Models for community-based long-term care for the elderly in a changing health system

Evaluation of aging in place model with home care services and registered nurse care coordination in senior housing

A state-sponsored evaluation of aging in place (AIP) as an alternative to assisted living and nursing home has been underway in Missouri. Cost, physical, and mental health assessment data reveal the cost-effectiveness and positive health 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 services of AIP and who qualified for nursing home care has never approached or exceeded the cost of nursing home care at either location. Both mental health and physical health measures indicate the health restoration and independence effectiveness of the AIP model for long-term care.

TigerPlace, A State-Academic-Private Project to Revolutionize Traditional Long-Term Care

The Aging in Place Project at the University of Missouri (MU) required legislation in 1999 and 2001 to be fully realized. An innovative home health agency was initiated by the Sinclair School of Nursing specifically to help older adults age in place in the environment of their choice. In 2004, an innovative independent living environment was built and is operated by a private long term care company, as a special facility where residents can truly age in place and never fear being moved to a traditional nursing home unless they choose to do so. With care provided by the home care agency with registered nurse care coordination services, residents receive preventative and early illness recognition assistance that have markedly improved their lives. Evaluation of aging in place reveal registered nurse care coordination improves outcomes of cognition, depression, activities of daily living, incontinence, pain, and shortness of breath as well as delaying or preventing nursing home placement. Links with MU students, faculty, and nearly every school or college on campus enrich the lives of the students and residents of the housing environment. Research projects are encouraged and residents who choose to participate are enjoying helping with developing cutting technology to help other seniors age in place.

A technology and nursing collaboration to help older adults age in place

This is an account of an active collaboration between Computer Engineering, Health Informatics, and Nursing within an academic health science center to improve the quality of life of older adults as they "age in place." The Sinclair School of Nursing at the University of Missouri-Columbia has developed a licensed home health agency, Senior Care, to provide the care needed by residents of TigerPlace, a specially designed independent living center near the University. Technology has the potential to help address common problems encountered by older adults related to functional decline. Collaboration between Nursing, Computer Engineering, and Health Informatics is likely on a path to improve the quality of life of seniors.

The effectiveness of the around-the-clock in-home care system: did it prevent the institutionalization of frail elderly?

This study compares two communities in Japan from the perspective of community health care resources and their use by the elderly during 1992-98. In one community, programs of home care services for the elderly were reorganized to provide around-the-clock in-home nursing and home help services seven days a week (ACC). Official records were the major sources of data. Evidence from the analysis indicated that ACC might contribute to less use of institutionalization as an alternative to home care, even though, in some instances, institutionalization is the only appropriate alternative.

Use of home and community-based services by elderly black and white females

The study purpose was to determine the impact of demographic, social, environmental, and health indicators on utilization of community-based services among black and white female elders. Existing data from a regional Area Agency on Aging was used and the sample (N = 1816) included low income and rural females. Races differed in use and services most frequently used were case management, outreach, congregate meal, and home delivered meals. Multiple linear and logistic regression indicated that age, payment source, income adequacy, residence, health conditions, sensory impairment, and function were associated with the number and types of services used, but these differed by race. Study findings have implications for health care providers, educators, policy makers, and planners.

Reconfiguring a Curriculum for the New Millennium: The Process of Change

Over the past decade, changing demographics, new technology, an increased focus on health promotion, and radical shifts in health care reimbursement have significantly impacted the nursing role. The purpose of this article is to review the process of change at one university as its curriculum evolved from an integrated acute-care focus to a community-based, health promotion framework. A review of the literature and survey data from students, alumnae, faculty, other universities, and curriculum consultants laid the groundwork for this process. Curriculum generation followed guided by data analysis, template design and revision, values clarification, sacrificing "sacred cows," and consensus building. Implications for nursing and nursing education are explored.

Around-the-clock nursing care for the elderly in Japan

PURPOSE

To describe the first phase of creating a Japanese model of community-based long-term care, called around-the-clock care (ACC), by operationally defining the components of ACC, identifying those eligible for the program, clarifying methods of planning and organization, and exploring outcomes.

DESIGN

Exploratory evaluation for the population of frail elderly Japanese citizens living at home. A convenience sample of 44 patients receiving care from four visiting-nurse-service stations during 3 months in 1994 was used.

METHODS

Needs assessments; record reviews of patient encounters; evaluations by patients, families, and visiting nurses; and reviews of administrative data.

FINDINGS

Nurses perceived that ACC stabilized medical status, reduced the emotional and physical burden of treatment, and improved hygiene. It also reduced family caregiving burdens and the stress of family caregivers' employment responsibilities. The highest rating of ACC by patient and families was for those with the most complex physical needs. Skilled nursing at home permitted early identification and treatment of problems before they became crises or required hospitalization.

CONCLUSIONS

Early findings suggest 24-hour nurse-home helper teamwork may be an effective system of community-based long-term care and should be considered a key element of future Japanese health policy.