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Aging in Place: a New Model for Long-Term Care

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Aging in Place: a New Model for Long-Term Care P1: FPX/FSX P2: FHY AS024-01 April 4, 2000 10:20 Char Count= 36642 Aging in Place: A New Model for Long-Term Care Karen Dorman Marek and Marilyn J. Rantz It is expected that at least 40 percent of the population over 75 will need extensive health care services late in their lives. The public has a negative view of nursing home placement that has, to some extent, been confirmed by research finding that the health of a frail older person deteriorates each time he or she is moved. The Aging in Place model of care for the elderly offers care coordination (case management) and health care services to older adults so they will not have to move from one level of care delivery to another as their health care needs increase. University Nurses Senior Care (UNSC) is the service entity of this project and provides as its core service care coordination with a variety of service options. These options include care packages or services at an hourly rate to meet individual client needs. The Aging in Place project will be evaluated by comparing project clients to residents of similar acuity in nursing homes and to similar clients receiving standard community support services. Data from this project will be important to consumers, researchers, providers, insurers, and policy makers. Key words: community based care, elderly, long-term care ISSATISFACTION with the care ing home care—that is responsive to elders’ of older adults is widespread in health care needs and consumer preferences. Dthe United States among con- This public–private partnership venture is an sumers, providers, family caregivers, and innovative Aging in Place model for the el- care providers. This dissatisfaction, along derly offering care coordination (case man- with the rising costs of long-term care, stim- agement) and health care services to older ulated the University of Missouri Sinclair adults residing in specially designed senior School of Nursing to plan for the develop- apartments, other senior private or public ment and implementation of a new model congregate housing, or in their own homes of care—a cost-effective alternative to nurs- in the community. With this new model, peo- ple will not have to move from one level of care delivery to another as their health care The authors acknowledge the contributions of Older needs increase. Frail older adults will have Adults Advisory Committee member, David Mehr, the opportunity to“age in place.” Aging in MD, and the Older Adults Executive Committee, Con- nie Brooks, MSN, RN, Victoria Grando, PhD, RN, Dean Emeritus Toni Sullivan, PhD, RN, FAAN, and Karen Dorman Marek, PhD, MBA, RN, is Adminis- Interim Dean Rose Porter, PhD, RN. Through the vi- trator of University Nurses Senior Care and Profes- sion and efforts of the many committee members at the sor of Clinical Nursing, Sinclair School of Nursing, University of Missouri–Columbia, this service project Columbia, Missouri. is now reality. The authors also acknowledge the support of the Marilyn J. Rantz, PhD, RN, FAAN, is Associate Pro- Health Care Financing Administration (HCFA). Re- fessor, Sinclair School of Nursing, University Hos- search activities were supported partially by HCFA pital Professor of Nursing, University of Missouri– grant #C-5–35903. The opinions expressed in this ar- Columbia, Columbia, Missouri. ticle are those of the authors and do not represent those Nurs Admin Q, 2000, 24(3):1–11 of the Health Care Financing Administration. c 2000 Aspen Publishers, Inc. 1 P1: FPX/FSX P2: FHY AS024-01 April 4, 2000 10:20 Char Count= 36642 2NURSING ADMINISTRATION QUARTERLY/SPRING 2000 Place is a much healthier approach as com- older adult care and services. Changing de- pared with our current long-term care deliv- mographics, the high cost of nursing home ery trajectory that forces a frail older person services, and the continuing shortcomings of to move from one setting to another as needs current models create a compelling need for change and results in mental and physical new approaches to long-term care for frail deterioration.1–3 In this model, all services a elders.9,10 person may eventually require are available The Aging in Place model allows older as needed so there is no need to move to a adults to age in the least restrictive environ- different place. ment of their choice. Key to Aging in Place is the separation of type of care with place Background and Importance of care. In this model, clients direct the tim- ing and intensity of health and personal care In 1990, the U.S. Bureau of the Census services delivered to them in their home. The ranked Missouri 12th in the United States, concept of home includes any residential set- with 14 percent of the state’s population ting in which formal