Reimagining Aging Care on Chicago's South Side with Estrelitta Harmon

On Chicago's South Side, where some communities record life expectancies decades shorter than neighborhoods just miles to the north, the conventional health care response has largely fallen short. Estrelitta Harmon, Executive Director of the Center for Better Aging (CBA), argues that the reason is straightforward: the system has been treating the wrong problem.

Speaking with James Leuthe, CEO of Scopewell Solutions, Harmon laid out why a neighborhood-level, whole-person approach is the only model capable of moving the needle on one of urban America's most persistent health equity challenges.

Zip code over genetic code

Harmon opened with a framing that shapes all of CBA's work. 'Your zip code is more important, more critical to your health outcomes than your genetic code,' she said, describing the gap that separates some South Side communities from their North Side counterparts.

She pushed back firmly on the instinct to address that gap through clinical interventions alone. Health care, she argued, accounts for only about 20 to 30 percent of a person's health outcomes. The remainder is driven by social determinants: food access, housing stability, transportation, safety, and the conditions of daily life.

Treating diabetes or hypertension in isolation, she said, is 'really just a band-aid' when the forces shaping those conditions remain unaddressed. A whole-person model that accounts for all of those factors is not optional; it is the minimum requirement for meaningful change.

The gap a person actually falls through

To illustrate why the current system fails older adults, Harmon walked through what a typical care encounter looks like in Englewood, the South Side neighborhood where CBA's clinic is based. A person visits the emergency department, sees a physician, receives a prescription or discharge instructions, and goes home. At that point, the system's responsibility ends.

What happens next is left entirely to the individual. Can they afford the prescription refill? Do they have food that matches the dietary plan their provider recommended? Can they physically re-enter their home if they were discharged using a wheelchair? 'The system isn't actually designed currently to support them beyond the service that's being provided,' Harmon said.

The same fragmentation applies to every other service a person might need. Arranging a meal delivery, securing transportation to a follow-up appointment, or connecting with a social worker each require separate phone calls to separate organizations, with no coordinating hand in between.

An ecosystem, not a new institution

CBA's response is not to rebuild the services that already exist, but to connect them. Harmon describes what CBA is building as an ecosystem, a single entry point where an older adult or their family can arrive and be routed to every resource relevant to their aging journey.

In practical terms, that means when a member is discharged from the emergency department, CBA schedules their follow-up appointment before they leave and follows up with a phone call. Members can also receive what Harmon calls a welcome home visit, in which a CBA representative goes to the person's home to confirm they are stable and have what they need. If a member misses a clinic appointment, CBA sends someone into the community to find them and address whatever barrier prevented them from showing up.

CBA also carries its services outward, running community-facing events at churches, senior satellite centers operated by the city, grocery stores, and through door-to-door outreach. 'We go find the people where they are,' Harmon said, 'so that you don't have to depend on going to the ED or to your doctor to ask a question.'

Building trust before building membership

For a new organization entering a community with deep skepticism toward institutions, Harmon said the most critical early investment has been in trust. CBA does not assume that residents will shift away from care relationships they may have maintained for decades simply because a new model is available.

The strategy has been consistent, visible presence. Showing up once is not enough; the organization commits to returning, to making sure residents and their families know what CBA offers and what they can expect. The promise, Harmon said, is dignified care from people who are genuinely invested in the individual's aging journey.

That emphasis on dignity is not incidental. It reflects a recognition that communities on the South Side have often experienced health initiatives that did not follow through, and that earning trust requires demonstrating reliability over time.

Managing a 40-plus organization collaborative

CBA works with more than 40 partner organizations to deliver its model, including five contractual partners in addition to the organization itself. Those partners range from organizations more than 130 years old to startups only a couple of years in operation, and their capacity to adopt new workflows or integrate with shared data platforms varies considerably.

Harmon likened the challenge to steering a very large ship, and said the key has been pairing clear organizational structure with genuine flexibility. 'The organization that is 100 plus years old is going to move more like a cruise ship, and the startup is going to move more like a jet ski,' she said, noting that managing both within the same initiative requires ongoing attention to how each partner is navigating the change internally.

The consistent thread holding the collaborative together, she argued, is alignment on mission. When partners share the same conviction about the model's value, the operational friction becomes workable.

Sustainability and early proof

CBA is currently grant-funded, which creates pressure to demonstrate impact on a compressed timeline. Rather than waiting for long-term health outcome data, Harmon said the organization has focused on leading indicators: clinic attendance, community event participation, repeat engagement, and reductions in emergency department utilization.

In roughly two and a half years of operation, CBA recorded more than 18,000 community touch points. That figure, Harmon said, gives current and prospective funders a concrete picture of reach and engagement while the model continues building toward the longer-term outcome data that will speak to the life expectancy gap directly.

The underlying logic is that demonstrated momentum at the engagement level credibly forecasts health outcomes further down the line. Showing that people are accessing care, returning for follow-up, and participating in prevention programming is the foundation on which a durable funding case is built.