Checking in on You: Addressing Loneliness With Care Callers

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Tom Haederle
Today's state of the art medical inventions achieve many amazing things. But to treat one particular condition that has great impact on a person's mental and physical health, care providers have turned to a much simpler tool. Something just about everyone has. The humble telephone.

00;00;30;06 - 00;01;05;07
Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA Communications. As highlighted in the U.S. Surgeon General's Advisory on Loneliness and Social Isolation released earlier this year, the impact of social isolation on physical and mental health is profound. Experts say loneliness is something we must pay more attention to as a society. Meritus Health of Hagerstown, Maryland, has heeded the call, enlisting volunteers to start making calls to patients who say they would really appreciate being checked in on now and then and offered a connection with a caring human voice.

00;01;05;10 - 00;01;19;21
Tom Haederle
The pilot program has been a huge success, as we hear in this discussion between Jordan Steiger, senior program manager of clinical affairs and workforce with AHA and Maulik Joshi, president and CEO of Meritus Health. It's a great story.

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Jordan Steiger
Maulik thank you so much for joining us today. The issue of loneliness is something I know is a big interest to our membership right now, and it's a conversation that's been happening on the national stage given the Surgeon General's interest in this topic. So we're really excited to have you here to talk about this.

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Maulik Joshi
Jordan, thank you so much. It's a real delight and just happy to be able to share and learn with each other.

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Jordan Steiger
Great. So tell our listeners a little bit about the issue of loneliness and why it's a public health concern for all hospitals and health systems.

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Maulik Joshi
Absolutely. So, you know, the impact on being socially isolated or lonely on your physical and mental health is pretty profound. It really is amazing. I think intuitively, we all think, yeah, mentally it can make you feel depressed and isolated, and that's all true. But on a physical basis, they say being lonely is like smoking 15 cigarettes a day.

00;02;16;14 - 00;02;40;25
Maulik Joshi
That's the impact on your health. So we know it's a significant public health issue. Like many things in the silver lining of COVID, this was heightened during COVID. We realized like, wow, we really need to connect with people and engage with people. And it gave us the opportunity to do that in different ways with different people. But this has been an issue that was prior to COVID and now we really need to work on it as a nation.

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Jordan Steiger
I definitely agree. So you have a program at Meritus Health called "Care Callers" that I know is addressing this very issue. So tell us a little bit about that.

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Maulik Joshi
Absolutely. I'm very passionate about this. I appreciate the chance. So, Meritus Health, just a quick 10 seconds. You know, we're not for profit health system in western Maryland. We serve a community of over 200,000 people. And our mission is simple: improve the health of our community. We have a Mertius Medical Center, 327 beds. We have a medical group.

00;03;13;19 - 00;03;34;23
Maulik Joshi
We have a variety of things, over 4000 team members taking care of our community. So we decided about a year and a half ago, let's really address loneliness. So when a person comes to our doctor's office, we ask them some questions. We ask them kind of the standard social determinants of health screening. Do you worry about putting food on the table?

00;03;34;25 - 00;03;58;10
Maulik Joshi
Do you worry about paying your utility bills? And have you been lonely? So if they say, yes, I'm lonely, we then have a care manager call them and say, Hey, would you want someone to call you once a week, once every two weeks, just to check in? Say hello ten, 15, 20 minutes. And what we've found is that program has really taken off.

00;03;58;11 - 00;04;28;15
Maulik Joshi
We started with a pilot and we started with volunteers. And we grow and grow and we're now up to calling 350 people every week or two weeks between almost 40 volunteers and two paid care callers. I'm one of the volunteers and my leadership team are volunteers. As I say, if you can round on patients in our hospital, you can round on people in your community because that's our job to take care of our community.

00;04;28;15 - 00;04;41;22
Maulik Joshi
So I love it. I can talk a lot more about kind of how we go on about it, but it's a simple way to engage with people in your community, to be social, to just check in and to help them.

00;04;41;25 - 00;05;01;29
Jordan Steiger
That's an incredible program and approach. I love that you mentioned this is kind of a social determinant of health and just folding that into your greater strategy and thinking about things like food security and, you know, loneliness is one of those things that we have to be thinking about as well. So I think that's really, really great. And I love that you yourself are a care caller.

00;05;02;02 - 00;05;07;14
Jordan Steiger
Can you tell our audience maybe an impactful conversation you've had with somebody?

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Maulik Joshi
Yeah, I mean, I can tell you first a number. So I started with someone and honestly, we used to talk about sports all the time. He was in his mid fifties. He actually came out of the correctional facility after being in for 15 years. Wow. He went to a doctor's office. We started chatting one day was like, oh, you know, I'm just going.

00;05;28;02 - 00;05;46;01
Maulik Joshi
He's like, Yeah, you know, I checked off this box that I was lonely when I was going in for a doctor's office, and this is nice. And again, we just talk about sports. He's since moved away, but it was a good way to connect. My two current people...one, she is 97 years old and she lives by herself here in the community.

