PROVIDENCE – Where else would you meet an entrepreneur who has developed a new website for seniors, caregivers and professionals, the winner of the business achievement award from the most recent “health and wellness” cohort at the Social Enterprise Greenhouse?

The answer, of course, is Olga’s Cup + Saucer on Point Street, where ConvergenceRI met with Deborah Burton, MS, a gerontologist and the founder of RIElderInfo.com, on a chilly early morning in mid-December, a week before Christmas, to talk about her new startup enterprise.

Olga’s, still the hub of innovation in the former Jewelry District, was humming. Two tables down was Neil Steinberg, president and CEO of The Rhode Island Foundation, deep in conversation. On the other side of the café was Courtney Hawkins, the director of the R.I. Department of Human Services, meeting with Linda Katz of the Economic Progress Institute. [“Aren’t you supposed to be on vacation?” Steinberg asked ConvergenceRI, with good humor, as he was leaving.]

ConvergenceRI had bumped into Burton at the holiday gathering at MedMates a week earlier, and Burton, who was busy networking, suggested a meeting, in part after reading the ConvergenceRI exit interview with Virginia Burke, the outgoing president and CEO of the Rhode Island Health Care Association. [See link below to ConvergenceRI story, “Changing of the Guard.”]

The idea for the website, Burton explained, had come in part as a result of the botched rollout of the Unified Health Infrastructure Project, or UHIP, where delays in applications by seniors to access home- and community-based services resulted in people having to wait for a long time. “Which,” Burton said, “made me really start to question: how are they staying home?”

In response, Burton continued, “I started holding some listening sessions, late last winter and early spring, all over the state.”

What Burton discovered was that many people had had a specific event, leading to the need for home care placement. Others were accessing small, little community resources.

The result of the listening exercise was that Burton had gathered a lot of useful information. “As a consultant, that’s a good thing, but as a human being, I knew that the information needed to be in the public domain,” she said. “So, I started writing everything down.”

Which, in turn, led to the idea of creating a website to serve seniors, caregivers and professionals. Burton worked with Englund Studios in East Greenwich to do the web design and marketing. “I told them it was going to be a big website.”

The goal of the new website, Burton continued, is straightforward: “When you think of aging, I want people to think of RIElderInfo.com. It is a reliable source of information. When there is new information available, it is being updated. When something is no longer accurate, it’s removed. It’s a trusted resource for the community to go to when they are in crisis. And, in a perfect world, it would happen before a crisis.”

One of the advantages of RIElderInfo.com, is that it can bring together information from disparate sources that are often created in silos, with little integration. An example that Burton cited was pets, or more specifically, the resources available to take care of pets of seniors, if and when the seniors might need care in a skilled nursing facility, say, for rehab following a knee replacement.

“To me, it just made sense that I needed to have a pet section [as part of the website],” Burton explained. “If you are going [to need] inpatient care, because you’ve fallen and broken a hip, a lot of times our pets are what is keeping us from dying from social isolation. They are keeping us engaged with the world, and making us get up every day.”

Here is the ConvergenceRI interview with Deborah Burton, entrepreneur, gerontologist and founder of RIElderInfo.com, talking about her efforts to build an inclusive website about aging that provides answers to questions if you are a senior, a caregiver or a professional.

ConvergenceRI: When did you officially launch the new website?
BURTON: I launched RIElderInfo.com this past fall. I was part of the Social Enterprise Greenhouse business accelerator program.

When I originally joined, I was thinking I was going to take my private elder care consulting business and expand it into a corporation, and that I would build this nice website on the side.

They took at look at it, and said, “I don’t think you realize how big this website is.” [Meg Wirth served as her mentor at SEG.]

I agreed; the website is big and it is important, and it has been needed for a very long time.

I, as a private consultant, was gathering tons of resources that would enable people to stay home for as long as possible.

I was hearing from professionals: we need CEUs [continuing education units], particularly at this time of year. And, I was hearing from the other side: we’re offering these CEU programs and people aren’t coming.

So, I’m gathering this information, I’m working with individuals in the community as a private consultant, and, with the UHIP issue, there were people who were applying for home- and community-based services through Medicaid who had to wait quite a lot of time.

[These people were saying]: I’m homebound; I need help bathing and dressing; I need help with grocery shopping and laundry.

In applying for Medicaid, they were stating, I’m homebound, I need help bathing and dressing, I need help with grocery shopping and laundry.

Which made me really start to question: how are they staying home?

ConvergenceRI: Who built your website?
BURTON: I worked with Englund Studios in East Greenwich. I told them it was going to be a big website. They said, no problem.

They asked: who is your market? I said: seniors, caregivers and professionals.

