Senior Outreach Nurse Program: One model for increasing access to health care for rural older adults

Background:

Older adults living in rural isolated areas of the country present important public health challenges because there is often a shortage of primary care physicians who will take Medicare patients and low income seniors often do not have adequate resources to meet their basic needs for health, wellness and independence.

Program Description:

The “Senior Outreach Nurse” provides a framework for providing healthcare and access to nutrition, housing, financial, and other services through a combination of direct service and referrals to partners. Nurses make a home visit to all new clients to assess health (including mental health) nutrition status, eligibility for financial assistance, public benefits, and other services.

Evaluation:

Referrals to other agencies are tracked. Surveys regarding satisfaction with nursing services and changes in health status are currently being administered to all clients.

Results:

From 2007 - 2009, 600 patient referrals were received, 1350 visits made. 87% of clients were referred to at least one new program-- 598 to a health care provider/facility/agency; 102 to community nutrition services and 526 to social service agencies -- 63% of clients followed through. In 2009, 41.2% of 228 new client referrals came from health care providers, 22.4% from family/friends/neighbors, 18% from senior centers. Preliminary results from surveys suggest that clients report improved health status and enhanced sense of security.

Conclusion:

Senior Outreach Nurse Program has been successful at developing collaborative partnerships to receive referrals and provide increased access to health care, nutritional services, and other community services to enhance health, wellness and independence.