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Establishing Partnerships to Address Social Issues with Older Adults.

It's 11:45 p.m. on a Saturday night and the fire fighters/paramedics assigned to Albemarle County Fire Rescue (ACFR) Medic 8 are en route to 808 Elm Street for an elderly woman who has fallen out of bed and in need of medical attention. Medic 8's crew is very familiar with 808 Elm Street and Gertrude Smith. Just today, it is the third call to this address and there are still hours to go before the shift ends.

The crew members pull up to Gertrude's apartment, remove the key from the front door lockbox, and go inside after a brief announcement--very much like the actions of a family member or a close neighbor. They approach the bedroom and find Gertrude on the floor in a state of panic--exhausted, covered in filth, and embarrassed about her condition. She cannot remember when she fell, but it has been hours.

The crew members help her up from the floor and to her wheelchair, clean her up, change the sheets, and tidy up the place. They even make her a sandwich and turn the television to her favorite show. Gertrude loves her fire fighters, because they always respond when she needs them, are polite, and take care of her needs with no complaints. She often refers to them fondly as "her boys."

Fire fighters are problem solvers and are very skilled at mitigating complex, technical emergencies. Their compassion and focus on customer service makes them a great asset for people like Gertrude Smith. However, older adults like Gertrude often have challenges that, on the surface, may seem simple and straightforward. But a deeper look reveals more complex social issues that require a highly skilled specialist who can assess the situation and get to the root of the problem. Gertrude's needs exceed that of a single agency and the long-term solution would require a team approach.

A group of dedicated fire rescue employees, motivated by their desire to "fix the problem," formed a task force with the mission of addressing Gertrude's challenges. Based on prior experience working with county and nonprofit agencies, fire rescue staff reached out and expanded the team to include agencies that were better suited to address social issues affecting older adults. The two primary agencies were the Department of Social Services (DSS), Adult Services Division, and the Joint Area Board of Aging (JABA), Options Counseling.

Adult Services at DSS investigates reports of abuse, neglect, and exploitation of adults older than 60 years of age with the goal to protect a vulnerable individual's life, health, and property without a loss of independence. JABA is a nonprofit agency that serves the Charlottesville/Albemarle region by providing an array of services to the aging community. One particular service JABA provides is options counseling, an in-depth conversation with the individual and their family to educate them about the specific resources available for care and services in their community. This process assists the individual in obtaining and maintaining optimum functioning in the least restrictive environment possible while respecting the individual's right to self-determination.

In Virginia, self-neglect is considered a form of adult abuse and is the most prevalent. Often the lack of social capital leads to isolation among older citizens. As a result, many individuals are reaching out to public agencies to fill in the gaps where natural support systems (social capital) such as relatives, faith-based organizations, and neighbors could ideally meet their needs. As with many social problems, sustainable solutions require an ecological and strengths-based perspective. Outside of a family system, public service programs should be encouraged to collaborate and develop innovative solutions to meet the needs of their communities.

One of Gertrude's significant challenges is that her closest family member, a brother, lived on the West Coast and they did not have a good relationship. She did not have local friends and rarely interacted with neighbors. Gertrude suffered from social isolation and did not generally trust anyone, especially officials that represent government or affiliated agencies. Gertrude refused to follow up with DSS or JABA for assistance and would always default to calling "her boys" when she needed care. The task force realized that the trusting relationship between Gertrude and the fire fighters could be used to help bridge a relationship with other agency staff. Therefore, the fire fighters would take on the role as the patient's advocate and slowly, but deliberately introduce DSS and JABA staff as their "trusted friends."


The process of putting the fire fighters in a role as the trusted friend proved to be very effective. The fire fighters spent generous time introducing Gertrude to the social workers and options counselors and often stayed during the initial assessment to help address questions and concerns. It turns out that Gertrude had significant health challenges, including undiagnosed mental health issues that exacerbated her declining living conditions. There was no doubt that gone unchecked, Gertrude would have continued on a downward spiral. Thanks to a group of dedicated public safety and social services staff, Gertrude is now receiving much needed care to improve her quality of life.

Creation of HUMAINS

Based on the success of Gertrude's case, combined with the need to address the high use of 911 services for nonemergency services among older adults, the task force formed the HUMAINS project--High Usage Customer Resource Network. The group's charter is:

".. to work collaboratively to provide resources to individuals that are frequent utilizers of the EMS system and have needs that cannot be met by the current system. This would include in home care, in home equipment or materials as well as external resources. Using all community resources available to aid in the betterment of the individual's quality of life and personal safety."

The HUMAINS group has expanded the team to include mental health resources and home health care. The group's caseload has expanded significantly, beyond its ability to address all needs. Long term, the strategy is to establish a sustainable program with full-time staff to help coordinate the efforts. In the meantime, Gertrude and other Albemarle County older adults are benefiting from a group of dedicated staff focused on helping their community. Vulnerable citizens who do not possess the ability or desire to seek added resources for their impediments are afforded the assistance of knowledgeable agencies genuinely dedicated to helping.

The HUMAINS project is an outstanding example of first responders projecting far beyond their typical service delivery model. The fire fighters, while willing to answer Gertrude's many calls for service, recognized that this defenseless little lady's needs exceeded their ability to truly solve her essential challenges.

The next time your agency identifies a need or challenge, take a look at the resources that already exist. Develop relationships with other agencies and determine if there is an opportunity to combine and create a force multiplier for problem solving. The future of service delivery is not likely to hinge on creating something new, rather on investigating the extant systems and thinking beyond your current vision.

By Dan Eggleston and Trish Suszynski

Dan Eggleston is the Chief of the Albemarle County (VA) Department of Fire Rescue.

Trish Suszynski is the Adult Services Supervisor with Albemarle County Department of Social Services.
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Title Annotation:locally speaking
Author:Eggleston, Dan; Suszynski, Trish
Publication:Policy & Practice
Geographic Code:1USA
Date:Feb 1, 2018
Previous Article:Leading at All Levels.
Next Article:PART 1: The Health and Human Services Workforce.

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