00;05;46;03 - 00;06;06;18
Maulik Joshi
And I've been talking to her for a year and a half every week, sometimes every two weeks, 15 minutes. You know, sometimes we restart our conversations, but we always remember certain things. I can tell you about her. She enjoys watching Jeopardy at night. I know where she got married. I know where she likes a vacation, all those things.

00;06;06;20 - 00;06;24;03
Maulik Joshi
But the fun part is, you know, after a few months of talking to her, I missed calling her one week because I had some other things going on. And she called me and she called me to check in on how I was doing and even remembered that I had allergies and was asking me how I was doing during allergy season.

00;06;24;05 - 00;06;42;07
Maulik Joshi
The second person; she also, you know, lives in the area by herself. We chat in so many ways in the story. I'll tell you about her ... we actually ran into each other last week. She was coming in for a doctor's office visit. I was coming into the building and she kind of noticed me. I kind of noticed her. 

00;06;42;07 - 00;07;01;20
Maulik Joshi
I had not physically seen her for a year and a half. We've just been on the phone. And so, you know, these all create bonds and relationships. We're not social workers. We don't we're not, you know, solving things, but we're really just being trying to be good human beings, talking to other human beings, making a difference. So I love it.

00;07;01;20 - 00;07;25;12
Maulik Joshi
And our team is all in. So again, we have leaders. We have over almost 40 volunteer years who do this. And these volunteers are people in the organization, people outside the organization who've heard about the program and want to call. So as we say in our volunteer, it doesn't take a lot, but it still takes a commitment. But 15 to 20 minutes a week. By the way, you know, how we got started is we found a little education.

00;07;25;14 - 00;07;44;27
Maulik Joshi
We kind of took it off the Internet. We modified it for ourselves. So every volunteer gets like a 30 minute education. You know, the things to talk about, if there's ever any issues, who to refer them to. Lots of different ways. But it's not like we're that, you know, highly trained individuals. We're just trying to be good people talking to each other.

00;07;45;00 - 00;07;57;22
Jordan Steiger
Well, it sounds like you're not even always necessarily talking about people's health with them. You're just connecting over human things like sports. You're mentioning your allergies, vacation, just these normal day to day conversations.

00;07;57;24 - 00;08;17;22
Maulik Joshi
Absolutely. So it's both. The cool part is also I've been able to send our mobile clinic to one of our houses to give them a COVID vaccination booster. So that worked out great. In other conversations when I have if they need transportation, Meritus provides a lot of transportation. I was able to help that person get to their doctor's office visit.

00;08;17;28 - 00;08;37;13
Maulik Joshi
So we are able to kind of help medically. But you're right, the non-medical is just having a chat about what's going on. You know, what about all this weather, right? I talk about some of the things we're doing at Meritus. And one of them asks me, how's that medical school coming along? So it's kind of fun to have this relation ship with each other and it's not like a appointment.

00;08;37;13 - 00;08;55;26
Maulik Joshi
I vary my times when I call. I call sometimes on the weekends, in the evenings, most of the time. And again, it's just a way to connect with people. But I have to say I'm just one example. There are so many individuals who are doing it. I have to add one more thing. About six months ago we said, Hey, what if we bring them in?

00;08;55;28 - 00;09;14;03
Maulik Joshi
And we invited them to come just during a lunchtime and we pair them with their Care Caller? And we just had a lunch and there were 30 of them there. And so people said we should do this again. So I think these are all little ways that we're trying to just impact and I have to tell you about the impact is is absolutely amazing.

00;09;14;03 - 00;09;37;04
Maulik Joshi
So we've been at it. We ask people four months after they've been in the program, are you less lonely? Out of 125 people, 118 people say they're less lonely. So even forgetting aside again, whether it's utilization, reduction or any of that, we're actually just making people feel less lonely. That's not bad.

00;09;37;06 - 00;09;51;22
Jordan Steiger
That's not bad at all. And I mean, in addition, like you said, you're connecting people to other services that you have. You're connecting them to others in the community by bringing them together. I think the positive outcomes are just it sounds like, you know, tenfold from this one program.

00;09;51;24 - 00;10;11;17
Maulik Joshi
And we actually just hired paid care callers in the last few months. So before that it was all volunteer run. And I would give that as advice to others who are thinking about things. Sometimes we over design our interventions and if we just say let's start small. Let's just -  literally this is what we did - we said, let's try this.

00;10;11;19 - 00;10;30;29
Maulik Joshi
A couple of us got names of people to call and we just called and we just built it from there. So I would always say just start, and start with volunteers. Build from there. Sure, we're spending a little bit of money, but not a lot. And we feel like the benefit is just big in terms of the the the well-being of the people we serve.

00;10;31;01 - 00;10;42;26
Jordan Steiger
Absolutely. And I think, you know, so many people go to work at hospitals and health systems because they care deeply about others. So I think this is a great way to engage your workforce and in doing work that is really meaningful.

00;10;42;29 - 00;11;07;01
Maulik Joshi
Absolutely. It really, I think, talks to the to the human heart and why we are doing what we do. Clearly, hospitals and health systems throughout the country, they provide unbelievable medical care,  righht? From the emergency room to delivering a baby. It's unbelievable. We really work with health care heroes. This is just another element of that. And it's the non-medical part.

