- Hello, and welcome to a special edition of Ask THE Specialists.

Today we take a look at rural health care here in central Michigan.

(upbeat music) Hi, and welcome back.

You're watching WCMU public television.

My name is Stefanie Mills and the focus of today's conversation is about a critically important program for older citizens here in central Michigan.

It's called the Healthy Aging Program and it's available thanks to Central Michigan's College of Medicine.

The goal is to provide quality care to people who may not have access to health care here in our area.

Now, to learn more about this program, we have Dr. Sethu Reddy and Dr. Jyotsna Pandey here to talk about it.

Doctors, thank you both for taking the time to be here today.

- [Dr. Sethu] Nice to be here.

- [Dr. Pandey] Nice to be here.

Thank you.

I do wanna point out that this program is not live today.

We will not be taking your questions this evening.

All the questions that we're going to be talking about here have been carefully selected ahead of time.

We will, however, be having a conversation about the needs for older population and the help that is available to them.

So doctors, healthcare has really become, has really been in the spotlight, especially, you know, for the for the past year the pandemic really bringing to light the needs and the shortfalls perhaps in our area.

And I think personally, I think one of the greatest challenges that we have for healthcare especially for older citizens is just the the geographical size of this region.

You know, according to the Healthy Aging Initiative website by 2016 the number of older adults in the US is projected to be nearly 100 million and that's up from about 47.8 million today and I'm curious, that's a US look what about those numbers for Michigan?

What, what does that look like?

- So in Michigan too, at the department of Health and Human Services in Michigan has been collecting yearly data.

And the overall population of Michigan has been relatively stable around 10 million but the number of people that are older adults service 65 for example, has risen from about 11% so like one out of 10, one out of eight to one in five.

So one out of five adults in Michigan is now over age 65.

So it is increasing.

Definitely.

- So with that said what are some of those leading health issues that are impacting older citizens?

- Well, I think for all aging societies, it's very similar.

You worry about social isolation, access to good medical care, in Michigan of course we're looking at rural versus urban, in some of the counties in Michigan the population density is like three people in a square kilometer.

Whereas in Wayne County it's a thousand people per square kilometer.

So we're spread out, a lot of older adults are living alone, long distance from family or friends and, if they're not accessing the healthcare system they could be living in Botswana.

You know, they're basically as removed as people in third world countries.

- Sure, absolutely.

Do we have any data?

You know, Michigan is an interesting state.

We have a lot of older adults, obviously that live in that live in Florida, but here in Michigan we have a completely different challenge too with the weather.

How does that factor into healthcare?

- Well, I think the winter being long probably accentuates the problem, the accidents.

It's not uncommon to have a heart attack when you're shoveling snow, but falls, which Dr. Pandey will talk about is a major crisis point where it's basically a two second event.

It can have life lasting or life impact in terms of shortening lifespan, quality of life, et cetera So anything we can do to prevent falls would be a major improvement, but Dr. Pandey - Yeah, especially, you know with the isolation that we have at the moment because of COVID, that adds to all of the issues.

Now because you're isolated, you're home bound you are moving less, you lose your strength and balance and that especially is more impactful in older adults.

So the fall risk increases just by isolation.

So other things that happen here, you know you fall once the number and the risk for falling again also increases because now you're scared.

So you don't want to move around a lot.

So all of those things kind of play into it and then if you get injured then basically it cuts about two to five years of time that you could have lived independently as you aged.

It actually shortens it by that many years.

- Which we'll talk about the different programs here in just a second, but that is why that's part of that Health Initiative Program, is the the fall risk assessment, that you're talking about.

Do we have real quick?

Do we have any data on older adults who are living in high risk situations in Michigan?

Is there anything out on that?

- Well, we have general data in terms of we know how many people are older.

We also know how many people are living at different income levels.

So believe it or not, almost 85% of Michiganders earn less than $50,000 per year household income.

When you look at less than $20,000 per year I think it's around 30% might be.

So it's quite devastating the economic status has an it major impact on health.

Somebody, you know, is that it's almost like we are living in a country where we have technically one of the best staffed and equipped healthcare systems and, but it's not within reach for the some of these older adults.

- And that's probably why part of this this program involves home visits and that's probably why that's so essential, right to help you kind of determine who might be a greater risk.

So we're gonna talk about that.

