of Johns Hopkins Bayview Medical Center, and Hale then worked together to find out what the clergy and laity thought about medical-religious partnerships. A national sample of clergy and laity showed that they were amenable to partnering and the areas they were most interested in were: health-related classes, screenings and preventive interventions such as vaccinations.
Hale and his associates were not the first to work on medical-religious partnerships but the model of educating lay volunteers to work in health care ministries was a first. Project REACH provided an opportunity to look forward, to develop a model of care that would be useful at that time and serve as a blueprint for the future, a means to meet the challenges of an aging society with ever increasing chronic conditions.
'… Potential to save lives'
Hale and Bennett's book, "Building Healthy Communities Through Medical-Religious Partnerships," describes "an innovative approach to the development of community-based health education and patient advocacy programs targeted at the prevention and management of disease." Already in its second edition, the book shows that partnering between health care systems and religions organizations, in Florida, can be remarkably successful at bringing appropriate care to people who are often difficult to serve. In his review of the book, Dr. Harold Koenig, of Duke University, said the book is way ahead of its time. Dr. Pat Fosarelli, who does reviews for the Journal of the American Medical Association, said, "The book literally has the potential to save lives."
"Healing Bodies and Souls: A Practical Guide for Congregations," co-authored by Hale and Dr. Harold Koenig, a psychologist, "offers a practical and engaging primer on developing a variety of initiatives for pastors, parish nurses, lay leaders and concerned parishioners. Their short volume mixes real-life congregational case studies with vital information to equip congregations in helping properly manage illness, navigate the healthcare labyrinth, manage or avoid disability, and even provide some life-saving and preventative medical services. While their case studies report on the many kinds of engagement congregations have taken on, each chapter also provides basic information on the most common healthcare challenges - diabetes, skin cancer, strokes, heart disease, Alzheimer's, Parkinson's, breast cancer, prostate cancer, glaucoma, and depression - and what can be done in local congregations."
Life's most rewarding work
In Hale's view, teaching at the college level is the best thing he could do as a profession. He never thought he would leave teaching, but he found that the work he did in Florida on medical-religious partnership and lay volunteer training was the most rewarding work of his life. His work here at Johns Hopkins involves establishing another program, which replicates REACH.
He already has 15 lay volunteers who will be trained in 10 weeks of classes starting in September. The lay training encompasses eight medical topics: heart disease, hypertension, cancer, chronic obstructive pulmonary disease, diabetes, prevention and disease management, depression and dementia; and three medical-related topics: medication management and vaccinations, advance directives and prevention of accidents and falls.
Once the course is completed, the lay volunteers will help in congregations and communities at large. In the spring, Hale plans to offer a session to train volunteers to be lay health advocates. These advocates would help patients who have no family or no family close by. These individuals provide a support system for the patient and offer practical help, as a family member might.
Hale believes that older adults can play a critical, life-saving role in health ministries. In this light, he mentioned Experience Corps, "a community-based senior volunteer program designed to support the academic success of children while also serving as a health promotion program for older adults." He said that Dr. Linda Fried, co-founder of Experience Corps, and members of the group, have a favorite quote, which they often use, "Older adults are our only increasing natural resource." Through Experience Corps, Americans older than 55 years of age tutor and mentor children in urban schools across the country. There are Experience Corps programs in Baltimore City, Baltimore County and Washington.
The only thing on Hale's last conference slide was "Dr. Burton was right!" I was curious as to what this meant. He told me that it goes back to when he was consulting with Dr. Burton on whether or not to pursue the lay health educators training.
After nine hours of meeting with Burton in Florida, Burton told Hale and his associates that the idea was medically sound; it had not been done anywhere else; and that they had the resources to do it. Burton also added two additional comments. He said the group would work harder than they ever had; and that it would be the most gratifying work they had ever experienced. According to Hale, it is the most meaningful work he has ever done. So, Burton was right!