The exterior of Catholic Charities.

Over the past several years in communities without free clinics or for those in the countryside with little connection to the outside world, a growing number of people living there – neglectful of their health for years – would often find themselves in hospitals awaiting treatment for illnesses that may otherwise have been avoided, putting a greater burden on the state’s medicaid system.

A new program locally, stemming from efforts meant to reduce those with preventable illnesses entering New York State’s hospitals, hopes to prevent these problems by going directly into the communities, “coaching” individuals on how to properly take care of themselves. Offered through Catholic Charities of Tompkins and Tioga County, the program, funded through a grant by Care Compass Network, seeks to “assist individuals in taking proactive steps to care for themselves and in developing a sense of control over their own health” through a mix of outreach, relationship building and more through community centers in the most far-flung reaches of the county.

Unlike a moving clinic or doctors providing house visits for patients, the program will look to directly teach its clients how to take on sustainable practices for long-term health, similar to programs already in place by groups like the Visiting Nurses Association, which trains people being discharged from the hospitals to care for themselves and follows through post-procedure with periodic checks, to ensure vulnerable patients are looking after themselves.

The model being pursued by Catholic Charities is somewhat different, in that the organization is focused more on pre-emptive care, trying to stave off preventable ailments before they happen. To reach potential clients, people like Sarolta DeFaltay, a Community Health Worker with Catholic Charities, have been focused heavily on performing outreach around the program, visiting local food banks and churches to connect with community members who might be able to benefit from what the organization has to offer.

“Maybe it’s not you who needs this service, but maybe you know someone,” DeFaltay said. “The people who need this program most might not be the ones to hear about it from a newspaper or online, but they might hear about it in line at the food bank, or from a local pastor.”

While preventable admissions to hospitals have been decreasing gradually among medicare patients over the past several years, according to the most recent data from the Iroquois Healthcare Association, which monitors New York hospitals, costs to the medicaid in New York State in particular saw gradual increases during that same time period. This, in turn, spurred the creation of the Delivery System Reform Incentive Payment (DSRIP) program, created with a specific goal to achieve a 25 percent reduction in avoidable hospital use over five years and setting the groundwork for this new program by Catholic Charities. The organization, DeFaltay said, is targeting rural areas largely because of their residents’ lack of access to care as compared to that experienced by city residents, who are close to various social services – like local food pantries or the Ithaca Free Clinic, located downtown – and might be more prone to be connected to their community.

“Research has proven the more proactive people are with their health care, the more likely they’ll be doing preventative care as well as visiting primary care doctors, versus going to the hospital or the emergency room,” DeFaltay said.

Anticipated need for the program is currently unknown, as Catholic Charities seeks to cast a wide net, looking to reach out to the elderly, people exiting physical therapy programs, and anyone suffering a health or wellness issue: essentially, anyone who could benefit from someone keeping them on a routine and offering them connections to the community they otherwise, may not seek out on their own. Doing so, however, involves the challenge of finding ways to motivate clients to take on making those changes voluntarily. Sometimes it’s about connecting with people who might be overwhelmed by all their appointments and health problems, helping them to break down massive problems they might be facing into smaller, more manageable tasks – like limiting one’s self to a single cigarette a day by the end of the month to taking a bike ride three times a week – to help spur other, positive changes in their lives.

“We’re pretty wide open as to who we can serve and in what way,” DeFaltay said. “It’s really about the person being self-motivated, because real change doesn’t happen unless someone wants that change. They have to be motivated.”

According to a news release accompanying the announcement, participants will choose which personal health issues they will focus on, whether it be addressing issues with diabetes or smoking to asthma and obesity.  Some program participants, according to the release, will be offered “health-positive” incentives such as access to free classes on exercise, cooking, and gardening, and those without transportation can access home visits should they choose to. Workers with Catholic Charities will also help clients recognize the warning signs they shouldn’t ignore, as well as assist clients as they manage their health records in order to give their health care providers accurate information.” 

For more information about the Health Coaching program, the public can contact Sarolta DeFaltay by calling 607-272-5062 ext. 29, emailing sarolta.defaltay@dor.org, texting 607-481-3060, or stopping by the Ithaca office.

Follow Nick Reynolds on Twitter @Nickthaca

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