This year’s cohort of Rural Scholars from the UMass Chan Medical School gave a two-for-one presentation, with recommendations for creating an integrated healthcare system to improve Martha’s Vineyard for residents who are older or have a disability. While the focus was on the older population, they share many needs with people who have disabilities, so both were addressed during the presentation held Thursday in the West Tisbury library.
Sponsored this year by Healthy Aging Martha’s Vineyard (HAMV), the eight students engaged Island stakeholders with interviews. The project scope focused on current Martha’s Vineyard residents 65 years or older, and the problem the scholars addressed was that these Vineyarders are “lacking sufficient resources to sustain safe and effective healthcare within the comfort of their homes.” This makes it difficult for people to “live at home as they age while having a strong quality of life.” The interviews were conducted in teams, and participants who were 55 years and older were also interviewed, alongside people who care for the focus group.
In total, 73 people were interviewed within a week, including “44 organizations, advocacy groups, or community members.” The questions were written in collaboration with HAMV, and participants were from all parts of the Vineyard, including Chappaquiddick.
These interviews revealed that 100 percent of those interviewed were concerned about a lack of housing and workforce as a “major barrier to improving home care,” 51 percent of respondents reported “increasing isolation among the elder population,” and 43 percent wanted “increased collaboration among services and community organizations.”
In particular, the shortage of housing creates a loop affecting workforce availability. Additionally, there is a lack of long-term care options and resources for older residents.
“Throughout our interviews, we zeroed in on several common needs of older adults, and these are things that came up again and again. So our ultimate goal is to improve people’s abilities to age in place, and not need to leave their homes,” medical student Claire Branley said.
Older Vineyarders need a multitude of support to age in place, which can be broken down into three categories: behavioral health (e.g. counseling), a social support system (e.g. homemakers), and an integrated health system (e.g. hospice). Access to these resources will be affected by factors like funding and communication.
“While each of these needs are being addressed in some form or another on the Island, there’s limits to many of these services,” medical student Erica Davis said.
Although bigger issues, such as fixing the housing issues, would take significant adjustments and policy changes for Martha’s Vineyard, there are immediate steps that can be taken to remedy some of the problems. One of these is creating an integrated and collaborative health system with improved communication among Island organizations.
“One of the most shocking things we learned when coming to the Island is that there were six towns,” medical student Gautham Chitturu said, adding that the interviews revealed having six towns on Martha’s Vineyard creates “a lot of challenges,” and centralizing the available resources would be a way to distribute them more efficiently.
One of the goals is improving communication among the Island’s Councils on Aging to improve the community’s knowledge about what is available to them. Chitturu also said improved communication, particularly an Island-wide coalition of caregivers and advocates, would help account for the “discrepancies that exist between the towns.”
“Something that we heard mostly from everyone, both from providers and residents, was that they learned of those services via word of mouth,” medical student Alex Lo said, adding that the group calls for making a website that is easier to navigate, and using other mediums, like a quarterly resource book.
Additionally, formal training should be established for home visits. Currently, most of these are self-directed. The place that could implement this for healthcare providers is Martha’s Vineyard Hospital. Utilizing the already present population, such as high school students and “second-career workers,” would be a way to fill in the workforce, and would also be a way to provide home visit care.
“HHA [home health aide] programs in the past in Martha’s Vineyard have included classes of 10 people, and traditionally have sold out in three minutes. So we know there’s a lot of interest,” nursing student Rachel Stroh said. Another resource to cover the workforce gap would be working with the Visiting Nurse Association of Cape Cod, which can also teach interested Islanders the skills they need for home health aide services.
People with disabilities, who are “often left out of these conversations,” face “similar gaps in services” on the Island, according to medical student Erica Davis. “It’s also important to recognize that as medical treatments for disabilities improve, the population of older adults with disabilities is growing, because they are living longer,” Davis said. “So this is creating a need for services that address both living with a disability and the struggles of aging.”
Davis listed various areas with “room for improvements” and recommendations to attain betterment for people with disabilities, such as cross-training support staff through workshops to improve spreading best practices, advocacy and awareness efforts to improve government funding, and employers adopting an inclusive employment model (e.g. the former Chilmark Chocolates), among others.
Moving on to behavioral health, the students found that many Islanders feel supported by their family and community.
“Which is a great thing. That being said, mental health disorders are still prevalent in Martha’s Vineyard and in the general population,” medical student Catherine Merton said. “These include things like substance and alcohol use, mood disorders, and social isolation and trauma.”
Merton continued that some mental health disorders are more closely tied to aging, such as isolation, which can be spurred by living alone. While there are mental health services on the Island, such as Martha’s Vineyard Community Services, there are still barriers to accessing help, such as stigma, misinformation, and limited options. A way to improve this is expanding the HUB table model, which is designed to proactively identify risk “before crisis occurs” and connect people to a team of health and human service providers. This model can be modified to support the elder population. For people with early dementia, a patient support group or companion program alongside expanding staff and resources to help them would provide support. As an example of a need for expanded staff, there are no neurologists on Martha’s Vineyard. Overall, mental health education for the general community (e.g. first aid training, dementia education) can help reduce older people’s reluctance to seek out help.
In terms of providing social support, nursing student Annie Lee suggested making a “sense of community” by fostering a feeling of the “good old days” through a peer enrichment program and getting volunteers from the Martha’s Vineyard Regional High School student body to help fill that need.
“I learned that they’re the Vineyarders, so go Vineyarders. Beat Nantucket,” Lee said, adding that the people are what makes Martha’s Vineyard special.
Other recommendations made by the Rural Scholars included establishing senior advocate services, such as phone calls from Council on Aging workers or volunteers, and annual nurse visits. The presentation also listed various funding opportunities that could be pursued, such as grants or hiring staff from AmeriCorps.
“So where do we go from here? We just touched on all of these interventions that we can provide, but one thing we all know is that no two people are alike,” nursing student Jenny Konjoian said, pointing out that a unique plan is needed for everybody.
The presentation was followed by a question and answer session, with plenty of people raising their hands to ask about elder and disability care on Martha’s Vineyard and the implementation of potential programs.
The students’ findings will be presented to the Dukes County Health Council, according to Dan Pesch, chair of the council’s Rural Scholars committee. This information will be considered when developing a strategic public health plan, such as how to allocate resources, funding, and implementation. HAMV will support this process.
Those interested in seeing the full presentation can do so when it is uploaded to MVTV.