The future of long-term care for the chronically ill

Longitudinal analysis of aging in place at TigerPlace: Resident function and well-being

This paper reports on a longitudinal eight-year analysis (2011-2019) of trajectory of function and well-being residents of TigerPlace Aging in Place (AIP) model of care. Residents were routinely assessed using standard health assessment instruments. Average scores from each measure were examined for changes or trends in resident function; decline over time was calculated. Scores for depression, mental health subscale Short Form Health Survey-12 (SF-12) remained stable over time. Mini Mental State Exam declined to mild dementia range (21-24). Physical measures SF-12 physical health subscale, ADLs, and IADLs declined slightly, while fall risk increased over time. When yearly trends in AIP were modeled with a referent group there was no significant worsening of functioning. The length of stay for TigerPlace residents continued to remain stable at nearly 30 months. Residents maintained function in the environment of their choice longer at cost less than nursing homes, and just above residential care cost.

'It is a completely new world you step into.' How older clients and their representatives experience the operational access to Dutch long-term institutional care

PURPOSE OF THE STUDY

The access process is an important first step in the long-term institutional care for older people. Access can be seen as a concept consisting of three closely related dimensions: availability, affordability and acceptability (three A's). This study takes a new perspective by investigating how older clients experience the access process.

DESIGN AND METHODS

Data were gathered through interviews with representatives of clients that were recently admitted in a long-term care facility, or if possible with clients themselves. A total of 33 respondents from 4 organizations that provide long-term institutional care were interviewed.

RESULTS

The first contact with the long-term care provider was made in several different ways. Finding a location nearby family was a common aim, which in urgent situations was not always feasible. Most respondents were satisfied about the process and felt taken care of personally. Yet, many respondents mention the lack of practical information and 'guidance' in the complexity of elder care. For acceptability, having a dedicated liaison in the organization was relevant.

IMPLICATIONS

The study revealed that the 3A model can be used to understand how older clients or their representatives experience the operational access process to long-term care. Especially the dimensions' availability and acceptability seemed to shape their experience.

The 3 A's of the access process to long-term care for elderly: providers experiences in a multiple case study in the Netherlands

The access process is an important step in the care provision to independently living elderly. Still, little attention has been given to the process of access to long-term care for older clients. Access can be described by three dimensions: availability, affordability and acceptability (three A's). In this paper we address the following question: How do care providers take the three dimensions of access into account for the access process to their care and related service provision to independently living elderly? To answer this question we performed a qualitative study. We used data gathered in a multiple case study in the Netherlands. This study provides insight in the way long-term care organizations organize their access process. Not all dimensions were equally present or acknowledged by the case organizations. The dimension acceptability seems an important dimension in the access process, as shown by the efforts done in building a relationship with their clients, mainly through a strong personal relationship between client and care advisor. In that respect it is remarkable that the case organizations do not structurally evaluate their access process. Availability is compromised by practical issues and organizational choices. Affordability hardly seems an issue. Further research can reveal the underlying factors that influence the three A dimensions.

The continued success of registered nurse care coordination in a state evaluation of aging in place in senior housing

Older adults prefer to age in place, remaining in their home as their health care needs intensify. In a state evaluation of aging in place (AIP), the University of Missouri Sinclair School of Nursing and Americare System Inc, Sikeston, MO, developed an elder housing facility to be an ideal housing environment for older adults to test the AIP care delivery model. An evaluation of the first 4 years (2005-2008) of the AIP program at TigerPlace (n = 66) revealed that the program was effective in restoring health and maintaining independence while being cost-effective. Similar results evaluating the subsequent 4 years (2009-2012) of the program (N = 128) revealed positive health outcomes (fall risk, gait velocity, Functional Ambulation Profile, handgrips, Short-Form 12 Physical Health, Short-Form 12 Mental Health, and Geriatric Depression Scale); slightly negative activities of daily living, independent activities of daily living, and Mini-Mental State Examination; and positive cost-effectiveness results. Combined care and housing costs for any resident who was receiving additional care services and qualified for nursing home care (n = 44) was about $20,000 less per year per person than nursing home care. Importantly, residents continued to live in private apartments and were encouraged to be as independent as possible through the end of life.

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.

Improving nurse care coordination with technology

Technology offers potential solutions to the pending crisis of healthcare for older adults, while healthcare workers are in short supply. Technology can enable remote monitoring of individuals and early detection of potential problems, so that early interventions can help older adults remain as healthy and independent as possible. Research is under way with passive monitoring technology in senior housing that is finding patterns in the data that can enhance nurse care coordination through early illness detection. With early detection, interventions can be more effective and reduce hospitalization and other healthcare expenses. Case studies are presented, and implications are discussed.

