Karen Dorman Marek

Clinical Outcomes of Aging in Place

BackgroundPrograms such as Medicaid Home and Community-based Services (HCBS) have provided an alternative to institutionalization through community-based, long-term care services; however, there are limited studies on the clinical outcomes of participants in these programs as compared to nursing home (NH) residents. ObjectiveTo compare clinical outcomes of individuals in a community-based, long-term care program to individuals of similar case mix in institutional-based, long-term care. MethodsA program called Aging in Place (AIP) was developed by the Sinclair School of Nursing in cooperation with the state of Missouris HCBS program. The AIP intervention consisted of nurse coordination of the HCBS program and Medicare home health services. A total of 78 AIP participants were matched with 78 NH residents on admission period, activities of daily living (ADLs), cognitive status, and age. The Minimum Data Set (MDS) was collected on the AIP group at admission and every 6 months over a 30-month period. Cognition was measured by the MDS Cognitive Performance Scale (CPS), ADLs by the sum of 5 MDS ADL items, depression by the MDS-Depression Rating Scale, and incontinence by rating on 2 MDS items related to urinary continence. The Cochran–Mantel–Haenszel method was used to test the association between the AIP intervention and clinical outcomes. ResultsThe AIP group clinical outcomes were better at a statistically significant level (less than .05) for the following outcomes: (a) cognition at 6, 12, and 18 months (p = .00); (b) depression at 6 and 12 months (p = .00); (c) ADL at 6 (p = .02), 12 (p = .04), and 24 (p = .00) months; and (d) incontinence at 24 (p = .02) months. In all 4 outcome measures, the AIP group stabilized or improved outcome scores whereas the NH groups outcome scores deteriorated. DiscussionStudy results suggest that community-based care with nurse coordination enhances clinical outcomes of long-term care participants.

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

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.

Nurse care coordination and technology effects on health status of frail older adults via enhanced self-management of medication: randomized clinical trial to test efficacy.

Background:Self-management of complex medication regimens for chronic illness is challenging for many older adults. Objectives:The purpose of this study was to evaluate health status outcomes of frail older adults receiving a home-based support program that emphasized self-management of medications using both care coordination and technology. Design:This study used a randomized controlled trial with three arms and longitudinal outcome measurement. Setting:Older adults having difficulty in self-managing medications (n = 414) were recruited at discharge from three Medicare-certified home healthcare agencies in a Midwestern urban area. Methods:All participants received baseline pharmacy screens. The control group received no further intervention. A team of advanced practice nurses and registered nurses coordinated care for 12 months to two intervention groups who also received either an MD.2 medication-dispensing machine or a medplanner. Health status outcomes (the Geriatric Depression Scale, Mini Mental Status Examination, Physical Performance Test, and SF-36 Physical Component Summary and Mental Component Summary) were measured at baseline and at 3, 6, 9, and 12 months. Results:After covariate and baseline health status adjustment, time × group interactions for the MD.2 and medplanner groups on health status outcomes were not significant. Time × group interactions were significant for the medplanner and control group comparisons. Discussion:Participants with care coordination had significantly better health status outcomes over time than those in the control group, but addition of the MD.2 machine to nurse care coordination did not result in better health status outcomes.

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.

Aging in Place Versus Nursing Home Care: Comparison of Costs to Medicare and Medicaid

The objective of this study was to compare the community-based, long-term care program called Aging in Place (AIP) and nursing home care, in terms of cost to the Medicare and Medicaid programs. A retrospective cohort design was used in this study of 39 nursing home residents in the Midwest who were matched with 39 AIP participants. The AIP program consisted of a combination of Medicare home health, Medicaid home and community-based services (HCBS), and intensive nurse care coordination. Controlling for high inpatient Medicare cost in the 6 months prior and the 10 most frequently occurring chronic conditions, multiple regression was used to estimate the relationship of the AIP program on Medicare and Medicaid costs. Total Medicare and Medicaid costs were

Nurse home visit programs for the elderly.

1,591.61 lower per month in the AIP group (p < 0.01) when compared with the nursing home group over a 12-month period. The findings suggest that the provision of nurse-coordinated HCBS and Medicare home health services has potential to provide savings in the total cost of health care to the Medicaid program while not increasing the cost of the Medicare program.

The relationship of community-based nurse care coordination to costs in the Medicare and Medicaid programs.

Nurses are the largest professional provider of health care services in the home setting. However, nurse home visit programs are diverse. The purpose of this review was to examine the many factors that influence the effectiveness of nurse home visit programs for older adults. Donebedian’s Quality Assessment Model was used to organize the review using the components of structure, process, and outcome. A total of 60 home visit studies were identified that met the following criteria: (1) nurses were a major or only provider of the intervention, (2) the intervention was delivered by home visits, and (3) the study included a comparison group. This review demonstrates the complexity of variables that determine the effectiveness of home visit interventions. Many studies demonstrated lower overall health care costs for the intervention group with either improved or at least no change in clinical outcomes.

The feasibility of integrating the Omaha system data across home care agencies and vendors.

The purpose of this evaluation was to study the relationship of nurse care coordination (NCC) to the costs of Medicare and Medicaid in a community-based care program called Missouri Care Options (MCO). A retrospective cohort design was used comparing 57 MCO clients with NCC to 80 MCO clients without NCC. Total cost was measured using Medicare and Medicaid claims databases. Fixed effects analysis was used to estimate the relationship of the NCC intervention to costs. Controlling for high resource use on admission, monthly Medicare costs were lower (

Senior care: making a difference in long-term care of older adults.

686) in the 12 months of NCC intervention (p = .04) while Medicaid costs were higher (

Patterns and problems associated with transitions after hip fracture in older adults

203; p = .03) for the NCC group when compared to the costs of MCO group.