The challenge
Providing effective wraparound care for older adults in frontier communities is particularly challenging. Oftentimes, care recipients and their caregivers have to travel for many hours to reach the nearest clinic or senior center. In San Juan County, Utah, where the population is majority Navajo, it takes 10-12 hours to drive from the northernmost community to the Area Agency on Aging (AAA) and the county seat in Monticello. If a caregiver forgets a form, they might have to make that trip twice to enroll their loved one in necessary, life-sustaining services.
If the clinic, the hospital, the AAA, and the senior center all have the same goal: to help older adults age safely in the community, they should be able to coordinate closely to share information, taking that burden off the shoulders of the caregivers and care recipients as much as possible. However, because it involves protected health information (PHI), that type of coordination is only possible with a modern, HIPAA-compliant technology system. Those technology investments can be costly and are typically found in large metropolitan areas. But in frontier communities, where access to care is even harder to come by, they can arguably make an even greater impact.
So how can San Juan County afford to invest in necessary infrastructure upgrades and leap to the forefront of service coordination across health and social care?
The solution
There are funders, such as the Learning and Action in Policy and Partnerships (LAPP) Grant, supported by the Center for Healthcare Strategies (CHCS), the Robert Wood Johnson Foundation (RWJF), and Data Across Sectors for Health (DASH), geared toward exactly this challenge: providing one-time infrastructure funds to allow communities to take the leap of connecting across sectors.
Tammy Gallegos, the director of the San Juan County Area Agency on Aging, collaborated with Mon Ami’s co-founder, Madeline Dangerfield-Cha, and the Nursing Manager of Blue Mountain Hospital, to apply for the $80,000 grant. Their application was one of the five selected from a pool of twelve applicants, as further described in this press release from DASH.
Mon Ami will provide an integrated technology solution to San Juan County AAA and Senior Centers, which will plug directly into the Electronic Health Records used by Blue Mountain Hospital. As older adults are being discharged from care by BMH, relevant information can be shared with the San Juan AAA team to enroll them in case management or home meal delivery services. Likewise, as AAA and senior center staff notice important changes in the health of their clients, they can flag that to the clinicians at BMH.
Key Takeaway
We don’t underestimate the time and resources it takes to invest in a strong technology platform to manage a wide range of services and to be able to partner with healthcare organizations. Nonetheless we have learned through our partners that there are always opportunities to be found for those with vision and determination.
The San Juan County team succeeded at securing their LAPP grant because they had the foresight to develop their management technology and data collection capabilities and to continue to strive for new ways to impact their community.
Although securing grants and partnerships may seem like a daunting challenge, we want you to know we’re with you every step of the way.