LOS ANGELES — Adults ages 50 and older who live in South Los Angeles now have help to get healthy and “HAPPI.” Instead of waiting for seniors to access and receive no-cost preventive health services, the new Healthy Aging Partnerships in Prevention Initiative meets them “where they are.”
Approximately 1.1 million people of all ages live in South L.A., and roughly 20% are 50 or older, said project leader and research scientist Kathryn Kietzman at the UCLA Center for Health Policy Research.
HAPPI, a community-based research project, has assembled a diverse team to encourage use of clinical preventive services. The collaborative effort includes:
- Los Angeles Department of Public Health;
- Southside Coalition of Community Health Centers;
- Los Angeles City and County Departments of Aging;
- Local community-based organizations; and
- A multidisciplinary group of UCLA investigators.
HAPPI is funded by HHS Mobilization for Health: National Prevention Partnership Awards Program and the UCLA Clinical and Translational Science Institute. It aims to increase the use of “high-value,” bundled services — including breast, cervical and colorectal cancer screening; influenza and pneumococcal vaccinations; and cholesterol tests — among older adults who are racial and ethnic minorities.
“Services for this population are being underutilized, even in the face of new provisions available through the Affordable Care Act,” Kietzman said. “They’re free but many people don’t know that.”
Program partners also want to reduce disparities in access to preventive services among black and Latino populations in South L.A. Many such people are living in underserved and socially and economically disadvantaged communities, she said.
The Southside Coalition of Community Health Centers believes 78% of its patient population have incomes below 100% of the federal poverty level. The not-for-profit includes eight federally qualified health center members and more than 40 health center sites in South L.A. that already provide clinical preventive services.
The Challenge of Encouraging Preventive Care
“Getting health care is typically a response to a problem, like caring for a wound,” Kietzman said. “And how many people can’t leave a job to go get a flu shot or get a mammogram done? Getting more ‘upstream’ health care can really prevent the trajectory of disease and death among a population — so the stakes here are very high.”
“Feeling ‘well’ is an issue with most people in general,” said June Levine, a nurse and the patient-centered medical home director at the Southside Coalition. “That means that no matter their socioeconomic level, people say, ‘I’ll take care of this later,'” she added.
Seniors pose a different kind of challenge, Levine said. “As we age, we are prone to more disability and chronic disease, and are sometimes on a number of medications that may interact differently,” she said.
She added, “For too long, the American health system hasn’t focused on caring for our elderly with an appreciation and understanding of their uniqueness. Historically, we also have not had enough physicians or nurses trained in geriatric health care.”
How HAPPI Works
HAPPI will train community health center workers on how to better deliver preventive care services. At the same time, the program will train community based-organizations to get involved with services delivery and will provide grants of between $10,000 and $20,000 to organizations that collaborate with a community health center.
The program will take a more holistic approach to encouraging the use of preventive care services. Kietzman said, “In our program, the responsibility doesn’t just fall on the primary care provider, but on the entire care team. A referral coordinator makes sure people get where they need to go — maybe they need to be referred out to another provider.”
In addition to the clinic component, HAPPI promotes evidence-based programs that have a culturally appropriate, community-based focus, she said.
“We know people engage and get connected at senior centers, pharmacies, the YMCA and particularly in church,” said Kietzman.
She cited the effectiveness of the earlier National Cancer Institute initiative, The Witness Project. In that effort, black women were able to receive education on breast and cervical cancers at churches and community centers.
“People are more open to education in a familiar setting among people they trust,” Kietzman said.
“The model works nicely because we have 16 multipurpose senior centers that provide more than just social and recreational resources,” said Anat Louis, director of direct services at the city’s Department of Aging. “The care manager or social worker will sit down with the senior and work on a care plan to address their needs and connect them with community resources such as their local clinic for their medical needs.”
Seniors also experience barriers such as transportation to and from the doctor, Louis said. “Our senior centers can help with that and with meals if they’re homebound, plus we have more than 100 dining centers that provide hot, nutritious meals five days a week.”
Centers can also assist with other financial or legal issues, she said. “They can provide health promotion screenings, as well as preventative education such as medication management, and fall prevention — often in conjunction with the family caregiver.”
Hopes for HAPPI
Karen Lincoln, founder and chair of Advocates for African American Elders at USC’s Edward R. Roybal Institute on Aging, applauded HAPPI’s targeted mission.
“African-Americans have a higher biological age relative to chronological age when compared to any other group,” she said. “That means their age is more associated with age-related illness, both fatal and non-fatal, even when we consider health behaviors.”
“As America works to transform our health system, prevention is gaining recognition,” said June Simmons, member of the Los Angeles Aging Advocacy Coalition and president and CEO of the Partners in Care Foundation. “It is exciting to see this powerful coalition of strong organizations working together to target these resources to change lives for the better.”
The HAPPI program is designed to motivate greater awareness of the aging population and result in positive outcomes, said Kietzman. “Practices will also be able to look closely at their clinical data, quantitative to qualitative, and at standards, both state and national. We’ll know how many women got a pap smear before and after the HAPPI program was launched. Data is a reflection of the kinds of outcomes they want to achieve or are achieving.”
She said data will be used to assess progress three years following the start of the program.
The coalition has also developed a plan to help clinics identify possible barriers and strategize on how to overcome them, Louis said.
“Our focus is prevention, prevention, prevention,” she said. “We want to educate people in a supportive way to help motivate them to apply what they learned to access and utilize clinical preventable services. We want our seniors to be healthy, independent and living in their homes for as long as possible.”