Integrating assisted living, PACE generates good outcomes for residents, operators

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Integrating assisted living, PACE generates good outcomes for residents, operators
Integrating assisted living, PACE generates good outcomes for residents, operators

NEW ORLEANS — Integrating Programs of All-Inclusive Care for the Elderly into assisted living can increase attention to residents, reduce the length of hospitalizations and increase resident satisfaction, according to Peter DeGolia, M.D., CMD, medical director of McGregor PACE in Cleveland. As a result, residents who receive PACE care tend to stay in their assisted living communities longer, he added.

DeGolia, one of three physicians with the PACE, shared his insights during a Wednesday morning session at the 2017 LeadingAge Annual Meeting & Expo.

There are 122 PACE across the country, he said. To be considered for enrollment, someone must be aged at least 55 years, meet the requirements for nursing home level of care (which vary by state), live in a service area and be living safely in the community (including assisted living) at the time of enrollment.

“We really very strongly believe that we add benefit to the services that the assisted living facility provides,” DeGolia said. “We try to augment their care. We don't try to take over their care. We want to be there as a partner working with them and add to the work that they're already doing.”

Personal care services, medication management and activities are three areas his team focuses on.

Residents benefit by having comprehensive, coordinated care, which they may not have had in the past, he said. “Now they really have an engaged group of health professionals working with them,” DeGolia said.

In addition to a physician or nurse practitioner, enrollees see nurses, CNAs and social workers and receive support services beyond healthcare, he said. All CNAs are trained as restorative aides.

For the integrative approach to be successful, DeGolia said, communication is critical. His PACE staff meets every morning, medical staff members huddle daily and smaller groups of staff meet at least weekly, as needed.

PACE representatives meet with assisted living community staff every one to three months, depending on the need. Those meetings help ensure that PACE workers understand each program participant's baseline status.

“This was a major problem we were having with assisted living facilities,” DeGolia said. “We just weren't getting the communication and the observation from the assisted living staff as to our residents and a change in their condition, so we were responding late to problems, and that was driving unnecessary care and unnecessary send-outs.”

DeGolia and colleagues tracked emergency department visits, hospitalizations, intensive care unit visits and skilled nursing visits for six months in the assisted living residents and others who receive McGregor PACE services. They found a 47% decrease in the number of overall skilled nursing admissions (among all of their PACE program participants,not just those who live in assisted living), as well as a substantial increase in the number of direct skilled nursing admissions (bypassing admission to the hospital). The number of days spent in the ICU also dropped substantially, DeGolia said.

“It's because we're recognizing change in condition earlier,” he said.

Assisted living communities that adopt an integrated care approach should expect to avoid unnecessary medical services, reduce medical costs and improve the quality of life of older adults, DeGolia said.

“Assisted living is an important component in the housing spectrum of care for our patients,” he said at the conclusion of his talk. “But we recognize that we need to augment the services that many of the assisted living facilities provide, because they're not quite as tuned-in to how quickly a change in condition can occur and how to act on that right now. Oftentimes, they're stretched. That's become even more so in the last several years. So we can really augment that and help then identify change and in many cases keep people in the facility longer.”

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