Copyright 7992 by The Cerontological Society of America The Cerontologist Vol. 32, No. 6, 853-855
Since 1988 two hospitals in Pittsburgh have conducted a semiannual Town Meeting for Seniors designed to provide community- based health education so that seniors can make informed decisions not only about medical care, but also about issues such as Medigap insurance, advance directives, and proper nutrition. Attendees have been predominantly white and middle class, reflecting the demographics of the surrounding area. The Town Meeting has been enthusiastically received by consumers and has led to the creation of several new community programs, including exercise classes, driver education classes, durable power of attorney workshops, and expanded insurance counseling services. Key Words: Consumer education, Hospital outreach, Client feedback
Health Care and Consumer Control: Pittsburgh's Town Meeting for Seniors
Feeling in control of one's destiny is associated with an increased sense of well-being and perhaps with improved health outcomes. One way to gain control is through education, especially in the arena of health care, as suggested by Slivinske and Fitch (1987). There is evidence that seniors who experience greater feelings of control are more satisfied with their lives (Reid & Ziegler, 1981). Opportunities for lay people to learn about health topics have become more common with the rise of consumerism in this country. Health care providers have come to welcome the "educated consumer" as a partner in the clinical encounter. Although today's consumer of heath services is increasingly likely to be elderly, seniors may feel less in control of their future health status than younger people (Bausell, 1986). In 1988 two hospitals developed a novel program for community-dwelling elders, called the Town Meeting for Seniors, with partial funding from a local foundation, to address this problem.
and residency programs in family practice and in internal medicine, as well as several fellowship programs. The second has 267 beds, a school of nursing, and offers a residency program in family practice. Both hospitals have recently constructed their own free-standing nursing homes, and both offer Accreditation Council on Graduate Medical Education (ACCME) approved fellowship training programs in geriatric medicine. Both hospitals have recognized the importance of meeting the special needs of seniors and have created administrative gerontology programs to respond to those needs. Goals
The Setting The city of Pittsburgh occupies most of Allegheny County, home to perhaps the oldest population in the nation, with over 17% of its residents over age 65. Community hospitals note that over half of their annual revenue comes from Medicare. The county includes 7 hospital-based outpatient geriatric assessment units, 26 adult day care centers, 67 senior centers, 62 skilled nursing facilities, and 25 acute hospitals. The Town Meetings for Seniors are sponsored by two not-for-profit community teaching hospitals located about 4 miles apart in middle-income neighborhoods. The first has 474 beds, a school of nursing,
Organization
1 Director, Geriatrics Program, Shadyside Hospital, 5230 Centre Avenue, Pittsburgh, PA 15232. 2 Medical Director, Gerontology, St. Margaret Memorial Hospital, 100 Delafield Road, Pittsburgh, PA 15215
Vol.32, No. 6,1992
The hospitals are near enough to one another for practical collaboration, yet far enough to avoid direct competition for patients. Since their inception in late 1987, the two gerontology programs have jointly sponsored a series of physician-oriented continuing medical education (CME) events. In mid-1988, it was decided to offer a new educational program aimed at elderly consumers of heath services, which would provide useful and important information to patients and families. The program was named the Town Meeting for Seniors to create the spirit of a traditional New England town meeting, where everyone in town gets a chance to speak up and where the town managers have to defend their actions in public. The goals of the Town Meeting were: 1) to provide an educational forum for the elderly and their families and caregivers; 2) to provide practical information about health services; 3) to foster a sense of empowerment among seniors; and 4) to increase the awareness of heath professionals about the real concerns of elderly consumers.
