Enrollment in a program of all-inclusive elderly care is largely a matter of luck
Research Activities, April 2009
As more and more of the baby boomer generation reaches retirement age, case managers have become more interested in keeping older adults in the community by maintaining independence. Services such as the community-based Program of All-Inclusive Care for the Elderly (PACE) that provide home-based, interdisciplinary assessment and service coordination for nursing home-eligible older adults can help to meet this need. But in determining whether older adults enroll in such programs, luck and happenstance play major roles, according to a new study by Anna Song Beeber, Ph.D., RN, of the University of North Carolina School of Nursing.
To explore how older adults come to enroll in the PACE program, she interviewed 5 older adults, 4 families, and 10 PACE staff. Key questions asked were "Tell me how you (or your family member) came to PACE" and "What was going on with you (or your family member) prior to coming to PACE?" Several circumstances were identified that led to recognizing a need for help. They included an acute event or crisis such as a hospitalization, injury, or acute illness, the older adult's or caregiver's drive to avoid entering a nursing home, and the caregiver's recognition that they needed relief from their care demands. Finding out about PACE came about by chance conversations with someone who knew about the program, visiting a senior center, or seeing the PACE van in the neighborhood.
The findings of this study have several implications for case management practice. For families seeking care after the occurrence of an acute event, case managers need to assess how prepared the family is for the older adult's long-term care needs, encourage the family and older adult to plan for long-term care, and provide the family with information about PACE and related programs. Because case managers are employed across the health care system, they are positioned to influence how older adults and their families obtain the information they need. This study was supported by the Agency for Healthcare Research and Quality (HS14697).
See "Luck and happenstance: How older adults enroll in a program of all-inclusive care for the elderly," by Dr. Beeber in the September/October 2008 Professional Case Management 13(5), pp. 277-283.