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Integrated long-term care for community-dwelling frail elders

Health Factors: Quality of Care
Decision Makers: Community Members State Government Healthcare Professionals & Advocates Nonprofit Leaders
Evidence Rating: Some Evidence
Population Reach: 1-9% of WI's population
Impact on Disparities: No impact on disparities likely

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Description

Integrated long-term care (LTC) is delivered by a multidisciplinary team of professionals who work collaboratively to meet the full range of patient needs. Team members plan care jointly and share patient records. In some cases, care is coordinated by a nurse care manager (Trivedi 2012). This type of care is usually delivered to elders with multiple, complex needs who live in community settings (Trivedi 2012, Beswick 2008). Frail elderly patients are at increased risk of adverse outcomes from conditions that could be prevented with early detection and treatment (Eklund 2009).

Expected Beneficial Outcomes

Reduced hospital utilization
Improved day-to-day functioning
Reduced nursing home use
Increased caregiver satisfaction
Reduced falls

Evidence of Effectiveness

There is some evidence that integrated long-term care reduces hospitalization of elderly patients with multiple, complex needs when compared to usual care (Beswick 2008, Trivedi 2012, Eklund 2009). Additional evidence is needed to confirm which intervention models are most effective (Trivedi 2012).

Integrated care can improve basic functioning and health while reducing nursing home use and caregiver burden (Trivedi 2012). In some circumstances, such care can also reduce patient risk of falling (Beswick 2008).

Integrated long-term care appears to reduce the total cost of care by reducing hospitalizations and nursing home care, but program expenses can erode cost savings in some circumstances (Trivedi 2012).

Implementation

United States

The federal Program for All-Inclusive Care for the elderly (PACE) offers home care for Medicare and Medicaid enrollees eligible for nursing home care but safely able to remain at home (CMS-PACE). This program has demonstrated positive hospitalization (Meret-Hanke 2011), health, and basic function outcomes (Grabowski 2006).

The Affordable Care Act (ACA), through the Community Living Assistance Services and Supports (CLASS) Act, establishes a voluntary insurance program to help participants pay for community living services. Participants must have been enrolled in the program for at least five years and meet functional disability standards to collect benefits (AOA-ACA).

Wisconsin

Family Care, a long-term care program that offers interdisciplinary case management and the option of home- or community-based care, is available in 57 counties (WI DHS-Family Care).

Implementation Resources

CMS-PACE - Centers for Medicare & Medicaid Services (CMS). Program of all-inclusive care for the elderly (PACE). Accessed on March 13, 2017
NCLTCI - National Clearinghouse for Long Term Care Information (NCLTCI). Long-term care (LTC). Accessed on September 22, 2016

Citations - Description

Beswick 2008* - Beswick AD, Rees K, Dieppe P, et al. Complex interventions to improve physical function and maintain independent living in elderly people: A systematic review and meta-analysis. Lancet. 2008;371(9614):725–35. Accessed on September 22, 2016
Eklund 2009* - Eklund K, Wilhelmson K. Outcomes of coordinated and integrated interventions targeting frail elderly people: A systematic review of randomised controlled trials. Health & Social Care in the Community. 2009;17(5):447–58. Accessed on September 22, 2016
Trivedi 2012 - Trivedi D, Goodman C, Gage H, et al. The effectiveness of inter-professional working for older people living in the community: A systematic review. Health and Social Care in the Community. 2013;21(2):113-28. Accessed on September 22, 2016

Citations - Evidence

Beswick 2008* - Beswick AD, Rees K, Dieppe P, et al. Complex interventions to improve physical function and maintain independent living in elderly people: A systematic review and meta-analysis. Lancet. 2008;371(9614):725–35. Accessed on September 22, 2016
Eklund 2009* - Eklund K, Wilhelmson K. Outcomes of coordinated and integrated interventions targeting frail elderly people: A systematic review of randomised controlled trials. Health & Social Care in the Community. 2009;17(5):447–58. Accessed on September 22, 2016
Trivedi 2012 - Trivedi D, Goodman C, Gage H, et al. The effectiveness of inter-professional working for older people living in the community: A systematic review. Health and Social Care in the Community. 2013;21(2):113-28. Accessed on September 22, 2016

Citations - Implementation

AOA-ACA - Administration on Aging (AOA). Affordable Care Act: Opportunities for the aging network. Accessed on October 5, 2016
CMS-PACE - Centers for Medicare & Medicaid Services (CMS). Program of all-inclusive care for the elderly (PACE). Accessed on March 13, 2017
Grabowski 2006* - Grabowski DC. The cost-effectiveness of noninstitutional long-term services: Review and synthesis of the most recent evidence. Medical Care Research and Review. 2006;63(1):3–28. Accessed on October 5, 2016
Meret-Hanke 2011* - Meret-Hanke LA. Effects of the program of all-inclusive care for the elderly on hospital use. The Gerontologist. 2011;51(6):774–85. Accessed on September 22, 2016
WI DHS-Family Care - Wisconsin Department of Health Services (WI DHS). Family Care: Options for long-term care. Accessed on October 5, 2016

Page Last Updated

January 5, 2015

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