Care Coordination reaches seniors’ mind, body and soul at Atlanta’s Panola Gardens

Panola - Sharon Dawson Reid

Care Coordinator Sharon Dawson Reid, center, with two residents before a play at Panola Gardens.

By LANCE CRANMER                                                                lcranmer@nationalchurchresidences.org

Before it even opened its doors, the vision for Panola Gardens was a community where housing and health care services came together under one roof. But to make that vision a reality, National Church Residences needed to find the right person.

“When the state agency awarded the important tax credits to National Church Residences to build Panola Gardens, they took a leap of faith that we would commit to an enriched service environment for our residents once we built the building,” said Michelle Norris, National Church Residences’ Executive Vice President of External Affairs and Strategic Initiatives. “That vision does not come to fruition without dedication and leadership of someone on the ground once the building opened.”

The organization found that leadership in Sharon Dawson Reid, Panola Gardens’ Care Coordinator.

“Sharon is an exceptional Service Coordinator,” said Terry Allton, National Church Residences Senior Vice President of Home and Community Services. “We are blessed to have her leading this effort!”

Sharon has been a member of the staff at Panola Gardens since the facility opened its doors in March 2015.

“As a Care Coordinator what I really do is work with the residents’ mind, body and soul,” Sharon said. “It’s a person-centered approach. It’s service coordination with care coordination laid on top of it.”

Using the concept of layering the two approaches has worked well for Sharon, especially when it comes to making partnerships and getting much-needed grants to fund projects.

“I have applied for several grants through Horizon Housing Foundation and they have been most kind to Panola Gardens,” she said, noting that over $16,500 has been awarded to her building. “They provide a lot of these classes for the residents that are free because of the type of grant that I applied for. I composed the grant and layered it with what I wanted to bring to the residents.”

Sharon found funding for Tai Chi classes which provide both mental relaxation and physical exercise.

She also brought in live musicians who provide entertainment, and also a form of music therapy.

“The way I proposed that grant is that (the music) stimulated the mind. They talk about the songs and who the musician was and where they were when they remember that song,” she said. “I’m always layering. It’s multifaceted.”

Other projects Sharon secured grant money for include art classes, live plays, free dental clinics, on-site physical therapists and chiropractors, and regular visits from a registered nurse to do health screenings and personal coaching for chronic diseases and medication questions.

“Built into those grants as well, even though they’re giving us all that money, I like to ask for even more money,” she said. “I have been given a lot of gift cards randomly given to residents for participating in at least one of these services. The residents are taking their time to come.”

As part of her job requirements Sharon hosts at least two educational wellness events per month. She is also required to plan at least 12 socialization events per year – but last year she held 91 of them.

“It engages their mind. Their thinking. It gets them walking. Gets them moving,” she said. “Every time a resident is in front of me I’m giving them something that is person centered. Something for the mind, body and soul. I go overboard trying to make sure these residents are well-rounded.”

Recently, she brought in retired NBA great Terry Cummings to speak to the residents.

“The focus of his speech was hope. It leaned on the spiritual side. Where the residents are in their lives. It is so this vulnerable population does not feel lost,” Sharon said. “It helps them transition through that period, if they are a widow or widower, or if they’re transitioning from a single dwelling or from living with family. Aging is a part of life and there’s a productive way to age.”

‘Home for Life’ to expand and serve Columbus’ Near East Side

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Christine Leyshon, National Church Residences Community Program Manager, and Rosemary Mathes, National Church Residences Service Coordinator, will be part of the team that will bring Home for Life to Columbus’ Near East Side seniors.

COLUMBUS, Ohio ­– The Osteopathic Heritage Foundation has awarded a Healthy Aging Initiative grant in the amount of $254,209 to National Church Residences to help the organization expand the Home for Life program to residents of Columbus’ Near East Side.

“The project is a combination of strategies,” said Jeff Wolf, National Church Residences Senior Vice President of Philanthropy and Mission Impact. “It expands the reach of our Home for Life model to seniors who live outside of our affordable housing properties, while the model itself is an innovation designed to help seniors in the community age in place.”

The Healthy Aging Initiative grant, administered over a two-year span, will touch the lives of nearly 700 at-risk Franklin County seniors. According to Wolf, “The grant is significant beyond its financial investment. A partnership with the Osteopathic Heritage Foundation provides an opportunity to launch innovative solutions that encourage community collaboration and the development of replicable programming.”

