Better Care for the Elderly

The aging of the American population is one of the primary drivers of increasing health spending.  A growing number of older Americans live in retirement communities which may provide a range of health or health management services.   Research published in Health Affairs examines several models being used in these communities.  (Health Affairs Article) Almost 90% of people over 65 have at least one chronic disease and 30% of those over 75 have four or more chronic illnesses.  This creates the opportunity for shuttling between multiple facilities and providers and between clinical settings and the patient’s residence.  Limiting the amount of shuttling and having better coordination of care that is needed would both improve patient quality of life and help keep health spending down.

One approach to solving this problem is the continuing care retirement community, which offers independent living, assisted living and nursing home facilities on one site and provides a variety of supports to keep people independent for as long as possible.  The article compares four different methods used in these communities to coordinate and manage care.  All of the sites had a medical clinic at the location, but in three of the settings, the physicians who came and practiced at the site also had external practices.  In the fourth, the physicians and care team were completely dedicated to the residents of the site.

The researchers compared rates of ambulatory utilization, ER use and inpatient hospitalizations across the settings.  While all of the sites had somewhat better than national utilization rates, the site with the dedicated on-site physicians had the lowest rates of total visits and doctor visits and by far the lowest number of specialty visits.  In addition, there was more continuity of care as only 6% of residents saw more than ten different doctors in a year, while 14-17% did at the other retirement communities.  Surgical inpatient admission rates were similar, but medical admissions, which are more elective, and emergency room use were significantly lower at the dedicated doctor site.  Finally only 5% of residents at this site over 75 died at a hospital compared with a national average of 27%.  The study indicates that these communities, which are quite expensive, can do a good job of providing health care with better outcomes and lower cost.  If the model could be applied to all populations, Medicare would experience a significant bump down in spending.