Linking senior care and companionship

“So, you used to be a preacher, tell us about that.”

Clara Jean Siler raised her left hand to her temple, trying to access something deep in her 90-year-old memory.

“It’s so long ago, I can’t hardly remember,” Siler said to the two nursing students sitting within arm’s reach in the cozy living room of her West Philadelphia home.

With a little prompting from her daughter, the memories started trickling in: She had followed her niece to Philadelphia from North Carolina many decades ago. And her niece, Pastor Bryant, got her involved in the church and ordained.

Simone Snead and Samantha Strasser, the two Penn nursing students, patiently listened. They were getting a read on Siler’s recall, but in the process, they were giving her another chance to tell the story of her life.

“Being with you for the past few weeks, you’ve told us so much about yourself over the years—you’re able to connect the dots from the people who came before you and your kids and granddaughter and your great-granddaughter,” said Strasser.

Siler smiled. Sometimes, just showing up is the best medicine.

Snead and Strasser, poised to graduate from the Penn School of Nursing in a few months, met “Ms. Jean” during their clinical rotation with Senior HealthLink. For years, Penn Medicine has managed the program, which pairs nursing students from schools around southeastern Pennsylvania with Penn Medicine at Home patients, like Siler, who, before transitioning to Senior HealthLink, had received in-home nursing care following a hospitalization for a pulmonary embolism. Senior HealthLink recently expanded into West Philadelphia, while also rolling social work students into the mix. Now, recent research shows the benefit of the extra attention for both students and aging patients.

“I like the idea that there’s someone always here who’s coming on a regular basis to just check on her health, and it’s been nice for my mom to have someone to engage with,” said Crystal Siler-Garbin, Siler’s daughter.

Learning perspective

Senior HealthLink started in the early 2010s to address the needs of a growing senior population in Chester County. It has been a win-win solution for nursing students at a handful of local schools to gain hands-on experience working with patients in a home setting while, in turn, those patients receive extra attention from the students as they transition from acute care for as long as they need at no cost. The patients typically enroll in the program as they are discharged from either Penn Medicine at Home nursing care or from the hospital.

Those patients tend to do well under the care of Penn Medicine at Home because they have consistency in somebody visiting and asking about medication and symptoms. But once they are discharged, that attention fades, and the risk of readmission rises. For the students, the program offers a chance to see patients in a more holistic way.

“It’s a great opportunity for them to see the struggles seniors have maintaining a home and aging in place. And that’s what a lot of our seniors want to do. They don’t want to go to nursing homes,” said Erica Neff, MSW, LCSW, a Penn Medicine home health practice specialist who manages the social work students in Senior HealthLink—a part of the program since 2024.

Typically, 16 nursing students per semester rotate into the program. Working in pairs, the students visit the homes of select patients who are 65 and older, typically once a week, spending an hour on each visit performing medical assessments, following up on medication regimes, and just talking.

“They are in the homes, beside their partner, making those judgment calls,” said Zakierah Harvey, LPN, a Senior HealthLink coordinator. For social work students, training in a field where small details can provide clues to meaningful solutions, these visits offer a unique way to teach the art of connection.

“You get to see the patient environment,” said Neff. The students can fine tune their powers of observation. It’s a chance to notice details like photos and trinkets that offer a window into the patient’s life. The visits also clarify the challenges patients might face in their home life that interfere with care.

The experience helps students apply classroom teaching and build confidence and independence.

“It’s really great to see them develop,” said Neff.

After the conclusion of each visit, the students report back to professional clinicians at Penn Medicine at Home to debrief and enter information into the patient’s electronic health record.

Close to a third of older adults in America live alone, often after losing a partner or another family member. That isolation is shown to have negative health effects, increasing risk for conditions ranging from high blood pressure and heart disease to anxiety and dementia. Simply by showing up, the student nurses and other health professional trainees become part of the treatment for loneliness.

“Students act as basic companions when they go out; they have great conversations,” said Marsha Grantham-Murillo, DNP, RN, associate director of Health Equity and Community Engagement for Penn Medicine at Home.

Loneliness is graded as part of the assessment when patients are enrolled, and then measured again as patients exit the program to see if it has improved.

Harvey says student nurses and social workers are often able to connect in a way primary care teams—and sometimes even family members—cannot. They find ways to build new links for patients outside of their homes, for example, by finding neighborhood senior centers that already have transportation where patients can socialize and take part in activities and classes.

“A lot of them enjoy the program, not just because of their clinical rotation, but the connections and rapport they build with these patients,” she said.

The social and educational benefits of Senior HealthLink are self-evident for the student nurses and patients. To better quantify the program’s health impact, in the summer of 2025, Senior HealthLink administrators conducted a pilot study tracking whether participants were readmitted into a care setting at a lower rate compared to similar patients who did not receive the student check-ins.

The pilot enrolled groups of patients in Chester County and West Philadelphia who were being discharged from nursing care with Penn Medicine at Home. There was also a control group who did not receive the intervention of the student nurses. The patients were being treated for conditions with high rates of readmission such as diabetes, hypertension, and heart failure. The patients were contacted with weekly in-person visits and phone calls.

“We were able to see that weekly hovering or frequent touchpoints with these patients post home care had a great impact in decreasing readmission,” said Grantham-Murillo.

She said the pilot sample was small, but between the two groups, there were only three emergency department visits and no hospitalizations for the group with student nurse intervention, compared to 14 emergency department visits and five admissions for the control group.

The goal now is expanding the student nurse program and connecting with more patients who fit the Senior HealthLink profile.

The program’s benefit was clear in Siler’s living room as conversation moved from memories to food. Her family members have been struggling to diversify what she wants to eat—a steady diet of pancakes, oatmeal, and peanut butter toast.

“We gotta keep you eating, any vegetables?” Strasser’s question was met with head shakes around the room.

“I made her promise; I wrote it in a book,” said Siler-Garbin, holding up a tattered notebook she used to keep track of her mom’s care. “Making promises she ain’t keeping!”

Everyone laughed: The family working hard to care for their mom, the mom into her 90s being told to eat her vegetables, and the students who had built a relationship with her and gained a new understanding of what it takes to be successful in their nursing careers.

“It’s just humanity, really,” Strasser said. “It’s getting to know the patient and connecting what we’re learning.”