Addressing Loneliness to Promote Health

Sometimes helping people adapt to the challenges in their lives and feel more hopeful about the future can start with a phone call. This is why Meritus Health, based in Hagerstown, Maryland, decided they wanted to test setting up a care caller program to check-in on patients’ well-being, offer conversation and connection, and provide links to resources, including food, transportation, and grief counseling. The need to reduce isolation in their patient population became apparent when their social health screening data found that one in twelve patients reported experienced loneliness in the prior week. More people identified loneliness as a need than housing stability, transportation, or other determinants of health.

Addressing loneliness may once have seemed like an unlikely focus for a health improvement effort. The COVID-19 pandemic, however, has put into sharp focus the negative impact social isolation can have on health. For example, according to the Centers for Disease Control and Prevention, people experiencing social isolation and loneliness have a 50 percent higher risk of dementia, 29 percent increased risk of heart disease, and 32 percent higher risk of stroke.

With this in mind, Meritus took part in a competitive grant award process to engage in a 12-month learning and action network (LAN) for organizations seeking to integrate social health into health care delivery to improve health, well-being, and equity for their populations. Meritus was one of three integrated delivery networks in the US chosen to participate in the LAN facilitated by the Institute for Healthcare Improvement (IHI) and sponsored by Pfizer.

To illustrate the importance of addressing loneliness and isolation, Lynnae Messner, Director of Outpatient Care Management at Meritus Health recently recalled a patient named Janie [not her real name]. After multiple surgeries, Janie had trouble with activities such as driving to appointments and bathing while keeping her surgical sites clean. She was also unable to participate in her favorite activities, like gardening.

Once she was enrolled in the Meritus Care Caller Program, for which Messner is the program manager, Janie expressed appreciation for having someone who simply took the time to call once each week and listen to her without offering advice she did not request. Often, Janie just wanted a kind listener when she expressed frustration over being unable to do the basic things she used to do.

After Janie mentioned her need for transportation support, a care caller connected Janie to a program manager, who then partnered with an outpatient care management team to get her a wheelchair and transportation to and from her appointments. After her surgeries, she was able to heal and get back outside to her garden. Eventually, Janie no longer felt like she needed the care caller program, but she was thankful that it would be there if she wanted it in the future. “[The Care Caller Program] gave her hope and connections to resources she wouldn’t have known about otherwise,” explained Messner.

The Care Caller Program serves any Meritus Medical Group patient who self-identifies as lonely as part of an annual questionnaire before an office visit. To avoid making cost a potential barrier, the program is free and staffed by volunteers and one paid staff member.

Meritus Health’s aim during the LAN was to have 50 percent of enrollees report feeling less lonely within four months of engagement. In the first year of the program, the Meritus team enrolled 114 patients in the program, and that number continues to grow as more volunteers are onboarded. The care caller team made a total of 1,027 calls in less than one year, and over 10,000 minutes were volunteered among the 39 care callers. The results have been extremely positive, with 92 percent of survey respondents answering “Yes” to “Does the Meritus Care Caller Program help reduce your loneliness?” — far exceeding their original aim.

Keys to Success

• Leadership engagement: The Meritus team received strong support from their leadership as they built the program. In fact, Meritus Health CEO and President Maulik Joshi, DrPH, has been involved in a multitude of ways, including participating in learning sessions, providing program direction and organizational support, and volunteering as a care caller. Members of the Meritus strategy team, outpatient quality team, and community services team have been involved in the LAN from the beginning, and many other Meritus leaders and team members are care caller volunteers. The breadth of the organizational support has been key to the reach of the program and keeps those at Meritus connected to the community they serve.
• Openness to having assumptions challenged: Though the Meritus team expected most participants in the care caller program would be elderly, they found that patients ranging in age from 30 to 50 expressed the greatest need. Many patients reported being highly engaged in the community, yet they still felt lonely.
• Listening to what people need most: Hearing from a caring person, whether it is once a week or once a month, offers support and human connection. “We try to get people engaged with activities,” Messner said. “It has been a really impactful way to ensure they have a level of comfort or support from the health care system and other supports when needed.”

Meritus tells volunteers that just 15 minutes a week can make a difference in someone’s life. Their CEO and President Maulik Joshi has learned this from experience. As a care caller volunteer, he checks in with three patients. One of them is a woman in her late 90s named Beth [not her real name]. After weeks of developing a strong rapport, Joshi was once unable to call Beth at their scheduled time, and she called to check up on him.