THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Friday, June 28, 1996 TAG: 9606280453
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY DEBRA GORDON, STAFF WRITER
DATELINE: VIRGINIA BEACH LENGTH: 143 lines
Sentara Health System's new Senior Community Care Center, which opens with a ribbon-cutting ceremony today, makes Hampton Roads part of a national experiment to allow frail elderly people to remain in their homes, rather than going to nursing homes.
The center combines the social aspects of an adult day care program with the medical facilities of a doctor's office. Its goal is to keep the frail elderly - those who might otherwise have to enter a nursing home - as healthy and independent as possible.
Advocates for the elderly like the idea, because it focuses on prevention and keeps elderly people in their own homes and communities, where they've built lifelong attachments. Public officials like it because they say it provides care at a lower cost than nursing homes.
``With cuts in Medicare and Medicaid, we're going to have to search for alternatives that allow families to participate in the care of the individual as a way to lower the cost of health care,'' said Sentara Vice President Steve Gold. ``If we don't, there will never be enough money to care for our senior citizens.''
Sentara spent $1 million renovating the former urgent care center on Newtown Road. The center, which can handle 150 people, is part of a national demonstration program called PACE - Program of All-Inclusive Care for the Elderly - modeled after a San Francisco-based project begun in the 1970s.
In 1983, San Francisco's On Lok - the name is Cantonese, meaning ``peaceful, happy abode'' - received a grant from the Robert Wood Johnson Foundation and waivers from the federal government and California to test the PACE concept.
The program proved so successful that in 1986, Congress authorized On Lok to mentor 15 other sites around the country, 11 of which are operating. Sentara's project is one of 14 additional sites. If it is successful, Sentara plans to open three more centers over the next four years in Norfolk, Portsmouth and Hampton.
Center participants must be 55 or older and meet state requirements for nursing home care - meaning they can no longer live alone. They also have to be eligible for Medicaid, the state health insurance program for the poor.
Four vans will bring members to the center several days a week for preventive health care, social activities and meals.
They'll be monitored for any medical problems, like dehydration, high blood sugar or skin rashes, which, left untreated, could turn serious and require hospitalization. They will also receive physical therapy, if necessary, and even mental health services.
In the evening, they go home in the van.
Family support is key to a successful PACE program, Gold said. Family members must be willing to care for the person when they're not at the center, to participate in planning meetings and to work with center staff members to reduce medical problems.
Sentara will help the family, Gold said. For instance, the company will provide personal aides if the participant needs help with dressing and bathing that the family member can't provide.
If family members need a break, Sentara will find members temporary ``foster'' homes with someone who knows how to care for the frail elderly.
The heart of the program is its team approach to helping the elderly person. Everyone on the team - including family members, the doctor, nurses' aides and even the bus driver who brings participants to and from the center - meets regularly to discuss the member's care.
``It is a true multidisciplinary approach to caring,'' Gold said.
It is also less expensive. Seventy percent of Virginia nursing home residents are on Medicaid. It costs the state about $2,200 a month for each Medicaid recipient.
Under the Sentara program, however, the state will pay about $1,825 a month for each participant - 95 percent of what state officials estimated it would cost to care for that person in the community.
``We're really excited about the program'' because it is the first step toward providing long-term care services in the community, said Department of Medical Assistance Services deputy director Joseph M. Teefey.
With the $1,825 Sentara receives each month, the company will pay for most medical services, including visits to specialists, medications, physical therapy and home health services.
Hospitalization, laboratory tests, X-rays and skilled nursing care will still be covered under participants' Medicare, the federal health insurance program for the elderly.
In two years, Medicare will begin a different method of payment. It will give Sentara a standardized amount each month for each participant, regardless of what services are used.
Sentara will seek to provide patient care for less money than it receives.
``We assume risk for caring for this population,'' Gold said. ``So the emphasis is on trying to keep them healthy.''
It's a significant risk. The population Sentara is targeting - those 85 and older - typically have several chronic medical problems, like diabetes, hypertension and heart disease. They may even eventually be sent to a nursing home for extended medical care. If that happens, Sentara has to pay for it.
The center is designed to meet the special needs of a very frail person. The examination room, for instance, has an electric hospital bed that moves up and down. It's easier for someone in a wheelchair to get into the bed than up on a stationary table.
A large, open space functions as the social center for recreational activities and meals. A room off to the side provides a peaceful place for naps, and a roofed, fenced deck offers a safe environment outside.
Nationally, PACE centers have shown savings of 5 to 15 percent over what it costs to keep participants in a nursing home, said Christine Van Reenen, executive director of the San Francisco-based National PACE Association.
Studies of existing PACE programs show that their participants, typically the most frail and ill elderly, are hospitalized just a bit more than the general Medicare population, which includes healthy older people.
PACE participants also have shorter hospital stays than the aged Medicare population as a whole. An average of 10 percent wind up in nursing homes, usually when the participant deteriorates to the point that he or she just can't stay in the community.
Sentara expects to have about 12 participants already approved when the center officially opens July 15. One of them may be 90-year-old Anna Evan, who has Alzheimer's.
Evan has been living with her daughter, Mary Hrudowsky of Chesapeake, for the past six years. She goes once a week to Sentara's adult day care center in Virginia Beach. But that isn't enough, Hrudowsky said.
Her mother needs constant care, and the strain is beginning to wear on Hrudowsky. She also wants to get a job outside the home. And yet, she won't consider a nursing home for her mother. ``That's one of the things I don't want to do to my mom.''
The help she would get for her mother through the Sentara center, she said, ``sounds like a dream come true.'' ILLUSTRATION: Graphic
ABOUT THE CENTER
Sentara Community Care Center's opening will be held today at 3
p.m. at the center, 665 Newtown Road. The public is invited.
The center is part of a national experiment in providing frail
elderly people with an alternative to nursing home care. If it is
successful, Sentara hopes to open three more centers over the next
four years in Norfolk, Portsmouth and Hampton.
To be eligible, people must be:
55 or older.
Eligible for Medicaid or eligible within three months of
acceptance.
Eligible for living in a nursing home.
A resident of Norfolk, Portsmouth, Virginia Beach or Chesapeake.
For more information, call Sentara Community Care Center at
456-2700.
Photo
CHRISTOPHER REDDICK/The Virginian-Pilot
Cuts in Medicare and Medicaid mean the health profession must find
ways in which families can help care for the individual, said
Sentara's Steve Gold, here with Dr. Rosanne Newman in a treatment
room at the new center. by CNB