The Effects of a Community-based Long Term Care Project on Nursing Home Utilization

Nocks, Barry; Learner, R. Max; Blackman, Donald; Brown, Thomas E.

doi:10.1093/geront/26.2.150

Cited by 26 publications

(10 citation statements)

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“…A number of studies have been conducted to determine whether formal home care services for frail older patients can improve medical outcomes and/or delay or prevent institutionalization. Some studies have found positive effects, 1–4 and other have not 5–7 . Inconsistency among the studies’ findings might be attributable, in part, to differences in study designs: the nature of service, definitions of eligibility, and outcome measures.…”

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confidence: 99%

Predictors of Nursing Home Placement in Community‐Based Long‐term Care

Tsuji

Whalen

Finucane

1995

J American Geriatrics Society

107

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confidence: 99%

Predictors of Nursing Home Placement in Community‐Based Long‐term Care

Tsuji

Whalen

Finucane

1995

J American Geriatrics Society

107

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“…These findings suggest that HMOs are wise to provide primary care to nursing home residents with GNPs or to encourage greater physician involvement. Expanded home health care programs involving a range of community‐based services and case management have had mixed results in national evaluations 42–46 . Based on these studies, the most consistent and greatest benefit of these programs may be in the quality of life for frail elderly residing in the community, not in terms of cost savings.…”

Section: Discussionmentioning

confidence: 99%

Geriatric Care Approaches in Health Maintenance Organizations

Kramer

Fox

Morgenstern

1992

J American Geriatrics Society

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The objective of this project was to describe geriatric care provided under Medicare-risk contracts in HMOs with established Medicare programs. These findings provided the basis for an invitational workshop, sponsored by the National Institute on Aging and the Robert Wood Johnson Foundation, to formulate a research agenda for geriatric care in HMOs. The case study method involved site visits to seven HMOs by a physician with expertise in geriatrics, a managed care specialist, and a program development specialist. Representatives from the HMOs included senior executive officials, physicians recognized for providing and promoting geriatric care, research and program development staff, and various clinical staff including pharmacists, geriatric nurse practitioners, nurses, and social workers. The most frequently encountered geriatric care programs were categorized by the following six objectives: (1) identifying high risk patients, (2) assessing multi-problem patients, (3) treating multi-problem patients, (4) rehabilitating patients following acute events, (5) reducing medication problems, and (6) providing long-term care and home health care. Unique programs identified from these site visits included screening methods for new enrollees, approaches to comprehensive geriatric assessment, use of skilled nursing facilities for intensive rehabilitation and postacute care, and drug profiling and review. Utilization of geriatric nurse specialists and programs aimed at coordination with social services were pervasive in many of these HMOs. Workshop participants proposed several research and demonstration projects in all six areas. Overall consensus emerged that HMOs with Medicare-risk contracts provide a valuable setting for experimentation in geriatric care. Given the current health policy emphasis on managed care and capitated payment methodologies, geriatric care research in HMOs should be a high priority.

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“…The project began in July of 1979, with voluntary nursing home pre-admission assessment and case management. The demonstration program became fully operational in July of 1980, and was completed in October 1984 (Nocks, Learner, Blackman, & Brown, 1986). CLTC began operating as a permanent program after the demonstration ended in 1984.…”

Section: Cltc Program In South Carolinamentioning

confidence: 99%

Aging in Place? Evidence That a State Medicaid Waiver Program Helps Frail Older Persons Avoid Institutionalization

Pande

Laditka

et al. 2007

Home Health Care Services Quarterly

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Long-term care will increasingly shift from institutions to home and community based services. Using data from a Medicaid home care waiver program in South Carolina, the Community Long-Term Care (CLTC) program, we evaluated differences in frailty and service use among CLTC clients between 1995 (n = 3,748) and 2005 (n = 9,157). The expectation was that CLTC clients had become more frail in that period, and had greater access to services in the community, results that might suggest the CLTC program had helped individuals to avoid institutionalization. Frailty measures included acute and chronic conditions, other health conditions, and activities of daily living (ADL). We evaluated the percentage of clients using services, and service use intensity. A large majority of clients in both years were impaired in at least four ADL. In 2005, CLTC clients were significantly more likely to have chronic conditions, including hypertension, chronic obstructive pulmonary disease, Alzheimer's disease, arthritis, diabetes, and renal failure (all p < 0.05). Clients were significantly more likely to receive specific services in 2005, including physical therapy, dialysis, and oxygen (all p < 0.05). Results suggest CLTC participants were more frail in 2005 than in 1995. This may reflect a successful effort to help individuals age in place in the community, delaying institutionalization. States may be able to control increases in Medicaid long-term care costs through home care programs that delay institutionalization.

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The Effects of a Community-based Long Term Care Project on Nursing Home Utilization

Cited by 26 publications

References 0 publications

Predictors of Nursing Home Placement in Community‐Based Long‐term Care

Predictors of Nursing Home Placement in Community‐Based Long‐term Care

Geriatric Care Approaches in Health Maintenance Organizations

Aging in Place? Evidence That a State Medicaid Waiver Program Helps Frail Older Persons Avoid Institutionalization

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