The Robert Wood Johnson Foundation announced today $4,6 million in grants to better coordinate community services so that elderly people with health problems can maintain reasonably independent life styles for as long as possible.
In making the announcement, Foundation President Dr. David E. Rogers said, "In most communities a variety of separate public and private agencies provide such services as home care, rehabilitation therapy, and home delivered meals, but too many elderly people and their families are unaware of the full array of services that could be available to them.
"All too often our elderly citizens are prematurely shunted off to a nursing home when with help from existing community services they could live longer in their own homes."
With Foundation support, coordinating organizations will be formed to locate elderly with health problems, assess their needs, notify agencies that can help them, and then follow up to make sure services were received.
In each case the coordinat ing organization is jointly created by a government-supported Area Agency on Aging and the major voluntary organization providing services to the elderly in the community.
The communities are: Lincoln, Nebraska and nine surrounding counties; Erie County, New York, which includes Buffalo; Summit County, Ohio, an industrial area 30 miles south of Cleveland; north central Philadelphia; Columbia, South Carolina and two surrounding counties; an eight-county region in northeast Tennessee; a section of north wes t suburban Chicago; and the northern portion of Baltimore County, Maryland.
The Health-Impaired Elderly Program was announced to the nation's governors in June and 38 states filed applications. Each grant totals approximately $600,000 and is payable over three years.
In addition to the funded projects, the Foundation has granted $450,000 to Harvard University in support of an evaluation of the program under the direction of Dr Paul Densen.
The Health-Impaired Elderly Program is administered bv the Mount Si liai School of Medicine in New York. It is directed by Dr. Kenneth G. Johnson, professor of community medicine at Mount Sinai and a senior program consultant of the Foundation.
The state agencies receiving support and the community organizations involved are:
- New York State Office for the Aging-Erie County Departmen t of Senior Services
- Ohio Commission on Aging- Summit Seniors Team Corporatipn;
- State of Nebraska Commission on Aging-Lincoln Area Agencv on Aging and Ehe Lincoln Medical Education Foundation;
- Maryland State Office on Aging-Baltimore County Area Agency on Aging;
- South Carolina Commission on Aging-Community Care, Inc.;
- Commonwealth of Pennsylvania Department of Aging-Philadelphi a Corporation for Aging;
- Tennessee Commission on Aging-First Tennessee-Virginia Development District; and
- Illinois Department on Aging- Suburban Cook Coiintv Area Agency on Aging.
Use of Home Care Agencies Helps Reduce Expenses
Better use of home care agencies can help to reduce medical expenses and release beds in nursing homes for those patients who need skilled nursing attention during the convalescent period. This seemed to be one of the more significant conclusions reached by health-oriented professionals at the recent. Discharge Planning Seminar sponsored by Blue Cross of New Jersey in cooperation with St. Clare's Hospital. There also appeared to be general agreement that this goal could be accomplished through greater communications and cooperation between nurses and physicians when making plans for patients who no longer need acute hospital care.
Emphasizing that home care is not a substitute for acute care in a hospital. Gloria Brillant, director of professional services and acting administrator for The Visiting Nurse Association of Morris County, remarked that it often is an acceptable alternative to prolonged institutionalization during the convalescent period, and sometimes should be considered in lieu of inappropriate admission to an institution.
In detailing the numerous services provided by the VNA, she stressed the importance of professionalism and the ability to meet the needs of each patient and that patient's family. "We feel that it is very important to care for the whole patient, not just the illness." said Ms. Brillant. "And," she continued, "we do include the family in our plans. In the course of visiting, we do not only give the injection or change the dressing..., we also counsel, we listen, we make referrals or contacts with other agencies. We teach. Teaching is a very important aspect of the service provided. We teach patients how to be as independent as possible, as long as possible. We teach families how to handle emergencies, and what to expect."
Reiterating the numerous services now available at home, she indicated that her staff consists of about 40 nurses; 2 nurse specialists; 4 nursing supervisors; a physical therapy supervisor, working with 10 therapists available through contractual arrangements; a speech therapy supervisor, with 7 therapists under contract; 2 occupational therapists via contracts; 2 community health dietitians; and 16 home health aides to supplement those available in cooperation with the Visiting Homemaker Service of Morris County. She added that the VNA services are available seven days a week and the office is open six days each week; and said that plans for the near future include having a nurse on call during other than the usual working hours, and increasing the intake staff so that the telephone referrals can be handled more expeditiously.
With reference to cost, Ms. Brillant said that because VNA is a certified home health agency, it is eligible for reimbursement from state and federal agencies, Blue Cross and other private insurance companies. Where no insurance coverage is available, a patient's fee may be reduced to meet ability to pay. She explained that in no instance is a patient denied services because of inability to pay, and that the United Way provides most of the funds which absorb these costs.
The seminar emphasized the need to evaluate the level of care required in determining whether a patient being discharged from a hospital should be sent to a nursing home for skilled nursing attention, or a boarding home for sheltered care; referred to a home health agency, an outpatient clinic or a rehabilitation center. Among the factors that enter into this decision were noted: age; diagnosis of condition; home situation; amount of assistance required in bathing, eating, toileting, walking, etc; equipment needed such as a walker, hospital bed, oxygen; continued monitoring of response to medications; and health education after discharge for patient and family.