The checkup’s in the mail

On Jersey Island, the postman always knocks twice on Christopher Brough’s door.

Every Monday and Friday, a Jersey Post letter carrier arrives at the 200-year-old row-house cottage for a quick chat.

Brough, by dint of age (he’s 76), a touch of hearing loss and history of a major stroke (“fully recovered!”), is a prime candidate for the “Call &

Check” program that supports older adults living at home.

“It’s peace of mind,” Brough says. “I look forward to it. It’s another contact during the day.”

Like the “Watch Over My Parents” program offered by La Poste in France, or the “Watch Over” service in Japan, the10-year-old Call & Check concept on this island has captured the attention of international postal services and their staff, including workers in Canada.

The potential to use Canada’s postal workers to check on and connect with often lonely older adults is detailed in a white paper by the National Institute on Ageing (NIA).

Japan Post’s Watch Over service, the NIA paper said, “has become one part of a broader national strategy to prevent kodokushi or lonely deaths,” a Japanese phenomenon of older adults dying alone, their bodies undiscovered for a long period of time.

While La Poste letter carriers in

France can go inside a senior’s home for coffee and a chat, Call & Check is meant to be a five-minute exchange outside the front door.

According to the NIA analysis, it could provide an introductory model without “radically altering” Canada Post’s current staffing structure.

“There is something really unique that needs to be looked at here,” says Dr. Samir Sinha, a former co-chair of the NIA and head of geriatrics for Sinai Health and the University Health Network.

“With an aging population, we’re going to see a decrease in the number of available family caregivers; we’re going to see more people living alone in the community, at a greater risk of social isolation. And so, we need to find creative ways that can help people remain independent and feel well supported.

“This is a neat initiative that Canada Post would be really well-suited to deliver, given the fact that they are delivering mail to millions of addresses and are a trusted service provider that could creatively address a significant social need.”

It is unclear where leaders of the Crown corporation stand on the idea. Canada Post did not respond to detailed questions from the Star.

The Call & Check program has captured the attention of some international postal services and employees looking to grow beyond their original purpose, expand job descriptions or stem the revenue decline that began after emails started replacing letters decades ago. In the third quarter of 2022, after a decrease in letters, packages and direct mail advertisements from the early pandemic period, Canada Post reported a loss of $227 million.

For years, letter carriers in Ontario’s Prince Edward County have kept an eye on older adults through the voluntary “rural route reassurance program,” alerting the county’s Community Care for Seniors Association to uncollected mail or other signs that something is amiss.

The Canadian Union of Postal Workers is on board, at least in theory.

“Many postal workers,” the union told the Star, “already informally check in on the seniors they know while working their routes, but CUPW would like this process to be formalized, with time allotted for postal workers to check in.

“Keeping seniors in their homes is a team effort — postal workers can provide social interaction and observe changes in behaviour,” CUPW’s statement said.

“It’s doesn’t replace the work of health care workers in the home, but instead provides an extra layer of safety.”

Brough is a retired teacher who lives alone with a tortoiseshell cat named Flossy. He keeps busy at his church and when he doesn’t feel like cooking, walks 275 metres to the local pub. He wears a “community alarm” around his neck that alerts the paramedics when pressed. “I don’t use that very often,” he said.

The postal workers are a support through the week. “They ask, ‘Anything we can do for you? And how do I feel today? What sort of week have you had?’ ” Brough said. When his car broke down, he told the letter carrier he needed a ride and his request was sent to Call & Check.

“They found a driver for me. I’ve got a new car now. When my washing machine gave out, they put me in touch with a laundry. I’ve got a new washing machine now.”

Located 22 kilometres from the French coastline, Jersey is a selfgoverning “possession” of the British Crown like Guernsey and the Isle of Man. Of the 103,267 residents in Jersey’s 2021 census, 18,736 were over 65 — including 25 centenarians, the majority of whom were women.

Jersey’s Department of Health and Community Services provides funding for the Call & Check service, which costs £6.75 or $11.10 (Canadian) for each visit. The government funding flows through Call & Check to Jersey Post.

Since the program’s inception in 2013, Jersey postal workers have made 79,867 official visits with older adult subscribers, and according to Call & Check, the doorstep greeting takes roughly the same amount of time as the delivery of a package requiring a signature.

The number of visits jumped during the pandemic’s early months because the government asked Call & Check to deliver medication to Jersey residents of all ages as they isolated at home, said program founder Joe Dickinson. Posties still deliver prescriptions to older adults.

