The new project aims to increase health literacy among seniors in Southeast Michigan

This article is part of Health condition, a series about how Michigan communities are stepping up to address health challenges. This is possible with funding from Michigan Health Foundation.

Seniors living in Southeast Michigan have a new superpower. PACE Southeast Michigan sites in Southfield, Detroit, Eastpointe, Dearborn, Sterling Heights and Pontiac have launched a new project called The Power of Understanding that uses proven health literacy tools to empower participants to engage as advocates for their own health.

PACE stands for Comprehensive Senior Care Program. A federally funded program, PACE provides comprehensive medical and social services at low or no cost to seniors living at home. Most participants have both Medicaid and Medicare insurance coverage. Those who do not qualify for Medicaid may pay an out-of-pocket fee that is roughly half the cost of living in an assisted living or long-term care facility.

“PACE makes high-quality health care accessible to seniors in all communities,” said Lori Arora, PACE Southeast Michigan vice president of community affairs, philanthropy and organizational development. “The power of understanding is an example of this, making healthcare even more accessible and understandable.”
Lori Arora.
PACE Southeast Michigan began training all staff members to implement The Power of Understanding in a series of sessions launched at its Eastpointe center in the fall of 2021. In early 2022, all six sites began actively engaging their participants in the program . A grant from the Michigan Health Care Fund helps cover the cost of the program. The National Institutes of Health defines health literacy as “the extent to which organizations equitably enable people to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.”

“We have engaged and trained all of our employees in health literacy—drivers, nurses, nursing assistants, our physicians and our administrators,” says Janice Rudd, PACE Southeast Michigan director of pharmacy and integrated clinical services. “That’s why we all appreciate how making medical language understandable improves outcomes for our participants.”

The reverse learning method enables understanding

In preparation for teaching staff how to better communicate with patients, the Power of Understanding program held focus groups with participants to develop a common language and reviewed informational materials to ensure they were engaging and easy to read. PACE Southeast Michigan also sought help from Cheers to Henry Forda leader in health literacy, and received permission to use materials developed by the health system to promote health literacy.

“Did you know that more than one in five Americans is functionally illiterate? That’s more than 43 million adults in the United States who can’t read or do basic math above a third-grade level,” said Nancy Combs, director of Nancy Combs Communications, a partner of PACE Southeast Michigan. “Henry Ford already checked [its handouts] for readability, accessibility, comprehensibility, diversity—all of which we know matter for patient education materials.”

The Power of Understanding training taught PACE Southeast Michigan staff to use reverse learning method to check understanding. When talking with participants, PACE Southeast Michigan staff ask them to state in their own words what they need to know or do about their health to confirm that they understand what is being shared.
Materials on the power of understanding.
“It’s always up to us to communicate clearly and effectively—and to check for understanding,” says Combs. “This is organizational health literacy. All the processes you put in place ensure that the patient has the tools to understand what they need to do to be healthy or to maximize their opportunity for health.”

In addition to Henry Ford Health, PACE Southeast Michigan worked with many other partners in developing The Power of Understanding: the Michigan Board of Healthon University of Michigan College of Pharmacyon Wayne State University College of Pharmacy and Health Sciencesand the PACE Association of Michigan. Rudd says these collaborations are what she has valued most about the program.

“It’s just an amazing thing to unfold and be a part of,” she says.

Managing diabetes, reducing hospital visits and improving quality of life

With nearly one-third of PACE Southeast Michigan participants living with type 2 diabetes, The Power of Understanding has a key focus on empowering them to master the strategies available to control their condition: diet, physical activity, accurate testing of blood sugar levels, and management of the drugs.
Materials on the power of understanding.
“Essentially, diabetes is incurable. So focusing on it is in line with our mission to see someone through to the end of their life, to provide dignity, integrity and high quality of care,” Rudd says. “Also, diabetes is very complex and not easy to manage. It requires participants to be truly involved in their care to be successful.”

Those who participate in the Power of Understanding program are expected to improve HbA1c levels, be more satisfied with communication with their providers, and reduce avoidable emergency room visits and hospitalizations. According to research published by the Journal of the American Medical Association, many hospitalized older adults develop complications unrelated to the reasons for admission. These “hazards of hospitalization” include delirium, malnutrition, urinary incontinence, pressure ulcers, depression, falls, infection, functional decline, adverse drug effects, and death.

“Hospitals are great when you have to be there,” says Arora. “But we know our participants. We take care of them daily. So we’d rather be the ones providing that care if we can avoid hospitalization.”

Caregiver confidence is critical

The power of understanding also aims to boost the confidence of people caring for family members at home. With one in seven adults over the age of 71 facing issues with dementia, those living at home with a family caregiver may need comprehensive care that goes beyond just activities of daily living but also includes managing finances, home repairs, meals, transportation to appointments, and more. PACE Southeast Michigan not only shares the training method so caregivers can make sure they are communicating well with their loved ones, but also hosts a caregiver support group and offers respite care.

“PACE works not only with participants, but with their caregivers as well,” says Stephanie Winslow, Executive Director, PACE Association of Michigan. “If we can help give them whatever tools they need, whether it’s education or support, it gives them a little bit of relief and they don’t feel like they’re alone.” This education that the Power of Understanding gives them does just that.”
Sadie Shattuck and Lori Arora review pamphlets about the Power of Understanding.
Arora and Rudd say they’ve already seen the impact of the Power of Understanding. Arora says she has heard PACE employees express that they can do their jobs better as a result of the program.

“Then there are the experiences we’ve had with individuals, hearing staff members say ‘Aha!’ moments, their stories of the personal impact they’ve made on patients,” Rudd says. “Our staff really understands how important the power of understanding is within their unique goals.”

Estelle Slootmaker is a working writer focused on journalism, book editing, communications, poetry and children’s books. You can contact her at [email protected] or

Photos by Nick Hagen.

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