began in 2017 by putting our Why into action at a low-income apartment complex in the Twin Cities; one afternoon a week with nurse volunteers providing a variety of social, functional and physical healthcare services to help elders self-care manage their complex chronic illnesses and the challenges that arise with aging. Our programs and interventions have helped program participants identify best and better self-care management skills to maintain their healthy blood pressure, glucose control, minimize isolation, increase their mobility and socialization, as well as identifying when to utilize health system resources, early and appropriately, to avoid a health care crisis.
We provide a range of free services, most times the same services to the same elders which helps each maintain their independent living, facilitate access to community services, confirm treatment plan understanding, and allows for early identification of emerging or urgent health needs. The population served, most with complex physical and social histories, are multicultural elders living independently; listed below, foundational programs with population outcomes.
To learn more about this community work or how Wisdom Wellness can happen in your senior housing community, please reach out info@wisdomwellnessmn.org
Care Coordination Program
In 2023, this program saw more than 700 participants with attendance at the weekly afternoon clinic being about 15-18 seniors each week. All received weekly vital sign checks, received Just in Time Care, and had a 1:1 conversation with a clinician to help the seniors manage their self-care. Of the total participants 80% take multiple medications, and live with hypertension (84%), diabetes (63%), hyperlipidemia (63%), asthma/COPD (34%), arthritis pain (28%), all live below the poverty level, and in a study on medication adherence with 22 program participants 35% were taking medication for depression. While the clinical picture is important, the value that Wisdom Wellness brings is an authentic appreciation of the human condition-who people are, what their lived experience has been, and how we work together to support what matters most to the elder in their self-care management plan, in their living spaces.
Frail Elder Visitor
Many seniors ‘living independently’ in community dwelling apartments, over the course aging with multiple chronic complex conditions, at times, become unable to leave their apartment. Numbers to this program vary as individual circumstances change over the course of time. This program reaches out to those individuals in their apartments; we visit during the weekly Wisdom Wellness open clinic providing the same services offered with our Care Coordination or Just in Time Care programs.
Outcomes: Reduction in isolation from the larger community. Early identification of any decline that might lead to an unsafe living environment and with Wisdom Wellness intervention, triaging to social services and other community resources, early mitigation of the negative effects from declining self-care.
Just in Time Care
In the course of the normal aging processes, older adults benefit from intentional time, accommodations, and thoughtful explanations of how to self-care manage medications, wounds, oxygen equipment, glucometers, self-injections, accessing health supplies, managing multiple appointments, and problem solving some of the social, functional, emotional, and physical barriers that can impede self-care management within their own daily story. Our clinical and non-clinical volunteers bring their expertise, friendly conversations, and cultural awareness to support the seniors in what they might need assistance with as they self-care manage in their own community. Simply, this program provides the senior with the opportunity to revisit the same personal health topics weekly, and this regular social interaction enhances a senior's quality of life by providing mental stimulation, reducing stress related to their unsureness on how to self-care manage, promotes a sense of belonging within the community, and helps to maintain cognitive function and better emotional health.
Outcomes: early identification when a senior is out of a prescription, not using the medication as prescribed, or has increasing symptoms of illness; intervention correction, triage or care plan adjustment is made, and the senior maintains independent self-care management avoiding a deterioration in their health and a possible hospitalization. Weekly in person reminders of their self-care steps, encouragement on their weekly successes at self-care, and reviewing the ‘to dos’ for the coming week, have helped the seniors be heard and valued, and also avoid hospitalization, eviction, and other negative effects of declining self-care.
Outcomes: self-care medication management that is demonstrated by blood pressure and diabetes control; decreased isolation and reported appreciation of available services as making a positive difference in the senior’s ability to self-care manage.
Wisdom Circles (Lunch and Learns)
Informal learning, activity or presentations, an hour of time each month open to everyone in the residential community; various community groups donate a lunch and a Wisdom Wellness volunteer, or partner, delivers the session. Average monthly attendance ranges 15-35. All gatherings incorporate content that is attuned to the aging adult with specific sensitivity to cultural appropriateness. All content provided is mindful of literacy, vision, hearing, cognition, and mobility limitations that, at times, are barriers in other settings for the senior to participate in this type of learning
Outcomes: Group learning offers safe space to identify population challenges rather than individual issues, and through this medium a safe space for discussion on self-care management and collective learning. Reduces isolation and provides an opportunity to share a healthy meal among peers.
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Medication Management and Pharmacy
Pick-Up
The pandemic delivered various challenges to this community; one of the primary challenges was the shut down of transportation helpers which provided mobility access for elders to pick up their medications; thus, these elders were experiencing long disruptions and gaps in taking their medications as prescribed. This program became the needed bridge between residents and a local pharmacy willing to coordinate with Wisdom Wellness to set up a monthly cycle for those eligible to obtain their medications through their pharmacy; this program has grown over the past 3 years and has between 14-20 seniors participating. Our long term goal is to expand with other local pharmacies for those who do not have benefit coverage through the current participating pharmacy.
Outcome: Access to all medications and health supplies for participating elders. Medication self-care management success demonstrated by blood pressure and diabetes control.
Interprofessional and Multi-Generational Volunteers
The program launched and continues today by bringing together learners and emerging professionals, those who have expertise, talent, and time to engage with elders who are self-care managing chronic complex conditions; collectively, the wisdom sharing offers untapped energy, joys, and learning. Different generations, disciplines and cultures come together, giving time, presence of self, and listening to understand how and what supports are needed for the elder to manage their own self-care independently. The independent living experience is real world self-care which is very different from hospital, nursing homes, home care or assisted living care. The stability of Wisdom Wellness’s presence weekly over the past almost decade of time has created a sacred space for the elder to share their thoughts, needs, and success about their day-to-day lived story.
Outcomes: Trusted and long-term relationship building acorss cultures; our services have been a stable reliable presence on site longer than any property management company for this low-income senior living community. Residents have indicated that the presence of the volunteers with Wisdom Wellness is comforting, positive, and helpful and “wish Wisdom Wellness was here more days” (survey done by the building board 2019).
