Strategies

Revise health care processes and provider roles to integrate mental health and substance abuse treatment into primary care; continue to refer patients with severe conditions to specialty care

Help participants share transportation via informal arrangements between individuals, formally arranged ridesharing programs, or other ride-matching services

Use a case management model for frail elderly patients living independently, coordinating aspects of long-term care (LTC) such as status assessment, monitoring, advocacy, care planning, etc.

Implement multi-component efforts that include coordination of health services by multidisciplinary teams of health care professionals, patient self-management, and patient education

Support self-contained, homelike dwellings for 10-12 elderly adults who require nursing care; universal caregivers, usually CNAs, provide care and other supports while clinical teams visit for specialized care

Train volunteers, professionals, or paraprofessionals to help residents assess and reduce environmental home health risks and recommend low cost changes (e.g., improved ventilation, integrated pest management, etc.)

Inform parents about lead exposure pathways and cleaning and hygiene techniques and undertake minor repairs or specialized cleaning

Provide funding, primarily to families with low or middle incomes, to repair, improve, or modernize dwellings and remove health or safety hazards

Offer incentives such as free or discounted bus, rail, or transit passes, reimbursements, partial payments, or pre-tax payroll deductions to encourage individuals’ use of existing public transit

Support a collaborative approach by a multidisciplinary team of professionals working to meet the full range of long-term care (LTC) needs for frail elderly patients living in community settings