'Senior Sensitivity' training helps staff understand

Participants simulate vision and hearing loss

Before they start their job managing the care of senior members, case managers at Senior Care Action Network (SCAN) Health Plan try to sort pills while wearing heavy gloves, strain to understand a speaker whose voice is muffled, and fill out a medical information form while wearing special glasses that simulate vision loss.

It's all a part of the Long Beach, CA-based Medicare Advantage Plan's Senior Sensitivity program to help employees feel, see, and hear what common physical and cognitive changes that occur with aging actually feel like and understand how much loss seniors experience as they age.

The health plan requires the Senior Sensitivity training for all of its employees, including board members, says Sherry Stanislaw, senior vice president at the health plan.

"The training is a good complement to the clinical training of the nurses and social workers, because they literally get to be in the shoes of the seniors. It helps our staff understand the challenges that their clients face in their everyday life and in adhering to their treatment plan," says Lisa Roth, MS, gerontology, director of independent living power and geriatric health management and monitoring.

For instance, during the training, Roth had to walk around with popcorn in her shoes to experience the pain of neuropathy or arthritis in a senior's feet.

"This class helps our case managers understand the problems that members face so they can work with them on strategies that keep them safe at home and out of the hospital. If the senior's eyesight or hearing is limited, the case managers know how to overcome the barriers," Roth says.

The health plan started its Senior Sensitivity training about five years ago.

"The program is based on experiential learning. We use tools to accelerate aging and help the participants understand how seniors may struggle with everyday activities as well as the challenges they face as they maneuver through the health care system," Stanislaw says.

Tools include vision loss glasses that simulate glaucoma, cataracts, and other eye diseases.

In one exercise, the participants are asked to put on the glasses and a pair of bulky gloves and try to open a pill bottle filled with small candies, and then sort the candies according to color.

"This exercise helps the participants understand how seniors struggle when they have arthritis or have lost dexterity in their hands and at the same time have impaired vision," Stanislaw says.

It's a real "ah-ha" moment for many case managers, who often suggest that members who are on multiple medications fill the compartments in a pill box with their medications for each day of the week, says Kelly Giardina, MS, gerontology, manager of geriatric health management and monitoring.

"It was hard to fill the box while we had gloves on. Another challenge was trying to separate pills by color while wearing glasses to simulate vision loss. It helps the case managers consider if they are being realistic to expect seniors to fill their pill box. From our perspective, it's easy to think they could use a pill box, but if they have a deficit, it could prevent them from implementing the plan. Typically, they need to have someone set up the pill box for them," she adds.

The participants have to fill out a standard medical information form, similar to the kind used in physician offices, and fill it out with their left hands (to simulate impairments caused by a stroke) and while wearing the vision-altering glasses.

They must write down what they hear on a tape when the speaker's voice is muffled.

"During the classes, we talk about common hearing loss problems, which are common in the senior population. Many seniors can hear vowels but lose their ability to hear consonants, particularly on the end of words. When we play the tape, the participants are straining to hear and understand, and most of them get most of the words wrong," she says.

The program also deals with psychological losses that occur as people age. The participants have to write down the three most treasured things they have - family members, jobs, etc. The facilitator walks through the room and starts snatching things away from the participants.

"It's amazing how people react when the facilitator takes away the things that are important to them," she says.

A memory loss exercise gives participants a list of items that they have to remember.

"At the same time we are doing these exercises, we also remind participants that you can never stereotype seniors. Not every older adult experiences all these losses. A lot of it is individual," she says.

The trainers give the class tips on how to compensate for the disabilities during their interaction with members.

The case managers at SCAN range in age from the very young to those who are almost seniors themselves. Some have experience working with patients face to face, but others have only telephonic case management experience, Roth says.

"Without the experience of a deficit yourself, it's hard to understand what seniors face in the real world and to come up with unique ways to help members be adherent. The classes give them the feel of having a deficit and serve as a good reminder to put ourselves in the situation of the seniors," she adds.

Part of the initial case management assessment is to gather information that helps the case manager understand any challenges the member may face, Roth says.

"We ask about their vision, their hearing, and other functional aspects to assess some of the potential challenges the member has, so we don't assume that the member can do things or understand things when they can't," she adds.

The case managers learn to adjust their pace and their volume as they interact with members, Giardina says.

"They stop and confirm that the member understands what they are saying and can repeat it back. It is a matter of adjusting interactions to compensate for whatever deficits the member may have," she says.

The case managers are trained to look for signs of deficits and vary the services they provide based on the different needs of their clients, Roth says.

For instance, if someone is visually impaired, the case managers may send them information in large print or provide an audio resource for the information.

"As a result of the program, the case managers work with the physicians to get the members a large-print copy of the medical questionnaire and send it to the members ahead of time.

"The case managers in our geriatric health management program always work on preparing the members for their doctors visits, helping them gather the information the doctor needs, and empowering them to make their doctor visits successful," she says.

As a backup to help overcome hearing and memory deficits, after the case managers talk to members, they send out a letter recapping what they have gone over during the telephone call, Giardina says.

"We do this because many of our members have trouble hearing, and it gives them the information in writing that they can take to their doctors," she adds.

The health plan uses risk stratification software to identify high-risk members based on their diagnoses and prior medical encounters.

When a member is determined to be at risk for hospitalization, the health plan's outreach staff contact them to find out if they are interested in enrolling in the case management program.

The case management program also receives referrals from physicians and from members who learn about the program and want to participate.

The case managers work with the members to help them manage their health care and adhere to the treatment plan. In addition to their extensive assessment, the case managers have information generated from encounter data with the physician medical group and hospitals.

"They have a picture of the patient before they call them. This puts us in a good position to come up with a plan to help the members manage their chronic conditions and live as independently as possible," Roth says.

The case managers use motivational interviewing techniques to determine the members' willingness to make changes and help them set short and long-term goals.

In addition to requiring Senior Sensitivity classes for its staff, the health plan has offered customized training to contracted providers to help them understand the challenges that the senior members face. For instance, during the training, the staff at physician offices spend a lot of time trying to fill out the patient registration form while using equipment that simulates deficits.

In Arizona, the health plan recently partnered with Dependable Medical Transportation Services to train more than seasoned van drivers about the challenges that seniors face.

SCAN has given classes to elementary school children to help them learn to better understand their grandparents.

"We talk to the kids about communicating with their grandparents and teach them techniques, like being face to face when they talk, so the seniors can hear them and pick up on both visual and audio cues. It's all a matter of understanding the other person's challenges," Stanislaw says.

(For more information, contact Lisa Roth, MS, gerontology, director of independent living power and geriatric health management and monitoring, e-mail: lroth@scanhealthplan.com.)