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In-Home Health Evaluations - unlocking the needs of older Americans

By Marc Rothman, MD on 5/25/22 8:57 AM

When President John F. Kennedy established Older Americans Month in 1963 there were just 17 million Americans over the age of 65. Today, that number is 54 million, and growing rapidly. Then as now, the needs of older Americans are too often not fully appreciated or acted upon.

As a practicing geriatrician and the Chief Medical Officer of Signify Health, I see clearly the issues that are having the most impact on the health and well-being of seniors today. Although there is a heightened awareness of the role that social factors play in physical and mental health, the reality is that these issues are as persistent as they are harmful. 

While I believe that Older Americans Month should be every month, the May observance offers a great opportunity to put a spotlight on opportunities to improve the quality of care and the quality of life for the seniors in our personal and professional lives.

Every person has a unique set of factors that influence their health and well being, and these factors increase in number, complexity and significance as we age. While some factors like genetics are pretty hard to modify, we can and should modify many of the social and environmental factors that have a direct impact on a person’s health and quality of life – but only if we identify them. 

And therein lies the challenge. How do you identify that someone is socially isolated, does not have an adequate supply of nutritious food, is experiencing domestic abuse or is not able to take their medications as directed by their doctor? 

The first step is to meet them where they are.  For seniors who receive an In-Home Health Evaluation (IHE) through their Medicare Advantage plan, these issues can be observed and shared with the visiting provider who then documents and shares that information with the senior’s primary care physician and health plan. A look at the data from IHEs we conducted in 2021 illustrates the social drivers that are impacting the health and well-being of many older Americans today.


In-Home Health Evaluations are a useful tool for documenting clinical and social gaps, as well as for performing diagnostic tests and preventive health screenings. Having current information about the health of the whole person that might not otherwise be available to the care team can help ensure older adults are connected to the care and services they need. 

We know that addressing complex issues like social isolation, food and financial insecurity and transportation requires much more than providing a referral. It truly does take a village of clinicians working together with community-based organizations and caregivers to connect seniors with resources that can help them and that they can trust. 

Listening and watching for these prevalent social drivers is an important first step in helping our Older Americans live to their optimal health, and something that we deeply care about at Signify Health. I invite you to learn about how we are living our commitment to improving health care quality in our Quality & Social Impact Report.