00;11;07;01 - 00;11;12;29
Maulik Joshi
But you'll see hospitals and health systems doing this all over the country. And these are just amazing special stories.

00;11;13;02 - 00;11;21;18
Jordan Steiger
Yes. And I think it's really exciting that we're able to share them today and, you know, hopefully inspire other members of AHA to start something similar if they don't have it.

00;11;21;21 - 00;11;39;08
Maulik Joshi
Then the one thing I would add is, you know, if there's any one thing I would really say is important is the social determinants of health is an input, not an outcome. And that's what I think this program is. We know loneliness is an issue, so we gather that and we collect it, but we're working on the what to do.

00;11;39;10 - 00;11;52;14
Maulik Joshi
And so to us that's social determine health is just an input. It's not the description of who they are. Getting to the outcome: I'm less lonely, that's what we're striving for. And I think that's the most important part, is think about the outcome versus just collecting all this data.

00;11;52;21 - 00;12;01;01
Jordan Steiger
Absolutely. Do you see any patterns or populations maybe of people that seem to be more lonely than others?

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Maulik Joshi
Yeah, you know, this is really interesting. So you think, well, maybe it's people who are not married who might be older. But what we found is of all the people who've been in now, we've had over 500 people in our program. A third are between 30 and 50 years old. Almost a third are married. So actually, I think it's that anyone can be lonely, unfortunately.

00;12;24;24 - 00;12;37;20
Maulik Joshi
And so, yes, there maybe a little bit more. And the older Americans and others. But really we're seeing people who are married, females, males doesn't matter where you live, who you live with. It's an area that we can address.

00;12;37;23 - 00;12;55;19
Jordan Steiger
And I think that speaks to the importance of what you mentioned earlier about screening everybody that comes in. It's not just focusing on maybe older adults who are coming in. You know, I think that's the stereotype people think about with loneliness and really making sure that you are able to reach anybody that needs that that extra support.

00;12;55;24 - 00;12;57;17
Maulik Joshi
Absolutely. Absolutely.

00;12;57;22 - 00;13;08;26
Jordan Steiger
What advice would you give other hospitals or health systems who want to get started with something like this? I know you said start small. Don't make it super complicated. Anything else, though, that you think is important?

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Maulik Joshi
Yeah, I mean, a great point. Again, start. I think that's the most important. Use quality improvement mindset. I think sometimes when we think about social determinants of health, it's complex, right? Absolutely. It's multifactorial. No one thing is going to solve all our our woes of health. But if you think about what you can start improving and how do you keep testing and how do you keep learning and making the program better, you get far fast and that's what you know.

00;13;37;01 - 00;13;53;29
Maulik Joshi
I say learn and fail fast, right? Because we started this with like, Hey, this sounds like a good idea. Let's give it a shot. And we just built it from there. We didn't create a big team. We didn't have a task force. We didn't set aside a budget. We didn't identify ten people. We just had a couple people said, should we try this?

00;13;53;29 - 00;14;16;23
Maulik Joshi
Why not? What's the harm? And so I would really keep saying, keep trying, because the more we can do, the better it's going to be. And we like many organizations, we're an anchor for our community. That's our job. That's our obligation to our society. And so we have to try these things. They won't always work. And I bet you someone else in the field will come up with something better and I'd like to learn from them.

00;14;16;23 - 00;14;20;11
Maulik Joshi
And the more we can try these things, the better we can all go faster.

00;14;20;18 - 00;14;26;26
Jordan Steiger
Absolutely. I think that speaks to the importance of sharing this. And if I ever hear another good example, I'll make sure I send it your way.

00;14;27;03 - 00;14;28;14
Maulik Joshi
I love it. Thank you.

00;14;28;16 - 00;14;41;16
Jordan Steiger
Yes. So as we wrap up today, Maulik, what do you think is really the most important takeaway for our listeners about loneliness, about the Care Caller's program, about engaging the community? What do you think is the biggest thing?

00;14;41;18 - 00;15;05;26
Maulik Joshi
Yeah, I think we've all talked about social determinants of health a lot, and they're certainly important. I think, number one, maybe this is not a top of mind or priority for your organization. Maybe it is food insecurity, maybe it's homeless, maybe it's other things. So I'd say pick the ones that matter. But again, to focus on the intervention and the improvement. We're going to always have the data, we're going to know the issue, but we've got to try.

00;15;05;26 - 00;15;12;17
Maulik Joshi
And so I think it's it's get started and and keep interviewing, keep implementing, I guess, improvements.

00;15;12;19 - 00;15;29;10
Jordan Steiger
Malik, thank you so much for joining us today to share more about your work and to enlighten our membership a little bit on the issue of loneliness. Again, I think this is something that's really important to a lot of communities across the country. So we're really grateful that you were willing and able to come share it with us.

00;15;29;13 - 00;15;37;11
Maulik Joshi
Thank you to the American Hospital Association for all you do, and thank you for the opportunity to share this. We're happy to share and happy to learn. We appreciate it.