Social isolation and loneliness are prominent public health issues commonly presented in late adulthood. Social isolation and loneliness are associated with increased health risks, including premature mortality, dementia, depression, heightened stress, and suicidality. These issues are even more common among older adults with chronic medical conditions. The Program of All-inclusive Care for the Elderly (PACE) is a care model providing adult day services that include medical, behavioral, and social services. In addition to assisting with care, PACE helps address social isolation concerns, specifically providing activities for participants that are engaging and fulfilling. Unfortunately, Wyoming state budget cuts eliminated Medicaid funding for Wyoming’s only PACE program. Therefore, all 138 members were discharged from PACE services in October of 2021, and important opportunities for former PACE members to socially engage were also likely diminished. Little is known about the impact of PACE closure on social isolation and loneliness, or what service program features may be important to socially sustain individuals at high risk for nursing home placement like those served by PACE. The purpose of the current project is to (1) evaluate the impact of the PACE closure on social isolation, loneliness, and health; identify needs and preferences for interventions to address social isolation among clients who have experienced the closure of the PACE program; and (2) to develop and pilot an intervention that addresses social isolation and loneliness. These interventions would be designed for older adults who live in the Wyoming community and are at elevated risk for nursing home placement. The former PACE members will be involved in the development of the program through community-based participatory research methods. Collaborating ideas with the participants and community partners will be important in establishing and implementing an effective intervention in the Wyoming community. The findings of this project will help us identify needs and concerns relating to social isolation in older adults and provide direction in developing an effective intervention that promotes social engagement throughout Wyoming.
The project team spent the summer preparing and completing qualitative interviews with former PACE participants and a few of their caregivers.
The process included the following:
Cheyenne Regional Medical Center sent out letters to individuals who transitioned from the PACE program to outpatient primary care with the same PACE primary care provider. Then, follow up calls were made by the study coordinator, to determine interest. Participants who were interested in the study were scheduled for an interview at a location of their choosing.
Participants were asked to complete sociodemographic information, a current health status questionnaire, and psychological measures looking specifically at depression, loneliness, and levels of social support. After completing the quantitative measures, the study coordinator interviewed the participants. Interview questions included asking about experiences during and after PACE, what the loss of PACE meant for them, and how their physical, emotional, and social well-being were impacted after the closure. All interviews were audio-recorded and transcribed by a professional transcriber. To analyze the data, we are currently reading the transcriptions, creating a list of key words and similar responses to put into larger categories. These larger categories are being placed in a codebook to eventually collapse across similar words to create themes.
So far, we have interviewed 12 participants, but we are hoping to recruit more in the near future.
PowerPoint Presentation: The End of PACE: Opportunity for Advocacy and Education
This past month, the Wyoming Center on Aging presented at the Gerontological Society of America in Indianapolis about the impact of the PACE closure and future direction regarding care for the older adult community. The presentation provided information about the themes we have found so far in regard to the closure of PACE, including social isolation, care loss, transportation loss leading to treatment delay, and loss of physical functioning.
Enrolling new participants
We are still recruiting participants!
If you are a former member of PACE or a caregiver for a person who was discharged from PACE, we invite you to contact us. Please call: 307-766-2829 and ask to speak with Basia Dabrowski.
Creation of the Community Advisory Board
Following a community-based participatory approach, we will soon be reaching out to former PACE participants, caregivers, and other members of the community to determine interest in creating an advisory board team.
What will the Community Advisory Board do?
This advisory board will meet monthly. Members will assist with any of the following activities, depending on personal preference:
review study findings
brainstorm possible solutions to social isolation and loneliness
help to develop a program to keep people meaningfully connected to others in the community
brainstorm ways to make the issues and concerns of former PACE participants known to the Cheyenne community and beyond
help to advocate with legislators and other decision makers for quality services for older adults
Who will be eligible to participate in the Community Advisory Board?
Former members of the PACE program
Caregivers of individuals previously served by the PACE program
Healthcare, allied health, or social service providers who were previously employed in the PACE program
Healthcare, allied health, social service providers who currently serve older adults in the Cheyenne community.
Students with interest in a career working with older adults.
Contact WyCOA for more information! wycoa@uwyo.edu | (307) 766 -2829