We're again, as I mentioned we are in a very rural setting, which is, you know we have people living in really remote locations which makes it hard for them to probably travel to appointments.

And again, that's why I think this program is essential.

So let's talk about the different parts of it.

So let the Healthy Aging Home Visit Fall Risk Screening Program.

Can you talk a little bit about that Dr. Pandey what's included, how long is it, does it cost anything?

- So first things first.

Okay.

So there's no cost.

It actually was envisioned as a program where the society benefited from it the community benefited from it and the students got educated at the same time.

Not only that, students from different professions learn to work together as a team.

So that's how we envisioned the program.

We basically go into, we recruit older adults that are living independently in the community they are healthy people that may or may not have a fall risk but they are living independently in the community, we go into their homes, the student team goes into their homes and then assesses their fall risk.

And if we find that there's a increased risk of fall then we let them know that and we also give them some amount of some kind of guidance as to how they can reduce their fall risk if they have to meet a physical therapist and that if they do go and talk to their primary care physician then that if they can just start walking three miles a day then that is that, you know, three miles is probably too much but three miles a week is probably something, you know as little as that can actually improve the healthcare.

So that's the healthy aging program.

- Okay.

Another part of it is the fall prevention through the I believe it's called the Otago Exercise Program.

Can you explain what that is?

- Yeah, so actually the Home Risk Assessment Program is the one that we started with.

And then we told them you need to get into an exercise program and many of these people came back and they said do you have an exercise program?

And we didn't at the time.

So it kind of organically evolved from there that we developed an exercise program and especially for people that are at moderate risk of fall.

So there was this program that was developed in New Zealand in a town called Otago.

So that's why it's called Otago Exercise Program and it's an evidence-based Exercise Program very simple exercises that can be done so a physical therapist will assess the patient, give them the exercises and as they do it and then progress them over time.

And we look after these people for one year and then hopefully after that they've become kind of self-reliant and they know what to do, but we've seen that people that have joined this program about 20% of the people that followed through we were able to reduce their risk from moderate to a low risk, which in case of older adults is actually no risk.

- Okay.

Got it.

That's great.

That's wonderful.

- Japan is being too modest of course but she's really done a great job of reaching out to local non-governmental organizations, the Commissions on Aging and Isabella Gratia and Clare counties great collaboration with the physical therapy group from mid Michigan to exercises.

And besides our medical school supporting, the Michigan Health Endowment Fund has been a really strong supporter of these projects.

- Yeah.

And we've also got support from the area agency on aging region seven.

They've been a great support in helping put this exercise program in the community as well.

- Alright, are people doing that together as a group kind of maybe like remotely are they just doing that at home?

- So initially when we started it it was supposed to be a group exercise program and we would go, we developed six centers in the three counties, Gratia Isabella and Clare.

And we would train students again, you know pre-PT pre-med students.

We would train them to be exercise trainers.

And under the supervision of a physical therapist they'd go there and supervise these groups.

But then during the COVID time we had to stop it.

And then actually the community asked us if we could do it, So now we are actually conducting sessions by telemedicine.

So the students are sitting in at CMU and the clients in their homes or sometimes two or three of them get together at a home so they put their cameras on, you know, eye pads.

And that's how they're communicating.

And we're doing the exercises.

- I gotta Imagine that, gosh, what a great way to like get yourself, in shape, you know to protect yourself right and prevent future falls but then also just to have that time to see other faces it may not be in person, but I have to I have to believe that that's also gotta be something good for your mental health too, especially now.

- Well, you know, one of the worst punishments we give our brothers and sisters is a solitary confinement and prisons and that's what we've been doing when the pandemic of course, and then when life hands you a lemon we make lemonade.

So your point earlier about home visits, in fact getting back to the way medicine was practiced 30 40 years ago, but now with technology we can innovate and provide the best things about home visits and house care, et cetera hopefully through modern channels.

- Absolutely.

All right talking about the next part of the Program which is ROAM, which is the Rural Older Adult Mobile Care.

Can you tell us how this works?

- Okay.

So this, again, snowballed out of the other programs that we were running into the community, you know, we'd go into these people's homes and they would sometimes ask us if we provided primary health care as well.

And we didn't at the time because we would just tell them, okay, you can come to the medical center, but we didn't really have a program.

