Organization:

Springwell Elder Services is a private local non-profit organization that focuses on

providing in home services and supports to elders, individuals with disabilities and those
who care for them. The agency is located in Waltham MA but their service area includes
the towns of Belmont, Needham, Brookline, Waltham, Wellesley, Newton, Watertown
and Weston. Springwell receives funding from the state and federal governments as well
from private donations and grants. The Office of Elder Affairs oversees the work
Springwell does and makes sure that it is within the lines of what the agency is being
contracted for.
Springwell offers many wonderful programs to the population it serves. Their passion, in
my opinion, lies truly with supporting the elders and individuals with disabilities living as
independently as they can out in the community. To address the needs of seniors and
folks with disabilities, Springwell works collaboratively with many providers in the
community such as hospitals, nursing facilities, home care agencies, visiting nurses
associations, senior centers to name a few. From these great partnerships, Springwell is
able to expand the existing programs they offer and also develop new initiatives.
Springwell is dedicated to keeping folks out of nursing homes through providing in home
services that are crucial to ones wellbeing and independence. Programs like meals on
wheels, personal care attendant, homemaking, companion, heavy chore cleaning,
transportation, medical escort, and money management allow people to successfully live
in their own homes and manage their medical needs and activities of daily living.
Programs like caregiver support and adult family care are geared towards families who
chose to take care of their loved ones. Springwell offers multiple resources to those

families and in some instances even reimburses them through a stipend for providing care
to their relative. Protective services is a crucial program offered at Springwell that
focuses on protecting seniors from being abused, neglected, and financially exploited.
The most recent new initiative Springwell has been implementing is the health
partnership program that specifically focuses on working with local hospitals (Mt.
Auburn, Beth Israel) on connecting eligible patients with Springwell services at the point
of discharge not only for the purpose of continuation of care, but also for reducing the
risk of re-hospitalization or nursing facility placement.
I see Springwell as an organization that focuses on promoting access to better quality care
in persons home. The programs they offer directly address the needs of consumers and as
a result, benefit overall US healthcare system by reducing rapidly growing health care
costs. Even though the costs associated with home care are not inexpensive, it is still a
considerably more affordable model that saves dollars invested in caring for patients in
hospitals or nursing facilities. Moreover, it offers a better quality lifestyle to the
individual.
Citations:
www.springwell.com
Topic Area Objective:
One of the objectives for older adults in healthy people 2020 is to reduce the proportion
of unpaid caregivers of older adults who report an unmet need for caregiver support
services (healthypeople.gov). Unfortunately, the lack of caregiver support is widely
known to Springwell. The information and consultation department gets multiple calls
from caregivers daily regarding services and supports available to them or their loved

ones. It is sad that many medical providers are often not familiar with the resources in the
community. Therefore, they cant point the family in the right direction. This is why I
personally find the health partnership program crucial in educating various hospitals and
doctors about services and supports available to their patients and caregivers.
Springwell offers family caregiver support program that helps a caregiver to be more
educated and feel supported with developing a plan of care for their relative. More often
than not, the caregiver support specialist makes a referral for the adult family care
program or the personal care attendant program that allow a caregiver to get paid for the
care they provide. In recognizing the needs of elders and the lack of family support,
Springwell also offers trainings and support groups that offer suggestions to reducing
stress and burnout, encourage a caregiver to be an advocate for their loved one and
connect a caregiver with other agencies that might help in providing better care.
I would hope that the goal of healthy people of 2020 is also a goal of executive office of
elder affairs, therefore, a goal of all area agencies on aging. It takes a collaborative effort
to make a positive change. I personally do not see this goal unrealistic but the outreach
and other service initiatives are certainly in the hands of agencies like Springwell. Thus,
the more medical providers are reached and educated about programs geared at
caregivers, the more likely the objective of reducing the proportion of unpaid
caregivers will be met.
Citations:
http://www.healthypeople.gov/2020/topics-objectives/topic/older-adults/objectives
Public Health Technique:

RE-AIM Framework is a public health technique that emphasizes the value it has in
planning, conducting, and evaluating caregiver interventions and policies(CDC, 2008).
The authors of the article Evaluating the Public Health Impact of Health Promotion
Interventions: The RE-AIM Framework focus on five core dimensions of this framework
that include Reach, Efficacy, Adoption, Implementation and Maintenance (Glasgow,
Voght, & Boles, 1999, p. 1323-1324). RE-AIM recognizes the importance of caregiving,
stress and burden associated with it, and the overall impact of caregiving on the US
healthcare system. Moreover, RE-AIM treats caregiving as an important public health
issue that has not been recognized until recently (CDC, 2008).
In applying RE-AIM framework to Springwells adult family care program, I discovered
how it could be applied in conducting program evaluation. In order to outline the results,
five core measures must be considered.
The Reach factor of the framework focuses on the percentage and risk characteristics of
persons who receive or are affected by a policy or program (Glasgow et al, 1999, p.
1323). It also measures how to target caregivers and do outreach (CDC, 2008).
Springwell has at least 30 families currently enrolled in the program (Loeb, A., personal
communication, February 5, 2015). It has also done great work in developing
partnerships with local hospitals, health care centers and nursing facilities to educate
them about the caregiver program. In addition, the internal information and consultation
department at Springwell always educates callers about the resources available to elders
and their caregivers (springwell.com).
The Efficacy dimension reviews how effective the program has been to the participants
and how satisfied they are with the program (Glasgow et al, 1999, p. 1323). The