“The Osteopathic Heritage Foundation is proud to partner with National Church Residences to share the Home for Life program with residents of Columbus’ Near East Side,” said Susan Beaudry, Director of Programs at the Osteopathic Heritage Foundation. “This innovative program has great potential to provide older, vulnerable adults with the care and support needed to remain in their homes and communities of their choice.”

National Church Residences’ Home for Life program is an outcomes-focused service model, using evidence-based assessments and evaluation tools to identify an individual’s needs and risk factors. By engaging those we serve where they live, Home for Life can identify and overcome social determinant factors that impact an individual’s ability to best manage their chronic diseases, leading to higher satisfaction and engagement, better health and cost savings.

“The objective is to improve access to care and self-management skills of older vulnerable populations by giving them the tools to understand and manage their own care, allowing them to remain in their homes as they age,” said Wolf.

This program will bring the Home for Life model to seniors on Columbus’ Near East Side who do not reside in a National Church Residences facility. The focus is on an area that surrounds the Champion Intergenerational Enrichment and Education Center, at 240 N. Champion Ave.

An Interview with Michelle Missler, Introducing Care Guide

The role of service coordinators is changing as they become more proactive in linking residents and clients to the services they need to age in their homes. It’s not easy to track the needs of dozens or even hundreds of residents, so National Church Residences now has a new tool to help the service coordinators with this important job.

National Church Residences Service Coordinators:

  • Help residents to Age in Place in their home
  • Link residents to services to help them remain independent
  • Provide cost savings to the resident, property management companies, and the government
    • Benefit entitlement education
    • Reduce apartment turnover
    • Reduce unnecessary hospital visits, 911 calls, and ER visits.
    • Reduce rehospitilizations and premature moving to higher levels of care.

This year, National Church Residences has launched a new online documentation system that allows our Service Coordinators to track the health and livelihood of their residents, in turn catching potential risk factors earlier that could result in less unnecessary hospital visits, a reduction in premature moving to higher levels of care and overall increase in resident’s quality of life.

This new documentation system, called Care Guide, was rolled out to 14 National Church Residences pilot communities in May and then following our National Conference in October the rest of Ohio was trained. By the end of the year, every National Church Residences Service Coordinator at our owned or managed properties will be trained to use Care Guide.

“This is a new way of empowering and guiding the Service Coordinators to be proactive in their work,” said Michelle Missler, Director of Supportive Services for National Church Residences Home & Community Services.

Michelle started her career with National Church Residences in 2003 as a Service Coordinator at Stafford Court and Village in Worthington, Ohio. “I remember sitting in my office at Stafford and I would wait for residents to come to me with needs. I never sought out a resident. This is the mentality of Service Coordination across the board and Care Guide is going to change that.”

National Church Residences Service Coordinators work in communities across the nation that house a large population of dually eligible vulnerable residents, people who receive both Medicare and Medicaid. This population is costing insurance companies a lot of money because of unnecessary 911 calls, rehospitalizations, and ER visits.

The Affordable Care Act penalizes hospitals when a person is readmitted for the same issue in less than 30 days. Care Guide arms the Service Coordinators with tools that allow them to be proactive. These tools include a Vulnerable Elderly Scale, Mini Mental Status Exam and a Geriatric Depression Scale. These tools help identify the highest-need residents who are most likely to end up traveling in and out of the hospital.

“With the addition of this new, proactive approach for providing services to our residents, we will be able to get ahead of a crisis.  Service Coordinators are fantastic at linking residents to great resources when the issue is presented to the Service Coordinator imagine a world where we will get ahead of a crisis and in turn prevent those stressful events in our residents’ lives.  That is the goal of this new approach to Service Coordination.  We want to help prevent these crises and make the lives of our residents happier, healthier and less stressful,” Michelle said.

In addition to those tools, a reporting function allows Service Coordinators to share the findings, showing the impact of the program. National Church Residences has hired a report analyst to categorize and group data into readable information.

“As we begin to gather data from Care Guide, we will be better equipped to tell the success and impact of the Service Coordinator program.  We will be able see exactly what interactions help a resident to age in place successfully.  The outcomes will show us where we can work to improve the care for our residents and pinpoint those interventions that help save lives and money. Service Coordination has always made a difference in the lives of our residents; we will now be able to show the impact in many different ways to many different audiences,” Michelle said.