Facilitating Aging in Place: Senior Care

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• The MU Sinclair School of Nursing operates a new and exciting practice called Senior Care (SC). SC is a home care agency that provides nurse care coordination and home care services to older adults. As a department of the MU Sinclair School of Nursing, SC exemplifies the education, research, and service endeavors of the school. The agencies mission is to promote the independence, dignity, and health of older adults by providing the services and support needed for them to live in the home of choice.

As a home care agency, SC is both a licensed Medicare certified home health agency and an in home care provider that is designated a home and community based provider (HCB) for the State of Missouri. In addition, SC provides private pay services for individuals not eligible for the (HCB) program.

SC specializes in care of the frail elderly and provides care that is different from traditional home health care, which is usually episodic and time limited. Clients of SC are assigned a nurse care coordinator who monitors their health both during an episode of illness and “checks in” with them routinely to be sure that their health care needs are being met. This type of monitoring helps the nurse care coordinator identify problems at the onset, so that more severe problems can be prevented or treated early, thus minimizing the client’s health risk.

To reach older client’s, SC offers services in congregate housing, such as wellness centers and foot care clinics. Housing complexes currently served include one privately owned apartment building for elderly residents and a public housing building. The wellness centers offer the care coordinators and nursing staff assigned to that building an opportunity to get to know the people who live in the building and to the assess the overall health of the community. Services have been developed to meet the specific needs of each community. One example of a new service that has been developed is the medication management program. One problem identified in the older adult communities is the difficulty many older adults have in managing their medication programs. This problem placed many older adults at significant risk for adverse events related to taking too much or little medication. To treat this problem, SC created a medication management program. In this program a care coordinator works closely with the older adults’ primary health care provider to develop a plan for medication management. The program includes monitoring for medication efficacy and side effects, reordering of all medications and designing methods of medication delivery, which could be medication set ups, actual medication delivery, or use of other devices designed to assist in medication administration.

Another example of a service is the use of a nurse mental health specialist to coordinates the care for individuals with mental illness. This service is funded by the Columbia Housing Authority and has helped several clients remain in their apartments and since this service was implemented a decline in the number of public disturbances and eviction rates for the building has occurred. Again, the crux of the intervention is keep the client’s in contact with their physician and encourage client’s to take their medications properly.

The outcomes of the project to date have been positive. Since opening in March of 1999, over 500 older adults in Boone County have been served. The use of nurse care coordinators has postponed or prevented nursing home placement in over 125 older adults. A major challenge is finding funding for nurse care coordination. SC is evaluating its program’s cost and outcomes. If the program can demonstrated a decrease in clients overall health care costs while improving or at least maintaining a similar quality of care it is hoped that a new reimbursement mechanism for care coordination can be created by state and possibly federal legislation.