Let us take a look at the so called golden years. In the later stages of life seniors are at greater risk for multiple medical conditions and complications from them. Care becomes more complex, especially if mental disorders accompany the physical condition. With the baby boomer cohort set to strain the health care system capacity, it is imperative that either capacity be increased or ways need to be found to allow seniors to remain at home but still receive the care they need. Here are some examples of innovation in geriatric care throughout the nation.
Before some seniors qualify for home health care via Medicare they may need more care but would still like to live at home. A partnership of the University of Nebraska, the Nebraska Medical Centre, funds this program as a service to the community. Assisting Seniors to stay Independent through Services and Teaching (ASSIST) accesses the expertise of geriatric trained nurse case managers to do in home assessments and instruction in self managing conditions. Seniors are also given advice on nutrition and safety. Nurses and doctors collaborate to note changes in condition and patients are also shown how to access community services. The success of the program is measured in how long clients can stay in the program. Client satisfaction is high, for example 95% report they were able to stay at home due to nurse advice or services. 89% believed their health improved in the program. Doctors also stated the program allowed seniors to manage conditions better to the point where there were fewer hospitalizations and emergency room usage.
Seniors often prefer to stay at home rather that go into a nursing facility. If their quality of life at home can be maintained through increased medical services that is the ideal scenario. The Aging in Place project has two divisions; Tiger Place and Sinclair Health Care which provides in home services. It is associated with the University of Missouri and is a licensed Medicare certified home health agency. The Center for Medicare and Medicaid gave a 2 million dollar grant to start the agency to evaluate the clinical outcome of ‘aging in place’. Since inception Sinclair HC has allowed more independence in the activities of daily living as compared to nursing home residences. Cognition, depression, and pain were also positively impacted. Tiger Place has reduces hospitalizations through early diagnosis of illness, as well as maintaining mobility and independence.
Preventive care and maintaining wellness are the core concepts of the Evercare program. Simplifying access to services increases the opportunity for seniors to stay healthy and independent, through coordination supplied by nurse practitioner case managers who head integrated teams including doctors, family, and nursing home staff. The NP creates a personalized care plan to detect potential conditions to ward off illnesses and hospitalizations due to crises. Although its inception was in Minnesota, 120,000 patients have gone through Evercare in 35 states.
The Payne Phalen Block Nurse Program in St. Paul, Minnesota takes advantage of the power of volunteers to assist low or moderate income ethnic seniors. It is a collaboration of 4 organizations, 2 of which are nursing schools. Volunteers communicate with seniors and nurses make home visits if deemed medically necessary. Some of the volunteers are nursing students, who also assist in the multicultural wellness clinics established in the public housing facilities. The clinics provide screening and medical education. There is synergy in the collaboration of the 4 organizations, and there is no doubt that the seniors themselves are teachers to those professionals involved. In keeping 89 senior citizens out of nursing homes in 2006-7 the state saved 4 million dollars.
The Living Independently for Elders Center (LIFE) in West Philadelphia gives inner city seniors an opportunity to remain at home in their familiar community. Again the team concept is used to provide integrated mental and physical medical services. Nurse practitioners and doctors in multidisciplinary teams combine practice, research and education. The LIFE program has achieved decreased hospitalization rates of preventable admissions at 2/3 of Pennsylvania’s nursing home rate. The program also has decreased rates of nursing home admissions. If a LIFE participant is hospitalized the team follows them to the hospital to ensure continuity of care as a professional familiar to the patient. The LIFE program is also Program of All Inclusive Care for the Elderly (PACE) program.
The On Lok Society in San Francisco was created by an RN to allow seniors to remain in their homes. A community based service, it is one of the oldest programs of day health center delivery. It was designed as an alternative to nursing home placement. The program is comprised of centers and clinics, and transportation is provided to these locations. Teams of doctors, nurses, therapists and social workers among other professionals provide medical and health care and also ensure that seniors stay socially active.
The On Lok Society was the pioneer of the Program of All Inclusive Care for the Elderly (PACE). PACE has been replicated nationally with at least 70 programs in 30 states. PACE has become a permanent provider under Medicare. The program has adopted innovation as a matter of course, utilizing electronic health records, care coordination, geriatric training, patient participation, benchmarking of best practices, use of protocols, cultural sensitivity, and end of life preparation.
To summarize, the key concepts of these geriatric care programs are as follows: respecting the senior’s wish to remain independent in their home and community, using prevention and early diagnosis of medical conditions to allow this to happen, multidisciplinary collaboration in teams of professionals, senior’s participation in their own care, understanding the link between mental and physical health, and willingness to adopt an innovative approach to care.
We have seen that health care is most successful if carried out where people spend most of their time be it school, work, or home. More of these programs need to be implemented nationwide; they must become the norm not the exception in care.
Medicine does not equal health care. It is not health care if someone waits until they are sick and then gets treatment.
Nurses are pioneering the reversal of current thinking that a citizen access expert help only when he or she gets sick. How about seeking expertise to stay well? It’s all about preventing patients and a better quality of life through good health.
Part 1 of this series is here: http://blog.mynursinguniforms.com/index.php/moving-from-treatment-to-health-promotion-preventing-patients/
Notes:
http://www.aannet.org/i4a/pages/index.cfm?pageid=3301
http://www.aannet.org/custom/edgeRunner/index.cfm?pageid=3303&showTitle=1
Article © 2010 My Nursing Uniforms.com / Young Lion Incorporated. Photo courtesy of kozumel
