Moving Long-Term Care Closer to Home

There are approximately 12 million people in the United States receiving home-based healthcare. According to recent data, about half of home health patients are aged 65 years and older and have one or more chronic conditions, with the three most common being hypertension, heart disease, and diabetes.¹ As the older adult population grows at an unprecedented rate, it is predicted that more older adults will choose to age in their homes, a trend likely influenced by the rising out-of-pocket cost of facility-based long-term care services.²  The articles included in this month’s issue of Annals of Long-Term Care: Clinical Care and Aging^® (ALTC ) offer several perspectives on how long-term care professionals can prepare themselves for the shift from institutionalized care to home-based care.

In this issue of ALTC, we are pleased to announce our partnership with the Eldercare Workforce Alliance (EWA), a group of 30 national organizations that represent healthcare professionals who are working toward practical solutions to prepare the healthcare workforce for a rapidly aging population. You will find their inaugural contribution, exploring how to improve the role of direct care workers within the home care setting by providing targeted medical training and meaningful career ladders. Specifically, EWA addresses how direct care workers can fill the gaps in managing chronic diseases, such as diabetes, hypertension, and dementia, in the home. As EWA notes, “Quality care for older adults, now and in the future, depends upon the quality of the workforce providing that care.”

The EWA’s article is followed by a case report from Stacy Schantz Wilkins, PhD, and colleagues that illustrates an underrecognized public health challenge: elder abuse and self-neglect. Wilkins and colleagues present two cases of self-neglect in elderly persons with cognitive impairment. In one of the cases, the patient resided at home and received weekly in-home services from a paid provider as well as informal housekeeping and financial assistance from a friend. The care team recommended that the patient consider moving into an assisted living or skilled nursing facility upon realizing during a clinical visit that the patient was mismanaging his medications at home. This patient also expressed worsening feelings of depression, anxiety, and anger. The patient refused to move into a long-term care facility, which prompted the care team to alert Adult Protective Services (APS). This article also includes a valuable decision tree that geriatric care providers can use to assess and manage self-neglect in older adults with cognitive impairment, including guidance on when to seek conservatorship and contact APS .

The next article in this issue presents a review of caring for patients with end-stage dementia. As Robin J. Sekerak, MD, and Jonathan T. Stewart, MD, assert, patients with end-stage dementia are underserved by hospice providers, often leading to unnecessary and aggressive life-prolonging treatments and undue patient and family suffering. The review article discusses four vital components of providing compassionate, patient-centered care in end-stage dementia: prognostication as a barrier to hospice eligibility; care planning strategies; management of the behavioral, cognitive, and physical complications of the disease; and guiding families through the bereavement process.

This issue of ALTC also contains the next handout in our series of Quick Guides. It outlines the important guidelines from the American Heart Association and the American College of Cardiology concerning the pharmacological management of patients with non–ST-segment elevation acute coronary syndrome. More news about cardiovascular health in older adults can be found in our LTC Bulletin Board.

We hope that you enjoy the articles and resources in this month’s issue. As this year concludes, the staff of ALTC would like to wish you and your family a wonderful holiday season and a healthy and happy New Year. We thank you for your contributions and readership, and we look forward to continuing to serve you.

Thank you for reading!

References

1.  Jones A, Harris-Kojetin L, Valverde R. Characteristics and use of home health care by men and women aged 65 and over. National Health Statistics Reports. No. 52. Hyattsville, MD: Centers for Disease Control and Prevention, April 18, 2012. www.cdc.gov/nchs/data/nhsr/nhsr052.pdf. Accessed November 20, 2014.

2.  West LA, Cole S, Goodkind D, He W; U.S. Census Bureau. 65+ in the United States: 2010. P23-P212. Washington, DC: US Government Printing Office, June 2014.