CareMore's Togetherness Program Addresses a Symptom of Living With Chronic Illness: Loneliness

Evidence-Based OncologyAugust 2018
Volume 24
Issue 10

CareMore's program is a first-in-industry approach to targeting loneliness as a health condition that can be diagnosed and treated through community-based interventions and close engagement with patients.

Over the last century, America has endured numerous health epidemics affecting individuals, families, and communities: polio, diphtheria, whooping cough, measles. Each resulted in the creation of vaccines, changes in health practice, and health education campaigns to help us address the epidemic.

Today we are facing an epidemic of a different nature. It is rooted not in a virus, bacteria, or toxin but in the soul. The epidemic is loneliness.

According to Sachin Jain, MD, MBA, FACP, chief executive officer of CareMore, the impact of loneliness on the emotional well-being of seniors is so great, it should be treated as a medical condition.1

And make no mistake, loneliness can be lethal.

Investigators at the University of California, San Francisco, who analyzed government data,2 reported that seniors suffering from loneliness have a 45% increased risk of mortality. Because loneliness weakens the body’s defense systems, it inhibits the ability of those who are lonely—particularly the elderly—to fend off cancer and other serious illnesses.

A study at Brigham Young University in Provo, Utah, suggests that social isolation poses as much a threat to longevity as obesity does.3

CareMore Health, an Anthem company, has been actively focusing on the impact of loneliness on the health of senior patients for the past year. The company launched the Togetherness Program in May 2017. The program is a first-in-industry approach to targeting loneliness as a health condition that can be diagnosed and treated through community-based interventions and close engagement with patients.

To diagnose loneliness, a provider might ask a patient, “Who would you call if you had a great day or if you had a bad day?” Sadly, many elderly patients do not have that “someone” to call to say, “I went out for a walk today; my pain is better today.” Or “It was a rough night; I didn’t sleep well, and I had trouble breathing.”

For patients dealing with chronic illnesses, a lack of social support and feelings of loneliness can sabotage recovery. CareMore’s clinical program fills this void. It incorporates a loneliness survey into an extensive initial health assessment protocol and assesses for loneliness at other health checkpoints.

Since the program launched last year, approximately 700 seniors have enrolled. Participants receive interventions that include weekly phone calls from Togetherness Connectors—full-time CareMore employees hired to manage the program—in addition to CareMore employees who volunteer to be phone pals. Patients also receive home visits from social workers, who help connect them to community-based organizations and other available CareMore Health programs.

One particular program, the Nifty After Fifty gym, offers a physical exercise program tailored to older adults, many of whom are battling at least 1 chronic illness. However, it’s more than a fitness center; it also serves as a social connection point for a population facing increasing health issues and limited mobility, which reduce the opportunity to meet peers and socialize. We are always heartened to retell the story of 2 widowed individuals who met at a Nifty After Fifty gathering, began dating, and eventually married at the center.

Another noteworthy success story involves a CareMore patient named John, who was struggling with loneliness and chronic illness. A 69-year-old with bladder cancer and diabetes, John enrolled in the CareMore Togetherness program last June after a discussion with Dr Jain. He shared that he was in a poor relationship with his wife and had a strained relationship with his children. He felt alone.

Through the program, John received support from a social worker who helped him develop coping skills and tools to help reduce his depression. However, his condition continued to worsen. After John learned that surgery was ruled out due to his deteriorated health, the Togetherness Program social worker continued to support him and his family, guiding them to reconcile their differences and focus on John’s health. This, in turn, helped John better deal with his prognosis. With the newfound support of his family and his improved emotional state, John compiled a bucket list and is now pursuing dreams he had long put off.

The case of another CareMore patient illustrates how loneliness compounds the stress and helplessness so many seniors with chronic disease face. During a lecture at a recent conference, Marjorie shared her own story about the pain of loneliness. “I have been dealing with chronic disease most of my adult life,” she said. “My friends don’t understand why I can’t go out and do things with them. I feel so lonely and left out of things in life.”

The CareMore Togetherness team and phone pals hear this same message often. Over half of patients report that their barrier to leaving their home is due to medical issues. “If it were not for my medical appointments,” Marjorie said with a dash of self-deprecating humor, “I would have no social life at all.”

One of the discoveries in the first year of the Togetherness Program is that it’s not just the patients with chronic illnesses who need our attention. Up to 70% of those caring for older, frail, and chronically ill patients say they, too, have experienced symptoms of depression.

In fact, a significant percentage of CareMore senior patients have taken on the responsibility as caregiver for sick family members. As they confront the deteriorating condition of their loved ones, combined with their own health issues, they begin exhibiting signs of depression. Their concerns over fiscal resources further compound the situation.

A vital objective of the Togetherness Program is to assess isolated patients’ concerns and barriers to overcoming loneliness—and to compassionately explore available options to guide them to an improved outlook. With increased attention to these previously unserved needs, CareMore’s Togetherness Program helps heal these patients.

Although initial outcomes data are still being analyzed, early results show that the program’s participants have increased engagement with CareMore’s Nifty after Fifty gym by 53%; their outpatient emergency room use has declined by 5%; and, despite a higher disease burden, acute hospital admissions are 11% lower per thousand.

CareMore’s Togetherness Program is confronting the loneliness epidemic the best way we know how—through consistent personal interaction. Whether patients are dealing with serious chronic illnesses such as cancer, recent loss, or general feelings of disconnection from society, the Togetherness approach is the same: Listen to patients, and ensure they know that someone is always there for them.


Robin Caruso is a licensed clinical social worker who joined CareMore in 2011. In 2017, she took a leading role in CareMore’s effort to combat loneliness among seniors as the health plan’s first chief togetherness office. A graduate of Oral Roberts University, she received her master in social work from the University of Southern California.


  1. CareMore’s ‘be in the Circle: Be Connected’ campaign tackles unmet challenge of senior loneliness [press release]. Cerritos, CA: CareMore; May 8, 2017. Accessed July 20, 2018.
  2. Perissinotto CM, Cenzer IS, Covinsky KE. Lonelineness in older persons: a predictor of functional decline and death. JAMA Intern Med. 2012;172(14):1078-1083. doi: 10.1001/archinternmed.2012.1993.
  3. Holt-Lunstad J, Smith TB, Baker M. Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015;10(2):227-237. doi: 10.1177/1745691614568352.
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