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Frailty
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
The program for all-inclusive care for the elderly (PACE) is a long-term comprehensive management model that aims to decrease hospitalizations and nursing home care in older patients [47]. Beginning in the 1990s in San Francisco, California, the program has been replicated across the country. In 1997, it became a permanent Medicare program due to its success [48]. Patients are followed across the continuum of care: outpatient clinics, day centers, home environments, and, if necessary, hospitals and nursing homes; the latter two settings attempting to be minimized but not program-ending for patients—patients are followed until the end of their lives.
The Program of All-Inclusive Care for the Elderly (PACE): An Innovative Long-Term Care Model in the United States
Published in Iris Chi, Kalyani K. Mehta, Anna L. Howe, Long-Term Care in the 21st Century: Perspectives from Around the Asia-Pacific Rim, 2013
Many U. S. institutions, including those of education, employment, and health care, have felt the impact of the demographic trend of population aging for some time now. But with much larger numbers and increased life expectancy, long-term care for frail elders has emerged as one of the most important familial, social, and financial issues on the policy agenda. Further, because the family is the primary source of caregiving for frail elders, long-term care for elders has been and continues to be a serious issue for most American families. In this article, the author examines problems of the traditional long-term care system and introduces the Program of All-Inclusive Care for the Elderly (PACE)-a nationally recognized, innovative community-based long-term care model in the United States.
The long and winding road (leads me home)
Published in Carrie Rich, J. Knox Singleton, Seema S. Wadhwa, Sustainability for healthcare management, 2018
Carrie Rich, J. Knox Singleton, Seema S. Wadhwa
Another trend impacting healthcare transportation in a significant way is the transition to home and ambulatory care.3,4 Home health is one of the fastest growing sectors in the healthcare industry. Over seven million patients are served in home health settings each year. It is often the lowest-cost option for delivering healthcare services that would otherwise be provided in the hospital setting.5,6 There is an anticipated growth of the home healthcare system of 70 percent by 2020. This is in comparison with 14 percent for the general US labor market (Ford, 2014). Primary care, in particular, is increasingly retail oriented and located outside of the hospital for optimal patient access.7 This means that more services will be physically located in the community rather than at the hospital. Fewer people will be venturing to the hospital as more people transition to ambulatory care sites. One example of an expanding ambulatory program in the US is the Program of All-inclusive Care for the Elderly (PACE), a comprehensive service for enrollees that includes transportation of enrollees from their homes to the PACE site.8 Alternatively, what are the transportation implications of moving large numbers (in small groups) of healthcare workers out to patients’ homes? With an inadequate transportation system, delivering ambulatory and home healthcare will be affected and will likely lead to both dissatisfied employees and patients. As hospitals across the country embrace ambulatory and home healthcare models, the time is now ripe to incorporate sustainability into the transportation system.
Prioritizing geriatrics in medical education improves care for all
Published in Medical Education Online, 2022
Samuel Rentsch, Caroline A. Vitale, Kahli Zietlow
Additionally, we advocate for incorporating innovative models of care as required clinical rotation sites where available. Sites of evidence-based geriatric models of care, such as Program of All-inclusive Care for the Elderly (PACE) or Acute Care of Elderly (ACE) units, as well as post-acute and long-term care settings, provide unique opportunities for trainees to participate in the care of older adults under the tutelage of clinicians well-versed in Geriatric Medicine. Healthcare systems can also enact meaningful change by adopting policies and practices that support the care of older adults. Age-Friendly Health Systems utilize the ‘4 M’s’ of geriatrics: Medication, Mobility, Mentation, and (What) Matters Most, to incorporate each of these core principals into the older care adults receive[23]. Such initiatives inherently provide education to all providers and staff regarding these geriatric concepts, while leading to improved patient satisfaction and healthcare outcomes. The Institute for Healthcare Improvement provides a formal Age-Friendly designation for healthcare systems who formally incorporate the 4 Ms framework into the care provided[24].
The Relationship of Fear of Falling and Quality of Life: The Mediating Effects of Frailty and Depression
Published in Journal of Community Health Nursing, 2022
Michelle A. McKay, Janell L. Mensinger, Christina R. Whitehouse
Although considerable literature exists investigating the relationship between FOF, frailty, depression, and quality of life in community-dwelling older adults, the factors that potentially mediate the relationship between FOF and HRQoL (such as frailty and depression) are less clear and may give us insight into an area for direct and/or indirect intervention development. Therefore, the aims of the current study were to investigate the sequentially mediating roles of frailty and depression in explaining the relationship between FOF and quality of life among Program for All-Inclusive Care for the Elderly (PACE) participants. PACE participants are high-risk community dwelling vulnerable older adults who meet criteria for nursing home admission and require healthcare services to live safely within the community.
Meaningful Engagement in the Nursing Home
Published in Journal of Gerontological Social Work, 2021
John E. Morley, Nancy Kusmaul, Marla Berg-Weger
Through the 1970s and 1980s, the U.S. government, concerned with costs and quality in long-term care, implemented a variety of policies and programs including home and community based (HCBS) waivers, the Program of All Inclusive Care for the Elderly (PACE), and Cash and Counseling (R.L. Kane & Kane, 2015). In 1986, the Institute of Medicine (IOM) issued a report highlighting the problems in nursing homes (Gebhardt, 1986). Rosalie Kane served on the interprofessional IOM commission (Institute of Medicine, 1986). This report led Congress to issue a number of nursing home reforms as part of the Omnibus Budget Reconciliation Act (OBRA) of 1987 (GovTrack.us, 2020). The OBRA (2020) law required that nursing facilities assess their residents using a standardized Minimum Data Set (MDS) which was used to derive quality indicators for nursing homes (Kane et al., 2003). This medically centered instrument excluded the role of quality of life so the Centers for Medicare and Medicaid Services (CMS) contracted the Kanes and their colleagues to develop quality of life measures (Kane et al., 2003; R.L. Kane et al., 2004). Among the domains of their quality of life measure were dignity, autonomy, meaningful activity, and relationships.