The Quality Improvement Program for Missouri's Long - Term Care Facilities (QIPMO) is committed to Missouri's Elderly.
The "Aging-in-place" model allows older adults to receive health care in their preferred place of living, eliminating the need for a more restricted living space, such as a nursing home.
TigerPlace is a specially designed elder housing project initiated by the MU Sinclair School of Nursing, working to provide elders a better quality of life.
In 1996, faculty from the MU Sinclair School of Nursing (SON) envisioned a new model of long term care based on the concept of aging in place (AIP). The traditional model of long term care forces older adults to move from home, to independent senior housing, to assisted living, then to a nursing home as health deteriorates. The aging in place model allows older adults to remain in the environment of their choice for as long as they wish without fear of forced relocation. The faculty worked with state legislators, industry advocates, and community leaders to enact the legislative changes in 1999 and 2001 to make AIP possible within the highly regulated long term care industry. This legislation designated four “aging in place” demonstration sites that are regulated by the Missouri Department of Health and Senior Services, but are regulated differently than traditional nursing homes or residential care (assisted living). In 1999, Sinclair Home Care, a home health agency developed by the MU SON, was created to provide care to residents of the MU AIP demonstration sites TigerPlace and Maplewood Apartments at Lenoir Woods, other private congregate senior housing, and public senior housing. The MU SON received a $2 million grant from the Centers for Medicare and Medicaid Services (CMS) to establish the agency and evaluate the effectiveness of the AIP mode in the community, other private congregate housing and public senior housing. In 2009, the Medicare and Medicaid components of the Sinclair Home Care agency were sold to Oxford HomeCare. The SON retained control of the AIP program and continues to provide services to the residents of TigerPlace and Lenoir Woods. Initial results of the AIP evaluation indicate the cost-effectiveness and positive health outcomes of AIP.
OBJECTIVES: To compare the cost to the Medicare and Medicaid programs between a community-based long-term care program called “Aging in Place” (AIP) and nursing home care.
DESIGN: A retrospective cohort design where AIP participants were matched to nursing home residents on admission quarter, age, ADL, and cognitive status and followed for 12 months. SETTING and PARTICIPANTS: A total of 39 nursing home residents in the same and neighboring counties in the Midwest were matched with 39 AIP participants.
INTERVENTION: The AIP program consisted of a combination of Medicare home health, Medicaid home and community-based services (HCBS), and intensive nurse care coordination.
MEASUREMENT: Total cost to payor using Medicare and Medicaid claims databases.
RESULTS: Controlling for high inpatient Medicare cost in the six 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 $1591.61 lower in the AIP group (p < .01) when compared to the nursing home group over a 12 month period.
CONCLUSION: 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.
Key words: older adults, long-term care, care coordination, home and community-based care, Medicaid costs, Medicare costs
This article describes the creation of Senior Care [now MU Sinclair Home Care], a practice of the University of Missouri Sinclair School of Nursing (MUSSON). Senior Care is a home care agency that specializes in care of frail older adults. Grant funds assisted Senior Care in start up, and the program generated more than $1.25 million in service revenue during the past fiscal year. More than 300 students, from nursing and other schools across the university, have used Senior Care as a clinical or service-learning site, and it is currently the site of several studies, totaling more than $3 million in funding. Senior Care is the service component of the MUSSON Aging in Place initiative. The next phase is the completion of Tiger Place, a living community for older adults, built in affiliation with Americare Systems. Senior Care and the Aging in Place initiative provide an excellent example of how nurses can be leaders in health system change.
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 (RN) care coordination are compared to 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, nor 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.
This is a methodological article intended to demonstrate the integration of multiple goals, multiple projects with diverse foci, and multiple funding sources to develop an entrepreneurial program of research and service to directly affect and improve the quality of care of older adults, particularly nursing home residents. Examples that illustrate how clinical ideas build on one another and how the research ideas and results build on one another are provided. Results from one study are applied to the next and are also applied to the development of service delivery initiatives to test results in the real world. Descriptions of the Quality Improvement Program for Missouri and the Aging in Place Project are detailed to illustrate real-world application of research to practice.
This paper reviews randomized, controlled trials (RCTs) that have attempted to increase physical activity behavior by aging adults. A systematic review was necessary because numerous studies target older adults, and previous reviews have addressed a limited range of primary studies. Computerized database, ancestry, and extensive search strategies by authors of research reported in English between 1960 and 2000 located diverse intervention trials. RCTs reporting endurance physical activity or exercise behavioral outcomes for at least five subjects were included. Integrative review methods were used to summarize extant research. Forty-two studies were retrieved. Seventeen RCTs with 6,391 subjects were reviewed. A wide variety of intervention strategies were reported. The most common interventions were self-monitoring, general health education, goal setting, supervised center-based exercise, problem solving, feedback, reinforcement, and relapse prevention education. Few studies individually adapted motivational interventions, used mediated intervention delivery, or integrated multiple theoretical frameworks into the intervention. Links between individual intervention components and effectiveness were not clear. Common methodological weaknesses included small samples, untested outcome measures, and time-limited longitudinal designs. Significant numbers of aging adults increased their physical activity in response to experimental interventions. The amount of increased activity rarely equaled accepted behavior standards to achieve positive health outcomes. Further work is essential to identify successful strategies to increase activity by larger numbers of elders and to accelerate the increase in activity by those who change activity behaviors. Sex and ethnic differences need further investigation. There is a vital need for rigorously designed studies to contribute to this science.