medical services are aged 65 and over. By the year 2020, this not provided as part of the housing compo- age group is expected to account for 25 per- nent. Home may mean a detached individual cent of Missouri’s population. Even now, home, an apartment in a family member’s Missouri ranks 8th in the United States in home or a large complex, or a unit in a con- the proportion of its population over age gregate housing arrangement with support- 85.4 It is expected that at least 40 percent ive services.11 Clients are treated as tenants of the “old-old” population will need exten- of their home rather than residents of an in- sive health care services late in their lives. stitution. However, the Aging in Place model At the same time, consumer preferences for is most successful when provided to individ- long-term care are changing. Above all the uals living in congregate or geographically elderly desire to maintain independence and close locations.8 quality of life. The trajectory of services cur- For Aging in Place to be successful older rently available often forces consumers to- adults must live in an environment sup- ward unsatisfactory and costly institutional portive of independence, and care must care such as nursing homes. Studies indi- be coordinated throughout the health care cate that older adults have a negative view system. Care coordination provides a sys- of nursing home services and strive to avoid tem to identify barriers, as well as to pro- such placements.5–8 As a result, they can be cure and coordinate services required by isolated in their homes, unwilling to reach the frail older adult. Clients who receive out for assistance until it is too late and their care coordination receive a comprehensive health has deteriorated. The public’s nega- assessment of their functional and cogni- tive view of nursing home placement is to tive capacities, strengths, abilities, limita- some extent confirmed by research that the tions, existing resources, and supports. A health of a frail older person deteriorates ev- plan is developed in partnership with the ery time he or she is moved.1–3 Research client based on the results of the assess- also emphasizes the fragmented disarray of ment. Clients are monitored and services P1: FPX/FSX P2: FHY AS024-01 April 4, 2000 10:20 Char Count= 36642 Aging in Place 3 are altered as the clients’ health care needs Project Description change. The focus of the Aging in Place project is Project Goal the development, implementation, and eval- uation of UNSC services for frail older The goal of the Aging in Place project at adults living in senior congregate hous- the University of Missouri–Columbia Sin- ing, public housing, and individual homes. clair School of Nursing is to allow frail UNSC is the first component to be imple- older adults to remain in one setting as mented of a “housing with services” model their health care needs intensify. University being planned by the Sinclair School of Nurses Senior Care (UNSC), a unique home Nursing. The larger project is a university- health agency designed and licensed specif- and community-based project, called Tiger ically for this project, provides care coor- Place, which will be located in Boone dination and links frail older adults to on- County in Columbia, Missouri, on approxi- going health care services. Care is provided mately 6 acres. It is a public–private partner- to older adults in senior private and public ship venture designed to help older adults housing as well as individual homes. Con- “age in place” in the least restrictive envi- gregate private and public housing are the ronment of their choice. Tiger Place will first areas of implementation. In many of the have Tiger Estates, a specially designed 100- area’s retirement communities a large pro- unit apartment complex that will facilitate portion of the residents are over 85 years independence, freedom, privacy, and dig- of age and very frail. Without care coor- nity. Tiger Estates is planned for comple- dination services most of these individuals tion by January 2001. However, UNSC be- would be forced to move out of the senior gan providing care coordination services to housing community into assisted living or frail elderly in the Boone County area in nursing home environments. Problems such March 1999. When Tiger Estates is com- as incontinence, poor personal hygiene and pleted, UNSC will provide care coordination nutrition, and medication mismanagement and services to individuals living in Tiger contribute to the older adult’s loss of func- Estates, in addition to other Boone County tion and resulting move to another setting. residents. Tiger Place also will have an aca- The majority of these problems can be con- demic center that will unite all the compo- trolled or prevented with early intervention nents of the project: research, practice, and and monitoring.
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