Aging in Place (AIP)

Public health advances have contributed to increased longevity; however, individuals are more likely to live longer with multiple chronic conditions. The existing health care system primarily focuses on treating disease rather than addressing well-being as a holistic construct that includes physical, social, and environmental components. The current commentary emphasizes the importance of supporting healthy active aging and aging in community. The barriers to aging in community and the state of the intervention science in response to this problem are discussed, and recommendations for future research are provided. Active aging is more than managing illness or care transitions—it promotes engagement, participation, dignity, self-fulfillment, self-determination, and support for older adults. To support aging in community and healthy active aging, a paradigm shift is needed in how the well-being of older adults is thought about and supported.

Davitt, J.K., Madigan, E.A., Rantz, M., & Skemp, L. (2016). Aging in community: developing a more holistic approach to enhance older adults’ well-being. Research in Gerontological Nursing, 9(1), 6-13.

The goal of this study was to compare utilization and cost outcomes of patients who received long-term care coordination in an Aging in Place program to patients who received care coordination as a routine service in home health care.

This research offered the unique opportunity to compare two groups of patients who received services from a single home health care agency, using the same electronic health record, to identify the impact of long-term and routine care coordination on utilization and costs to Medicare and Medicaid programs.

This study supports that long-term care coordination supplied by nurses outside of a primary medical home can positively influence functional, cognitive, and health care utilization for frail older people.

Popejoy, L., Stetzer, F., Hicks, L., Rantz, M.J., Galambos, C., Popescu, M., Khalilia, M.A., & Marek, K. (2015). Comparing Aging in Place to home health care: impact of nurse care coordination on utilization and costs. Nursing Economics, 33(6), 306-313.*

The University of Missouri (MU) Sinclair School of Nursing (SSON) stepped up to the challenge of creating a different way of supporting older adults as they age, providing care on their own terms. Working with stakeholders, including consumers, politicians, community leaders, and long-term care advocates, MUSSON opened a home healthcare agency and partnered with Americare Systems, Inc. to build a new senior living community focused on care coordination. This new model of care is called Aging in Place (AIP) and implementation of the model required strategic planning for shifting public policy, ongoing project effectiveness evaluations, stakeholder involvement, building a business for the AIP project, developing the care coordination program, passing legislation to enable building a demonstration site, building and operating the demonstration site, and overcoming challenges to diffusion of the care model. The goal of AIP is to allow older people to remain in the environment of their choice for as long as they wish without fear of forced relocation to a higher level of care (assisted living or nursing home). This chapter will discuss how public policy was successfully influenced by engaging others to create a much-needed new model of care coordination for older adults living in the United States.

Rantz, M., Popejoy, L., Musterman, K., & Miller, S.J. (2014). Influencing Public Policy through Care Coordination Research. In G. Lamb (Ed.), Care Coordination: The Game Changer; How Nursing is Revolutionizing Quality Care (pp. 203-220). Silver Spring, MD: American Nurses Association.

Older adults prefer to age in place, remaining in their home as their health care needs intensify. In a state evaluation of Aging in Place (AIP), the University of Missouri Sinclair School of Nursing and Americare System Inc., developed an elder housing facility to be an ideal housing environment for older adults to test the (AIP) care delivery model. An evaluation of the first four years (2005-2008) of the AIP program at TigerPlace (n=66) revealed that the program was effective in restoring health and maintaining independence while being cost effective. Similar results evaluating the subsequent four years (2009-2012) of the program (n=128) revealed positive health outcomes (fall risk, gait velocity, FAP, handgrips, SF-12 PH, SF-12 MH, GDS), slightly negative ADL, IADL, and MMSE, and positive cost-effectiveness results. Combined care and housing costs for any resident who was receiving additional care services and qualified for nursing home care (n=44) was about $20,000 less per year per person than nursing home care. Importantly, residents continued to live in private apartments, while encouraged to be as independent as possible through the end of life.

Rantz, M., Popejoy, Lori L., Galambos, C., Phillips, L.J., Lane, K.R., Marek, K.D., Hicks, L., Musterman, K., Back, J., Miller, S.J., & Ge, B. (2014). The continued success of registered nurse care coordination in a state evaluation of Aging in Place in senior housing. Nursing Outlook, 62(4), 237-246.

Loss of balance and diminished gait are major fall risk factors in older persons. Literature suggests that physical activity based on dance may improve balance and gait. The aim of this pilot study was to determine whether dance-based therapy affects the balance/gait of community-based frail seniors. The Roy Adaptation Model and Environmental Press Theory were used as joint frameworks.

Krampe, J., Rantz, M.J., Dowell, L., Schamp, R., Skubic, M., Abbott, C. (2010). Dance-based therapy in a program of all-inclusive care for the elderly: an integrative approach to decrease fall risk. Nursing Administration Quarterly, 34(2), 156-161.

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