Evaluation of Aging in Place Model with Home Care Services and Registered Nurse Care Coordination in Senior Housing
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Available online at www.sciencedirect.com Nurs Outlook 59 (2011) 37e46 www.nursingoutlook.org Evaluation of aging in place model with home care services and registered nurse care coordination in senior housing Marilyn J. Rantz, PhD, RN, FAANa,*, Lorraine Phillips, PhD, RNb, Myra Aud, PhD, RNb, Lori Popejoy, PhD, RNb, Karen Dorman Marek, PhD, MBA, RN, FAANc, Lanis L. Hicks, PhDd, Isabella Zaniletti, MAe, Steven J. Miller, MAb a Sinclair School of Nursing and Family and Community Medicine, School of Medicine, University Hospital Professor of Nursing, University of Missouri, Columbia b Sinclair School of Nursing, Columbia, Missouri c College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin d Health Management & Informatics, School of Medicine, University of Missouri, Columbia e Medical Research Office, University of Missouri, Columbia article info abstract Article history: A state-sponsored evaluation of aging in place (AIP) as an alternative to assisted Received 25 June 2010 living and nursing home has been underway in Missouri. Cost, physical, and Revised 20 July 2010 mental health assessment data reveal the cost-effectiveness and positive health Accepted 27 August 2010 measures of AIP. Findings of the first four years of the AIP evaluation of two long-term care settings in Missouri with registered nurse care coordination are compared with national data for traditional long-term care. The combined care and housing cost for any resident who received care services beyond base Keywords: services of AIP and who qualified for nursing home care has never approached Aging in place or exceeded the cost of nursing home care at either location. Both mental health Nurse care coordination and physical health measures indicate the health restoration and independence Assisted living effectiveness of the AIP model for long-term care. Nursing home Cite this article: Rantz, M. J., Phillips, L., Aud, M., Popejoy, L., Marek, K. D., Hicks, L. L., Zaniletti, I., & Miller, Elderly S. J. (2011, FEBRUARY). Evaluation of aging in place model with home care services and registered nurse care coordination in senior housing. Nursing Outlook, 59(1), 37-46. doi:10.1016/j.outlook.2010.08.004. As people age, most want to remain as active and survey, most people age 45 and older want to remain independent as possible for as long as possible, in their current residence for as long as possible. This maintain an excellent quality of life, and live at home tendency increases with age; 92% of those between surrounded by family and friendsdnot in institutions the ages of 65 and 74, and almost all of those over the e like nursing homes.1 4 According to a recent AARP age of 75 (95%), want to remain at home.5 The goal of This research was supported in part by a grant from the Centers for Medicaid and Medicare Services: Aging in Place: A New Model for Long-term Care, Grant #18-C-91036; US Administration on Aging, Technology to Enhance Aging in Place at TigerPlace, Grant #90AM3013 Parts of this paper were presented at the American Academy of Nursing’s annual conference, November 5-7, 2009, Atlanta, Georgia. * Corresponding author: Dr. Marilyn J. Rantz, Sinclair School of Nursing and Community Medicine, School of Medicine, University Hospital, University of Missouri, 2440 Shady Hills Lane, Columbia, MO 65279. E-mail address: [email protected] (M.J. Rantz). 0029-6554/$ e see front matter Ó 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.outlook.2010.08.004 38 Nurs Outlook 59 (2011) 37e46 aging in place (AIP) is to allow people to remain at with findings of early nursing home diversion8,9 and home and be provided with supportive health care community-based nursing case management demon- e services as needed.1 Faculty at the University of Mis- strations.10 13 Faculty toured best-practice long-term souri (MU) are evaluating an AIP model of care that care sites around the country and met with a variety of combines home care services and registered nurse health care providers from a range of disciplines, (RN) care coordination in two independent congregate community leaders, and other geriatric researchers to senior housing buildings. One is specially designed define the AIP model of care. Based on these discussions, and state designated as the only AIP site where care the final model combined the best of community-based can be provided through the end of life, hereafter health care with intensive RN care coordination.3 known as “AIP 1 TP.”6 The other is an independent Unfortunately, state long-term care regulations were living apartment setting within a continuing care not flexible enough to execute the AIP vision. retirement community (CCRC), where RN care coor- dination and some services help people remain inde- The faculty of the SSON began working to change pendent for as long as possible before moving to