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Bridging Gaps in Senior Health and Wellness: A Pilot Community Health Worker Initiative for Washburn County

Launching a CHW-led initiative to support aging residents with healthcare access, nutrition, and social connection

Full Project Name:Bridging Gaps in Senior Health and Wellness: A Pilot Community Health Worker Initiative for Washburn CountyPrimary Community Organization:Aging and Disability Center of Washburn CountyPrincipal Investigator:Leslie Ruffalo, PhD, Family MedicineAward Amount:$250,000
Award Date
November2025
Project Duration:24 months

Project Summary:


This project aims to address the urgent health and social service needs of the county’s aging population through a dedicated Community Health Worker (CHW) program. Washburn County, a largely rural area in northwest Wisconsin with a median age significantly higher than the state average, faces unique challenges as 37% of its population is over 60, with a notable portion of seniors living alone. These demographics reflect a growing need for coordinated support to help seniors access essential healthcare, nutrition, and social resources. This project aligns with the priorities outlined in the County’s Community Health Needs Assessment and the Aging & Disability Resource Center’s Aging Plan.

It will focus on three main aims:

  1. establishing a CHW to support health equity by helping seniors access healthcare services, manage care plans, and maintain social connections;
  2. expanding senior nutrition programs to improve attendance at congregate dining sites and enhance home-delivered meal services; and
  3. bolstering social health support by recruiting volunteers to provide companionship to homebound seniors.

The CHW will conduct regular wellness checks, offer referrals to mental health and social services, and collaborate with local organizations to integrate social engagement opportunities at meal sites. Using both quantitative and qualitative data, the project team will evaluate outcomes, including increased access to care, reduced isolation, and improved participation in nutrition programs. Through this initiative, Washburn County will take meaningful steps toward fostering a more supportive, connected, and health-focused community for its aging residents.

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