Case Study: Getting in Front of COVID-19: Addressing Social Determinants of Health to Save the Lives of Seniors
Humboldt County, CA
The first case of COVID-19 in Humboldt County, Calif., was confirmed on February 20, 2020. As of April 4, the number of cases in the county total 44. Three-quarters of Humboldt County’s cases are located around areas with the largest populations: Eureka, Arcata, Fortuna and McKinleyville, which are all larger communities located in the north and west end of this vast frontier area of over 4,000 square miles.
Southern Humboldt Community Healthcare District (SoHum Health) is located in Garberville, California. This is a town of 1,126 residents in the southern-most end of Humboldt County, 65 miles from the principal city and county seat of Eureka to the north and west. It has not yet recorded a positive test for COVID-19 and hopes to keep it that way.
As the number of cases of COVID-19 in the county grows, it is critical to minimize avoidable exposure to COVID-19 whenever possible. Because some individuals who contract the COVID-19 virus have no symptoms or only mild symptoms, they may not be aware they are carrying the virus. Residents have been instructed to shelter-in-place and practice social distancing if they must go out.
Experts agree that seniors and those with comorbidities and compromised immune systems are at greatest risk of illness from COVID-19. Seniors with comorbidities are at the apex of risk categories. At SoHum Health, senior initiatives are a strategic priority. For that reason SoHum Health has gone to extraordinary measures to secure the safety of the 3,400 seniors in its district.
Jerold Phelps Community Hospital is the anchor for SoHum Health. This is a nine-bed critical access hospital with a 24-hour emergency room; acute care inpatient unit; outpatient services, including lab, radiology, and mammography; eight-bed skilled nursing facility; rural health clinic; and family resource center.
Mobilizing the assets of the family resource center, SoHum Health has established a vast network of clinical professionals, social workers, care givers and volunteers to cater to the needs of area seniors whom are sheltering-in-place. Among its many services include several that address the social determinants of health for housebound seniors such as assistance with basic needs: groceries, clothing, hygiene supplies, housing and transportation.
SoHum Health intervenes with seniors proactively so they may shelter-in-place. Specifically this is accomplished through direct contact with senior residents and follow-up by volunteers and as necessary, clinicians.
SoHum Health’s Senior Life Solutions (SLS) is an intensive group therapy program designed to meet the needs of individuals over the age of 65 struggling with depression and anxiety often related to aging. Due to the current shelter-in-place order and the design of the program, SLS is being suspended indefinitely. During the COVID-19 crisis, this facility has been repurposed as a communications center.
Hospital staff and trained volunteers make calls to seniors to determine their needs – groceries, pharmaceuticals, errands – and schedule visits to keep seniors home and safe. Using a 16-question script and action plan, SoHum Health has organized a broad coalition of support from the Humboldt County Department of Health, Office of Emergency Services, Chamber of Commerce, local banks, fire districts, service groups such as Rotary International and others to provide for their needs.
The Healy Senior Center in Redway, California is an important resource to seniors in Southern Humboldt County. It operates a certified Meals on Wheels Program that delivers hot and frozen meals three days per week. Working with SoHum Health, it is crucial to meeting the nutritional needs of homebound and disabled adults over 50 years old.
Like other hospitals, Jerold Phelps has experienced decreased inpatient, outpatient and ER visits of about 50%. While this is a blow to its finances, it allows the health district to redeploy its staff. Senior Life program staff, medical assistants, hospital registration staff and Family Resource Center staff and a social worker are assisting with calls and deliveries. The local Rotary International chapter and other organizations have initiated telephone greetings for seniors to reduce their social isolation.
The early success of this initiative is the result of and a tribute to the many organizations and the dozens of volunteers who make it happen. Collaboration is ongoing, and the Healy Senior Center has been instrumental in coordinating delivery and logistics.
Humboldt County has significant gaps in its internet service due to broadband deficiencies. SoHum Health quickly had to improvise with its telephone network to fill these gaps.
Communicating about the pandemic and the public health threat is vital to saving lives. Using local media outlets like the Redheaded Blackbelt, press releases, websites and social media such as Facebook, Twitter and Instagram have helped canvas the community and raise awareness of the need for sheltering-in-place and social distancing as well as the availability of services to support these efforts.
SoHum leaders are planning to relocate nursing home residents to a local hotel. In the event of overcrowding due to a COVID-19 surge, the skilled nursing facility is a better venue for inpatient care and will allow the hospital to separate its patient population to minimize community spread. With only one portable ventilator and no ICU beds, this separation is imperative. Additional efforts include expanded telehealth services using the Southern Humboldt Community Clinic, a full-service rural clinic and visiting nurse program.
Because of its frontier nature, mail is typically delivered to post office boxes located in town. To alleviate seniors from having to go out, SoHum Health is working with the U.S. Postal Service to serve as carriers during the crisis and keep seniors safe.
The goal for SoHum Health now and into the future remains to keep seniors healthy and reduce their exposure to COVID-19. Plans are in place to address contingencies should the community experience a surge, but hopefully that will be avoided by proactively addressing social determinants of health for seniors.
The broad relationships formed in this effort have proved successful in keeping seniors safe. It has also opened the vision to new services to promote the health of the whole person through telehealth, social networking and personal wellness.
CEO, SoHum Health