Colleagues, patients, and representatives of community and government agencies were consulted 853
Downloaded from http://gerontologist.oxfordjournals.org/ at Stockholms Universitet on July 14, 2015
Fred H. Rubin, MD, 1 and Judith S. Black, MD, MPH2
The third meeting, in September 1989 at a synagogue near the other hospital, discussed legal, ethical, and financial aspects of aging. Following an introductory presentation by a medical ethicist, the audience broke into small-group workshops to discuss one of four topics: alternatives to independent living; setting limits on medical intervention; safety at home and on the road; and important legal docu854
ments (durable power of attorney, living will, and guardianship papers). After a break, the workshops were repeated, so that each participant could attend two of the four sessions. The workshops were led by an interdisciplinary faculty, including physicians, nurses, social workers, lawyers, clergy, and a state trooper. Each participant received an extensive collection of written materials. The fourth meeting, in May 1990 at a church in a residential neighborhood equidistant from both hospitals, was a repeat of the third one. Number three had been extremely well received, yet nobody from this target neighborhood had been in attendance, so we repeated it for their benefit, with minor changes. A session on financial planning was included, presented by a bank trust officer and financial planner. The fifth Town Meeting, in October 1990 at the same synagogue that hosted the third, was devoted to health promotion and wellness and consisted of a large plenary session instead of separate workshops. The first speaker was a geriatrician, who presented an overview of the scope of health promotional activities. This was followed by a motivational session on enhancing self-esteem by an elderly woman from the community, then by a set of chair exercises led by two exercise physiologists. The audience participated energetically and became quite boisterous. A presentation on nutrition led into a refreshment break, which was followed by a pharmacist's discussion of the rational use of over-the-counter medications. The program ended with a general questionand-answer session. For each Town Meeting, one or the other hospital has taken the lead in organization. Costs have been divided equally, and topics and format have been developed jointly. After the first Town Meeting, the two gerontology departments handled local arrangements without the services of an outside executive director. The steering committee continues to meet periodically to review the Town Meeting and provide expert advice. Topics are selected based on the evaluation forms completed by participants; community residents literally decide for themselves what they want to learn more about. Funding
The Town Meeting gets support from four sources. First is the registration fee of $5 per person, which generates no more than $800 per event. Second is inkind service from local agencies, primarily the Area Agency on Aging, which contributed printing and mailing of brochures for the first four meetings. Third is grant support from the Pittsburgh Foundation, which initially granted $4,000 in seed money to organize the Town Meeting, then added $17,696 in 1990 as partial support for the next four meetings. Finally, the two hospitals split all additional costs equally, as part of the annual budgets of the two gerontology departments. For the first five meetings combined, each hospital contributed approximately $15,000, not an unreasonable sum for the amount of community goodwill the Town Meetings have generated. The Gerontologist
Downloaded from http://gerontologist.oxfordjournals.org/ at Stockholms Universitet on July 14, 2015
about this new consumer forum. A steering committee was constituted, including representatives of most of the local community agencies concerned with the elderly. These included senior centers, the local American Association of Retired Persons (AARP), the Area Agency on Aging (AAA), church groups, a local foundation, a large local corporation, the Pennsylvania Department of Aging, and others. A geriatric social worker with experience in community organization was hired as part-time executive director. Clerical support was provided by the two gerontology program offices. Printing of brochures and other materials was donated by the AAA. Mailing lists were generated both from commercial sources and from the agencies represented on our steering committee. One of the hospital community relations departments coordinated publicity, including media coverage of the Town Meeting itself. The first session of the Town Meeting was held in November 1988 on the grounds of a seminary located midway between the two hospitals. This day-long event focused on heath consumerism and featured a keynote address by Esther Peterson, age 82 at that time, who has been an advocate for working people, women, and consumers for decades. In 1961 she was appointed Assistant Secretary of Labor by President John F. Kennedy, thereby becoming the highest ranking woman in the Kennedy administration. Following the plenary session, attendees broke into workshops on three topics: helping your family doctor help you; paying for the high cost of health care; and managing the burden of family caregiving. Each session was repeated, so that attendees could participate in two of the three. After lunch, a panel of health care experts, including a physician, a nurse practitioner, a social worker, a hospital CEO, and the executive director of a senior center, fielded comments and questions from the audience on a wide range of topics. At the end of the day, all participants were encouraged to complete evaluation forms. Additionally, observers in each of the sessions met to draft a summary document of key issues of concern to consumers, as expressed during the Town Meeting. Subsequent meetings have been held semiannually. Due to limited financial resources, all subsequent sessions were reduced to half-day programs. The second, in June 1989 at a church near one of the hospitals, concentrated on issues of insurance coverage, including Medicare, Medigap policies, and long-term care insurance. Following the formal presentations, there was an extended question-andanswer session and then an opportunity for individuals to register for private insurance counseling sessions at a later date.