And many of the times, you know these people lived in, live in dispersed, rural remote areas and distance from a medical clinic is one of the big things.

That's when we thought about the ROAM care let's bring the doctor's office to the patient's home and provide the primary health care that they need.

That will help reduce Morbidities.

You know, many of these older adults have diabetes and hypertension.

We would be able to give them better care.

So those would be controlled and again, these two are again, fall risk factors.

So we'll also, you know, probably improve the quality of life and the ability to live independently longer.

So that's where it came out.

And probably Dr. Reddy can expand more on how the program works.

- Yeah, and the other aspect of ROAM care is to actually prevent the emergencies and urgent episodes of care.

So a typical visit to an emergency room costs about $5000, just stepping in through the door and forget all the other aspects.

So we can provide preventive care and improve their safety and improve their well being, make sure they get their vaccinations, et cetera babies preserve their health so that they don't have to fall and break a leg or get pneumonia unnecessarily, et cetera.

So that's the idea that a preventive care rather than treating the more expensive episodic care here?

- Well, I think it's, you know helps people be more aware of their health, you know when they have that contact right, with somebody at a place or in their home.

I wanna talk about the qualifications for ROAM, which is I believe a patient has to be 60 years or older a resident of Isabella, Clare or Gratiot County in need of a primary care physician or having difficulty visiting your primary care physician or having transportation issues to those doctor's appointments or repeated visits to the emergency room.

Do you see this program ROAM specifically kind of expanding, well, maybe just the Healthy Initiative Aging Program expanding in general beyond those three Counties.

- Yes, actually just before the COVID hit we were going into the Midland County.

We had talked to the commissions on aging there and the plan was to kind of help it expand in in an organic way as we were setting up County by County but that has taken a backseat for the moment but we have plans.

- You have plans - We've talked to some of those state representatives, offices, et cetera but this almost can be seen as a demonstration project where if we're successful then it's certainly easy to replicate the state wide and maybe it can be handled by Michigan Department for Health basically and so that's a great plus.

We've had some good feedback already by our event cycle.

Our coordinator has actually gone physically in a fully gowned and masked to our older folks home and got great feedback.

They appreciate somebody coming and visiting and telephonically or virtually seeing me in the office and taking care of their problems.

- The last part, the last branch, I guess of this is called CARES.

So can you expand a little bit about, the CARES program?

You know, what kind of information are you looking for there?

- Okay.

CMU CARES actually came out of a student coming to my office and saying she wanted to do something for during the COVID time that would help the community.

So we sat down and we thought about it as to what she could do.

She wanted to develop a tool kit for people that were stuck at home that would help them be resilient and be able to kind of a crisis preparedness kit.

So CMU CARES is basically our attempt to create a crisis preparedness and preparedness kit.

We've been the way we went about it as we interviewed older adults in the community because we don't know exactly what they're facing and what they need.

So we got a group of students together they recruited people from the community rural, older, rural, independent living older adults and asked them about what their needs were and what their hardships were during the COVID time.

So we, again, isolation came up that they were, the resources were available but they weren't prepared to access those resources.

So that came up.

Those are the two major themes that have come up and now we are building a crisis preparedness kit based on the data that we collected from these interviews.

- How, were the students reaching those adults?

Like for somebody who wants to be a part of this program today?

How, can they get in touch with somebody?

- Oh, so we have commissions on aging we advertise through them we send out flyers to meals on wheels program.

Because they are sending out a lot of people and through their social work networks, we send out that and this we've advertised on the radio.

There is a number to call and, - The ROAM 989-774-7020 - Okay.

All right.

Okay.

And like I said, we'll provide that number too.

Are the Healthy Aging IPE home visits the same as ROAM is it all included?

- It's a little different, Dr. Pandey explained that for the medical students.

- Right.

So the IPE home visits are the for healthy people's fall risk assessment.

- [Stefanie] Okay.

Got it.

- So that was the first program, then it snowballed into the Otago Exercise Program.

And then from there it snowballed into the ROAM Care Program, and while we were setting up the ROAM Care Program COVID hit so CMU care has developed out of it.

Now there's another program which we are starting on the 1st of March which is called Living Free.

So there was another set of patients.

There is another set of people in the community that fall and then they go to the emergency room, they're not hurt.

