Guided care reduces the use of health services by chronically ill older adults

Guided care reduces the use of health services by chronically ill older adults

From the March 14 2011 Science Daily news item

ScienceDaily (Mar. 14, 2011) — A new report shows that older people who receive Guided Care, a new form of primary care, use fewer expensive health services compared to older people who receive regular primary care.

Research published in the March 2011 edition of Archives of Internal Medicine ***found that after 20 months of a randomized controlled trial, Guided Care patients experienced, on average, 30 percent fewer home health care episodes, 21 percent fewer hospital readmissions, 16 percent fewer skilled nursing facility days, and 8 percent fewer skilled nursing facility admissions. Only the reduction in home health care episodes was statistically significant.

According to the study, Guided Care produced even larger reductions in a subset of patients who received their primary care from one well managed health system. Guided Care patients in Kaiser Permanente of the Mid Atlantic States experienced, on average, 52 percent fewer skilled nursing facility days, 47 percent fewer skilled nursing facility admissions, 49 percent fewer hospital readmissions, and 17 percent fewer emergency department visits; the differences for skilled nursing facility days and admissions were statistically significant….

More information about Guided Care is available at  twww.GuidedCare.org.
From the Web site…”Guided Care® is a new solution to the growing challenge of caring for older adults with chronic conditions and complex health needs. A Guided Care nurse, based in a primary care office, works with 2-5 physicians and other members of the care team to provide coordinated, patient-centered, cost-effective health care to 50-60 of their chronically ill patients. The Guided Care nurse conducts in-home assessments, facilitates care planning, promotes patient self-management, monitors conditions monthly, coordinates the efforts of all health care professionals, smoothes transitions between sites of care, educates and supports family caregivers, and facilitates access to community resources. ”

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Related Articles

• Guided Care improves physician satisfaction with patient/family communications (scienceblog.com)
• Chronic disease care poorer in nursing and residential homes under GP target scheme (eurekalert.org)
• Post Trauma Care: Better Chance Staying At Home (medicalnewstoday.com)

Health and Well-Being in the Home A Global Analysis of Needs, Expectations, and Priorities for Home Health Care Technology

Health and Well-Being in the Home A Global Analysis of Needs, Expectations, and Priorities for Home Health Care Technology

From the Rand Corporation summary

n both industrialized and transitioning countries, population aging and better survivability have led to a rapid increase of the prevalence of chronic disease and disability. As a result, there is growing concern about the financial sustainability of health care systems, which is compounded by capacity constraints and workforce shortages. Advanced home health care solutions promise to mitigate these pressures by shifting care from costly institutional settings to patients’ homes and allowing patients to self-manage their conditions. A global study of the needs, priorities, and expectations of key stakeholders regarding home health care in six countries (China, France, Germany, Singapore, the United Kingdom, and the United States) revealed that, despite their potential, such technologies face a number of barriers to adoption. Restrictive coverage and existing incentives for in-person home care create obstacles, as does limited patient readiness because of insufficient health literacy. Concerns about audience-appropriate product design and support and limited data on effectiveness and efficiency also impede uptake. Realizing the promise of telecare requires a concerted stakeholder effort, including creation of a conducive policy environment, design of convincing products, and development and dissemination of persuasive evidence.

Aging safely at home? California’s disabled elderly are barely holding on

Aging safely at home? California’s disabled elderly are barely holding on

From the January 31, 2011 Eureka news alert

The network of public services that supports California’s low-income, disabled elderly is fragile, affecting the ability of these vulnerable residents to live independent lives in their own homes, according to a new study from the UCLA Center for Health Policy Research.

This policy note reports the first findings from a yearlong effort to follow the lives and challenges encountered by several dozen representative older Californians in Los Angeles, San Diego, San Francisco and Santa Clara who are enrolled in Medicare and Medi-Cal and who receive in-home and community care.

The documentary project comes as California lawmakers consider additional cuts to a network of services that help seniors remain “safely in their homes” — the stated goal of these public programs and the way in which an overwhelming number of Americans say they want to age.

The policy note, “Holding On: Older Californians with Disabilities Rely on Public Services to Remain Independent,” shows seniors struggling to live functional lives in the face of already reduced caregiving hours. For example:

Caring for the caregivers

Sara cares for her disabled son and husband, whose heart disease, diabetes, incontinence and limited mobility require 24-hour care. There’s help from In-Home Supportive Services (IHSS) and other family members, but Sara is the primary caregiver. Now, her back is acting up. She’s been delaying seeing a doctor to take care of her own needs — who will care for her family if she’s hospitalized?

Delicate balance

Paralyzed by polio, Mary breathes with the help of a ventilator and gets around in a wheelchair. She needs help to dress, bathe, use the toilet and eat. She’s created an elaborate system to meet her needs, using maximum IHSS hours of support and offering room and board to another caregiver in return for care. Mary’s happy with her life and rates her health as “excellent,” but she knows that even a small change in the delicate balance of her care system will send her to a nursing home.

His choice

Incapacitated by stroke and diabetes and confined to a wheelchair, Jack spent time in a nursing home a couple of years ago, and he’s not in a hurry to go back. In the nursing home, he felt unsafe and more isolated than he does in his own house with support from IHSS. Jack’s a realist. He knows a nursing home may be in his future again, but he wants to choose when and where he’ll go.

