The Role of Senior Housing in Hospitalizations Among Vulnerable Older Adults With Multiple Chronic Conditions: A Longitudinal Perspective

Park, Sojung; Kim, BoRin; Kwon, Eunjung

doi:10.1093/geront/gnx046

Cited by 10 publications

(13 citation statements)

References 31 publications

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“…Reductions in high‐cost service utilization among residents of affordable senior housing can improve resident quality of life while reducing burden on health systems and generating cost savings for payers. The findings of the R3 and R3 2 evaluations are consistent with recent literature assessing the effect of housing with on‐site services on certain high‐cost health services that are often considered to be avoidable: Inpatient hospitalizations 8,15,17,18,26–28 and ED use 15,16,18,27,29 . To our knowledge, this is the first study to demonstrate a reduction in 30‐day hospital readmission among low‐income housing residents with access to on‐site supportive services that uses a direct comparison group (residents in low‐income buildings without access to on‐site supportive services).…”

Section: Discussionsupporting

confidence: 86%

“…Inpatient hospitalizations 8,15,17,18,[26][27][28] and ED use. 15,16,18,27,29 To our knowledge, this is the first study to demonstrate a reduction in 30-day hospital readmission among low-income housing residents with access to on-site supportive services that uses a direct comparison group (residents in low-income buildings without access to on-site supportive services).…”

Section: Discussionmentioning

confidence: 99%

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The effect of the right care, right place, right time (R3) initiative on Medicare health service use among older affordable housing residents

Tavares

Simpson

Miller

et al. 2022

Health Services Research

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Objective To determine the effect of an affordable housing‐based supportive services intervention, which partnered with health and community service providers, on Medicare health service use among residents. Data Sources Analyses used aggregated fee‐for‐service Medicare claims data from 2017 to 2020 for beneficiaries living in 34 buildings in eastern Massachusetts. Study Design Using a quasi‐experimental design, a “difference‐in‐differences” framework was employed to isolate changes in outcomes, focusing on changes in pre‐ and post‐intervention health service use across two stages of the intervention. Phase 1 encompassed the initial implementation period, and Phase 2 introduced a strategy to target residents at high risk of poor health outcomes. Key health service outcomes included hospitalizations, 30‐day hospital readmission, and emergency department use. Data Collection Medicare claims data for 10,412 individuals were obtained from a Quality Improvement Organization and aggregated at the building level. Principal Findings Analyses for Phase 1 found that hospital admission rates, emergency department admissions and payments, and hospital readmission rates grew more slowly for intervention sites than comparison sites. These findings were strengthened after the introduction of risk‐targeting in Phase 2. Compared to selected control buildings, residents in intervention buildings experienced significantly lower rates of increases in inpatient hospitalization rates (−16% vs. +6%), hospital admission days (−25% vs. +29%), average hospital days (−12% vs. +14%), hospital admission payments (−22% vs. +33%), and 30‐day hospital readmission rates (−22% vs. +54%). When accounting for the older age of the intervention residents, the size of the decline recorded in emergency department admissions was 6.7% greater for the intervention sites than the decline in comparison sites. Conclusions A wellness‐focused supportive services intervention was effective in reducing select health service use. The introduction of risk‐targeting further strengthened this effect. Age‐friendly health systems would benefit from enhanced partnerships with affordable housing sites to improve care and reduce service use for older residents.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

The effect of the right care, right place, right time (R3) initiative on Medicare health service use among older affordable housing residents

Tavares

Simpson

Miller

et al. 2022

Health Services Research

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“…If patient characteristics are similar, it will be possible to compare mortality, hospitalization rates, and all variables of interest, including cost of care, between these 2 care settings. Depending on the profile of the KASAF’s participants, we could also compare foster care with home care or residential care facilities [ 38 ]. The collection of epidemiological data in foster family is therefore an essential step to carry out randomized studies between these different care pathways, with the aim of determining the most effective and efficient care.…”

Section: Discussionmentioning

confidence: 99%

The Health Care Trajectories of Older People in Foster Families: Protocol for an Observational Study