Vol.32, No. 6,1992
855
types of hospital workers; 3) inadequate access to accurate information about Medicare and other types of health insurance, including long-term care insurance, and difficulties of completing insurance forms; 4) inadequate in-home services for dependent elders; and 5) insufficient numbers of highquality assisted-living facilities. The report led to a number of positive actions within our community. Both hospitals responded by increasing social worker availability to outpatients, especially individuals undergoing ambulatory surgery; by instituting specific training in sensitivity to the special needs of seniors for all new employees; by accomodating the physical and sensory needs of seniors in construction of new facilities; and by substantial expansion of free insurance counseling services. Implications
The Town Meeting for Seniors series has been a successful model of empowering elderly health care consumers through community education. Joint sponsorship by two independent community hospitals has deepened the resources available without creating conflict. Both hospitals consider the time and effort needed to organize and manage the Town Meetings to be consistent with the hospitals' mission and worthy of inclusion in the annual budget. Besides generating community goodwill, this program has led to the implementation of several ongoing spin-off programs, as noted. Some problems remain. First, because the Town Meeting moves from site to site, logistics are often time consuming. Inadequate acoustics are a common complaint by attendees, despite elaborate attempts to provide appropriate amplification. Second, because the agenda and location keep changing, attendance is difficult to predict far enough in advance to provide appropriate amounts of food and supplies. Third, publicity for each session has been uncertain. Surveys indicate that people are attracted by the brochure received in the mail but are unaware of the newspaper, radio, church bulletin, and television announcements. Efforts are presently focusing on senior centers for publicity. Tips for successful replication of this model in other communities include: start by speaking with patients and consumer groups to identify problems; build a broad base of community and local government support; seek start-up financial support locally; focus on topics of immediate interest to older consumers, such as medical insurance, advance directives, and cardiac risk reduction; constantly seek consumer feedback; and respond to unmet needs by developing new services. References
Bausell, R. B. (1986). Health-seeking behavior among the elderly. The Cerontologist, 26, 556-559. Reid, D. W., & Ziegler, M. (1981). The desired control measure and adjustment among the elderly. I n H . M . Lefcourt(Ed-), Research with the locus of control construct. Vol. 1: Assessment methods. New York: Academic. Slivinske, L. R., & Fitch, V. L. (1987). The effect of control-enhancing interventions on the well-being of elderly individuals living in retirement communities. The Gerontologist, 27, 176—81.
Downloaded from http://gerontologist.oxfordjournals.org/ at Stockholms Universitet on July 14, 2015
Outcomes Between 80 and 160 individuals have attended each session of the Town Meeting for Seniors. The audience has tended to become larger each time, although even at number five 62% were first-time attendees. Participants were asked to complete a written questionnaire at the conclusion of each Town Meeting to evaluate the usefulness of the presentations. For the most recent Town Meeting (number five), 92% of the participants completed an evaluation form. Ninety-seven percent of respondents considered the Town Meeting helpful to them. Individual presentations were rated good or excellent by at least 87% of respondents, with some topics receiving a 99% good or excellent rating. As done previously, the audience was asked what should be covered in future Town Meetings. The typical audience member was a white woman, age 75, with an annual household income just over $20,000, who resided within 5 miles of the meeting site and who learned of the event by receiving a brochure in her mail. Nineteen percent of the audience was under age 65, 73% was aged 65 to 84, and 8% was 85 or over. Seventy-eight percent were female and 93% were white, reflecting the demographics of the neighborhood. A forum such as the Town Meeting may not be the best vehicle for providing health education to a lower socioeconomic stratum. In response to the intense interest noted in legal and ethical issues associated with aging, both hospitals have begun regularly scheduled workshops conducted by an attorney in which participants actually execute a durable power of attorney, which is notarized on the spot. Registration for these workshops has been brisk, with a waiting list that often extends for several months. In response to the demonstrated enthusiasm for low-level aerobic exercises, ongoing exercise programs have been developed at or near each hospital. Following a session on safe driving, the hospitals initiated an ongoing series of senior driver education classes, which have become very popular. Most Pennsylvania automobile insurers offer premium