Headline
Program led by a nurse practitioner and community health worker improved housing stability, access to primary care, and chronic disease management among older women experiencing homelessness.
Background
Homelessness amongst individuals 55 and older is increasing, with women in this population experiencing greater health disparities than men. Bridges to Elders is a care management program led by a nurse practitioner and community health worker to address the health and social needs of women in a Boston shelter. This study measured the program’s impact on participants’ housing stability, access to a primary care provider, and chronic condition status.
Findings
The team conducted intake assessments with all participants to understand their medical and social needs and followed up with individualized visits and case management activities. Data collected during enrollment and following program completion were analyzed to determine any changes in measured outcomes. Among the participants included in the analysis, there was a 17% increase in housing stability, 35% increase in primary care access, and 47% decrease in reported uncontrolled chronic conditions.
Policy/Program Takeaways
Multidisciplinary care teams including a community health worker can provide community-based, individualized care to older adult populations who need support managing their complex health and social needs. Community-based organizations and health systems can apply this evidence to inform implementation of specialized programs like Bridges to Elders.