Ponce De Leon Foundation 2018 to 2023 Report

Urban Health Plan, Inc.

The Center for Healthy Aging (CFHA) was developed in 2016 to address the complex needs of vulnerable and frail older adults, especially those over 80 and those with cognitive or mental impairments. It provides compassionate, comprehensive services using an interdisciplinary team-based care model.

The CFHA uses an integrated, experienced, bilingual healthcare team; conducts proactive screenings to identify and address patients’ unique needs; and provides embedded care management and support services with a strong focus on clinical quality improvement. Its goal is to support older patients and improve their quality of life through comprehensive services customized to their health care needs and all provided in one location. The Urban Health Plan looked to address several areas of need: food insecurity, safety in the community, and fall prevention. UHP would purchase one hundred $50 gift cards to distribute. The nutrition and social services departments worked closely together to identify patients over 65 with food insecurity, and they were provided with the gift cards. They were able to identify a vendor and to their health care needs and all provided in one location. The Urban Health Plan looked to address several areas of need: food insecurity, safety in the community, and fall prevention. UHP would purchase one hundred $50 gift cards to distribute. The nutrition and social services departments worked closely together to identify patients over 65 with food insecurity, and they were provided with the gift cards. They were able to identify a vendor and arrange a deal to provide ID bracelets to about 100 individuals with Alzheimer’s disease, dementia, or memory impairment. Lastly, they were able to purchase a VNG machine. The VNG is a test of the inner ear and portions of the brain. The VNG can help the provider understand the causes of patients’ dizziness or balance problems and recommend interventions that can prevent falls.

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