When we think about how to manage the health of elderly family members, there is a tendency to look at the question from a medical angle. Insurance regulations force us to think about doctors, hospitals, and medications. But there are some elder care programs that deliver geriatric health care by promoting wellness — rather than treating old age as an illness. Health promotion is an idea that’s been embraced by the staff at the LIFE Center in Philadelphia. This philosophy guided the program’s founders who were educators from the University of Pennsylvania’s School of Nursing.
Enrolling a family member in a “wellness” oriented healthcare program can change the way you look at the entire process of aging. People in the LIFE Center get all of their healthcare through the program. They can attend adult day services during the week and have access to a team of LPN’s, nurse practitioners, social workers, and caregivers who are on duty at LIFE Center every day. If an elder needs physical or occupational therapy, they can get that at the center, too. There is even a geriatric dentist available. The design of the LIFE Center is based on the PACE (Program of All-Inclusive Care for the Elderly) program — which was originally developed in San Francisco in the 1970’s. Today there are 75 PACE programs in 29 states. Many programs have multiple sites within a city. You can find out whether there is a program near you by clicking on this PACE link and typing in your zip code.
In a recent interview with Kevin Hook, the Chief Nursing Officer for Penn’s LIFE Center in West Philadelphia, I learned about the process elders must go through to qualify for these comprehensive services. Mr. Hook explained that elders must be certified as being income eligible for both Medicare and Medicaid. If you live in Philadelphia, you obtain this income certification through the Philadelphia Corporation on Aging. In other states or counties, you can contact the Area Agency on Aging.
The process takes some time and you have to answer a lot of questions, but once you are certified, the benefits of this kind of program are significant. For each new elder, the program’s care team completes a social needs assessment and a nursing assessment. They use this information to create a care plan that will help keep elders living safely in their own homes for as long as possible. Staff members work with the elder and their family members to put together a transportation plan as well as system of other supports. The one care issue that may annoy some elders is the fact that you must get all care from the program’s physicians and nurse practitioners. People who feel loyal to a long-time doctor may not want to switch. But the comprehensive nature of the program offers good reasons to do so.
One reason for the success of PACE programs is that they are economically advantageous. All care is delivered through one system and emergency visits are minimized. Penn’s LIFE center also relies heavily on nurse practitioners. A nurse practitioner is an advanced practice nurse with advanced education that has prepared them to diagnose and treat common illnesses. The roles and responsibilities of nurse practitioners vary in each state because their duties are regulated at the state level. In many states, nurse practitioners can prescribe a wide range of medications when they are needed. This reduces the patient’s number of more costly visits to doctors or hospitals. Because elders at the LIFE Center receive care from an entire team, they also get attention faster when a problem develops. Many of the program’s caregivers have close relationships with the patients and they can convey information to the nurse practitioners if they notice a sudden change in their condition. The Penn program also has the capacity to work with elders who have developed symptoms of dementia. Their day program has a special unit for these patients and a set of onsite protocols to ensure they are safe.
Although we don’t have a program like this near us, it seems like a great option for families who have access to one. Team of caregivers+lower costs+more contact with elders = better sleep for everyone.