For the Love of Health

Aging in Place with Good Neighbors with JoAnn Bruch and Harold Naylor

• ChristianaCare • Season 3 • Episode 5

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According to Delaware Health and Social Services, by 2030 more than 150,000 New Castle County residents will be over 60 years old. A majority of those residents are homeowners who hope to stay in their homes.

As Delaware's population ages, physical barriers within their homes threaten their independence and quality of life. When stairs become mountains and bathrooms transform into hazard zones, the consequences extend far beyond inconvenience. Missed medical appointments, preventable falls, isolation, and difficulties for first responders to access patients are the hidden costs of homes that no longer serve their aging residents.

Thanks to a partnership between ChristianaCare and Good Neighbors Home Repair, dozens of our New Castle County neighbors are safer and healthier in their own homes. ChristianaCare HomeHealth Senior Medical Social Worker JoAnn Bruch and Good Neighbors Executive Director Harold Naylor join us to share how their services have teamed up to reduce ER visits by 80-90% among those they've helped, delivering a six-to-one return on investment while restoring independence.

With their 100th patient milestone recently celebrated, the partnership continues expanding to meet growing needs, showing that sometimes a hammer and nails can be just as powerful a tool for good health as a stethoscope. Don't wait for a crisis to consider how you might be able to age in place - start the conversation by listening today.

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Partnership for Aging in Place

Speaker 1

Without exception. Every family that they have touched has been changed for the better.

Speaker 2

You're listening to For the Love of Health, a podcast about delivering care and creating health, brought to you by Christiana Care. Hello everyone, I'm Jason Tarkarski.

Speaker 3

And I'm Megan McGuhrman. Welcome to For the Love of Health brought to you by ChristianaCare.

Speaker 2

According to Delaware Health and Social Services, by 2030, more than 150,000 Newcastle County residents will be over 60 years old. A majority of those residents are homeowners who hope to stay in their home.

Speaker 3

A ChristianaCare partnership is helping dozens of those Newcastle County neighbors be safer and healthier in their own homes. To tell us more, we're joined by Christiana Care Home Health, senior Medical Social Worker, joanne Bruch, and Good Neighbors Home Repair Executive Director, harold Naylor. Harold and Joanne, thank you both for your time today. Thanks for having us.

Speaker 4

Thanks for having us Best thing we've done all day.

Speaker 3

Let's start big picture Talk about this partnership between Christiana Care and Good Neighbors and the real why behind it.

Speaker 4

So about six years ago, Good Neighbors, was really burdened by the idea of aging in place and we knew that the kind of repairs that we do are for warmer, safer, drier, healthier. And when we talked about safety, we realized that there's a subset of all of our homeowners, our patients, our neighbors that has to do with slips, trips and falls, and we were ready to partner in the area of health care, and so we made some overtures to Christiana Care. We weren't able to do anything about it initially because COVID happened. Two years later we started with Joanne and some of her team and we made our first referrals into installing mobility modifications that allowed us to get into this.

Speaker 1

And it's been great. The work that Good Neighbors has done for families has been just phenomenal. Honestly, they've changed people's lives since we started this program.

Home Health Referral Process

Speaker 3

Joanne, walk us through that a little bit. So you have a patient and you refer to Good Neighbors. How does that work?

Speaker 1

So I work for Christiana Care, home Health and when folks are discharged from the hospital, if they are not able to get out of their house for whatever reason maybe they have ambulation issues, maybe they are just too sick to leave the house, maybe their house isn't suited so that they can get out the doctors will do a referral to home health. Our team will go out, they'll do an assessment, they'll provide physical therapy, occupational therapy, speech therapy, nursing and, if there's a need, medical social work. So we all go out to the house so that they can get out of the bathroom or get into the bathroom or even get to a doctor's appointment. Because when people are discharged from the hospital, a lot of times there's follow-up appointments that need to happen, or maybe they need to see a specialist. But when you can't get out of the house, how do you get there? So that impedes somebody's ability to get the medical care that they need. So they'll do a referral, they'll call me and they'll say hey, you know we have this patient that needs this.

Speaker 1

What do you think? And I'll reach out to the patient gets a little bit of information. Do the referral and what's good about Good Neighbors is I might do a referral for a banister or a grab bar, but they'll go out and they'll meet with the patient and they'll see many other things that might need to be modified to make that home accessible. So it's been wonderful.