Nonprofit health care services marketing: persuasive messages based on multidimensional concept mapping and direct magnitude estimation

Persuasive messages for marketing healthcare services in general and coordinated care in particular are more important now for providers, hospitals, and third-party payers than ever before. The combination of measurement-based information and creativity may be among the most critical factors in reaching markets or expanding markets. The research presented here provides an approach to marketing coordinated care services which allows healthcare managers to plan persuasive messages given the market conditions they face. Using market respondents' thinking about product attributes combined with distance measurement between pairs of product attributes, a conceptual marketing map is presented and applied to advertising, message copy, and delivery. The data reported here are representative of the potential caregivers for which the messages are intended. Results are described with implications for application to coordinated care services. Theory building and marketing practice are discussed in the light of findings and methodology.

Family caregivers' viewpoints towards quality of long-term care services for community-dwelling elders in Taiwan

The population of elderly people in Taiwan is increasing rapidly, and long-term gerontology care has become an important issue in this greying society. The purpose of this study is to explore family caregivers' viewpoints and opinions regarding the long-term care services for community-dwelling older adults in Taiwan. A qualitative study was conducted between August and December of 2005. Fifty family caregivers agreed to participate in this study. Data were collected by focus group interviews, in order to obtain the experience and expectation of family caregivers concerning long-term care services in their daily lives. Through content analysis and peer discussion,the data were categorized into five major themes: (1) praise for the services;(2) flexibility of long-term care services; (3) comprehensiveness of long-term services; (4) linkage and extension of existing resources; and (5) activeness of service provision. Study findings from the family caregivers' viewpoints should contribute to the improvement of long-term care services and provide a basis for designing suitable programmes to enhance community-dwelling in situ elderly people 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.

Early detection of health changes in older adults

We have placed a network of sensors in a residential home for the elderly who are aging in place. Restlessness data is displayed as graph of event counts detected by sensors over some time interval, typically a day. This data is related to the actual activities as recorded by the resident. We show two cases of elderly individuals. In both cases the individuals underwent surgery. The restlessness indicators showed changes in patterns that were related to those events. Analyzing the data even at this level we gain increased confidence that technology will be a welcome addition as the population ages and require increasing care.

Women's experience of ageing with a chronic condition

AIM

This paper is a report of a study to explore the experiences of 'almost old' women as they grow older while living with a chronic condition.

BACKGROUND

Little is known about the contextual effects of ageing and how it shapes and is shaped by a woman's chronic illness experience. Nurses' understanding of this phenomenon can have positive effects on how their client accesses and responds to healthcare.

METHOD

Seven women aged between 50 and 58 years participated in this interpretive descriptive study that explored the issues of ageing with a chronic condition. Three focus groups were held between March 2003 and March 2004. Transcriptions were analyzed after each focus group. Participants were given the opportunity to respond to the findings as the analysis progressed.

FINDINGS

The experience of living with a chronic illness foreshadowed what was to come with ageing and embodied the ageing process: it was just part of their lives. Alongside this, the women now felt less out of place. Their peers were catching up and beginning to experience aspects of participants' everyday reality. The women, however, experienced double jeopardy because ageing amplified the ongoing vulnerabilities of living with a chronic condition.

CONCLUSION

Nurses who recognize the resourcefulness and expertise of women who live with a chronic condition can effectively be co-strategists in their helping them to age well.

Entrepreneurial program of research and service to improve nursing home 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.

Technology for successful aging

Americans are living longer, and research shows that seniors are embracing independence, and will benefit from living in the same place. These are the rationale for 'Aging in Place' and the development of Tiger Place, an 'Aging in Place' Environment in Columbia Missouri. Our goal is to minimize intrusion, allow the resident complete control over privacy and treatment (if any), and to provide substantive improvement in quality of life. Nevertheless there continues to be significant risks to the elderly which results in reduced functional and cognitive activity. While there has been much technology developed to ameliorate these factors, there is no comprehensive evaluation of the benefit of these devices nor a comprehensive strategy to improve the quality of life of seniors as determined by functional ability and possibly later cognitive ability. With our partners at the University of Virginia we are developing a system of sensors, to monitor the activity of seniors in their residences. We measure motion, footfalls, sleep and restlessness, we have stove sensors and sensing mats, all connected wirelessly to a computer which performs an initial evaluation and data transfer to a secure server for further study. Based upon the monitor data we will implement an intervention to ameliorate functional decline. Focus group studies determine the attitudes, concerns and impressions of the residents and staff. We find that senior's attitude to technology is healthy and they will try helpful approaches. In addition to the statistical comparisons, we model the data using hidden Markov models, integrate or fuse the monitor data with video images, and reason about behavior using fuzzy logic. The results of this work will additionally reduce the workload on caregivers, foster communication between residents and family, and give these seniors independence. We have requested and received IRB approval for this study.

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.

Care of the elderly as a global nursing issue

The size of the world's elderly population is growing at a rapid rate, with the 60 and older population of Europe and North America outpacing total population growth in recent decades. As life expectancy lengthens, the quality of that life becomes an issue of importance to nursing practitioners and nursing educators. Developed countries and developing countries will be faced with different challenges when determining service delivery models for their aging populations. Innovation in delivery models and comprehensive and longitudinal data are needed if the goal of aging in place is to be achieved.