Kentucky Homeplace

Evidence-level

Effective (About evidence-level criteria)

Description

Compared to the rest of the state and country, eastern Kentucky residents are statistically poorer, have less formal education, and have inadequate health insurance. In addition, a majority of the counties in Kentucky are designated as Medically Underserved Areas. Rural, low-income community members lack proper knowledge of their health conditions and run into barriers of social/cultural inhibitors, financial burdens, and transportation.

Kentucky Homeplace was created in 1994 by the University of Kentucky Center of Excellence in Rural Health and funded by the Kentucky General Assembly to combat health disparities in rural areas of the state. This community health worker (CHW) initiative, first based in the eastern town of Hazard, KY, has since connected thousands of rural Kentucky residents with medical, environmental, and social services. Currently, 26 counties located in the Appalachian region of eastern Kentucky are being served by Kentucky Homeplace.

Services offered

Kentucky Homeplace trains CHWs, usually individuals who were born and raised within the community, to provide access to numerous health and social services. Kentucky Homeplace emphasizes care coordination and health coaching.

A majority of the clients are at 100%-133% of the federal poverty level. Kentucky Homeplace does not charge clients for services provided. Within their communities, these services include:

• Free health information
• Health Coaching for clients and family members
• Chronic Disease Self-Management Program (CDSMP)
• Diabetes Self-Management Program (DSMP)
• Eye exams and eyeglasses
• Hearing aids at reduced rates
• Reduced or no-cost medications
• Reduced fee for dental services and low-cost dentures
• Sliding fee referrals for doctor visits
• Enrollment/re-enrollment for Medicare, Medicaid, and other available insurance

Kentucky Homeplace:

• Implements programs to promote, maintain, and improve individual and community health
• Assists communities and individuals to adopt healthy behaviors
• Trains CHWs to help find solutions that address social determinants of health
• Facilitates communication and care coordination between patients and providers
• Advocates on behalf of their clients
• Collects data to help identify individual and community needs

Kentucky Homeplace is an approved Tier-1 CHW training center in Kentucky recognized by the State Office of Community Health Workers. Hundreds of individuals have completed CHW training with Kentucky Homeplace. In addition, a new pilot program allows students at two high schools in Hazard, KY, to receive dual credit while completing CHW training by Kentucky Homeplace managers.

Two Kentucky Homeplace offices operate as regional sites for Project CARAT (Coordinating & Assisting the Reuse of Assistive Technology), which refurbishes and donates assistive technology or durable medical equipment, like manual wheelchairs or shower benches, at no cost to those in need.

A CHW shares her experience helping a patient access colon cancer screening:

Results

From July 2001 to June 2024, Kentucky Homeplace served 196,801 clients and provided 5,344,547 services with a combined medication and service value of $416,537,169. The return on investment (ROI) is $11.33 saved for every $1 invested.

In a 2016-2018 pilot program offered by Kentucky Homeplace and WellCare of Kentucky, Kentucky Homeplace CHWs provided six-week health workshops to participants with chronic disease diagnoses such as asthma, diabetes, high blood pressure, or obesity. Workshops focused on topics like nutrition, medication, exercise, and mental health. Participants also received gas cards to help with transportation barriers.

The pilot program reached almost 2,000 rural Kentuckians in 30 counties. A year after the pilot, Kentucky Homeplace reported that participants had a 10% reduction in emergency room (ER) visits, a nearly 13% reduction in non-emergency ER visits, and a 23% decrease in inpatient admissions. Hospital inpatient days dropped by more than 27%, and WellCare estimates that the cost of healthcare for participants dropped by 13.5%, or almost $2,300 per year.

WellCare compared healthcare service utilization one year before and after the program: For participants with diabetes, ER visits dropped by 16% and hospital admissions were reduced by almost 29%. Costs fell by 16.9%, or $3,424 per member per year. Participants with diabetes and asthma had 22% fewer non-emergency ER visits.

For more specific, recent information on the statewide impact of Kentucky Homeplace, view the latest Quarterly Reports.

National Recognition:

Kentucky Homeplace has received numerous awards and recognition over the years, including the National Rural Health Association's 2008 Outstanding Rural Health Program Award. See a list of more awards.

Kentucky Homeplace was a collaborating partner in C-Change, an organization that assembles key cancer leaders from private, public, and not-for-profit sectors and from across the cancer continuum: prevention, early detection, treatment, and quality of life.