And then it is determined that they don't have a medical reason for that fall, they are discharged from the hospital.

They are at increased risk of fall but they are lost to follow up.

So Living Free Program would be for those people where we work with them to reduce their fall risk.

So this recruitment will occur, from the hospitals and we've collaborated with four hospitals in the area McLaren with Michigan, Covenant and St Mary's.

So we have actually expanded to sag in our side as we were going along.

- I mean, the underlying principle of course is doctors tended to be lone Cowboys or cow girls doing by themselves.

And that Japan has been really helping with the interprofessional education so how can doctors work with other health professionals as a team and to think of themselves not as just working by themselves.

- I think what I really enjoy learning about this is that, you know, this is fairly all relatively new, right?

And, you know, you've talked about how things have evolved.

And, one of the things that I took away is this particular Healthy Aging Program kind acts like tries to keep people in their homes.

Right.

I think people prefer to stay in their homes and it helps them do so in a healthy way, right.

In an informed way.

Real quick I wanna go over those different arms again of the program, just for people who have any questions but the Healthy Aging Initiative Program includes those home visits, the Fall Risk Screening Program Fall Prevention, the Otago Exercise Program CARES.

And then of course the rural adult, the ROAM Care Program.

So those are all the different arms that are part of this.

Now, going back to what I just mentioned, this has been fairly new.

How did this all get started?

- Well, it all started because we wanted to set up an Interprofessional Education Program for the students.

And at around the same time there was also kind of awareness growing that we don't have enough geriatric teaching in the curriculum.

So we decided to combine the two so make the Interprofessional Education Program about geriatric health.

So kind of killing to probably not use that analogy (laughing) - [Stefanie] we're following you.

- Okay.

So, right.

So that's where we started and from there, as I said it snowballed into multiple Programs.

- Yeah.

Yeah.

We've got about four minutes left and I wanted to talk too about, how crucial, your know there's so much student involvement with this program here.

Real quick, what is the outlook for healthcare specifically for geriatric care are more workers needed?

- Oh, definitely.

I mean, I think we're not quite Japan yet in terms of the number of people that are older.

Japan has one of the highest older population I think but we're getting there and so definitely you can see changes happening in our society, et cetera for travel restaurants, targeting older people.

So definitely need more folks to look after older adults.

The other issue we've talked about before about diabetes, but Alzheimer's is going to be huge epidemic going forward.

And you're gonna need even more specialists to very complex situations, you know, not just medical but social political problems.

- CME is College of medicine I think is really seen as a leader, especially for those students who are looking to get into this field.

How does a program like this really give them kind of a, a leg up over someone else?

- Yeah.

So, you know, if you think about it no matter what specialty the student goes into it does not have to be geriatrics per say any specialty that they go into, they will see older adults.

And if 20% of the population is older adults they'll probably see more than 20% of their patients would be older adults.

So this gives them an awareness and the way to interact learn to interact with the older adults as a band they're still undergraduate students.

- And I think for CMU and the College of Medicine we have to walk the talk, right?

So our mission is to improve rural healthcare.

So this obviously is a shining example of that mission.

- Absolutely.

And real quick, we've got about two minutes but how does a program like this benefit not just a students?

I mean students and future healthcare workers, but the public too?

- So in this, we are actually collaborating with the community-based organizations like Commissions on Aging, Area Agency on Aging.

We also collaborate with the local health providers.

So community-based practitioners and then we also talk to the stakeholders which are the older adults to get their input as to what pro what they need and then try to provide it back to them.

So, so in a way we are, you know it's a 360 edition of everybody's point of view to pro build and provide a program for older adults.

- And we've been educating some of the local primary care physicians about preventing falls.

For example, for ROAM Care plan is to eventually refer the patients back to the PCP in their community.

- I guess I had known that falls have, has fallen is a major issue.

But gosh, just, I mean, how deep of an issue that is for older people is, is really important.

So thank you both for your work and doing this and helping keep those older populations healthy and in their homes longer and... - we're getting older too so we have a self-interest.

- Right.

Well, thank you so much for taking the time to be here today share your knowledge with us and just helping, you know bring awareness to this program, and I hope that more, you know, if you're watching today and you have questions, don't hesitate to reach out.

Thanks for watching.

Have a great day.

- Thank you.

- Thank you.

(smooth music)