Developing and Scaling a New System for a Non-Profit Serving Seniors in their Homes

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About this Client

Our client is the leadership organization supporting the more than 5,000 community-based programs across the country that are dedicated to addressing senior isolation and hunger. By providing funding, leadership, education, research and advocacy support, our client empowers its local member programs to strengthen their communities, one senior at a time.

In this project we partnered with a non-profit medical research organization that addresses the cost of healthcare and improving healthcare delivery in homes, hospitals, and community-based organizations, primarily through developing high-quality, lower-cost models of care for seniors. They explore opportunities that will improve acute care for seniors in the emergency department, home, and community; chronic care settings for older adults that may need care at home; and supportive services so seniors can receive the care they need, at a lower cost, wherever they are.

Executive Summary

Our client engaged us to help them explore what was both a challenge and an opportunity to ensure seniors could safely age in their homes: how to identify and address issues before they led to a decline in their client’s health?  Often the meal delivery drivers were the only person a senior would see each day.  The changes these volunteer drivers observed in their clients’ well-being could indicate the start of a bigger issue. 

Interviews conducted with the member organizations across the US provided insights to design an easy Change of Condition checklist for drivers to follow and a system for them to submit alerts that indicated a change of condition in the people they visited in their homes.  After testing the system with 2 sites, we scaled to over 25 organizations using a networked mentoring model so that members could help each other with operational issues and change management challenges.

Although there were technical challenges, staff were surprised by how well their drivers adopted the new operating model.   Many volunteers saw Change of Condition as validation of the good work they performed, increasing their confidence that their observations would be acted upon.  And because health risks were being captured systematically, executives could go to funding partners with clear evidence of the value they provided in keeping their clients safe and thriving in their homes as they aged.

The Challenge

Seniors are living longer and want to live out their lives in their own homes.  And because of their older age, today’s seniors are more likely to face multiple chronic conditions that limit their mobility.  Studies have found that providing services to seniors in their homes to ensure proper nutrition, social connection, medication adherence and a safe home environment results in greater well-being as well as lower healthcare costs.

Our client’s member programs started by delivering nutritional meals to seniors in need but found that they were in an ideal place to provide more than a meal.  Many of their volunteers are themselves retired, and often adopt their clients like family.  They have a vested interest in ensuring they don’t become socially isolated, that their homes adapt to reduced mobility challenges as they age, and their nutrition and medication needs are met.  What’s missing is a systematic, scientific approach to delivering “more than a meal” that can be consistently applied by a heterogenous set of member organizations themselves serving a diverse population of seniors.

Most organizations run pretty lean operations and utilize mostly manual processes to deliver their services.  Their staff is not particularly tech savvy, and they assume that their volunteers similarly avoid technology solutions.  Implementing a new, unknown technology to put in place a system in their operation that could manage the robust application of “more than a meal” would require a collective effort.

The Solution

Inceodia was engaged in both in the original solution discovery and as a program evaluator to ensure identification and adoption of best practices key to scaling the system across many member organizations.  We used a design approach to interview and observe 6 programs’ operations who were diverse in the types and numbers of clients they served, the services they provided and the community organizations they partnered with.  These empathy interviews helped to uncover the motivations and challenges of different staff members and volunteer drivers as they delivered their services to their clients.

For example, we discovered that though the drivers agreed that their job was to do more than just deliver a meal, to also watch out for potential dangers, they did not agree on what they should be looking for, even in husband and wife teams who were working a route together!  Many felt that they had a trusted relationship with their clients and feared being perceived as a “big brother” that would enforce safety precautions that infringed on the freedom people enjoyed by living in their own homes.  And staff worried that technology would get in the way of the relationship they had built with both their clients and their volunteers, keeping them at a distance.

The Change of Condition solution was a simple checklist of wellness categories that were developed by a university partner through cross-disciplinary expert opinion and a review of the literature to identify commonly used categories of health and social needs.  To systematize application of this checklist, it was built into software used by the drivers to manage their meal delivery routes.  If a driver saw a change in their client for one of the 7 wellness indicators, they would check the box in an app on their mobile device and the alert would be sent to the office for follow-up.

The design of the app addressed many of the needs discovered in the interviews.  Although initially it was envisioned that assessment of the wellness indicators would need special training, we found that this was would de-motivate volunteers who wanted to help people, not adhere to a strict protocol.  Instead we focused on creating a very simple and straight forward checklist that was easy to administer.  We also built-in two-way messaging so that staff could let the volunteer know that they were following up on an alert they received, which resulted in improved communication between the volunteer and staff.  Volunteers felt that their observations were valued, like they were part of a team caring for the clients.

Once we had piloted the new system with 2 organizations over the course of a year, Inceodia stepped in to help scale to a broader set of  programs.  We did a network assessment to understand the operational capabilities of over 250 member organizations and solicited early adopters using baseline criteria for success: e.g. current utilization of software in their operations, care coordination services beyond meal delivery or partnerships with healthcare organizations in the community.  These 10 organizations became our lead sites, helping to develop best practices for implementation that could be utilized by the next wave of expansion sites.

Through interviews and survey assessments, we developed a blueprint for organizations to follow as they implemented the system in their operation.  Each month we would assess their progress and compare it to the data collected in the Change of Condition software, sharing our findings back with the organization staff.  Where were people getting stuck?  Because we took a network approach to scale, holding frequent group discussions and where needed, 1:on:1 coaching, these programs were more open to learning and growing, adopting the practices that worked for them.

The Results

By the end of this 3-year effort, nearly 25 programs had successfully adopted Change of Condition monitoring in their operations.  While a few volunteer drivers refused to use the technology, most embraced the new system, praising the ease of use of the app on their mobile devices and how it empowered them to fully deliver “more than a meal”. Within the organization operations, staff could start to see and address trends in the data – which clients were experiencing repeated alerts?  How effective were the partners they were referring to at resolving the issues?  Executives started conversations with new healthcare partners in their community, opening the door to new funding opportunities that were previously out of their reach.

Ultimately the real result is in the well-being of the seniors in their homes.  While it is too soon to see health trends, members are reporting that they have been able to help their clients avoid health declines.  And the clients’ families are noticing, growing their confidence that their loved one is being well cared for on a daily basis.