Total Dollars Awarded by the Robert Wood Johnson Foundation (August 2000 to July 2004): $ 186,672

Grantee: Pike Place Market Foundation, Seattle, WA

Co-funders: Pike Place Market Foundation

Problem: The target population for the Pike Place Market Senior Wellness program is homeless and disabled elderly residents of downtown Seattle – a neighborhood with more diversity of income, history, and culture, and a higher concentration of seniors, than any other in the city. In contrast to downtown’s thriving business community, its residential community is: older; poorer; substantially less employed; more isolated; and disabled (1/3 of isolated seniors are disabled). Downtown is also the sickest of our city’s neighborhoods – it leads the city in all cancers, heart disease, chronic liver disease, pneumonia, TB, AIDS, influenza, and hospitalizations for depression, psychoses, unintentional injury, and suicide.

Goals: The Market’s Senior Wellness Program is working to adapt a traditional senior wellness model to the needs of a severely disadvantaged population. A joint project of the Pike Market Medical Clinic and Pike Market Senior Center, the program’s goals are: 1) to improve access to health care for disenfranchised patients and clients; and 2) to change clients’ perception of their ability to improve their health - especially among those who are focused on basic survival or who may feel dis-empowered in other aspects of their lives. Upon enrollment, participants are coached and guided through a plan they define and one that incorporates the reality of their living circumstances. An individual’s “Wellness Program” usually consists of three components:

• Lifetime Fitness (low-impact exercise - regular walks and Tai Chi classes);
• Self-Management of Chronic Conditions (blood pressure clinics, Healthy Topics” coffee hours on specific subjects, such as smoking cessation, anxiety management and memory fitness); and
• Health Enhancement (“Feeling Your Best” seminars in downtown apartment buildings offering nutrition and exercise advice).

Findings: Development of an effective evaluation tool has been difficult. Since the beginning, staff have observed that participants are reluctant to sign consent forms - primarily due to the high incidence of mental health issues among participants and chaotic and changing living conditions. Early on, staff learned that many more participants were dealing with basic survival issues than planners imagined, and that participants moved in and out of the program more frequently than expected (example: a participant may lose his/her housing or suffer a bout of severe depression, making him/her unable to participate for a period of time). As a result, the program now defines three levels of participation:

1. Pre-contemplation The program’s RN and Social Worker pitch the program in various community settings, including: weekly blood pressure screenings at the Senior Center and neighboring apartment buildings; and individual contacts at activities such as the Senior Center’s daily hot lunch. Currently, 88 people are in this stage
2. Contemplation. After hearing the pitch, people begin spending time in one or more of the program’s activities. Activities fall into six categories: nutrition, social work, fitness, self-management of chronic conditions, socialization and health enhancement. An additional 40 people are currently in this stage.
3. Participant. A “participant” is someone who has filled out the simplified health questionnaire and is working on a personal health goal. Enrollment has grown in the past six months from 53 to 107.

The program’s evaluation tool, “Wellware”, is a product of Senior Services of Seattle-King Co. and was installed in the Market in July 2002. To-date, 11 participants’ results have been evaluated by the UW and we are pleased to report that 73% of participants have improved or maintained in their chosen goals. Specifically, the health of 2 has improved; 6 have maintained previous health status; and the health of 3 participants has declined.

Graduates 2003