I told them it has to be super-easy to navigate, and very clean, visually. Simple.

We went live Oct. 19, [2018].

ConvergenceRI: What has been the feedback?
BURTON: I sent it to the Medicare QIO [Quality Improvement Organization] Patient Family Advisory Council.

ConvergenceRI: Healthcentric Advisors?
BURTON: Yes, they have a Patient Family Advisory Council. And asked them to review it for ease of navigation, content, visuals, everything.

They reviewed, and then made a couple of small recommendations. I had used an italicized font on one page, and they said: It is really hard to read.

I just got the formal endorsement yesterday [Dec. 17, 2018] from the PFAC.

The Senior Agenda Coalition RI has accepted it and added it to their resource guide.

I don’t know if you know Gerry LePage, he has been an information referral specialist for 20 or 30 years at Child & Family Resources in Middletown. He has given [the website] rave reviews and put in shortcuts on his desktop, so he can access it all the time.

Kelly Ward, who works out of the patient medical home over at the Providence VA, she said: “Thank you for doing this; our colleagues really needed this.”

I’m getting a lot of really positive feedback.

ConvergenceRI: Could you explain how the market works for your website? In my experience, the people most in need of information are often most resistant to getting it. Even if the information is valuable and accessible, it doesn’t mean that people are going to make use of it.
BURTON: Yes. That’s very true.

ConvergenceRI: Have you built in a feedback loop?
BURTON: There is a newsletter for seniors and caregivers. There’s also a newsletter for professionals. There is also an events calendar for each.

The idea is that it does not become a “one and done” when they visit the site. [Assuming the voice of a potential customer:] Oh, I needed a list of nursing homes, I’ve gotten my list, and now I never need to come back.

A lot of times there is this misperception that individuals over the age of 60 are only interested in flu shots and bingo.

You may want to go see a concert; you may want to go see a guest lecturer, you may want to participate in volunteer opportunities. The events calendar is [aimed at] keeping people engaged, which is really important to reduce social isolation.

ConvergenceRI: How does that play out community-wise, in terms of networking?
BURTON: I am still working on reaching out. So, one of the things, I participate in the Lt. Gov.’s Long-Term Care Coordinating Council.

I’m also a member of the Aging and Community Subcommittee, which has now transformed into Age Friendly RI.

What we really did was to identify what are the resources around the state, and respond to people, who were consistently saying: we need a website.

ConvergenceRI: From the perspective of the seniors, I know someone who refuses to use a computer, who is techno-phobic.
BURTON: For the seniors directly, they may or may not access the site.

It would be more likely to be the caregivers – the caregivers when they are at work, when they are on their phone. [Assuming the voice of caregiver]: I know something is not right with Mom and Dad, and I know they need help.

How do I find out what’s available out there? What’s available in the community? How do I get Mom to the doctor when I have to go to work?

If they live in Little Compton, and Mom has to come up here for a cardiac appointment, there’s transportation in Little Compton. But it is for residents of Little Compton.

So, there are resources out there, but they haven’t ever been available in one place. The caregivers can now access a mobile-friendly site.

As far as outreach, I write for Senior Digest [a free monthly print and online newspaper]; there is an article now in the December issue. I am also looking at doing some outreach to have a larger social media presence as well.

I am also looking at targeted outreach into the non-English, limited English proficiency community, because the website can be translated into 10 languages, one of them being English. It has been validated for Chinese, Portuguese and Spanish, so far.

The language on the website is written in a really simple style. Part of that is to address any kind of literacy issues that anyone in any language might have.

ConvergenceRI: Have you coordinated with folks such as Clinica Esperanza? Clinica Esperanza runs a free clinic in Olneyville and it deals a lot with the immigrant population. Or, with ONE Neighborhood Builders, and the health equity zone?
BURTON: I am going to reach out to folks at Progreso Latino. And the Spanish radio station.

ConvergenceRI: Are you familiar with the Neighborhood Health Station in Central Falls?
BURTON: Yes. It’s a sister site to the Scituate Health Alliance. I am going to reach out to Dr. Michael Fine.

ConvergenceRI: Have you networked with PACE RI?
BURTON: Yes, I just saw Kelly Ann Lee [Vice President of Community Engagement and Enrollment] yesterday from PACE. As a matter of fact, PACE is one of the topics on the website.

PACE can serve as a tremendous resource for folks and it is not something that is well known.

ConvergenceRI: One of the big issues in the home health care field is that some 50 percent of the people who have trained and been licensed as CNAs don’t use their license, according to sources.
BURTON: Right. Being a CNA is really hard.