Speaker 4

So where we pick up is from Joanne's referral is that we go out, as she said, and our team is not. They're not occupational therapists, but we really have a heart for the ministry that we do and so, as a result, we actually go in and we actually interview the homeowner and again we call them our neighbor and we ask them how do you get around your home, tell us all the different things you do and activities for daily living and those things. And so we actually spend as much time probably an hour to two hours just interviewing the homeowner to see how do they get around and where do they think or where do they see their problems being. And so that's kind of where the process starts.

Speaker 2

A lot of this work seems focused around the concept of aging in place, which may not be a term that a lot of people are familiar with. So what does that mean, and how have you seen that evolve over the past decade or so?

Understanding Aging in Place

Speaker 1

So my experience working with patients is that for the vast majority of the time, people want to stay in their home for the duration of their life. Nobody wants to go to a nursing home or an assisted living facility and, quite frankly, a lot of people don't have the finances to go to those facilities. People do better in their own home. If their home is safe for them, if they have the support that they need, people generally do better in their own home. So aging in place is a great idea. If your home is suited for that. It has to have the ability for you to use the bathroom to be able to get out if there is a doctor's appointment or an emergency. If there was a fire in the house, how do you get out?

Speaker 1

So aging in place is what everybody wants generally, but your home has to be adaptable for that. So if there's modifications that can be made, that's fantastic. Insurance doesn't cover that and a lot of, I would say, for home health. The vast majority of our patients are seniors who are living on fixed incomes, so their income may only be Social Security, and that doesn't cover what you need to pay for a bathroom modification or to have a ramp put in, because those repairs or modifications cost thousands of dollars and when your only income is Social Security, there's no extra income to put towards any of that. So being able to have those modifications done allows people to age in their home, provided they have the support that they need in their home. Provided they have the support that they need, and I think with the program with Healthy Homes and Good Neighbors, it's allowed more people to actually actualize that.

Speaker 4

For us, aging in Place is actually an extension of our motto no-transcript.

Speaker 3

How are you seeing the improvements to these homes translate into better health?

Speaker 4

So for us healthy homes is a subset of our total. Again, we're Good Neighbors. Home Repair and healthy homes is the name of our division or our program. That really gets at this intersection of housing and health. Because when we repair a home again we're trying to make them warmer, safer, drier, healthier. But on the safety side, if we can make their home safer and their health improves and they have fewer slips, trips and falls, which is what may have gotten them into trouble in the first place then their whole health, their outlook, it changes them drastically.

Speaker 1

And I would just add on that I've seen the impact it has had on people's psyche, on just their whole outlook. I mean I could tell you countless stories about how people's lives have been changed for the better. We had a patient recently whose home was so cluttered that our occupational therapy and our physical therapists couldn't get in there to do therapy. They need to have room to walk and to be able to move a rollator or a wheelchair or a walker. And when the house is cluttered and not because maybe the person is a hoarder, but because they just don't have the ability, the physical ability, to keep up with the house and our physical therapists and our occupational therapists can't get out there to do the therapy because of all the clutter, then they're just not ever going to improve. And so Good Neighbors gets a referral from me and I'm saying, hey, it's not a modification, but this will help this person and they've gone out and cleaned out somebody's home so that our therapist could get in there and do what they needed to do, so that that person can regain whatever mobility they're going to regain. We had a family that I referred that when we walked in the front door the patient was sleeping in a hospital bed in the living room. She had not had a bath or a shower in a very long time, and so I made the referral to Good Neighbors to say you know, can you just do a bathroom modification so that her son can get her into the bathroom and get her into the shower? That was my goal.

Speaker 1

Good Neighbors went out, they took the time to get to know her and they her into the shower. That was my goal. Good neighbors went out, they took the time to get to know her and they said what would make your life better? And she said I want to sleep in my bedroom. And she had not slept in her bedroom in years, and so her son had started to use it as storage for medical supplies and whatever else. And good neighbors went in. Not only did they modify the bathroom so that she could get a proper shower, but also that she could sleep in her bedroom, and it just changed her life. I mean, that was just the best outcome in the world for her. She finally had privacy, the living room was now a living room and she had a shower.

Before Good Neighbors

Speaker 4

Wow, things that seem so simple like getting a proper bath or getting clean and sleeping in your own bed, for our neighbors is so profound.

