Saturday, February 25, 2012

Going Home and Staying Home, Away from Nursing Homes

Home is where the heart is and where care ought to be.


February 25, 2012 – A movement away from nursing homes back to the home is gathering steam. Anticipated cuts of $56 billion now underway and over the next 10 years from the Obama administration are driving this trend.

So are desires of the old and the frail to be home again. So are technological trends that allow home monitoring. So are emergence of teams of skilled health care professionals – doctors, nurses, social workers, nutritionists , occupational therapists - who are ready and willing to deliver care in personal homes. And so is the emergence of a new health care model, PACE (Program for All-Inclusive Care of the Elderly), which features care at adult day care centers, In the home, and occasionally at doctors’ offices.

I have personal experiences with home care. When my mother was dying from lung cancer, she desperately wanted to die at home. But Medicare policies at the time allowed pay only for hospital care. Mom died unhappy, alone, and desolate in the hospital. My twin sister had Mad-Cow disease, Jacob Creutzfeld disease. Her mental state was deteriorating quickly. Her family chose to have her cared for at home by hospice nurses. It was the right decision. She died peacefully at home, surrounded by the ones she loved.

An article in the February 23 New York Times “ A Shift from Nursing Homes to Managed Care at Home” describes the elements of the trend away from nursing homes and back to personal homes.

Nursing homes are closing facilities because of lowered reimbursements and higher costs. As an alternative, nursing homes are embracing a new model of care – care at home and at adult day care centers administered by teams of health professionals. The model is less expensive than nursing homes. It is more compassionate and satisfying for the frail elderly.

Because of economic pressures, the number of nursing homes and nursing home beds is going down in America. Over the last 6 years, 350 homes have closed. More closings will come. The Archdiocese of New York is shuttering 2 of 7 homes it owns. The diocese is opening a PACE center (Program for the Inclusive-Care of the Elderly).

At PACE, patients may spend the day at an adult day care center. But they go to sleep in their own bed at night – often with a health aide or nurse nearby. They are given preventive care to keep them out of nursing homes. They live out their days at home.

When necessary, a nurse may visit them at home to change pill boxes or inject drugs. Patients may go to PACE centers 2 or 3 times a week, but they know they’ll be going home after each PACE visit. In New York, PACE receives $4000 a month from Medicare and $3300 a month from Medicaid, in either case less than the $9000 a month required by nursing homes. The aim of the New York model and 29 programs in other states is to keep people out of nursing homes.

Towards the goal of keeping people out of nursing homes, new and innovative technologies are springing up. An example of these devices are audiovisual units sitting on tables next to patients’ bedsides. Ordinary telephone lines connect patients to caregivers. When patients need help or sense a complication, they initiate calls to doctors and nurses, who can visually observe the patients, listen to hearts and lungs, take blood pressures and pulses, record weights, even measure blood oxygens.

It is Skype and more. It is telemedicine in action. It is care delivered away from nursing homes. It is decentralized care – the wave of the future.

Tweet: Nursing homes across U.S. are downsizing and switching to a new care model, delivering care in day care centers and in patients’ homes.


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