In 2014, Congressman Hal Rogers presented a Health Impact Award to Kentucky Homeplace for its Improving Diabetes Outcomes (I DO) Campaign. Funded by a grant from the Elevance Health Foundation (formerly the Anthem Foundation), I DO is a nurse-led outreach initiative coordinated by CHWs to educate patients about their diabetes. This is important because 31 of the 38 Kentucky Homeplace counties that participated in I DO are located in the "National Diabetes Belt." In that region, 11% or more of adults had been told by a healthcare professional they have diabetes, yet the belt has the lowest number of certified diabetic educators to help individuals live healthy lives.

Kentucky Homeplace has been recognized by the U.S. Department of Health and Human Services' Healthy People 2020 initiative for its work to improve colorectal cancer screening rates.

For more detailed program results:

Cardarelli, R., Horsley, M., Ray, L., Maggard, N., Schilling, J., Weatherford, S., … & Gilliam, K. (2018). Reducing 30-Day Readmission Rates in a High-Risk Population Using a Lay-Health Worker Model in Appalachia Kentucky. Health Education Research, 33(1), 73-80. Article Abstract

Cardarelli, R., Roper, K.L., Cardarelli, K., Feltner, F.J., Prater, S., Ledford, K.M., ... & Cantrell, C. (2017). Identifying Community Perspectives for a Lung Cancer Screening Awareness Campaign in Appalachia Kentucky: the Terminate Lung Cancer (TLC) Study. Journal of Cancer Education, 32(1), 125-134.

Cardarelli, R., Reese, D., Roper, K.L., Cardarelli, K., Feltner, F.J., Studts, J.L., ... & Shaffer, D. (2017). Terminate Lung Cancer (TLC) Study – a Mixed-Methods Population Approach to Increase Lung Cancer Screening Awareness and Low-Dose Computed Tomography in Eastern Kentucky. Cancer Epidemiology, 46, 1-8.

Feltner, F., Thompson, S., Baker, W., & Slone, M. (2017). Community Health Workers Improving Diabetes Outcomes in a Rural Appalachian Population. Social Work in Health Care, 56(2), 115-123. Article Abstract

Kitzman, P., Hudson, K., Sylvia, V., Feltner, F., & Lovins, J. (2017). Care Coordination for Community Transitions for Individuals Post-Stroke Returning to Low-Resource Rural Communities. Journal of Community Health, 42(3), 565-572.

Feltner, F.J., Ely, G.E., Whitler, E.T., Gross, D., & Dignan, M. (2012). Effectiveness of Community Health Workers in Providing Outreach and Education for Colorectal Cancer Screening in Appalachian Kentucky. Social Work in Health Care, 51(5), 430-440. Article Abstract

Tarasenko, Y.N., Schoenberg, N.E., & Bennett, K.L. (2011). The Emergency Department as a Potential Intervention Recruitment Venue among Vulnerable Rural Residents. Journal of Primary Care & Community Health, 2(2), 77-81.

Whitler, E.T., Feltner, F., Owens, J., & Gross, D.A. (2005). Kentucky Homeplace Defeat Diabetes Screening Test: an Analysis of Rural Kentucky's Challenge to Overcome the Growing Diabetes Epidemic. Journal of the Kentucky Medical Association, 130(7), 307-314. Article Abstract

Schoenberg, N.E., Campbell, K.A., Garrity, J.F., Snider, L.B., & Main, K. (2001). The Kentucky Homeplace Project: Family Health Care Advisers in Underserved Rural Communities. Journal of Rural Health, 17(3), 179-186. Article Abstract

Kentucky Homeplace is also featured in RHIhub's Community Health Workers Toolkit Program Clearinghouse.

Challenges

Challenges for implementing and maintaining the CHW program include:

• Funding mechanisms for sustainable employment
• Workforce development and training
• Occupational regulations
• Standards and guidelines for publicly funded CHW program evaluation and research
• Staff retention in grant-funded or annual contract situations

Replication

Kentucky Homeplace has provided CHW training for nearly three decades to CHWs within Kentucky as well as numerous other states across the nation. Lessons learned in the Kentucky Homeplace model have enhanced the success of other programs, service delivery, and research projects. For more information on training opportunities, go to Community Health Worker Training.

Building upon the successes of the Kentucky Homeplace program, Kentucky Care Coordination for Community Transitions Program (KC3T) was developed. The CHW served as a patient navigator for clients who suffered a stroke. The CHW started service upon patient admission and served on the discharge planning team. After discharge, the CHW conducted home visits and provided self-management education and health coaching along with assisting the client to overcome an array of obstacles and barriers. The results: Participants in KC3T had no stroke-related 30-day readmissions compared to 42% of non-KC3T participants who were readmitted within 30 days of discharge.

Contact Information

Mace Baker, RN, Homeplace Director
Kentucky Homeplace
606.439.3557
mace.baker@uky.edu