Senior outreach to services

Guest Column

According to Ralph Waldo Emerson, “Nothing astonishes people so much as common sense and plain dealing.” The following account demonstrates the effectiveness of this philosophy. In the summer of 2003, the Bernardine Franciscan Sisters Foundation (BFSF) board of directors decided to invest $100,000 in a dynamic, collaborative project to support older adults on the Virginia Peninsula. The Peninsula Agency on Aging (PAA) was invited to convene a planning committee to design the program.

Following several community-wide planning sessions, the consensus was that the best use of BFSF funds would be to have PAA Care Coordination staff visit senior housing complexes on a regular basis. This would provide ease of access to supportive services designed to assist older individuals to remain safely in their homes.

The planning group determined that barriers to services such as lack of transportation to the PAA office to apply for assistance could be removed by conducting on-site outreach. Thus the Senior Outreach to Services (SOS) program was born.

Another important part of our plan was to reduce paperwork as much as possible. We discovered that in many cases a two-page form was sufficient to not only connect seniors with services, but to also follow-up and assure the services were delivered. The “two pager” replaced a 12-page form.

With a reduced workload, thanks to the streamlined client-intake process, and ready access to the care coordinator, it was not surprising that in the first year of operation SOS served more than 800 individuals. This was in stark contrast to the 200 served the previous year, using the traditional paperwork intensive approach.

As noted above, one of the greatest challenges for seniors in income-based housing is the lack of access to reliable transportation. The SOS program provides them an on-site counselor who meets with residents in their own communities to share information, provide education and resources that help them to remain independent and safe in their own homes. Services range from fall prevention and chronic disease self-management classes to information on local transportation resources, Medicaid, energy assistance and the Supplemental Nutrition Assistance Program (SNAP) eligibility, or how to select the best Medicare drug plan. Having this kind of information on-site is invaluable.

Over the past 15 years, SOS has served more than 10,000 seniors, received statewide and national recognition for innovation and has been replicated by the area agency on aging in Loudon County, Virginia. Additionally, PAA has leveraged funding to sustain the service after the generous support of the BFSF ran its course.

To this day Peninsula seniors and family caregivers continue to benefit from this common-sense approach to assist individuals to remain in their homes and communities while enjoying a better quality of life.

Peninsula Agency on Aging is the state-designated local organization serving seniors and family caregivers in Newport News, Hampton, James City County, York County, Poquoson and Williamsburg. PAA may be reached at 757-873-0541 or or

About Sister David Ann Niski 13 Articles
Sister David Ann Niski is executive director of the Bernadine Franciscan Sisters Foundation. A strong advocate and supporter of the Virginia Peninsula not-for-profit agencies, she can be reached at 757-886-6025 or by e-mail at

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