Help from a Home Care Companion: Paul’s Story

Loneliness and isolation can worsen health conditions, and in response, CMS helps promote companionship

Published February 7, 2024

It was Paul Vicino’s 71st birthday, but he wasn’t in a celebratory mood. Sidelined with a major knee injury that forced him to stop working, he was struggling with isolation and a loss of mobility.

That day, a home health companion arrived for the first time and brought a cake and a birthday card.

“I was very touched by that,” said Vicino, of Parkville, MD. “A little thing like that made all the difference, made me feel comfortable.”

Vicino’s home health companion was funded through the Health Equity Advancement Resource and Transformation (HEART) payment, a special payment provided to participants in the Maryland Primary Care Program to address health-related social needs, such as food insecurity and housing instability. The HEART payment and the Maryland Primary Care Program are part of the Maryland Total Cost of Care Model, a Centers for Medicare & Medicaid Services Innovation Center model (pilot) that aims to promote better health care in the state.

When the HEART payments first began in 2022, Clinical Associates, Vicino’s primary care provider, sent out a survey to patients to gauge interest in which types of non-clinical support, such as vouchers for groceries or free rides to medical appointments, patients might be most interested in receiving. The response was not what the Clinical Associates team expected.

“The biggest issue [expressed by our patients] was isolation, loneliness,” said Peter Beilenson, director of population health for Clinical Associates and a former Baltimore City health commissioner. “Rather than doing food or transportation, the more important thing for our patients was actually services in the home or a senior companion.”

A 2020 report by the National Academies of Sciences, Engineering, and Medicine found that one-quarter of community-dwelling Americans aged 65 and older were socially isolated, and a significant proportion of adults in the United States reported feeling lonely. Other studies have found that loneliness and isolation can worsen health conditions such as dementia, heart disease and mental health, and can increase the risk of premature death.

Clinical Associates began contracting with a few providers of home care companions.

Vicino had a few different home health companions before he found a good match in Dawn, who is similar in age and interests. She comes to his home for five hours a day, three times a week, and helps with cleaning, cooking and running errands such as grocery shopping, going to the bank or driving him to appointments.

Vicino, a classically trained painter and printmaker who graduated from the Maryland Institute College of Art, said he enjoys chatting with Dawn and even made a painting for her. “We talk about music, she’s into jazz, we reminisce,” he said.

Vicino was working in health care and transporting a patient in a wheelchair in 2021 when he injured his knee, forcing him to stop working. Initially in a wheelchair himself, Vicino said he has gradually gone from using a walker to a cane as he’s worked to overcome his injury. Besides the physical issues from the injury, he said he spent a lot of time “wasting away” in bed before the home health companions helped get him more active.

“The worst problem seniors have is they’re by themselves,” Vicino said. The program, he said, has “turned my life around.”

While Clinical Associates does use some HEART payments to pay for groceries or car rides to medical appointments, the vast majority of the money goes to pay for senior companions, Beilenson said.

“I think [loneliness] is very underappreciated compared to other health care needs, it’s a major issue,” Beilenson said.

Vicino credits the program with helping him regain his mobility and activity, and said he hopes to be able to work again.

“My ultimate goal is maybe to get back into the workplace,” Vicino said. “I’m not the type to retire.”