The Aging in Place ProjectAssuring Quality At-Home Servicesfor Seniors

Marilyn Rantz, PhD, RN, FAANCurator’s Professor, Sinclair School of NursingUniversity of Missouri, Columbia, MO

www.agingmo.com

AIP Vision, Foundation, Goal Dramatically change the way long-term care is

provided in this country through a new approach

RN Care Coordination/Community Case Management

Getting people the right services at the right time to maximize regaining or maintaining health and independence

Provide research and education opportunities

AIP tested in community, private and public housing, now at TigerPlace

CMS grant 1999-2003, wellness center focused, licensed home health agency for Medicare, Medicaid, private insurance, private pay, served over a hundred monthly 2006

TigerPlace opened 2004, expanded in 2009 and 2011, serving 65 daily in housing and now 85 in rehabilitation

Key Clinical and Financial Outcomes RN care coordination reduces adverse health events, improves

care outcomes, nursing home utilization, and costs less Clinical outcomes better (ADL performance, less depressed

and better cognition, continence, pain and shortness of breath) Cost savings $1,591 per month (nursing home comparison)

$483 (community comparison) Costs for any TigerPlace participant (even through end of life)

has not approached nursing home care (average annual care cost for 2008 was $7,331 for those nursing home eligible and $2591 for those not eligible, plus housing cost)

Over $10.1 million in grants; hundreds student experiences

Challenges Building and operating TigerPlace required

legislation in Missouri (1999 and 2001) Continuing regulation interpretation and concerns

from traditional nursing homes Medicare referrals from our health system Melding for-profit partner with University Medicare and Medicaid funding stream for RN care

coordination, change federal regulations Explaining new approach to services and

billing to consumer

Policy Implications

Medicare and Medicaid funding for RN care coordination

Bundling services so RN can order the needed community services (PT, DME)

Incentives for consumer health promotion and independence

Leadership Implications Communicating the vision and practice in day to day

activities Grant writing and journal publications Team building, for practice, for research, for education Keeping the vision and outcomes alive at the

University Translating outcomes into public policy messages and

strategically targeting the messages for change