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Open in a separate window Source: Adapted from Kodner [ 3 ]. Each of Models of assessment for elderly models is elaborated on below.
Key program components are described first. This is followed by a case presentation depicting the process of care, using a different hypothetical patient for each model. Evaluation results, including findings on quality and cost impacts, are then discussed.
Finally, the lessons learned will be briefly summarised. Social health maintenance organisation 11 The Social HMO is a federally funded demonstration project, which combines health and social care, both acute and long term, into a single, care managed delivery system [ 2931 ].
The program is targeted primarily to elderly Medicare beneficiaries, and is predicated on the belief that an integrated approach will facilitate more appropriate care and lower costs. The four Social HMO sites are: Targeting The Social HMO is open to all Medicare beneficiaries age 65 and over who live in communities served by the demonstration.
Enrolment is voluntary, and is designed to ensure a cross-section of functionally independent and impaired elderly.
Benefit package The model supplements existing Medicare benefits, which consist primarily of acute-oriented medical care delivered by primary care physicians and physician specialists, in-patient hospitalisation for acute and short-term psychiatric careshort-term outpatient mental health care, and skilled nursing home and home care services for short-term, post-acute needs.
Non-institutional long-term care benefits include personal assistance services, homemaking, rehabilitation therapies, meals, respite, and adult day health care.
These additional services are funded, in part, through gains in efficiency from existing Medicare benefits e. Financing Financing is accomplished through prepaid capitation. Medicare pays the Social HMO monthly, on the basis of percent of the adjusted average per capita cost for each enrolee.
Inherent in this method is an economic incentive to encourage the use of home- and community-based services in lieu of institutional care. Thus, the fundamental challenge in designing the Social HMO has been in grafting a long-term care support system to a medical care delivery system. Each of the Social HMO sites were given flexibility to accomplish this goal in their own manner.
Differences between sites reflect the particular orientation and experience of the sponsoring entities. Whereas Medicare Plus II and Seniors Plus emphasised the building of linkages with and between institutional- and community-based long term care providers, Elderplan and SCAN Health Plan focused on developing a managed care infrastructure, as well as medical care capabilities.
Other significant differences between the sites relate to program auspices and size. All sites were required to enrol a minimum of individuals a number considered by the original designers to be important from an economy of scale perspectivealthough this target proved difficult to meet initially, in some cases.
In both examples, however, the implementation of the model depended on managing complex provider relationships and care arrangements across a relatively diffuse organisational network.
Care management, however, is a central feature at all four sites. This co-ordination function, which is the responsibility of a specialised unit at each site, allocates the long-term care benefit to enrolees who meet the above eligibility criteria.
Members of the care management team include nurses, social workers and other health professionals. Their tasks include comprehensive assessment, care planning for long term care services and other expanded benefitsservice authorisation and arrangement, and ongoing patient monitoring and follow-up.
A multidisciplinary form of team care is used, whereby care managers and providers share patient information and discuss and recommend care decisions. There are two unique aspects of this care management system that are important to note.
First, assessment and care planning activities include the elderly enrolee and family carers, as well as the primary care physician. Second, needed long term care services are delivered by providers under contract with the Social HMO.
Thus, access to quality care according to agreed-upon standards is assured, as is payment to the provider.
Several clinical management tools are employed in the care management function described above. The Health Status Form HSF is a screening instrument that is conducted on enrolment and periodically thereafter, designed to identify enrolees at-risk through self-reported health status.
The form collects information on current medical complaints and physical problems, and ongoing care. It is used by the Social HMO as part of a population-based, high-risk screening process to identify unmet medical and social needs that may require immediate attention, including the need for long term care.
Referrals for comprehensive assessment come from two major sources: Care managers may also conduct such assessments when called for by clinical judgement. The Comprehensive Care Plan is then developed by the care manager and primary care physician, in collaboration with the enrolee and family carers.
This care plan lists specific long term care goals for the patient, as well as the services needed to improve their health and functional status. The plan is also used as the basis of assigning service responsibility and authorising care.
Process of care A case example will help illustrate the process of care found in this model on an ongoing basis.A needs assessment is a systematic process for determining and addressing needs, or "gaps" between current conditions and desired conditions or "wants".
The discrepancy between the current condition and wanted condition must be measured to appropriately identify the need. The need can be a desire to improve current performance or to correct a deficiency.
MODELSOF COMMUNITY CARE FOR THE ELDERLY INVOLVING COLLABORATION BETWEEN SPECIALIZED GERIATRIC SERVICES AND PRIMARY CARE PRACTITIONERS Summary table of relevant services/models 2.
References of studies/reports summarized 3. References of potentially relevant reviews assessment,treatment, and education of frail elderpersons and their. Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
INTRODUCTION — Geriatric conditions such as functional impairment and dementia are common and frequently unrecognized or inadequately addressed in older adults.
Identifying geriatric conditions by performing a geriatric assessment can help clinicians manage these conditions and prevent or delay their complications. Fully integrated care for frail elderly: two American models.
Dennis L. Kodner, PhD, Senior Vice President and Corinne Kay Kyriacou, PhD, Co-ordination techniques include comprehensive assessment procedures, care management, joint care planning and team care, disease management.
Presbycusis (also spelled presbyacusis, from Greek presbys "old" + akousis "hearing"), or age-related hearing loss, is the cumulative effect of aging on barnweddingvt.com is a progressive and irreversible bilateral symmetrical age-related sensorineural hearing loss resulting from degeneration of the cochlea or associated structures of the inner ear or auditory nerves.