participant S. Abramova reported feeling more supported and educated about the
resources available to her in the community. Abramova also claims that receiving a
stipend for care tremendously helps with meeting her elderly mothers needs. In addition,
the offered trainings and support groups have improved her own wellbeing and lowered
the amount of stress directly related with planning for hospice care (personal
communication, February 2, 2015).
Adoption reviews the attractiveness and appropriateness of a setting in which the
program is delivered (Glasgow et al, 1999, p. 1323). Springwell has done exceptionally
well with trying to accommodate different times and locations for their trainings and
support groups. Often the groups are held after work hours and the location changes from
month to month to accommodate those families who live father away (springwell.com).
Implementation refers to the extent to which a program is delivered as intended
(Glasgow et al, 1999, p. 1323). According to Springwell case manager, Ariane Loeb, the
adult family care program is a successful program with high participant satisfaction rate.
It is known to have low staff turn over; therefore there is high consistency in delivering
intervention. The trainings offered usually are scheduled to address the important topics
of caregiving to make sure the information is equally distributed to all caregivers
(personal communication, February 5, 2015).
Finally, the maintenance factor measures the extent to which innovations become a
relatively stable, enduring part of the behavioral repertoire of an
individual/organization/community (Glasgow et al, 1999, p. 1324). Most often than not,
both consumer and a caregiver report to be happy with the program. Very rarely do
people disenroll from the program. The elders like the fact that they can stay home cared

by their family till their last day and the caregivers value the agencys support in making
it possible for their relative to receive care they need at home (Loeb, A., personal
communication, February 5, 2015).
As a result of the program review above, I can draw a conclusion that RE-AIM public
health technique is an effective tool for gathering evidence-based information while
working through the five dimensions of the framework. Moreover, according to Glasgow
et al (1999), the model can help decision/policy makers to have more complete
information on which to base adoption or discontinuance of programs (p. 1324).
Citations:
Abramova, S. Personal Communication. February 2, 2015.
Caregiver Support Program. http://springwell.com/care_support.php

Center for Disease Control and Prevention and the Kimberly-Clark Corporation. (2008).
Assuring Healthy Caregivers, a Public Health Approach to Translating Research Into
Practice. Retrieved from http://www.cdc.gov/aging/pdf/caregiving_monograph.pdf
Glasgow, R., Voght, T., & Boles, S. (1999). Evaluating the Public Health Impact of
Health Promotion Interventions: The RE-AIM Framework. American Journal of Public
Health, 89 (9), pages 1322-1325. Retrieved from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1508772/pdf/amjph00009-0018.pdf
Loeb, A. Personal Communication. February 5, 2015.
Health Promotion Philosophy:
From the description of RE-AIM framework, I can conclude that this public health
technique follows the social change health promotion philosophy. It is clearly seen in

their focus of calling for initiatives to move caregiver interventions into public health
practice(CDC). The framework understands the challenges associated with
implementing such programs but it also recognizes the benefits for caregivers, seniors
and the healthcare system.
This tool can be widely used in assessing or developing programs and policies. It
incorporates all the important questions that must be asked when evaluating or drafting a
policy/developing a program. The framework also looks at the outcomes for each of its
core measures that are closely interconnected.
The goal of RE-AIM, in my opinion, is to help organizations create more effective
programs and policies that would provide caregivers the support they need in better
caring for their relatives. If adopted, this approach will most certainly lead to social
change, which in turn could contribute to reducing spending in the healthcare system.
Citations:
Center for Disease Control and Prevention and the Kimberly-Clark Corporation. (2208)
Assuring Healthy Caregivers, a Public Health Approach to Translating Research Into
Practice. Retrieved from http://www.cdc.gov/aging/pdf/caregiving_monograph.pdf
Ethics:
In my opinion, RE-AIM public health technique is a tool of ethical analysis that can help
organizations to develop programs that will address the need for improved caregiver
support. The five dimensions of this technique highlight the aspects of important
measures that are crucial to development of a policy or evaluation of a program. RE-AIM
also promotes personal autonomy that is carried through the entire assessment process.
According to David Buchanans article Autonomy, Paternalism, and Justice: Ethical

Priorities in Public Health, autonomy is described as the capacity of a person to

critically reflect upon and then accept or change ones desires, values, and ideals
(Buchanan, 2008, p. 17). The autonomy in this case is given to the agencies that are
evaluating their programs or developing policies. With autonomy, the policy makers are
given power to draft policies for improving initiatives geared at caregiver support.
Buchanan (2008) also argues that many Americans are unhappy with paying higher taxes
to absorb growing costs of healthcare (Buchanan, p. 18). RE-AIM addresses this issue as
well with the focus on encouraging long-term care provided by families rather than
hospitals and nursing homes but only with appropriate caregiver supports. This way the
overall costs will hopefully diminish, as it is more cost-effective to care for elders in a
home setting.
Therefore, there is nothing unethical about RE-AIM technique that should stop any
agency from implementing it in their policy development and/or program evaluation.
After all, since the code of ethics emphasizes that public health should seek the
information needed to implement effective policies and programs that protect and
promote health, RE-AIM most certainly can contribute to development of stronger,
person-centered programs/policies that will be beneficial to the society as a whole.
Citation:
Buchanan, D. (2008). Autonomy, Paternalism, and Justice: Ethical Priorities in Public
Health. Health Policy and Ethics, 98(1), 15-20.
Code of Ethics. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447186/