Speaker 4

So there's all kinds of other qualitative as well as quantitative kind of things that happen as a result of a well-intact or well-serviced or well-maintained home. Quantitatively, the incidence of slips and falls or falls in ER visits have decreased by over 80%, closer to 90%, and what we do is we track the at time zero, when we actually start the repairs, and then we come back six months later and we interview the patient and we say what's changed and they'll tell us that this is how many times we were going to the hospital before and here's how many now, and the reductions are again between 80% and 90%. And so that translates into hospital cost, that translates into lost time if they're working, that translates into needs for their family, their other families, to come in and make changes or to come and help. Quantitatively it more than pays for itself. Johns Hopkins did a study some years ago with something called the Capable Program, about seniors aging seniors and they determined that the return on investment for the repairs that we're doing is six to one.

Speaker 2

It's clear this program is making a massive difference for the people, that it does help. But what would be happening with the community, what would be happening with Delaware's aging population if you didn't exist, if you weren't out there helping these people?

Speaker 4

Well, if you're really wealthy, you can just hire companies to come out and do this. If you're not, Well.

Speaker 1

So when I first started doing this job, getting out of the house has always been an issue, because people have mobility challenges. And you know, when you buy the house when you're young, you're not thinking I'm going to age in place here, and so you want the two story home, and then you never think that I'm going to have to figure out how I'm getting out of this house when I'm 85. And so when I first started doing this job, before Good Neighbors was around, people would call fire departments to have the fire department come out and help them get out of the house or get back into the house. Well, that's great if the fire department is available, and generally the fire department doesn't like that. So people were either missing appointments or they were calling the fire department, or they were that.

Speaker 1

So people were either missing appointments or they were calling the fire department, or they were calling multiple family members who are not trained in how to help somebody get down the steps. And so one has a leg, one has an arm, and they're trying to help people get down the steps and into the car. And that's how people were doing it before Good Neighbors. Now when I see those needs, I'm able to send a referral over. The Good Neighbors gets out there pretty quickly and gets the work done so that people can actually get to appointments that they need to get to get out of the house if there is an emergency or just get out to enjoy their life, you know, just to be able to get out and go for dinner if they wanted. Just the simplest tasks that before were not manageable were not manageable.

Speaker 4

The difference of being able to not just recommend but actually execute and implement these changes is profound in the lives of folks.

Speaker 1

Yeah.

Future Plans and Expansion

Speaker 2

You've recently hit a major milestone of having helped 100 patients, 100 people, with this program. What does the future look like for this program, for this partnership and for helping Delaware's aging population in general?

Speaker 4

The good news is that we have the ability to expand. The bad news is there's more need, and we live in a time when baby boomers are aging and so the need for these kinds of services, the mobility modifications, are going to increase. So we've added more staff, we've trained more people, we're getting more trucks, we're getting more funding and we intend to go deeper and further with our Christiana Care program, and so far we have a really good model to build on.

Speaker 1

Christiana Care program and so far we have a really good model to build on, without exception. Every family that they have touched has been changed for the better. Whenever I go out to see patients if Good Neighbors has been out there they all say the same thing oh my God, they're just wonderful and they're so happy that they don't need to worry about how to get to appointments, or that they can get into the bathroom, or that they can sleep in their bed, that they can walk safely down the hall All of these little things.

Speaker 1

That would not be possible without good neighbors.

Speaker 4

We love this partnership. It speaks to our mission as a Christian ministry to love on and care for people. So we do it in a very tactical way, but we also do it in a spiritual and relational way and so this speaks to our hearts. This is our backyard Newcastle County. We expanded to Newcastle County eight years ago and it now represents two-thirds of all of the families that we get to serve. This year we're on track to serve 250 ministry-wide. So we started out much, much smaller but again, through great partnerships like the one we have with Christiana Care, we're now serving more and more folks.

Speaker 3

Harold and Joanne, thank you both so much for your time today.

Speaker 2

Thanks for having us. Check out the show notes for more information on Christiana Care's partnership with Good Neighbors Home Repair.

Speaker 3

And you can always keep up with. For the Love of Health on social media, just search Christiana Care on your favorite platform.

Speaker 2

We'll be back in two weeks with another great conversation.

Speaker 3

Until then, thanks for joining us for the love of health.

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Megan McGuriman

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