ConvergenceRI: I appreciate the effort that is being made to keep people in their homes as long as possible, but I have never seen a good cost analysis of what 24/7 care is – and what’s required.
BURTON: When you think about costs, and not in terms necessarily of Medicaid, if you are looking at nursing homes in Rhode Island, general financial statistics, on average, I think it is $315 a day. This is strictly just private pay, before Medicaid kicks in.

Here’s the thing. A lot of Rhode Islanders, I believe, I would have to go to the website to get the exact number, but the average income for individuals over the age of 65 in Rhode Island is around $45,000. Which means the monthly income is putting you outside of the Medicaid range.

Now you have to find resources that you can afford, because, in one way, $45,000 is a lot, in other ways, not so much – particularly if we are buying our houses later in life. If you are buying a house at age 40, with a 30-year mortgage, you’re still paying your mortgage when you are 70.

People don’t necessarily have a lot of financial ability to do a lot; they are trying to access community resources.

They are trying to figure out: how do I do this. Or, perhaps, they are sharing responsibilities with adult children who are also still working. [Assuming the voice of an adult child]: How do I access services to keep Mom home? How do I get grab bars put into the bathroom so Mom can get in and out of the shower safely?

And, maybe they don’t know about the home modification grant that is out there or other opportunities.

ConvergenceRI: Have you done a study of the demographics involved?
BURTON: As far as?

ConvergenceRI: In terms of the old old population in Rhode Island?
BURTON: We have one of the oldest populations over the age of 85 in this state.

ConvergenceRI: Yes. I was wondering if you’ve actually broken it down by community?
BURTON: If you want to look [the aging population] by community, there is a really good table that has been done, and the table lives on Age Friendly Rhode Island website, and it’s called, “Healthy Aging Data.”

It was developed originally in Massachusetts, the professor who did it for Massachusetts has come and done it for Rhode Island. So, if you want to know, you can break the data by community, what’s the age demographic, what’s the health demographic, what’s the income demographic, across the state.

[For instance], Block Island is actually one of our oldest communities, looking at the data where you identifying the community as your residence. Block Island is very underserved, unfortunately.

Even for me, in my work as a consultant, because I get motion sick, so the ferry is not so good.

ConvergenceRI: Is there any data about the people who are in nursing homes now? Who are they? What have they been diagnosed with? What is there determination of care [using de-identified data]?
BURTON: What causes them to be there.

One of the things you need to be aware of when you are looking at taking people and returning them to the community is: are there sufficient community resources for that person? Is there affordable housing? It’s a huge issue.

So, if you’ve been in a nursing home for six months or longer, you may not have housing to go back to; now you need to have housing. Housing shortage is a huge problem.

ConvergenceRI: Do you find that there is an absence of conversation around such issues?
BURTON: There are conversations about how we keep people at home. But shortage of staff, in order to do that, has been a problem. Lack of knowledge of what’s available in the community has been an issue.

ConvergenceRI: Is it also an issue that certain standards have been set for nurses that do not apply to home care?
BURTON: The regulations are different, but there is certainly a standard of care expectations. Absolutely.

But, if there is not sufficient staff to reach parts of the state where there are very few CNAs available to go, that makes it more challenging.

ConvergenceRI: Where?
BURTON: Washington County, Burrillville, Pascoag.

So, if you want to say, move someone back to their home in Exeter, and they need someone to come in to help them get in and out of the shower, that becomes a real challenge when there are no staff available.

There are organizations – URI is working on a workforce development grant – so if you’re looking at, regardless of state Medicaid home- and community-based services, or receiving Medicare services in the community, it’s still going to be a CNA or a nurse coming out to your house.

If you look at strictly the persons doing that [providing those services], if there are not enough people doing that job, the payer source is not as important. There’s just not enough.

ConvergenceRI: Can you tell me a bit more about the health and wellness accelerator at the Social Enterprise Greenhouse?
BURTON: I won the Social Enterprise Greenhouse business achievement award for the health and wellness accelerator. I’m very excited about that.

ConvergenceRI: How many participants were there?
BURTON: There were 12 in our class. It was a wonderful opportunity.

My background is I have master’s degree in Gerontology, in the management of aging services from UMass Boston. My brain lights up when it comes to all things aging. I’m a member of the Gerontological Society of America. A thousand years ago, I was a nurse’s aide before you even had to be certified.

ConvergrenceRI: In your opinion, what makes for an engaged community around aging?
BURTON: An engaged community is actually one that is showing up and participating in some way.

I can measure by Google Analytics if they are coming to the website. I can follow up with some of the events listed on the calendar by asking: Have you noticed an increase in attendance.

I think that engagement is one of those things that can be challenging to achieve.