According to the researchers, all participants in the study are aware that the networks of care they’ve cobbled together could easily unravel, and most say they’d rather “make do” by eating less often, letting their homes become less safe or allowing their medical conditions to worsen than give up their independence and go to a nursing home — the likely scenario if they lose the in-home services they now rely upon.

“These seniors are using every sort of innovation and self-deprivation to make do,” said Steven P. Wallace, the study’s senior author and associate director of the UCLA Center for Health Policy Research. “They have nowhere to turn if their fragile care systems are further undermined.

“Policymakers need to see the faces of these vulnerable Californians as they crunch the numbers in budget discussions,” Wallace added. “Further cuts are an assault on their independence. Slashing in-home and community care will also increase total health care costs as these seniors increasingly use emergency room care, are hospitalized or enter institutions — under conditions that could have been prevented.”

Budget cuts looming

California, which is home to the largest number of older adults in the country, has several programs funded by federal, state and local dollars to assist low-income adults with disabilities. Proponents of these programs say that while such care isn’t perfect, it is far less expensive and more humane than the alternative — placing seniors in publicly financed nursing homes.

Yet, IHSS program-hours were trimmed by 3.6 percent in January 2011, and they face further across-the-board cuts of 8.4 percent, plus additional targeted reductions in the governor’s proposed budget. Adult day health care centers are slated for elimination, and supplemental security income cash benefits are to be reduced for single low-income aged and disabled individuals.

All the older adults in the study receive IHSS support, ranging from 20 hours of in-home help each month to the maximum of 283 hours per month. Most need help with household tasks, such as cleaning and cooking, and personal tasks like getting dressed or taking medications. Many require help getting in and out of bed, bathing and using the toilet. Some who might benefit from adult day health care or other supportive programs are unable to participate because of limited mobility or lack of transportation.

“California’s current system to support old and young adults with disabilities at home operates in silos and is not person-centered,” said Bruce Chernof, M.D., president and CEO of the SCAN Foundation, which is funding the study. “The Brown administration has an important opportunity to design a more stable, integrated, efficient and person-centered system that can meet the needs of these vulnerable residents throughout the state.”

Related Resources

• Home Care Services (MedlinePlus.gov) has links in areas as related issues (as nursing home alternatives), financial issues,organizations, and law/policy)
• US Administration on Aging has links to local programs, a benefits check up, related information, and more.
• National Association of Area of Area Agencies on Aging includes information on policy/advocacy, programs and resources/publications. It also includes links to local resources.

 

Caring for the elderly: Dealing with resistance

Caring for the elderly: Dealing with resistance
Caring for the elderly can be challenging — particularly if a loved one is resistant to care. Understand what’s causing your loved one’s resistance and how you can encourage cooperation.

Excerpts From the Mayo Clinic Tip Sheet

What’s the best way to approach a loved one about the need for care?

If you suspect that your loved one will be resistant to care — whether from family, other close contacts or a service — you may be hesitant to bring up the topic. To start communicating with your loved one about his or her need for care:

• Choose a time when you and your loved one are relaxed. This will make it easier for you and your loved one to listen to each other and speak your minds.
• Ask questions about your loved one’s preferences. This will help you provide the type of assistance your loved one wants. What type of care does your loved one want or need? Does your loved one have a preference about which family member or what type of service provides care? While you may not be able to meet all of your loved one’s wishes, it’s important to take them into consideration.
• Enlist the help of family members. Family and friends may be able to help you persuade your loved one to accept help.
• Don’t assume that your loved one is unable to discuss care preferences. While your loved one may be ill, he or she may still have care preferences and be able to make some decisions regarding care. If your loved one has trouble understanding you, be sure to simplify your explanations and the decisions you expect him or her to make.
• Don’t give up. If your loved one doesn’t want to discuss the topic the first time you bring it up, try again later.

What are the most effective strategies for managing resistance to care?

Getting an aging loved one to accept help can be difficult. To encourage cooperation, you might:

• Suggest a trial run. Don’t ask your loved one to make a final decision about the kind of care he or she receives right away. A trial run will give a hesitant loved one a chance to test the waters and experience the benefits of assistance.
• Enlist the help of a professional. Your loved one may be more willing to listen to the advice of a doctor, lawyer or care manager about the importance of receiving care.
• Explain your needs. Consider asking your loved one to accept care to make your life a little easier. Remind your loved one that sometimes you’ll both need to compromise on certain issues.
• Pick your battles. Focus on the big picture. Avoid fighting with your loved one about minor issues related to his or her care.
• Explain how care may prolong independence. Accepting some assistance may help your loved one remain in his or her home for as long as possible.
• Help your loved one cope with the loss of independence. Explain to your loved one that loss of independence isn’t a personal failing. Help your loved one to stay active, maintain relationships with caring friends and family and develop new physically appropriate interests.

Keep in mind that these strategies may not be appropriate when dealing with a loved one who has dementia.

Two related resources

• Caregivers (MedlinePlus) has links to overviews, coping materials, organizations, related issues, and much more
• National Association of Area Agencies on Aging provides information on how to locate a local area agency for personalized responses to questions, caregiver support and resource information , and additional resources and programs