Feasibility of a volunteer/health care provider navigation partnership to support frail rural-dwelling older adults

Potential impacts of this project include enhanced quality of life for frail older adults and their families, reduced use of healthcare resources that arise from unnecessary transitions in care, enhanced roles for hospice volunteers, increased capacity for palliative care in rural communities and improvement of rural communities overall as they become desirable places to age in place.

Research Results

Findings: Evaluation six months into the one-year intervention period indicates the intervention is mutually beneficial for older adults and volunteers. Volunteer navigators had conducted 93 visits with older adults, demonstrating a high degree of resourcefulness and creativity. Older adult clients/family were satisfied with the intervention (rated highly important to their care). Volunteer navigators are satisfied in the navigation role indicating they would participate in the role again and recommend the role for others.

Impact of findings: Preliminary findings suggest that this unique volunteer/healthcare provider navigation partnership has the potential to enhance the quality of life of older adults living in a rural setting while providing a satisfying role for volunteers.

Download Dr. Wendy Duggleby’s report: Navigation Competencies for the Care of Older Rural Adults at the End of Life

Publications, presentations and webinars

Why this research matters to:

Policy        Families        Researchers

About the Project

Assisting the frail rural elderly to age in place is essential to quality of life at end-of-life.  An innovative way to assist older adults to age in place is to provide navigation services where a knowledgeable individual advocates, facilitates community connections, coordinates access to services and resources and promotes active engagement of frail older adults with their community. The navigator ensures that older adults leverage the resources available to them and seeks to further develop those resources in the rural community.

The purpose of this project is to pilot a volunteer/healthcare provider partnership to provide chronic illness navigation for frail older adults living in the community in one rural site in British Columbia. The objectives of the project are: (1) to test the feasibility and acceptability of the volunteer/healthcare provider navigation partnership, (2) to develop and evaluate a curriculum and protocol for educating rural volunteer and healthcare provider navigators, (3) to trial the Consolidated Framework for Implementation Research data collection strategies in preparation for a multi-site trial and (4) to provide a cost analysis of the volunteer/healthcare navigation partnership.

For more details on the project rationale, objectives and research plan, click here.

Project Team

Principal Investigators:

Barbara Pesut, PhD, RN — University of British Columbia

Wendy Duggleby, PhD, RN, AOCN — University of Alberta

Co-Investigators:

Marion Brown, PhD, BA, BSW, MSW — Dalhousie University

Konrad Fassbender, PhD — Covenant Health

Sunita Ghosh, PhD — University of Alberta

Lars Hallstrom, PhD, BA — University of Alberta

Candace Konnert, PhD, RPsych — University of Calgary

Cheryl Nekolaichuk, PhD, MEd, BScPharm — Grey Nuns Hospital

Carole Robinson, PhD, BSc, RN, BSN, MSN — University of British Columbia

Grace Warner, PhD — Dalhousie University

Knowledge Users and Partners:

Pansy Angevine, RN — Alberta Health Services

Elisabeth Antifeau, RN, MScN, GNCCC — Interior Health

Sharon Baxter, MSW — Canadian Hospice Palliative Care Association

Kathryn Downer, PhD — Pallium Canada

Lygia Figueiredo — Capital District Health Authority

Lorraine Gerard — British Columbia Hospice Palliative Care Association

Donna Hanczaryk — Victorian Order of Nurses

Paul McIntyre, MD, FCFP — Capital District Health Authority

Michelle Peterson Fraser, RN — Alberta Health Services

Cheryl Tschupruk, MSW — Cancer Care Nova Scotia

Terri Woytikw — University of Alberta

Project Contact: Barbara Pesut — barb.pesut@ubc.ca

CAT 2014-CP

Key Findings For Families

Potential impacts of this project include enhanced quality of life for frail older adults and their families, reduced use of healthcare resources that arise from unnecessary transitions in care, enhanced roles for hospice volunteers, increased capacity for palliative care in rural communities and improvement of rural communities overall as they become desirable places to age in place.

