The Chelsea‐Village Program (CVP) is a long‐term home healthcare program for a largely isolated and impoverished frail homebound aged population, based at Saint Vincent's Hospital in New York City. Since January 1973, our CVP teams of physicians, nurses, and social workers have cared for the homebound aged over the long term. Twenty‐seven years later, we have made 42,866 home visits to 2264 persons in lower Manhattan, an area of New York City housing a high concentration of older people. Our purpose is to help our patients remain in their own homes and community at the maximum possible level of personal control and to maintain the best attainable health. Additionally, the program is a valuable component of the Hospital's Primary Care Adult Medicine residency program. It also serves as a laboratory for the study of health problems faced by the homebound aged and the solutions to these problems. The program, a medical‐social model, has required modest philanthropic investments, dedicated service by physicians, nurses, and social workers, and the support of a hospital with a strong charitable mission. The CVP experience has encouraged the creation of other long‐term home healthcare programs across the country, including the Medicaid‐supported Nursing Home Without Walls program that spans New York State. Thus, the CVP can be viewed as a model rather than an idiosyncratic non‐replicable phenomenon. As such, the program has established that multidisciplinary healthcare teams, in collaboration with a teaching hospital, can provide long‐term home health care to homebound older people in the local community. Moreover such a practice is mutually beneficial. J Am Geriatr Soc 48:1002–1011, 2000.

Prehospital code status decisions can be made effectively within the NH setting. Outside of medical intensive care, DNR orders have no impact on NH and hospital care intensity in the short term. In the final 6 months of life, however, hospital use is less for the DNR subgroup.

A large proportion of hospital stays stem from rapid readmission of elderly patients. These patients represent high cost users of inpatient care. Intervention in the hospital admission-readmission cycle may serve the interests of patients and payors alike. Data collected through comprehensive geriatric assessment can be useful in identifying those patients at high risk of readmission and who might benefit from more intensive in-hospital or post hospital attention. However, risk factors for readmission are largely unknown. We conducted a prospective study of elderly patients admitted to a metropolitan teaching hospital medical service and assessed by a geriatric team, to increase our knowledge of the factors associated with hospital readmissions. The most powerful predictor of hospital readmission within 6 months proved to be prior hospitalization. Attempts to reduce rehospitalizations in elderly patients must focus on those with prior recent hospitalizations.

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Background.\p=m-\Engaging older persons in consideration of use of life-sustaining measures, such as cardiopulmonary resuscitation, tube feeding, and urgent intubation, is widely recommended, yet uncommon.Methods.\p=m-\Westudied the short-term impact of a physician-initiated discussion, geared toward guiding informed decision-making, with 20 frail elderly homebound patients. A battery of psychologic rating scales was administered in a pre-post design. Eighteen subjects completed the protocol. Fifteen of the mentally capable surviving subjects were reinterviewed 18 months following the initial discussion to evaluate durability of their decisions.Results.\p=m-\Mostwelcomed the discussion and clear choices regarding future care usually emerged. Depression rating scales decreased slightly for the entire sample. For the subgroup having relatively internal locus of control, there was an increase in life satisfaction scores. No patient demonstrated signs of emotional trauma consequent to the discussion. On follow-up, several patients were indecisive about their choices.Conclusion.\p=m-\Involvementof these patients in decisionmaking appeared to have no adverse effects, and, for some, it was therapeutic, possibly through enhancement of personal control. Durability of their decisions was not a consistent finding, however.Control over the use of life-sustaining interventions is the subject of intense controversy. Participants in the ongoing debate include physicians who feel that they un¬ derstand prognosis best, theorists who advocate for pa¬ tient self-determination, and public policy makers con¬ cerned with growing costs of care. Most agree that involvement by elderly persons in making decisions about their own fate is appropriate.Early communication with the elderly concerning ad-vanee directives has been recommended,1 yet such discus¬ sion remains an uncommon practice.

There exists a deficiency of accurate information regarding standard nutritional parameters in people of greatly advanced age. In order to begin obtaining appropriate data, we assessed nutritional status in 45 elderly homebound individuals with a mean age of 84 yr, using anthropometric methods, skin testing, and blood analysis. We compared our data with those from the HANES survey, a reasonable approach to the testing of new possible standards for nutritional assessment. Our results suggest that standard measures in common use are inappropriate for people of greatly advanced age.

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St. Vincent's Catholic Medical Centers of New York initiated a study in 2009 to assess the health needs of residents of New York City (NYC) municipal housing at the Robert Fulton public housing complex in Manhattan. The aim of this project was to provide valid data on perceived health services needs of the residents of a NYC housing project. These data may also be used to support hospital and community collaborative strategic decisions for developing resident-appropriate health and social services and would be valuable for use in formulating policies and programs by other interested nonprofit health and social services organizations and government. We designed a 28-item instrument and pilot tested it with our research team and members of the population under study. The English and Spanish surveys were designed as an in-person surveyor-administered instruments addressing four domains: demographics, access and barriers to health care services, risk behaviors, and perceived health needs. The sampling was an apartment-level stratified random sampling. A 20%, 188 apartment sample was drawn from the population of 944 housing units. Our response rate was 92% (173/188 apartments). Background methods, and demographic results are reported in this article. A second article will report on the needs assessment results.