By Kristi Willett

Since its inception in 1994, Kentucky Homeplace has linked thousands of rural Kentuckians with medical, social and environmental services they otherwise might have done without. To mark the program’s 25th anniversary, a celebration is set for May 16 at the University of Kentucky Center of Excellence in Rural Health (CEHR) in Hazard.

During the ceremony, Dr. Fran Feltner, director of the UK Center of Excellence in Rural Health and principal investigator for Kentucky Homeplace, and Mace Baker, director of Kentucky Homeplace, will be joined in recognizing the program by Dr. Connie White, deputy commissioner of the Kentucky Department for Public Health and Mark Birdwhistell, vice president for health system administration and chief of staff at UK HealthCare. A presentation of awards and a reception will also be held.

The Beginning

More than 25 years ago, leaders came together to discuss and find solutions to ongoing health disparities and the lack of access to care for the underserved and underinsured citizens of the commonwealth, Feltner said. These leaders included the late State Representative Paul Mason from rural Letcher County and State Representative Leonard Gray from Louisville who together introduced Kentucky House Bill 2 to establish Kentucky Homeplace.

The project was funded by the Kentucky legislature to link residents who lived in areas without access to care with available services with the goal of addressing health disparities throughout the more rural parts of Kentucky where cancer, heart disease, hypertension, asthma and diabetes were found at unusually high levels.

Building on Success

Today, Kentucky Homeplace is a nationally recognized community health worker (CHW) initiative in 30 counties in Eastern Kentucky, where residents are statistically poorer, less educated and less likely to have medical coverage than those in other parts of Kentucky and the nation.

“Over the years many people have needed help with access to healthcare and many social needs,” Feltner said. “I have seen firsthand how Kentucky Homeplace meets the needs of the people they serve. People who may have gone without lifesaving care. For this reason, I cannot imagine Kentucky without Kentucky Homeplace.”

Adding It Up

Since July 2001, Kentucky Homeplace has provided more than 4.9 million services to 161,968 clients. Services include health education programming and helping to alleviate some of the barriers of the social determinates of health such as economic instability, health literacy, lack of insurance, transportation, access to healthy food, housing, lack of knowledge about services and inadequate knowledge about a client’s own health conditions.

Kentucky Homeplace CHWs possess an enormous wealth of knowledge which enables them to fulfill their role, said Mace Baker, Kentucky Homeplace director. “Each day they encounter new and unique barriers that their clients face, and they utilize a combination of years of knowledge of available resources and of building connections within their communities to meet these needs,” he said. “They also have the unique ability to draw upon the collective knowledge of all Kentucky Homeplace CHWs to assist clients with a multitude of services.”

Linking Clients to Services

Initially, the CERH recruited 36 family healthcare advisers—now called community health workers—to serve as the link between clients and services. They were lay health workers who were trusted members of the communities they served who received training to promote and carry out healthcare services. In their role, they visit clients in their homes, complete assessments and direct those clients to agencies where their needs can be met.

The workers originally operated in the west end of Louisville and 13 counties — Bell, Clay, Floyd, Knott, Letcher, McCreary, Owsley, Perry and Whitley counties in Eastern Kentucky as well as Allen, Butler, Monroe and Wayne counties in Southcentral Kentucky. All services were offered to clients free of charge.

Although at one point the program’s service area grew to 58 counties — covering nearly half of the commonwealth — state budget cuts over the years has led to Homeplace offices being shut down and the service area decreased in size.

Today, 22 CHWs continue to provide services to residents across 30 counties in Eastern Kentucky with services that have grown to include:

• Assisting in accessing crucial resources like eyeglasses, dentures, home heating assistance, food, diabetic supplies and free medical care and prescriptions.
• Facilitating communication between clients and their physicians.
• Helping clients to effectively comply with their medical care instructions.
• Helping clients to improve their health behaviors through educational programs targeting nutrition, physical activity, weight management, smoking cessation and diabetes self-management.

“The people who receive services through Kentucky Homeplace have come to trust and know that they matter and that the community health workers are there to advocate for them,” Feltner said.

–Kristi Willett is with the University of Kentucky.