Helping Seniors in Public Housing Take Charge of Their Health

    • August 7, 2013

In 2007, the Robert Wood Johnson Foundation (RWJF) named Alfred Davis a Robert Wood Johnson Foundation Community Health Leader in recognition of his work with the Boston Housing Authority to engage isolated seniors in healthy activities and habits.

The problem. Seniors and those with disabilities living in Boston’s public housing complexes often are isolated, sedentary, and reluctant to venture far from home. Research shows that exercise, healthy living, and socialization can help older adults prevent and deal with chronic diseases and lead more active lives. How could these older adults be encouraged to step out and take control?

Finding his mission in a changing city. Alfred Davis grew up in the segregated Memphis of the 1940s and 1950s where he attended a private Catholic school whose entire student body was African American. After high school he joined the Navy, serving in the Vietnam conflict. Davis spent the last year of his tour stationed in the First Naval District in Boston. He was part of the team that plucked returning Gemini astronauts from their capsules after touch-down in the Atlantic Ocean.

Following his honorable discharge, Davis went to work for the Boston Redevelopment Authority, while completing his college degree at the University of Massachusetts. His first job there was resettling poor minority families in housing that the city had rehabilitated with federal funds.

“There were a lot of run-down or abandoned brownstones in the heavily populated areas of the South End of Boston,” Davis says, “and the city felt there was good opportunity to expand into those neighborhoods. That is how urban renewal started to build.”

After a stint in the Mayor’s Office of Fair Housing, Davis moved to the Boston Fair Housing Commission and from there to the Commission on Affairs of the Elderly. His efforts to ensure adequate services for residents of the city’s 35 properties designated for the elderly and people with disabilities came to the attention of the administrator of the Boston Housing Authority.

By 1994, Davis was on board as program director of resident services. Soon after, he applied for, and received a $695,000 grant from the federal Department of Housing and Urban Development, which allowed him to hire a staff of resident services coordinators. That, Davis says, “is how the whole thing started.”

“The whole thing” is a network of programs to promote healthy lifestyles among Boston’s low-income elderly population.

Getting seniors up and moving. As Davis ventured into the senior housing complexes, he observed at lot of sedentary residents. “Walking to the mail box or going to the local bodega or the liquor store was the most exercise most people were getting,” he says, “no matter what their ethnic background.”

Davis’s staff at the time—Cynthia Collins (currently director of social services at United Housing Management in Boston ) and Lauren Newson (currently a consultant with the Visiting Nurse Association )—were both work-study students in Boston University’s PhD program and Davis was their field instructor. “We got to talk to some of the top minds there about what we thought would be a great program to engage people where they live and get them interested in better nutrition and better overall health,” Davis recalls.

In their neighborhood walkabouts, Davis and his team noticed that four of the housing developments for low-income seniors and people with disabilities were within walking distance or a short drive from a public golf course and the public zoo.

To get them out of their apartments and onto the golf course, they created a 16-session golf program, called Put a Swing in Your Life, which included a presentation about golf mechanics by an instructor, warm-up exercises, and training in the basics of golf. The emphasis was on developing balance, muscle flexibility, concentration, and hand-eye coordination. Another key goal of the golf program was to promote socializing. So Davis promoted the program as a golf club, and did the same with the walking program he set up.

Davis’s team promised seniors a snack and bottle of water if they would join either the walking club or the golf club. “We were surprised that we had an overwhelming number of people who signed right up,” Davis says.

The fact that groups of seniors and people with disabilities were out and about in the neighborhood did not go unnoticed. After an article about the housing authority’s new program appeared in the Boston Globe, residents from other senior housing developments began calling to find out how to get involved. Soon, under Davis’s guidance, aerobic exercise, nutrition and cooking classes, and even bowling were added to the program mix to encourage older adults toward healthy habits.

“We talked to people about what made them happy,” Davis says, “and especially what made them happy as a group. So we put them in those kinds of settings to see if that would raise their self-esteem, or put a smile on their faces, or just make them feel better about the pain they might have been in.”

“How can you help yourself?” Participants represented a diverse mix of ethnicities and backgrounds, Davis says, and offered a potentially rich source of information about the health and well-being of people of color. Researchers began to look more closely at the population.

One study, led by Maureen O’Connor, PsyD, at Boston University, tracked the impact of Put a Swing in Your Life on participants, and reported significant decreases in pain and increased vitality.

Another research project, at the Boston University Alzheimer’s Disease Center, built on concerns that Alzheimer disease and dementia were not being properly identified in non-White communities. Researchers wondered to what degree lifestyle or environmental factors in these diverse populations had an effect on the development of Alzheimer disease, diabetes, heart disease, cancer, and other chronic diseases.

They interviewed seniors about their interactions with health care systems in their country of origin and in the United States. Did they see a doctor when they had health problems? Were they able to talk about themselves with their health provider?