Project Contact: Barbara Pesut — barb.pesut@ubc.ca

Key Findings for Families

  • Older adults and family are very happy with the program and said that the service is very important to them
  • According to the older adults, the benefits of the NCARE program are:
    • becoming comfortable asking for help
    • having someone available and well-informed to assist them
    • knowing there was someone there to help
    • being told what services were available in their community
  • Volunteer navigators are very satisfied with their training and their role
    • average length of visits from the NCARE volunteers was 80 minutes
    • most visits are in the client’s home while some are over the phone
    • volunteers are very creative when it comes to supporting the needs of their clients

Volunteer Navigators with the NCARE program are able to assist older adults living at home with chronic illness by:

  • Connecting with clients through regular visits in their home
  • Providing clients with information and linking them to resources in their community
  • Supporting clients to better deal with their health and well-being

Why This Matters

A program called NCARE is being developed and studied as a way to help older adults who live at home in a rural setting with chronic illness. NCARE is a service where volunteers receive three days of special training in navigation so that they can build connections between clients and families and their communities to help improve their quality of life. NCARE volunteers visit their clients in the home on a regular basis to find out what their needs are, help them find services to meet their needs and support them as they live with illness.

About This Study

  • NCARE is a program where a trained volunteer works with older adults and their family members as navigators to support, build community connections, organize access to services and resources and to help them to be more engaged with their community (NCARE)
  • This study wanted to find out if the NCARE program can support older rural adults who live at home with chronic illness
  • This study is being conducted in a rural area in British Columbia. Seven volunteers, 18 older adults and three family members took part in the study 
  • Volunteers visit clients in the home every two to three weeks over a one-year period to provide navigation services. A nurse navigator supervises the volunteer navigators 
  • So far (six months into the program) patients are very satisfied with NCARE program. They rated the service as very important to them and talked about many of the benefits they received from having a volunteer navigator come to their home
  • Volunteers are also happy with the training and being a navigator with the NCARE program

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Policy

Potential impacts of this project include enhanced quality of life for frail older adults and their families, reduced use of healthcare resources that arise from unnecessary transitions in care, enhanced roles for hospice volunteers, increased capacity for palliative care in rural communities and improvement of rural communities overall as they become desirable places to age in place.

Project Contact: Barbara Pesut — barb.pesut@ubc.ca

Key Findings for Policy

  • The NCARE program partners volunteers and healthcare provider to facilitate navigating the healthcare system for frail older adults living in rural communities and shows promising results
  • Older adults are highly satisfied with the program, citing many benefits and rating it as highly important to their care
  • Volunteer Navigators are highly satisfied with their role and the training

This navigation partnership provides services to a currently underserved population while more formally connecting volunteers and health care providers to leverage the capacities of both. 

  • An effective curriculum and protocol for educating rural volunteer and healthcare provider navigators has been developed, evaluated and refined.
  • Linking this volunteer/healthcare provider partnership program to existing healthcare services and hospice societies will support policies and programs relating to community service integration, a palliative approach to care and sustainability.

Why This Study was Needed

Living and dying in place is an essential part of quality of life at end-of-life for rural older adults. However, older adults living at home with complex chronic illness, particularly those who do not yet qualify for home-based nursing care, often live with unmet needs and heavy symptom burden resulting in poor quality of life. The NCARE program is an innovative navigation service designed to assist older adults to age in place by having trained volunteers to work alongside frail older adults and family members to advocate, facilitate community connections, coordinate access to services and resources and promote active engagement of older adults with their community.

Study Summary

  • The objective was to: (1) evaluate a volunteer/healthcare provider navigation partnership as a way to support frail rural older adults; (2) develop and evaluate a curriculum and protocol for educating rural volunteer and healthcare provider navigators; (3) trial a framework for data collection and analysis in preparation for a multi-site trial; and (4) provide a cost analysis of the volunteer/healthcare navigation partnership at the end of the study 
  • At a single rural site in BC, seven volunteers were recruited and given three days training in navigation. Volunteer navigators visit two clients recruited from the community at home every two to three weeks to provide navigation services. Volunteer navigators are mentored by a dedicated nurse navigator.

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Researchers

Potential impacts of this project include enhanced quality of life for frail older adults and their families, reduced use of healthcare resources that arise from unnecessary transitions in care, enhanced roles for hospice volunteers, increased capacity for palliative care in rural communities and improvement of rural communities overall as they become desirable places to age in place.

Project Contact: Barbara Pesut — barb.pesut@ubc.ca

Key Findings for Researchers

The benefits of NCARE to frail older adults living at home in rural communities include: confidence in being able to ask for help, knowing there was backup when needed, helping put experiences into context and bringing awareness of available resources.