statutes and regulations that would enable AIP to traditional care settings within the CCRC, hereafter happen. Working with state legislators and officials, known as “AIP 2 MW.” The purpose of this article is to community leaders, and health care industry advo- describe the findings of the first four years of the cates, legislation in 1999 and 2001 established four AIP state-sponsored AIP evaluation of these two long-term pilot sites. MUSSON, in partnership with AIP 1 TP, care settings in Missouri. Cost and health assessment applied for and received designation as an AIP pilot data are presented and compared with traditional site. AIP 2 MW was added later to increase the sample long-term care data. size and to evaluate the effect of AIP RN nurse care coordination and other care services in a traditional The typical long-term care trajectory forces older CCRC elder apartment site, where there are industry adults to move from home, to independent senior incentives to move residents from apartments to housing, to assisted living, and then to nursing home traditional long-term care as care needs increase. as their health and functional abilities decline. The first move is often the result of inadequacies of the home In 1999, MUSSON established Sinclair Home Care, environment to accommodate healthy aging. Struc- a licensed home health agency specializing in the care tural features of the home, such as stairs, width of of frail older adults, as a department within the school. doorways and hallways, and bathroom and kitchen To enable launching the operation, the school received design, may impact a person’s ability to function safely a grant from the Centers for Medicare and Medicaid and, consequently, result in a move to senior housing, Services (CMS) to establish the home health agency assisted living, or a nursing home.2 Once an older adult and evaluate AIP.14 Sinclair Home Care provides clin- moves into an assisted living or nursing home envi- ical experiences to students from nursing, medicine, ronment, state and federal regulations define what and other health professions. The agency developed services may be provided, staffing patterns, building innovative ways to care for and manage the care of safety standards, and how payment for care is made. older adults.14 Sinclair Home Care was specifically Although regulations differ from state to state, they developed to provide care to the residents of AIP 1 TP, often define a specific level of ability that a resident AIP 2 MW, and other independent and public housing must maintain to remain in independent housing or sites, with the goal of implementing and evaluating the assisted living environments. Regulations require that AIP model of care. a resident move to a higher level of care as their health deteriorates and their self-care abilities decline. For AIP Results from the initial evaluation indicate that to be successful, a facility must adjust the services community care with RN care coordination improved provided and level of care criteria to meet a resident’s clinical outcomes when compared with individuals of increasing care needs, thus avoiding the need to similar case-mix in nursing homes.15,16 Moreover, the discharge the resident to a higher level of care.7 RN care addition of RN care coordination to home-based long- coordination is essential for AIP because care is term care programs provides savings to the total cost of provided in different settings from a variety of health health care to the Medicare and Medicaid programs when care disciplines.2 compared with nursing homeebased and home and communityebased services.17 The AIP care model at AIP 1 TP and AIP 2 MW is based on these findings, combining Background home health services with RN care coordination. In 1996, faculty from the University of Missouri (MU) The Locations Sinclair School of Nursing (SSON) imagined a new model of care that would allow residents to age in place without the fear of forced relocation. Several faculty had active AIP 1 TP was specifically developed as an ideal AIP research programs about older adults; they were familiar housing environment for elders and to evaluate the AIP Nurs Outlook 59 (2011) 37e46 39 model. Built by Americare Systems, Inc. (Sikeston, MO), as hospitalizations. The monthly fee for AIP services is a leading long-term corporation, in collaboration with lower at AIP 2 MW, a reflection of the less intense care the University of Missouri, AIP 1 TP opened in 2004 as coordination and fewer services provided. The AIP a 31-unit building with a variety of apartment styles monthly service fee is included in the monthly apart- including studio, alcove, and one and two bedrooms, ment rent for both sites. Residents may also contract all meeting universal access standards. The facility for additional health care services, such as personal was built to nursing home standards, licensed as an care, medication management, or other professional intermediate care facility (ICF), and operated as inde- services.