The Promise of Community Health Workers
These specialists link underserved communities and the health care system
(Editor’s note: This story is part of a series for The John A. Hartford Foundation.)
They go by different names: outreach workers, promotores, non-traditional health workers, community health representatives. Whatever they may be called, community health workers (CHWs) act as a vital link between health services and the neighborhoods they serve.
These frontline public health professionals understand the unique needs of their underserved communities — from language barriers to lack of transportation or access to healthy food. They focus on building trust by applying their special understanding of language and/or culture to improve health knowledge and ultimately, improve health.
The community health worker concept is gaining traction as health systems look for ways to control costs, reduce hospitalizations and better manage patients' long-term, chronic conditions. There were about 56,000 community health workers in the U.S. in 2018, according to the U.S. Bureau of Labor Statistics.
“Families are not nuclear anymore. As you age, you need that community around you.”
While community health workers serve all ages, from infants and new moms to older adults, it’s perhaps this latter group that can most benefit from access to social services and improved quality of life.
“A community health worker can step up to be an advocate, someone to center the care around you and your needs,” said Marquita Rockamore, director of Cuyahoga Community College's community health worker program in Cleveland.
More hospitals and even physician offices are employing community health workers to assist patients who need help navigating the medical system or managing their care.
There are no income requirements for older adults to use community health workers. Their free service is offered by many insurance plans, docto'rs offices, mental health clinics, hospitals and social service agencies, according to Jasmine Brown, a community health worker in Cleveland. Most of the Medicare patients community health workers assist are at, or below, the poverty line, with annual incomes between $12,000 and $36,000. Some social service programs, like Meals on Wheels, may have income, age or disability requirements to qualify.
Community Health Workers Are 'Feet On the Ground'
“Community health workers generally have shared life experiences with the target population, which could be linguistic, socio-economic, racial or anything else that bonds them together," said Sergio Matos, executive director of the Community Health Network of NYC, an independent professional association of CHWs.
Many barriers get in the way of access to doctor visits, and health providers often aren't aware of those issues or able to help, Matos explained. Community health workers are the “feet on the ground" that help patients access the services they may need.
“What if the person’s literacy level is such that they don’t understand what’s happening to them? What if they don’t know how to fill out that paperwork? That’s where the community health worker comes in,” said Rockamore. “They can be an intermediary between the doctor and senior, explain a treatment or [hospital] discharge plan, and do what’s called a 'teach-back' to make sure they understand what to do and how to do it, what this medicine does, how this condition affects them.”
Rockamore, a former social worker, is in the process of becoming certified as a community health worker.
Community health workers can also provide direct services, such as informal counseling, care coordination and health screenings — whatever it takes to get people healthier and more empowered to take charge of their health.
“Families are not nuclear anymore,” Matos said. “As you age, you need that community around you.”
How Community Health Workers Work
Community health workers participate in multi-disciplinary teams, in group sessions or one-on-one in homes and community settings. They may act as case managers and coordinate care; conduct health promotion and coaching; help people navigate the health system and serve as a bridge between local residents and other health or social service professionals.
That could be anything from helping fill out an application for home meal delivery to arranging rides to the doctor’s office, or teaching people how a healthier approach to cooking will help them better manage their diabetes.
“They need Meals on Wheels, they need transportation to their appointments, they need transportation to the pharmacy. Some need assistance with getting their homes cleaned or their gutters cleaned, just the little things that we do every day,” said Brown, who serves residents in Cuyahoga County and surrounding areas, focusing primarily on the 65-and-older population.
“Every day I hit the ground running to find these resources or community resources to help them,” Brown said.
Brown, who was certified through Cuyahoga Community College's training program, says simple things can go a long way to helping people stay healthy and out of hospitals.
Enhancing communication, using available services appropriately and improving health management reduces the need for emergency and specialty services, according to the American Public Health Association. That improves the overall health of communities and saves the health system money through avoidable visits to the emergency department and fewer hospital or nursing home admissions.
“You’re educating the public to use the services correctly, how to take their medications properly, keeping their blood pressure down so there are less pills to take. It’s all about preventable care,” said Brown.
Community health workers can also relieve some of the pressure put on family caregivers.
The average annual wage for community health workers is about $43,000, so most people with these jobs are not in it for the money. Many are like Brown, who just want to give back to their communities.
“I just love what I do and I love finding these resources,” she said. Her grandmother had Alzheimer’s disease, so Brown understands how valuable culturally appropriate education and connections to the right services are to families. “It really does make a difference,” she noted.
One challenge she finds in working with older people is that they often don’t want to ask for help. “They think that’s for the next person,” Brown said. “A lot of the conversation is about it being OK to let me help them. You’ve got to build that relationship to get them to trust you.”
To access community health worker services, a physician's office or city information line (211 or 311) is a good place to start, as well as a local area agency on aging. Make a list of specific needs and questions, Brown advises, including medical and social needs.
Take it one step at a time, because finding the help you or a loved one needs can sometimes be overwhelming. “But that’s what keeps me going,” Brown said. “I can provide this little service that makes just the biggest difference.”