Boucaud-Maitre¹,

Villeneuve²,

Simo-Tabue³

et al. 2023

JMIR Res Protoc

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Background With aging of the population, the search for alternative models of care adapted to older people with dependency is necessary. In this setting, foster families (1-3 older people per family) could be an alternative to nursing homes, residential care facilities, or community- and home-based care. Objective The KArukera Study of Ageing in Foster Families is a prospective cohort study designed to investigate the care pathways of older people with dependency in foster care over a year. The 1-year hospitalization rate (main objective), cost of hospitalization, incidence of mortality, prevalence of geriatric syndromes, and quality of life of residents will be assessed. Quality of life and burnout of their respective foster caregivers will also be studied. Methods This study cohort will include 250 older people living in foster families in Guadeloupe (French West Indies), as well as their respective foster caregivers. Both older people and caregivers will be interviewed concurrently on site at three time points: (1) at baseline, (2) at 6 months, and (3) at 12 months. For older people, we will collect anthropometric measures, cognitive impairment, depressive and anxiety symptoms, functional abilities, physical frailty, information on general health status, quality of life, and care pathways (hospitalization, mortality, and medical and paramedical consultations). We will also assess the quality of life and burnout symptoms of family caregivers at each follow-up. A phone update of vital status (alive or death) and care pathways of residents will be carried out at 3 and 9 months after the baseline examination. Results Recruitment opened in September 2020 and ended in May 2021, with 109 older people recruited and 56 respective foster caregivers. The 1-year follow-up was ended in June 2022. Data analyses are ongoing and the first results are expected to be published in May 2023. Conclusions Foster families are a potentially innovative way to accommodate dependent older people. This study could help define the clinical profile of older people adapted to foster families in the transition from frailty to dependency. The effectiveness of foster families, in terms of hospitalizations and mortality, will be compared with other models of care, particularly nursing homes. In this setting, a twin study carried out in nursing homes in Guadeloupe with similar aims and outcomes will be conducted. Beyond mortality and morbidity, the numerous outcomes will allow us to assess the evolution of geriatric syndromes over time. Trial Registration ClinicalTrials.gov NCT04545775; https://clinicaltrials.gov/ct2/show/NCT04545775 International Registered Report Identifier (IRRID) DERR1-10.2196/40604

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“…Low-income older adults who live in senior housing, which provides support for health and social services, report better health compared to their counterparts who are not in senior housing (Park et al, 2017). Senior housing buffers the negative impact of SES disadvantage on cognitive trajectories in late life and reduces hospitalizations among older adults with multiple chronic conditions (Park et al, 2018; Park et al, 2019). Greater social cohesion, a measure of P-E fit, predicts greater global well-being and lower negative well-being over four years in middle-aged and older adults (Mejía et al, 2017).…”

Section: Person–environment Interaction and Adaptation In Late Lifementioning

confidence: 99%

Clinical practice: A foundational geropsychology knowledge competency.

Jacobs¹,

Bamonti²

2022

Clinical Psychology: Science and Practice

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Most psychologists who provide services to older adults have not received professional training and education in geropsychology. To meet the mental health needs of the growing population of older adults, psychologists without specialty training would benefit from developing foundational knowledge competencies for clinical practice with older adults. Clinical care of older adults offers unique challenges as mental disorders are often complicated by medical illnesses, functional impairments, and latelife stressors, which contribute to under-detection and under-treatment. Age-and disease-related cognitive, sensory, and functional changes necessitate treatment adaptations and a holistic approach to care to maximize older adults' adjustment to aging and overall well-being. This article reviews the foundations of clinical practice with older adults. Specific topics covered are psychopathology in late life, neuroscience of aging, functional changes in late life, common medical illnesses in older adults, and the concept of person-environment interaction as it relates to adaptation in the context of functional changes. Public Health Significance StatementGeneralist psychologists without specialty training in geropsychology will be tasked with providing care to a growing patient population of adults 65 years of age and older. To meet this demand, all providers should attain foundational knowledge competencies in clinical practice with older adults. Dissemination of foundational knowledge competencies in geropsychology is a vital step in enhancing the mental health workforce in preparation to meet the unprecedented growth in the number of older adult patients and their families.

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The Role of Senior Housing in Hospitalizations Among Vulnerable Older Adults With Multiple Chronic Conditions: A Longitudinal Perspective

Abstract: As one of the first efforts to build empirical knowledge on health care use among vulnerable elders in senior housing, our findings underscore the importance of continued research into these environments as a possible alternative to existing models.

Cited by 10 publications

References 31 publications

The effect of the right care, right place, right time (R3) initiative on Medicare health service use among older affordable housing residents

The effect of the right care, right place, right time (R3) initiative on Medicare health service use among older affordable housing residents

The Health Care Trajectories of Older People in Foster Families: Protocol for an Observational Study

Clinical practice: A foundational geropsychology knowledge competency.

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