High-touch, flexible care: The Optum ‘secret sauce’ for helping residents age in place

After Ronalee “Ronnie” Zeise’s husband died in 2022, she was unsure whether she would be able to stay in the Denver-area senior community where the couple had lived for nearly a decade.

Having lost most of the use of her arms in a car accident years earlier, her husband had been her main caregiver. Without him, she had a hard time just getting to doctor appointments because she can’t drive. Even when she made it to all of her appointments, she struggled to get the information she needed and make sense of it all.

To keep her in independent living as long as possible, Eaton Senior Communities helped her enroll in the Optum care model and UnitedHealthcare® Assisted Living Plan, which offered more assistance than she was receiving under her late husband’s retirement benefits.


Today, Zeise says her health has greatly improved. She attributes that in large part to the reduced stress that comes with regular visits from a team dedicated to ensuring she is getting all the care she needs.

“My outlook has improved considerably,” Zeise says. “Because they answer phone calls. They come when they say they are going to come. I don’t have to worry about getting answers for things.”

The secret sauce: high-touch, personalized, whole-patient care

Keeping residents in their communities is at the core of the Optum care model.


“It’s a high-touch model that’s focused on the patient and the patient’s goal of care,” says Stephanie Mello, a regional president for senior community care for Optum in Rhode Island. “That’s really what I would consider the secret sauce.

“A lot of people say that they have a patient-centric model. But one of the things that you will find from our model is that it truly engages not only the patient, it engages the family, it engages the other care providers in the building to come together and create a whole wrapper around things. It’s about how we connect with that resident every single day.”

Beneath that wrapper is a focus on four key areas: preventing decline, advanced care planning, care coordination and chronic conditions support.

  • Preventing decline

A top priority of the care teams is helping members maintain activities of daily living, or ADLs, says Jamie Babcock, vice president of clinical operations for senior community care at Optum. ADL decline is one of the main drivers for people moving out of their homes and into the next level of care.

“Hip fractures for example, can often lead to a skilled nursing stay,” says Babcock. “So it’s about helping them maintain their independence and safety through efforts like falls prevention.”

  • Advanced care planning

The Optum care teams have in-depth, empathetic conversations with members and their families about where they are, what they value, what their wishes are, where they think they’re going and what their likely disease trajectory looks like.

“It’s not always a pleasant conversation because nobody wants to discuss mortality,” Mello says. “But it’s a necessary conversation and one, when done in a compassionate way, can alleviate some of the unknowns for the patient and their family.”

  • Care coordination

Another pillar of Optum’s care model is ensuring that residents get all the help they need.

In Zeise’s case, Eaton worked with both Optum and Medicaid. Zeise now gets once-a-week help with laundry and cleaning from Medicaid, while Optum ensures she gets more medical care at home, including therapy, vision and dermatology exams, even mammograms. And her prescriptions are delivered right to her apartment.

  • Chronic conditions support

Management of and support for chronic illness is a critical component of all senior care, and a key focus of the Optum care teams, says Patricia Chace, a medical director who oversees care teams in Iowa, Minnesota and Wisconsin.

Besides helping members navigate care across what are often multiple specialists, they educate them about their disease trajectory so they know what to expect and can plan the best care to fit their lifestyle and long-term care goals.

Easing resident transitions — and preventing unnecessary ones

Helping residents age in place in senior communities is a two-fold mission: easing their move into senior living, and then keeping them there. That’s why regular visits are such an important benefit.

“Going into a senior community is the first transition for a lot of seniors, kind of like sending your kids off to school for the first time,” Babcock says. “We do everything we can to partner with the members and families to calm the anxiety and show there are all these resources that we’re going to wrap around your loved one to ensure that they have a smooth transition.

“Then we do everything we can to keep them in their new home and let them age in place, gracefully and on their time.”

This article is sponsored by Optum and is adapted from a new Optum white paper. To read the full paper and learn more about the Optum care model, visit optum.com/aginginplace.