reductions to graduates of these classes. One of the Town Meeting's goals has been to provide a vehicle through which health care consumers could voice their opinions to the professional community. This is accomplished through the extensive "open microphone" discussion periods included in each Town Meeting. For the first, in 1988, we videotaped the entire day and created a summary report of the key issues troubling consumers. This report was circulated widely throughout Allegheny County, with copies sent to the chief executive officers of all acute care hospitals, government officials, all community agencies dealing with seniors, insurance companies, and leaders within the professional communities. The report highlighted five key areas of concern: 1) inadequate access to hospital departments of social services by outpatients; 2) lack of sensitivity to the special needs of older or disabled patients by all
Since 1988 two hospitals in Pittsburgh have conducted a semiannual Town Meeting for Seniors designed to provide community- based health education so that seniors can make informed decisions not only about medical care, but also about issues such as Medigap insurance, advance directives, and proper nutrition. Attendees have been predominantly white and middle class, reflecting the demographics of the surrounding area. The Town Meeting has been enthusiastically received by consumers and has led to the creation of several new community programs, including exercise classes, driver education classes, durable power of attorney workshops, and expanded insurance counseling services. Key Words: Consumer education, Hospital outreach, Client feedback
Health Care and Consumer Control: Pittsburgh's Town Meeting for Seniors
Feeling in control of one's destiny is associated with an increased sense of well-being and perhaps with improved health outcomes. One way to gain control is through education, especially in the arena of health care, as suggested by Slivinske and Fitch (1987). There is evidence that seniors who experience greater feelings of control are more satisfied with their lives (Reid & Ziegler, 1981). Opportunities for lay people to learn about health topics have become more common with the rise of consumerism in this country. Health care providers have come to welcome the "educated consumer" as a partner in the clinical encounter. Although today's consumer of heath services is increasingly likely to be elderly, seniors may feel less in control of their future health status than younger people (Bausell, 1986). In 1988 two hospitals developed a novel program for community-dwelling elders, called the Town Meeting for Seniors, with partial funding from a local foundation, to address this problem.
and residency programs in family practice and in internal medicine, as well as several fellowship programs. The second has 267 beds, a school of nursing, and offers a residency program in family practice. Both hospitals have recently constructed their own free-standing nursing homes, and both offer Accreditation Council on Graduate Medical Education (ACCME) approved fellowship training programs in geriatric medicine. Both hospitals have recognized the importance of meeting the special needs of seniors and have created administrative gerontology programs to respond to those needs. Goals
The Setting The city of Pittsburgh occupies most of Allegheny County, home to perhaps the oldest population in the nation, with over 17% of its residents over age 65. Community hospitals note that over half of their annual revenue comes from Medicare. The county includes 7 hospital-based outpatient geriatric assessment units, 26 adult day care centers, 67 senior centers, 62 skilled nursing facilities, and 25 acute hospitals. The Town Meetings for Seniors are sponsored by two not-for-profit community teaching hospitals located about 4 miles apart in middle-income neighborhoods. The first has 474 beds, a school of nursing,
Organization
1 Director, Geriatrics Program, Shadyside Hospital, 5230 Centre Avenue, Pittsburgh, PA 15232. 2 Medical Director, Gerontology, St. Margaret Memorial Hospital, 100 Delafield Road, Pittsburgh, PA 15215
Vol.32, No. 6,1992
The hospitals are near enough to one another for practical collaboration, yet far enough to avoid direct competition for patients. Since their inception in late 1987, the two gerontology programs have jointly sponsored a series of physician-oriented continuing medical education (CME) events. In mid-1988, it was decided to offer a new educational program aimed at elderly consumers of heath services, which would provide useful and important information to patients and families. The program was named the Town Meeting for Seniors to create the spirit of a traditional New England town meeting, where everyone in town gets a chance to speak up and where the town managers have to defend their actions in public. The goals of the Town Meeting were: 1) to provide an educational forum for the elderly and their families and caregivers; 2) to provide practical information about health services; 3) to foster a sense of empowerment among seniors; and 4) to increase the awareness of heath professionals about the real concerns of elderly consumers.
