CareMore's Prescription for Loneliness Removes Barriers to Togetherness

It starts with the portable oxygen tank that never arrives. Or the widower’s grief that has not eased. One woman lost her car in an accident, so she stopped driving.

The seclusion that comes with aging in America is more than just unfortunate; it’s a health problem that CareMore CEO Sachin H. Jain, MD, MBA, FACP, says affects 43% of seniors over age 65. A study in 2016 showed a direct connection between the size of one’s social network and health, and CareMore cites research that compares extreme isolation to smoking 15 cigarettes a day.

In May, Jain took on this problem when he announced that CareMore, which operates Medicare Advantage plans in 7 states, would reach out to 1100 seniors it had identified as socially isolated. The mission: prevent the cognitive decline, weight gain, depression, recurrent stroke, and early death that loneliness can bring. Treating loneliness, he said, was an approach unfamiliar in medicine, because doctors don’t bring up problems they can’t solve.

But Jain knew a person who could. Enter Robin Caruso, LCSW, CareMore’s first chief togetherness officer, who is charged with managing the Togetherness Program.

Caruso spent many years working in hospice, which taught her what she calls “active listening,” a skill she uses today with those who need a friendly ear.

“Dr Jain’s letter went out in July, and we’re still getting calls,” Caruso said a few weeks before Thanksgiving, as she described how the health plan made that first touch with the seniors it had identified. More than 300 self-referrals came in after Jain’s letter encouraged plan members to call if they needed assistance or just a conversation. Some called right away, while others waited.

“One lady had her master’s in chemistry,” Caruso said. “She had held on to that letter for 2 weeks. She said, ‘I’m so embarrassed to say I’m lonely.’”

When The American Journal of Managed Care^® spoke with Caruso, the CareMore staff were gearing up for the holidays, asking seniors if they had places to go. Caruso said the holidays can be the 1 time of year seniors get to see their family, although the season also can be stressful and a reminder of loved ones lost. For those who have no place to go, CareMore tries to connect them with a community organization.

Many seniors report that when they lost a spouse, all their social connections went away, too. Or, it’s too hard go to familiar places alone. Caruso described one widower who had several conversations with a CareMore staff member before he worked up the nerve to listen to music at his local senior center. Now, he’s a regular.

“He said, ‘I felt like I was in high school. All the guys were on the side and all the women were dancing. I made so many friends.’”

Caruso said the calls are “very organic.” While there are some standard topics—are seniors taking medications, are they still driving—much of the conversation is open-ended. Already, CareMore staff have identified members with uncontrolled mental health conditions or those not taking medications. Staff members help identify, and remove, barriers to interaction. They connect seniors with local resources, including CareMore gyms at existing facilities. In some cases, home visits are needed.

Staff also identify barriers to medication adherence. “One of the larger connections we make is with our pharmacy department—we know when seniors can’t get their medication or when they can’t afford their medication.”

Some problems are easily fixed, but the senior didn’t know who to call. For example, CareMore staff found out a beneficiary was eligible for a portable oxygen tank, but it had never arrived.

Beyond the individual success stories is the bottom line: will the program help keep seniors healthier? Caruso believes it will. CareMore is getting close to the 6-month mark when it will measure success, with a combination of clinical outcomes and quality-of-life metrics.

The program is already a lifeline for some beneficiaries with chronic conditions. Caruso described a patient who has chronic obstructive pulmonary disorder. One day, she called to say, “I just wanted you to know I had a bad night. It’s so nice to talk to someone who is not a nurse or a doctor.”