Aging the Healthy Way

When the 78-year-old man first came to see Diane Nuñez, he was visiting the emergency room at a local hospital about once a month to get treatment for severe asthma attacks. Gregory (not his real name) had suffered asthma all his life. It continued to get worse.

After each visit, doctors gave him new medicines and some type of inhaler device. Gregory wasn’t really sure how to use them. The hospital provided little instruction.

Unsure of how to use his medications and equipment properly, Gregory’s future probably included more frightening asthma attacks and more expensive hospital visits. Fortunately, he was a regular visitor to the Escalante Senior Center in Tempe, where Nuñez works as a nurse practitioner.

“I could see he didn’t know how to mix treatments and use the equipment properly,” says Nuñez, also an assistant professor of nursing at ASU. “When you go to the hospital, if you don’t learn how to do your treatments there they will send a home health aide to your house. You get one or two home visits. That’s it. But some people don’t learn that fast.”

Because Gregory visited the center daily, Nuñez could offer him assistance that the hospital could not. She administered his daily treatments. She also showed him how to put his machine together each time.

“We used some creative techniques,” Nuñez explains. “I took a big paper and drew the machine, all the pieces, and how to fit them together. When Gregory needed to use it he could roll it out the diagram each time. It took probably three months for him to gain strong enough understanding that he could do it on his own. But now he’s been doing well for four years.”

Gregory’s monthly hospital visits stopped. During the past four years, he has been in the hospital a few times total.

Gregory’s tale is one of many individual success stories generated by the Healthy WAY Program in Tempe’s Escalante neighborhood. The program is part of the Escalante Health Partnerships. It is designed to address the unmet health needs of Tempe neighborhood residents.

Healthy WAY was the first of the Partnerships’ programs, founded in 1991 by ASU nursing professor Betty Gale. It specifically addresses the needs of older residents.

“The College of Nursing was involved with the Escalante neighborhood for quite a while. They saw so many needs there—safety issues and health needs,” says Charlotte Armbruster, a faculty associate in the College of Nursing and the program director for the health partnerships.

Healthy WAY participants range in age from 56 to 90 years, with the majority being 65 and over. The program offers health promotion and education, group screenings, and individual wellness planning. To date, it has enjoyed remarkable success.

For example, Healthy WAY participants average 4.2 doctor visits per year, compared with a national average of 7.1 office visits for their peers nationwide.

Healthy WAY participants spend an average of 1.6 days in the hospital each year, compared to 2.1 days for the national group.

Healthy WAY participants report better health than their peers, responding to survey categories such as physical functioning, body pain, vitality, and mental health.

Escalante is a multi-ethnic, low-income neighborhood. The majority of the older adults in the area are women who live alone and report annual incomes of less than $6,000.

“If they see their doctor even two times a month and the co-pay is $10, that hurts them financially,” explains Nuñez. “If I’m able to triage and work with the doctor over the phone, I can help keep patients from being in the doctor’s office all the time.”

For example, one of her patients has congestive heart failure. The woman requires daily monitoring of her blood pressure, weight, and other health indicators.

“If she had to go to the doctor every day that would cost a lot!” says Nuñez. Instead, Nuñez monitors the woman at the center and refers her to a doctor only when necessary.

The health and financial benefits Healthy WAY offers its participants are obvious. But the program also helps lower costs for everyone. Nuñez notes that all of her clients are on Medicare, which is taxpayer-funded.

“All of us are paying for their healthcare, so it behooves us all to keep them healthy,” she says. “Our program costs are really minimal compared to the impact on the overall economy. If there were more programs like ours, there wouldn’t be so many costs.”

Healthy WAY takes a holistic approach to health. The program takes advantage of the strengths of the community and the resources of the attached community center. Nuñez calls it “one-stop shopping” for health, socializing, physical conditioning, and more.

Seniors can socialize with their friends at the center, attend a health class, and then go exercise in the gym or swimming pool, for example. Nuñez works with clients to create a personalized wellness plan.

The center also hosts workshops and courses on topics ranging from how to communicate with your doctor to managing diabetes. The program also offers numerous health screenings such as cholesterol and hearing tests, flu vaccine clinics, and geriatric massage therapy.

“The successes [of Healthy WAY] have to do with seeing the clients every day, or on a regular basis,” explains Nuñez. “This group is a very close knit family network.”

Many of the clients live alone. They may not have family members to help them manage prescriptions or other health issues. At the senior center they have friends to talk to and a trained nursing staff to help them.

R. J.’s Story
R. J. is 65 years old and has had diabetes for more than 20 years. His wife was his primary caregiver. She gave him his daily insulin injections and planned his diet. When she died, R. J. became responsible for managing a disease he really didn’t understand. His health care providers assumed that he knew all about diabetes because he had lived with it for so long. Because of that misconception, they did not offer any help.

R. J.’s health took a nosedive. He needed increased amounts of insulin and began suffering complications such as foot ulcers and kidney problems.

Then R. J. visited a nurse at the Escalante Senior Center. She helped him enroll in a diabetes education class provided by his health plan. She met with him weekly to review concepts learned in the classes. She offered support. She checked his blood pressure and foot condition weekly, and monitored his glucose levels periodically as well.

After six months of such individualized care, R. J. now takes half as much insulin as he did before joining the program. His blood pressure readings have normalized. His foot ulcers have disappeared and his kidneys are functioning within acceptable ranges.

All of the health services provided through the Escalante Health Partnerships are free of charge. The program is sustained through partnerships with more than 100 local groups, including nonprofit organizations, local government agencies, schools and businesses. These groups provide goods, services, and monetary contributions. In addition, more than 300 volunteers each year help keep the Health Partnerships alive and well.

Participants themselves often give back to the program.

“There are no fees or co-pays. However, many clients will voluntarily give a donation to the center for the services if they are able,” says Nuñez. “People say coming here is what keeps them going. It helps them stay well.” The benefits of better health reach far beyond the confines of the Escalante neighborhood.

“These are high-cost clients,” Nuñez says. “If we can keep them well it has a national impact on healthcare. And on their quality of life.”—Diane Boudreau