Many people dying in institutions have unmet needs for symptom amelioration and emotional support.
BY 2008, AS MANY AS 54% of the work force will provide some assistance to an elderly relative, according to the U.S. Department of Labor. RAND Health, a unit of the RAND Corporation, developed 236 quality-of-care indicators for care delivered to the vulnerable older adult population-those mostly likely to die or become frail-and then used the system to assess the quality of care delivered to community-dwelling older adults enrolled in one of two managed care plans. The study, Assessing Care of Vulnerable Elders (ACOVE), identified 22 conditions that account for the majority of healthcare costs for older adults and analyzed prevention, diagnosis, treatment and follow-up.
The study indicates that vulnerable elderly receive only about half of the care recommended, as measured by the percentage of time providers adhered to quality indicators. Preventive care measures rank the lowest at 43%, while treatment indicators are 81%. In addition, providers administer appropriate care with an adherence rate of 83% for acute care problems vs. 51% for chronic conditions.
The results of the ACOVE study indicate overall that the healthcare provided to the elderly is not as high-quality as it could be, leading researchers to review and test practical interventions to improve performance of some of the lower ranking procedures.
Oakland-based Kaiser Permanente has developed a set of core competencies to address the needs of older adults, including accountabilities for elder care; integrated clinical and business planning and decision-making; quality/performance improvement; clinician attitudes, knowledge and skills; member/caregiver activation and participation; core services such as population screening, caregiver support, healthy lifestyles, prevention, advanced illness care coordination and palliative care; and internal and external collaborations.
A SPECTRUM OF CARE Highmark Blue Cross Blue Shield's SecurityBlue, a Medicare HMO, is another Medicare Advantage organization that knows the senior population backward and forward. Its eight-year-old People Able to Lend Support (PALS) program helps members remain independent by providing assistance with daily tasks, such as transportation, shopping and small home repairs free of charge. Thus far, volunteers have provided 26,000 hours of in-home services to 15,000 older adults in 16 counties in western Pennsylvania.
Highmark applies what it calls "whole person care" to its senior population by moving the member through a continuum of care, including chronic disease management, case management, acute care, wellness prevention and symptom management.
"We offer tools across the entire spectrum of care not only for the really healthy or the really sick, but to enable members to make the most out of their lives at any stage," says Judy Black, MD, medical director of senior products.
SeniorCare Blue, with about 5,300 members started in 1998, and specifically addresses the needs of the frail elderly in nursing homes. A joint venture subsidiary of Keystone Health Plan West and Presbyterian SeniorCare, the program also provides utilization management and discharge planning activities for all short-term nursing home cases of the Medicare Advantage plan.
SeniorCare Blue combines the expertise of geriatric nurses, social workers and a physical therapist who meet at the nursing homes to assess member needs, ensuring members are receiving their benefits; oversee discharge planning; and coordinate care after members are discharged from the facilities. "We are able to provide seamless care to members by working closely with the nursing homes and their staffs to coordinate benefits with the plan more easily," Dr. Black says.
Akin to SeniorCare Blue is a proven model developed by Evercare, part of UnitedHealth Group's Ovations business unit. The company began in 1987, as a demonstration project, and received approval from the Centers for Medicare & Medicaid Services (CMS) in 1994 to expand to other markets. Currently operating in 15 states, its demonstration projects received permanent status as a Special Needs Plan in 2004 through the Medicare Modernization Act (MMA).