Every month, a group of older adults goes to Washington, D.C.'s Sibley Memorial Hospital, but they don't see a doctor or get tests. They're not sick. They come just for laughs.
They gather in a room next to the hospital cafeteria for the "Laugh Cafe," one of the activities offered to local seniors, including the 7,300 members of Sibley's Senior Association. The price of admission is one joke, recited out loud. Experts say laughing can be good for your health, and everyone in the room strongly agrees.
"Absolutely, it's the best medicine," said Joanne Philleo, 79, from Bethesda, Md.
"I like to come with Joanne, and I love the jokes," said Jean Altimont, 89. "I never dreamed of telling a joke in front of a group, and the first time I came, I was real nervous."
Some jokes took a few twists before getting to the punchline, a few were almost R-rated, others were one-liners: My husband wanted more space, so I left him outside. I sold my vacuum because it was gathering dust. Why do men like smart women? Because opposites attract.
And if one had been told before, no one cared.
The association for those age 50 or older also offers other activities, including French and Italian conversation classes, day trips to museums, a current events group, and -- the latest addition -- tango lessons. In addition, members receive discounts on hospital parking and at the gift shop, pharmacy and restaurant. In all, more than 10,000 seniors participate.
"I call this a senior center without walls," said Marti Bailey, the association's director. The program started in 1987 with exercise and patient-support groups. Members pay a one-time $40 membership fee.
Concerns About Marketing
Sibley is one of several hospitals in the Washington area -- along with others across the country -- offering social activities and other benefits to help seniors stay healthy and out of the hospital, while encouraging them to visit. Participants do not need to have been patients.
But some hospital finance experts are concerned that the activities are less about health than about marketing to Medicare beneficiaries, especially those who can go to the hospital of their choice when they need care because they are not enrolled in private insurance plans with limited provider networks.
Gerard Anderson, director of the Center for Hospital Finance and Management at the Johns Hopkins Bloomberg School of Public Health in Baltimore, said such programs across the country can be a good business strategy. (Anderson was not speaking on behalf of Johns Hopkins Medicine, whose six hospitals include Sibley.)
"If they can get you in the door and you have a pleasant experience, then the next time you need to go to the hospital, you have a place you've been to and where you feel comfortable," Anderson said.
Medicare, which covers 55 million older and disabled Americans, provides as much as half of some hospitals' income. "Medicare may not be the best payer, but they are still a very good payer, and a filled bed is better than an unfilled bed," he said.
While hospitals may be seeking brand loyalty, they can also appeal to the increasing number of older adults living independently who are looking beyond traditional senior centers and local social service agencies to meet their needs.
"Hospitals are trying to promote the notion of the health and wellness of aging and trying to change their image from places of sickness and death to ones of health and wellness," said Fredda Vladeck, director of the Aging in Place Initiative at the United Hospital Fund, a health research and philanthropic organization.
And the strategy may be working.
"This is isn't a hospital per se, because there's so many things to do," said Philleo, joining her friends for lunch in the Sibley cafeteria after the Laugh Cafe event. "This is a place that contains a hospital."
"And they make a great Philly cheese steak," said Tom Reynolds, 78, the Laugh Cafe's volunteer leader and joker-in-chief.
The Virginia Hospital Center in Arlington runs a similar outreach project for seniors. Its program, called the Senior Health Department, offers free lectures on healthy aging, assessment of fall risk and memory, exercise classes (for a small fee), yoga and a mall-walking group. A separate Senior Associates program provides 1,600 members -- who are at least 60 years old and pay an annual fee of $45 ($65 for couples) -- with annual blood screenings, complimentary parking and discounts on exercise classes and meals.
"Some older people don't like to cook for themselves, and this may be the only hot meal they get" for the day, said Cathy Turner, the hospital's director of health promotion and senior health.
The hospital setting provides "a level of comfort," said Turner, especially for seniors who may feel intimidated at a fitness club or YMCA.
'Dance and Rock-and-Roll'
"You can exercise at home, but it's not the same," said Donna Miller, 56, who recently drove with her friend Glorious "Glo" Mary Cooper, 61, to downtown Silver Spring, Md., for an event run by Holy Cross Hospital's Senior Source program. The main attraction was a dance class where participants practice routines set to Broadway show tunes -- with top hats and canes -- and Motown hits.
"The best way to stay healthy is to do things you like, like dance and rock-and-roll," Cooper said.
"When you get into a group like this, it's so inspiring, it just works, it flows," Miller said.
Last year, 4,800 people 55 and older participated in Senior Source programs. Offerings include classes on disease management, financial planning, fall prevention, low-impact exercise, dance, art appreciation and a current-events discussion group. A class called "Are You Smarter Than Your Smartphone?" promises to unlock the secrets of cellphones.
The Senior Advantage program at George Washington University Hospital has about 9,000 members. Anyone 65 or older can join for a one-time $10 fee ($15 for couples) and receive hearing tests, health insurance counseling and discounts at the cafeteria and gift shop.
Several other Washington-area hospitals also offer programs for seniors, including Inova Health System and Suburban Hospital.
Some activities require a nominal fee, but the hospitals generally pick up the bulk of the cost. Nonprofit hospitals consider those expenses part of their community benefits, the wide variety of services that they offer along with free medical care for low-income patients that help maintain their tax-exempt status.
Although it may seem counterintuitive for hospitals to try to keep people healthy when they are in business to treat illness, new Medicare payment incentives and penalties encourage hospitals to reduce patient readmissions, improve care and make hospitals "think more broadly about what health care really is," said J.B. Silvers, a professor of health-care finance at the Weatherhead School of Management at Case Western Reserve University in Cleveland.
During a break between classes at Sibley Hospital, Bailey acknowledged the hospital's changing mission.
"Health-care transformation requires we do everything we can to increase people's health, rather than waiting for them to get ill," she said. "Health care doesn't stop when you leave the hospital."