While the service began through Jersey Post, Dickinson said Call & Check began operating separately several years ago, in part because he wanted to expand the program by offering additional deliveries such as door-to-door laundry services, hot meals or packaged meals to warm up later, all following individual dietary needs. Currently, Call & Check organizes grocery deliveries through local charities.

Call & Check is now consulting an association of informal caregivers on a package of “independent living” services, although Dickinson said the post office does not plan to get involved.

“The big thing that worries me,” he said, “is that the postal services as we know them will eventually disappear. You’ll have box deliveries but that will be it. Unless they evolve. Evolve into something else. And supplying things that support people living at home seems to be the obvious place to evolve it.”

Wellness checks for older adults, along with fee-based deliveries of medicine, meals or groceries, can significantly increase profits, according to a 2015 report by the Office of Inspector General for the United States Postal Service.

It cited the example of grocery deliveries for older Americans, saying the service could earn annual profits ranging from $27 million to $134 million (U.S.) depending on the market share. Those figures were contested by the United States Postal Service, the organization that delivers the mail, saying they were too generous given the bulk of the packages.

The idea of transforming Canada Post services is not revolutionary. As the NIA report notes, after public hearings into the future of the Crown corporation, a 2016 federal report recommended supports for older adults.

The NIA paper, called “Special Delivery: How Canadian Postal Workers Could Better Enable Ageing in the Right Place,” quoted from recommendations from the House of Commons Standing Committee on Government Operations and Estimates suggesting Canada Post “look to other industry leaders that have successfully adopted innovative service models, to develop a more innovative growth agenda to expand its services.”

One such model, the NIA paper said, suggested the leveraging of postal workers to provide scheduled home visits to older Canadians.

“In addition to providing a new and innovative source of revenue for Canada Post,” the paper said, “such a program could also help to improve that ability of an increasing growing number of older Canadians to age in the right place.”

The Jersey program, it noted, is more likely to fit with a potential Canada Post model.

Like Canadian letter carriers, the Jersey Post workers do not enter homes. During Call & Check visits, the postie stands outside the door and, after chatting about the weather or the view of France on a sunny day, they ask five individualized questions that pop up on an app created by Toronto’s NexJ Health.

Based on medical conditions or other needs, the questions range from, “How are you feeling today?” to “Have you taken your medication?” or “Is there anything you need?”

The postal worker types a short response to each question into the app, a virtual-based platform that runs on the IBM cloud, and according to NexJ Health president Daniela Liggio, the answers are automatically transmitted to the Call & Check office, along with relatives, neighbours or service organizations named on the list for notification.

Several years ago, the service was picked up by the U.K. Home Office for possible use in elder abuse prevention. Its pilot project with England’s Royal Mail ran in London, Liverpool and North Yorkshire.

Dickinson said the Home Office requested that the app’s final question be “Is anything, or anyone, bothering you?” After a 2018 trial, media reports quoted the U.K. department responsible for security saying the program “had the potential to improve the well-being of participants.”

Known as a tech innovator, Dickinson said his plan for Call & Check began as a pilot project after the chair of Jersey Post asked for help with ideas to stem the postal service’s diminishing revenue.

“He said to me, ‘We’ve got a real problem,’ ” Dickinson recalled. “’Every postal service in the world is in decline. We don’t really deliver letters anymore, we deliver boxes. We’re all in a bad place so can you think of anything we could do?’”

Dickinson, who spent his career in science and technology, was inspired by an earlier observation. In 2011, while living in England, he had a brain hemorrhage and after a year spent recovering at home, he had grown attuned to the daily arrival of the letter carrier, a reliable presence.

“At the same time, I started to read things about the aging demographic,” Dickinson said, citing the massive increase in older adults. “How would we want to support people? And the only real way to support them was likely in their own homes.”

The most recent global figures from the World Health Organization predict the number of people 60 and older will hit 1.4 billion by 2030, an increase of 56 per cent from 962 million in 2017. According to Statistics Canada, nearly onequarter of Canadians will be 65 by 2031 and by 2050, up to 2.7 million will be over the age of 85.

It works for Paul McQuarrie. A veteran letter carrier with Jersey Post, he’s been to Christopher Brough’s cottage door over the years and to the homes of those who’ve signed up for the service on his regular route.

While postal workers ask questions about well-being, McQuarrie said they will sometimes alert Call & Check for immediate help, knowing a client is at home but doesn’t answer the door. When that happens, he says Call & Check quickly sends a health care or social services team to the home or staff go themselves, depending on the information on file.

“That’s as far as we go,” said McQuarrie. “We don’t give medicine. We don’t give care. And we’re not going to break into the house or do anything daft.”