  • Volunteer/healthcare provider navigation partnerships are both feasible and acceptable
  • Volunteers feel prepared in their role after their navigation training, are able to demonstrate a high degree of resourcefulness in their navigation activities, and mentorship is important to their development
  • This navigation partnership provides services to a currently underserved population while more formally connecting volunteers and health care providers to leverage the capacities of both

Why This Study was Needed

Assisting the frail rural elderly to age in place is essential to quality of life at end of life. An innovative way to assist older adults to age in place is to provide navigation services where a trained volunteer works alongside older adults and family members to advocate, facilitate community connections, coordinate access to services and resources and promote active engagement of frail older adults with their community (NCARE).The NCARE program has been developed to address the social challenges of rural older adults living with advanced chronic illness at home with poor support, but has yet to be evaluated.

How This Study Addresses the Gap

  • The objectives of the project are to: (1) test the feasibility and acceptability of the volunteer/healthcare provider navigation partnership as a way to support rural older adults living with chronic illness; (2) develop and evaluate a curriculum and protocol for educating rural volunteer and healthcare provider navigators; (3) trial the Consolidated Framework for Implementation Research (CFIR) as a framework for data collection and analysis in preparation for a multi-site trial; and (4) provide a cost analysis of the volunteer/healthcare navigation partnership at the end of the study
  • The study was a single site, which included three co-located rural communities in British Columbia with the support of a community advisory committee. The curriculum for preparing volunteer and healthcare navigators was presented as a three day workshop to seven volunteers. Following the volunteer training,18 older adults and three family members took part in the evaluation. A Nurse Navigator matched the Volunteer Navigators to clients. Volunteer navigators have been visiting older adults in the home on a regular basis (every two to three weeks on average) over a one-year period to provide navigation services

Future Research

  • How best to integrate volunteer/navigation partnerships within currently existing healthcare services
  • How to develop and sustain navigation through hospice’s societies

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Publications

Potential impacts of this project include enhanced quality of life for frail older adults and their families, reduced use of healthcare resources that arise from unnecessary transitions in care, enhanced roles for hospice volunteers, increased capacity for palliative care in rural communities and improvement of rural communities overall as they become desirable places to age in place.

Principal Investigators

Barbara Pesut, PhD, RN — University of British Columbia

Wendy Duggleby, PhD, RN, AOCN — University of Alberta

Publications

Duggleby, W., Robinson, C., Kaasalainen, S., Pesut, B., Nekolaichuk, C., MacLeod, R., Keating, N., Santos Salas, A., Hallstrom, L., Fraser, K.D., Williams, A., Swindle, J. & Struthers-Montford, K. (May 26, 2016). Developing Navigation Competencies to Care for Older Rural Adults with Advanced Illness. Canadian Journal on Aging.35 (2) 206-214. doi:10.1017/S0714980816000131.

Presentations

Pesut, B., Duggleby, W. (September 2015). Feasibility of a volunteer/healthcare provider partnership to support frail rural-dwelling older adults. 3rd annual TVN Conference. Toronto, ON.

Webinars

Piloting of volunteer and healthcare provider partnership to provide navigation for rural, frail older adults — Barbara Pesut and Wendy Duggleby

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Rationale

Potential impacts of this project include enhanced quality of life for frail older adults and their families, reduced use of healthcare resources that arise from unnecessary transitions in care, enhanced roles for hospice volunteers, increased capacity for palliative care in rural communities and improvement of rural communities overall as they become desirable places to age in place.

Principal Investigators

Barbara Pesut, PhD, RN — University of British Columbia

Wendy Duggleby, PhD, RN, AOCN — University of Alberta

Rationale: An innovative way to assist older adults to age in place is to provide navigation services where a knowledgeable individual advocates, facilitates community connections, coordinates access to services and resources and promotes active engagement of frail older adults with their community (NCARE). The navigator works alongside older adults and family to ensure they can leverage the resources available to them while seeking to further develop those resources in the rural community.

Objectives: Test the feasibility, acceptability and conduct a cost-analysis of volunteer/healthcare provider partnerships to provide navigation for older adults living with advanced chronic illness in three co-located rural communities.

Research plan: Pilot study conducted in at three co-located rural communities in British Columbia. Seven volunteers were recruited and provided with three days training in navigation. Curriculum constructed for this project included navigation learning manuals, workshop materials and case studies. Volunteer navigators visited clients at home every two to three weeks and were supported by a dedicated nurse navigator who also conducted regular visits with clients and held debriefing sessions with volunteer navigators.

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