New Minnesota program boosts participation in senior fitness classes

July 07--As she approaches her 80th birthday, Ardella Cherry knows she needs to keep her body moving and her spirits up if she has any hope of remaining independent. Halfway through an eight-week class to improve balance and fitness she already feels more confident.

"Getting older can be a process where you feel like you're a hindrance," Cherry said at her "A Matter of Balance" class, which was held at her senior-housing complex north Minneapolis. "I look at things as an adventure. Try to have fun."

Minnesota's aging agencies have spent the past decade trying to get more people to attend healthy-aging classes, which research shows can be a low-cost and effective way to teach those with chronic diseases or at risk of falls how to improve their health. But it has been a slow and frustrating process at times, fraught with poor participation and canceled classes.

In the face of a rapidly aging population, a new statewide initiative known as Juniper aims to exponentially boost participation in the classes by taking an obvious but unusual tact: getting doctors and insurance companies involved.

"Part of the problem with our health care system is that for so long patients have treated their doctor as all-knowing," said Dr. Sara Lindquist, a board-certified internist and geriatrician and Juniper's director of health care integration. "If we can help patients be more proactive in caring for themselves instead of putting all their care in the hands of physicians who they see only once a year or every six months, it can potentially be a transformative cultural shift."

Juniper -- a reference to the evergreen shrub known for its long life and interconnected root structure -- relies on the state's seven Area Agencies on Aging plus the Chippewa Tribe. Rather than working independently to serve their regions, Juniper aims to unify their efforts and build upon the organizations' established relationships with nonprofits and community-service organizations.

A three-year, $3 million grant from the Margaret A. Cargill Philanthropies helped build a website, YourJuniper.org, which makes it easier for the public to register for classes and for health care providers to refer their patients. It also allows Juniper to accept contracts from health insurers or employers.

The idea behind Juniper is to organize and standardize what now is an informal and haphazard smattering of wellness classes, whether at the local YMCA or a church basement.

"These programs have been around for decades," said Georgia Lane, the senior planner and developer at the Arrowhead Area Agency on Aging based in Duluth. "What hasn't been around is a way to link them. They pop up at community centers or different faith communities, and live only as long as one person stays enthused. Juniper allows for a sustained delivery network and improves medical outcomes. It's a unique value."

From the start, participation in Juniper's evidence-based programs exceeded expectations. The original goal was to have 2,000 people enrolled over the first three years. More than 1,700 Minnesotans completed a class in 2015, the inaugural year, according to the Metropolitan Area Association on Aging, which is spearheading the project.

Since then more than 6,500 people have attended programs that run for six to 12 weeks and often include a mixture of discussion and strength-building exercises, such as tai ji quan, a form of tai chi adapted for seniors and others with physical limitations to prevent falls.

This year, 580 classes will be offered under the Juniper umbrella, serving 5,200 people.

"We're just starting to scratch the surface," said David Fink, program developer for the Metropolitan Area Agency on Aging, who also trains workshop leaders around the Twin Cities. "To really impact the overall culture of wellness of our state, we have to make it a lot easier for a lot more people to find classes, get to classes and understand why they're useful."

Public health officials have long known that social, economic and behavioral factors are tied to poor health. But with a shortage of geriatricians and financial pressure to avoid preventable hospital readmissions, the medical community is eager find ways to lower costs and improve health.

A fall that causes a significant fracture can cost $34,000, and often precipitates a downward health spiral. About a quarter of patients will stay in a nursing home for at least a year after the fall, and one in four people who fracture a hip will die within a year. Minnesota has the third-highest death rate for falls in the U.S., nearly twice the national average, according to the Minnesota Department of Health.

"The challenge we have as a community and an aging population is that the intervention for remaining independent is based on such things as preventing injuries, preventing falls -- interventions that are not classic medical acute care," said Dr. Thomas von Sternberg, associate medical director of geriatrics, home care and hospice at HealthPartners, which has joined the Juniper network. "They are more long-term behavioral and attitudinal."

With research showing that patients are 18 percent more likely to attend classes if a physician recommends it, von Sternberg said it makes good medical sense and business sense to make Juniper's resources a routine part of every primary-care visit.

"The secret sauce is, can you get people to keep doing the program, to keep showing up, doing it at home, and normalizing exercise and balance -- like brushing your teeth," he said. "That's our challenge. It's not like taking a pill. It takes a conscious decision to do your activities differently. We need a partner like Juniper in that."

On the insurance side, HealthPartners has set up a billing and claims system so that Juniper is reimbursed like any other provider of services.

"What's nice about Juniper is it's the main connector of all partner programs," said Nancy Hoyt Taff, HealthPartners' public health program manager for government programs. "You can find them yourself or our member services coordinator can help. It's an easier shopping experience if you will."

Kari Benson, executive director of the Minnesota Board on Aging, said the Juniper model has the potential to bring smaller service providers, which are not as well funded, into the fold.

"It will help the local organizations continue to do what they're doing and not get bogged down in administrative pieces," she said, "and it leaves room for local community flexibility and uniqueness."

Dawn Simonson, executive director of the Metropolitan Area Agency on Aging, is working to make Juniper self-sufficient. Now that the website and technology backbone are in place, the focus will shift to expanding the number of class locations and in building more nontraditional partnerships.

"Health care organizations are getting to know us in a new way," she said. "We're building on what's already out there, and we're building a brand that many kinds of organizations can work under."

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