Wellness programming for retirees can help slash health care costs
Wellness programming for retirees can help slash health care costs
'Compression of morbidity' potential highest among seniors
Keeping employees healthy long after they retire is more than just a praiseworthy endeavor: It can help save big bucks, claim wellness experts. "It's important to target seniors from the perspective of health care cost reduction, mainly because these are the populations that have the greatest potential to have compression of morbidity," says Larry S. Chapman, MPH, chairman and senior consultant for Summex Corp., an Indianapolis-based health services vendor.
Compression of morbidity, Chapman explains, is a concept developed by James Fries, MD, professor of medicine at Stanford University in Palo Alto, CA. "What it basically asserts is that if you change the health risk behavior of a group, it actually compresses, or reduces, the morbidity in that group." Fries' most recent article on the topic appeared in the April issue of the New England Journal of Medicine."1
(Even elderly people who are frail and out of shape can benefit from starting a new exercise program. See the related story on p. 75.)
For companies that provide retiree benefits, this issue will take on growing importance in the years to come, Chapman predicts. "Many of us will have a longer work life even when we are `retired' - either through paying, or non-paying jobs," he says. "It is important that we are not impaired or limited by chronic conditions. At the same time, we know that disability increases with age. It's important to keep those individuals more active, more fit, and more capable of functioning."
Finally, there is an increasing level of health care use as one comes down to end of his or her life. But it is "very clear that the outlook improves if we improve behaviors," notes Chapman.
For the retiree population, then, wellness becomes a critical preventive health issue. "If we can keep them healthy and out of the hospital, it's a good situation for all of us," notes Keith Young, who heads the Health Care Region 8 UAW-Chrysler Training Center in Newark, DE.
There's also a human resources consideration involved in wellness programming for retirees. "We don't want our employees to feel that once they retire we've forgotten all about them," says Greg Gomolak, human resources staff executive at the UAW-Chrysler National Training Center in Detroit. "We know they have concerns, issues that affect them, that we need to take a look at." UAW-Chrysler provides its retirees with an annual conference that includes health care screenings, a health fair, and fitness programs, and offers several regional seminars, as well.
A healthier senior population is a worthy goal, but how realistic is it? Can individuals who have been sedentary for years be motivated to adopt a new and healthier lifestyle? "The evidence is that yes, they can," says Chapman, whose organization does considerable work with the senior population. "For example, it is often during the senior years that chronic disease starts limiting life activities; at that point, people are much more open to making changes." Of course, it's easier still if retirees are already practicing healthy lifestyle habits. (See the related story on p. 76, which details a retirement preparedness program for employees.)
Retirees are clearly not a homogenous group, Chapman notes. "There are different levels of compliance at different times, so you want to put in place a proactive kind of programming that allows you to monitor individuals and adjust your strategies accordingly."
For example, Summex uses a senior health risk appraisal instrument and screens retirees every six months to reassess their health status. "Also, we are using `stage of readiness to change' assessments to see where they are when they start," he says. "Our programming is built off of those findings."
Wellness programming for seniors carries its own set of challenges, says Chapman. Here are a few of the more common challenges, and recommendations for addressing them:
Distance: Many retirees live far from the headquarters' fitness facility. This requires a more pro-active program that reaches them by phone and/or by mail. Make sure to use large print that is easy to read and understand, and follow up by phone on a regular basis.
Different levels of physical fitness: Put together a questionnaire that will tell you what activities the individual is engaged in. Younger retirees (55-65) tend to have very low levels of disability, and can perform a broader range of exercise. Once they get beyond 65, many become sedentary. "The length of sedentary time before beginning to exercise again is one of the keys to designing the program," says Chapman. "It requires specialized knowledge, such as that provided by the American College of Sports Medicine."
Work with a self-care vendor with a seniors specialty. A self-care generalist may not be qualified for the job.
If you are just starting to program for seniors and/or retirees, Chapman recommends that you incorporate the following components:
· A health risk appraisal every six months;
· A personalized follow-up report sent to the individual that is geared to his personals needs, including specific suggestions;
· A selection of self-directed change materials to help them start getting active. The materials may include a 12-week physical activity program, including sections on stretching, record keeping, what to eat, what shoes to buy, and so forth.
· A toll-free health advice line that is sensitive to senior issues
· A medical self-care component covering both acute and chronic conditions.
· An incentive program that includes medication compliance and medical care recommendations. "This population is probably more motivated by money than the working population," Chapman notes. Consider premium rebates, or supplemental medical coverage discounts. "Those would be pretty powerful," Chapman says. Also, link your incentives with merchandise that is self-care oriented - such as cold packs or heating blankets.
(A comprehensive list of strategies for senior wellness programming in the managed care environment can be found in the story on p. 77.)
UAW-Chrysler has put some of these principles into practice with its post-retirement program. "We bring retirees into our national training center here for a two-day conference, and then we hold a couple of one-day conferences at selected regional centers around the country," says Gomolak. This year they will be in Syracuse, NY, and St. Louis.
Local retiree chapters at those locations coordinate the regional programs. For the national conference, the national training center works through individual active locals, local presidents, and retiree local chapter chairs. "We send out what we call a `call letter,' at least 60 days prior to the conference, and sometimes 90-120 days before," Gomolak says.
Health screenings are provided for all attendees. They include blood pressure, cholesterol, glucose screening, and a bone density scan. "This is important; a lot of the retirees are scared to go to the doctor. We felt if we made the screenings available, and as painless and as quick as possible, they would go through the testing process," explains Darrell Motley, UAW international representative in Detroit.
The national conference also includes seminars on long-term health care, and a video presentation on positive aging. "Out fitness director gives a presentation on aging slowly," notes Gomolak. Other topics include financial planning, social security, tuition assistance, and UAW legal services. "We also bring them up to speed on training programs we do here that affect current employees," he adds.
Each year, UAW-Chrysler also sponsors a Health Care Awareness Month, which includes health fairs. "Our retirees are invited to these health fairs," says Young. "They include prostate cancer screenings, and the distribution of self-care guides." All sessions and programs are free of charge to retirees, he notes.
"These programs are also financially beneficial for the company," says Motley. "It's a cost-saver to both employer and employee."
They have also been popular with their targeted population. "I believe over 75% of the retirees who were here this year have gone through the screenings," says Motley.
Reference
1. Vita A, Terry R, Hubert H, Fries J. Aging, health risks, and cumulative disability. N Engl J Med 1998; 338:1,035-1,040.
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