When the interviews revealed cultural barriers to good communication, Davis and his team realized they could lend a hand. They began talking to the older adults about how to communicate more effectively with health care professionals and how to take better charge of their own health.

“We started to empower them to look at their consumption and at the ethnic products they purchased and where they purchased them,” Davis says. “If they could spend less money in a larger food store rather than going to a local bodega, they needed to look at that as part of their overall health. We said, ‘Look at yourself and your environment. You hear people talking about how much you are costing the system because you are sicker. So what can you do, how can you help yourself?’ ”

A visit to the emergency room. One resident answered that question in a very dramatic way. She was participating in an intergenerational program that Davis had helped to create, which put students at a local trade school in contact with elderly residents. Students studying the culinary arts prepared breakfast for the seniors, and those working toward cosmetology licenses did their hair and nails. When health sciences students came in to take everyone’s blood pressure, the woman was in for a shock.

“Her blood pressure was over 230, so we rushed her to the hospital,” Davis recalls. “The doctor told her the risk she was taking, and she started to talk to us about it being around her diet.” It turns out she was a lover of pork products and an inveterate snacker. The blood pressure scare motivated her to exercise and to make a list of what she bought at the grocery store and show it to Davis and his staff. After three months she went back to the doctor for a checkup. Her blood pressure was normal and she had lost nine pounds.

“The doctor said to her, ‘I can’t believe the change in you,’ ” Davis says. “And it all happened because she went to our program and had that interaction with the young people at the school.”

“That’s the simplicity of it,” he says. “I just want to get people to stand up, you know what I’m saying? If someone is sitting all the time, you say, why don’t you try standing up. Then you ask them to take that first step. You take baby steps and do those things that you can get some instant gratification from.”

Becoming an RWJF Community Health Leader. Davis was named an RWJF Community Health Leader in 2007. The grant came at just the right time, Davis says, because other groups were competing for scarce public funding. “We were not the only game in town. Everybody was saying, ‘Oh, that’s what we need to do to be engaged with seniors and those with disabilities.’ Everyone was applying to the same funding sources. The grant enabled us to continue. We were able to make those funds last for five years.”

Funding programs for seniors is increasingly difficult, Davis says. “You can get politicians to put on a dinner or throw a cookout for people who are elderly or have disabilities, but getting them to put sustainable dollars into programs or adding to budgets to bring additional staff aboard” is a lot harder.

Still, Davis keeps pushing forward. One new avenue of funding has come through the African Heritage and Health Program, which is promoting the African Heritage Diet to encourage people to get back to the staples of their ethnic homelands, such as grains, beans, and greens. Boston is a pilot site for the program and residents in senior and disabled housing are participating.

In another new project, made possible with a grant from the federal Broadband Technology Opportunities Program, the housing authority has partnered with Connected Living, a private company that develops technology to support seniors. Together, they are teaching seniors how to track their personal health habits and important health information on their computers or cell phones. “That way they can gather information on a flash drive to take to their doctor or show to their children or grandchildren,” Davis says. “We found that when people started using technology to track their activities, they wanted more activities to do in regards to their personal health.”

Simple things make a difference. Walking around town, Davis sees the impact of increased socialization and physical activity on seniors. “I run into people all the time, in the grocery store or on the streets,” he says. “I see their faces, see their skin. I see a person with a bottle of water. Those kinds of things impact me all the time about this work.

“There are a lot of simple things that poor people can do,” he says. “You don’t have to have the Slimfast or all the things you see on media to be able to affect your health.”

RWJF Perspective. Established in 1991, RWJF recognized the first 10 Community Health Leaders in 1993. They are unsung and inspiring individuals who work in their communities—often among the most disenfranchised populations—to address some of the nation’s most intractable health care problems. The formal recognition of these Robert Wood Johnson Foundation Community Health Leaders and their programs often launches them to greater levels of influence and extends their reach to serve more vulnerable populations. For more information on the program see Program Results Report.

Under the RWJF Community Health Leaders award, each year RWJF has provided a $125,000 award to 10 individuals and their organizations ($105,000 supports a project at their organization and $20,000 goes directly to the leader for personal development). RWJF also connects the RWJF Community Health Leaders with each other so they can continue their work with the support and experience of their peers and previous award winners.

“Community Health Leaders are characterized by three specific traits—they are courageous, they are creative, and they are committed,” says National Program Director Janice Ford Griffin. “The Foundation recognizes the tremendous resource of experience among the leaders and we look forward to mining that resource as we consider future initiatives.”

“Through the Robert Wood Johnson Foundation Community Health Leaders award, we at the Foundation have the opportunity to recognize innovative and courageous local leaders behind ground-breaking efforts in communities across the United States,” said Sallie George, MPH, program officer at RWJF. “These individuals remind us that one person can have a powerful impact on health and health care within their communities.”

The latest round of leaders was chosen in the fall of 2012.