Colleagues, patients, and representatives of community and government agencies were consulted 853
Downloaded from http://gerontologist.oxfordjournals.org/ at Stockholms Universitet on July 14, 2015
Fred H. Rubin, MD, 1 and Judith S. Black, MD, MPH2
The third meeting, in September 1989 at a synagogue near the other hospital, discussed legal, ethical, and financial aspects of aging. Following an introductory presentation by a medical ethicist, the audience broke into small-group workshops to discuss one of four topics: alternatives to independent living; setting limits on medical intervention; safety at home and on the road; and important legal docu854
ments (durable power of attorney, living will, and guardianship papers). After a break, the workshops were repeated, so that each participant could attend two of the four sessions. The workshops were led by an interdisciplinary faculty, including physicians, nurses, social workers, lawyers, clergy, and a state trooper. Each participant received an extensive collection of written materials. The fourth meeting, in May 1990 at a church in a residential neighborhood equidistant from both hospitals, was a repeat of the third one. Number three had been extremely well received, yet nobody from this target neighborhood had been in attendance, so we repeated it for their benefit, with minor changes. A session on financial planning was included, presented by a bank trust officer and financial planner. The fifth Town Meeting, in October 1990 at the same synagogue that hosted the third, was devoted to health promotion and wellness and consisted of a large plenary session instead of separate workshops. The first speaker was a geriatrician, who presented an overview of the scope of health promotional activities. This was followed by a motivational session on enhancing self-esteem by an elderly woman from the community, then by a set of chair exercises led by two exercise physiologists. The audience participated energetically and became quite boisterous. A presentation on nutrition led into a refreshment break, which was followed by a pharmacist's discussion of the rational use of over-the-counter medications. The program ended with a general questionand-answer session. For each Town Meeting, one or the other hospital has taken the lead in organization. Costs have been divided equally, and topics and format have been developed jointly. After the first Town Meeting, the two gerontology departments handled local arrangements without the services of an outside executive director. The steering committee continues to meet periodically to review the Town Meeting and provide expert advice. Topics are selected based on the evaluation forms completed by participants; community residents literally decide for themselves what they want to learn more about. Funding
The Town Meeting gets support from four sources. First is the registration fee of $5 per person, which generates no more than $800 per event. Second is inkind service from local agencies, primarily the Area Agency on Aging, which contributed printing and mailing of brochures for the first four meetings. Third is grant support from the Pittsburgh Foundation, which initially granted $4,000 in seed money to organize the Town Meeting, then added $17,696 in 1990 as partial support for the next four meetings. Finally, the two hospitals split all additional costs equally, as part of the annual budgets of the two gerontology departments. For the first five meetings combined, each hospital contributed approximately $15,000, not an unreasonable sum for the amount of community goodwill the Town Meetings have generated. The Gerontologist
Downloaded from http://gerontologist.oxfordjournals.org/ at Stockholms Universitet on July 14, 2015
about this new consumer forum. A steering committee was constituted, including representatives of most of the local community agencies concerned with the elderly. These included senior centers, the local American Association of Retired Persons (AARP), the Area Agency on Aging (AAA), church groups, a local foundation, a large local corporation, the Pennsylvania Department of Aging, and others. A geriatric social worker with experience in community organization was hired as part-time executive director. Clerical support was provided by the two gerontology program offices. Printing of brochures and other materials was donated by the AAA. Mailing lists were generated both from commercial sources and from the agencies represented on our steering committee. One of the hospital community relations departments coordinated publicity, including media coverage of the Town Meeting itself. The first session of the Town Meeting was held in November 1988 on the grounds of a seminary located midway between the two hospitals. This day-long event focused on heath consumerism and featured a keynote address by Esther Peterson, age 82 at that time, who has been an advocate for working people, women, and consumers for decades. In 1961 she was appointed Assistant Secretary of Labor by President John F. Kennedy, thereby becoming the highest ranking woman in the Kennedy administration. Following the plenary session, attendees broke into workshops on three topics: helping your family doctor help you; paying for the high cost of health care; and managing the burden of family caregiving. Each session was repeated, so that attendees could participate in two of the three. After lunch, a panel of health care experts, including a physician, a nurse practitioner, a social worker, a hospital CEO, and the executive director of a senior center, fielded comments and questions from the audience on a wide range of topics. At the end of the day, all participants were encouraged to complete evaluation forms. Additionally, observers in each of the sessions met to draft a summary document of key issues of concern to consumers, as expressed during the Town Meeting. Subsequent meetings have been held semiannually. Due to limited financial resources, all subsequent sessions were reduced to half-day programs. The second, in June 1989 at a church near one of the hospitals, concentrated on issues of insurance coverage, including Medicare, Medigap policies, and long-term care insurance. Following the formal presentations, there was an extended question-andanswer session and then an opportunity for individuals to register for private insurance counseling sessions at a later date.
