Not an isolated incident
Robyn Golden, associate vice president of social work and community health at Rush University Medical Center in Chicago, knows her health system is in a unique position. Isolation and loneliness among patients is at an all-time high nationwide due to the COVID-19, but it’s also not something providers are tackling en masse yet.
It doesn’t have to be that way. There are low-cost options providers can use to help move the needle. Rush a few months ago started screening patients for isolation and loneliness and integrated it into the electronic health record system. When a patient scores high on their screening, they’re assigned to a team that creates a plan for them, and they receive periodic check-in phone calls. The “Friendly Caller” program has made over 700 calls to older adults since April 2020 when it first piloted.
“It’s rare for a hospital to have a social services agency built in,” Golden said. “But social isolation doesn’t happen in isolation. Often people will have other comorbidities: depression, anxiety, increased risk of substance use and other health conditions.”
Some of Rush’s solutions do cost money for services that insurers usually don’t cover. But there is a tie to the bottom line: Providers can see progress in measures like readmissions, patient utilization and provider burnout, all which are directly connected to the social determinants of health, including isolation and loneliness. And often addressing one social determinant like isolation can also impact others; providers might find through interventions that a patient needs better access to transportation, food or housing assistance.
Golden and other experts say the pandemic has increased the imperative for health systems to address isolation and loneliness.
University of Maine Center on Aging Director Lenard Kaye describes loneliness as the feeling of having limited contact with others. Isolation is physically having limited contact with others. They don’t always occur together. But coupled, they can be deadly. In fact, the federal Health Resources and Services Administration says loneliness and isolation can have the same negative impact as smoking 15 cigarettes a day.
Historically, the task of targeting loneliness and isolation has been left to community senior centers and agencies on aging. The growth in health systems providing solutions has mainly been within risk-based models, academic medical centers and other integrated care providers.
“One thing all older adults do is usually go see the doctor,” said Katherine Suberlak, vice president
“Social isolation doesn’t happen in isolation. Often people will have other comorbidities: depression, anxiety, increased risk of substance use and other health conditions.” Robyn Golden, associate vice president of social work and community health at Rush University Medical Center in Chicago
of clinical programs at primary-care provider Oak Street Health. “So we are in a great place to be the screener. I think that’s enough of a business case, because we know it exists.”
Health leaders can also look at solutions through an inclusion lens. Four in 10 low-income adults age 50 and over reported facing challenges accessing various resources during COVID-19, including a fifth who had challenges accessing food and a similar number who had issues accessing healthcare services, according to AARP.
Screening for loneliness/isolation can be a first step to address the issue and improve outcomes and potentially reduce costs. A year ago, Oak Street Health added an evidencebased screening tool, the UCLA Loneliness Scale, to its annual patient health risk assessment.
But just asking the question— without a recommendation or treatment that a provider can offer— can leave providers with a “now what?” quandary.
Cindy Jordan, CEO of Pyx Health, which offers a platform designed to reduce loneliness and social isolation, said many organizations haven’t ventured into handling this part of a patient’s life for a couple of reasons. Healthcare delivery is still largely using a medical model based on treatments. And there’s not an abundance of obvious treatments.
She contends that loneliness should be a treatable, billable condition to entice providers to start helping their patients address it.
But Suberlak doesn’t think loneliness and isolation should be pathologized, mainly because that would just create more stigma, and the solutions are often low-cost.
“We are using low-tech interventions, which include proactive wellness calls, and then creating an individual care plan with a patient to say, ‘What are you able to do right now, what are your strengths and resources,’ and tapping into that,”
Suberlak said, adding that Oak Street employs social or community health workers to help target these patients.
Solutions, even for organizations that take on risk and have an imperative to keep their costs low, require buy-in from leadership. It doesn’t take much to sell the finance team of a hospital or primary-care provider to start doing screenings, which falls under a patient-focused risk assessment. But health providers can also team up with community organizations that have traditionally been the agencies to help address isolation and loneliness. Oak Street, for instance, partners with the Foundation for Art & Healing, which sends art supplies to their patients to
n then use in virtual group art classes.