Vol.32, No. 6,1992
855
types of hospital workers; 3) inadequate access to accurate information about Medicare and other types of health insurance, including long-term care insurance, and difficulties of completing insurance forms; 4) inadequate in-home services for dependent elders; and 5) insufficient numbers of highquality assisted-living facilities. The report led to a number of positive actions within our community. Both hospitals responded by increasing social worker availability to outpatients, especially individuals undergoing ambulatory surgery; by instituting specific training in sensitivity to the special needs of seniors for all new employees; by accomodating the physical and sensory needs of seniors in construction of new facilities; and by substantial expansion of free insurance counseling services. Implications
The Town Meeting for Seniors series has been a successful model of empowering elderly health care consumers through community education. Joint sponsorship by two independent community hospitals has deepened the resources available without creating conflict. Both hospitals consider the time and effort needed to organize and manage the Town Meetings to be consistent with the hospitals' mission and worthy of inclusion in the annual budget. Besides generating community goodwill, this program has led to the implementation of several ongoing spin-off programs, as noted. Some problems remain. First, because the Town Meeting moves from site to site, logistics are often time consuming. Inadequate acoustics are a common complaint by attendees, despite elaborate attempts to provide appropriate amplification. Second, because the agenda and location keep changing, attendance is difficult to predict far enough in advance to provide appropriate amounts of food and supplies. Third, publicity for each session has been uncertain. Surveys indicate that people are attracted by the brochure received in the mail but are unaware of the newspaper, radio, church bulletin, and television announcements. Efforts are presently focusing on senior centers for publicity. Tips for successful replication of this model in other communities include: start by speaking with patients and consumer groups to identify problems; build a broad base of community and local government support; seek start-up financial support locally; focus on topics of immediate interest to older consumers, such as medical insurance, advance directives, and cardiac risk reduction; constantly seek consumer feedback; and respond to unmet needs by developing new services. References
Bausell, R. B. (1986). Health-seeking behavior among the elderly. The Cerontologist, 26, 556-559. Reid, D. W., & Ziegler, M. (1981). The desired control measure and adjustment among the elderly. I n H . M . Lefcourt(Ed-), Research with the locus of control construct. Vol. 1: Assessment methods. New York: Academic. Slivinske, L. R., & Fitch, V. L. (1987). The effect of control-enhancing interventions on the well-being of elderly individuals living in retirement communities. The Gerontologist, 27, 176—81.
Downloaded from http://gerontologist.oxfordjournals.org/ at Stockholms Universitet on July 14, 2015
Outcomes Between 80 and 160 individuals have attended each session of the Town Meeting for Seniors. The audience has tended to become larger each time, although even at number five 62% were first-time attendees. Participants were asked to complete a written questionnaire at the conclusion of each Town Meeting to evaluate the usefulness of the presentations. For the most recent Town Meeting (number five), 92% of the participants completed an evaluation form. Ninety-seven percent of respondents considered the Town Meeting helpful to them. Individual presentations were rated good or excellent by at least 87% of respondents, with some topics receiving a 99% good or excellent rating. As done previously, the audience was asked what should be covered in future Town Meetings. The typical audience member was a white woman, age 75, with an annual household income just over $20,000, who resided within 5 miles of the meeting site and who learned of the event by receiving a brochure in her mail. Nineteen percent of the audience was under age 65, 73% was aged 65 to 84, and 8% was 85 or over. Seventy-eight percent were female and 93% were white, reflecting the demographics of the neighborhood. A forum such as the Town Meeting may not be the best vehicle for providing health education to a lower socioeconomic stratum. In response to the intense interest noted in legal and ethical issues associated with aging, both hospitals have begun regularly scheduled workshops conducted by an attorney in which participants actually execute a durable power of attorney, which is notarized on the spot. Registration for these workshops has been brisk, with a waiting list that often extends for several months. In response to the demonstrated enthusiasm for low-level aerobic exercises, ongoing exercise programs have been developed at or near each hospital. Following a session on safe driving, the hospitals initiated an ongoing series of senior driver education classes, which have become very popular. Most Pennsylvania automobile insurers offer premium reductions to graduates of these classes. One of the Town Meeting's goals has been to provide a vehicle through which health care consumers could voice their opinions to the professional community. This is accomplished through the extensive "open microphone" discussion periods included in each Town Meeting. For the first, in 1988, we videotaped the entire day and created a summary report of the key issues troubling consumers. This report was circulated widely throughout Allegheny County, with copies sent to the chief executive officers of all acute care hospitals, government officials, all community agencies dealing with seniors, insurance companies, and leaders within the professional communities. The report highlighted five key areas of concern: 1) inadequate access to hospital departments of social services by outpatients; 2) lack of sensitivity to the special needs of older or disabled patients by all
