Rantz hopes the results will convince lawmakers to fund nurse care coordinators for Medicaid-based home health programs. Currently, reimbursement for nurse visits is low, so home health care agencies tend to provide as few as possible.
"I think if we could convince the feds to pay for nurse care coordination, we would be able to significantly reduce the need for nursing home admissions," Rantz says. "We could help people stay healthier at home longer."
After the 1999 study, Rantz and her colleagues wanted to learn how effective the aging-in-place model might be in a setting like TigerPlace and other housing complexes that would house seniors in a place with access to multiple services.
The first step was finding a private business to build the facility and manage its operation. In 2001, the Sinclair School of Nursing entered into a partnership with Americare Systems Inc., an elder-care-focused company located in Sikeston, Mo. Americare supplied the nearly $4 million needed to construct TigerPlace, a 32-apartment facility. The company, employing a staff of 22, is responsible for day-to-day operation. The University, meanwhile, is free to use TigerPlace for research.
TigerPlace is not the first elder care facility with ties to a university exploring aging-in-place concepts. Several universities, including Pennsylvania State, Kansas State and Ohio State, have ties to continuing care retirement communities, an aging-in-place model that has been around since the 1970s. Continuing care retirement communities have three different levels of facilities -- independent living, assisted living and skilled nursing care -- all on one campus. Residents move from one facility on the campus to another as their care needs increase.
It's an improvement over the elder care status quo, but less than perfect. "Every time you move on a CCRC -- from senior housing to residential care to a nursing home -- every one of those moves is traumatic, physically and mentally," Rantz says.
At TigerPlace, residents face no moves. Thanks to two Missouri statute changes made specifically to accommodate aging-in-place research, TigerPlace residents stay put, even when they need skilled nursing care. This is in spite of the fact that TigerPlace does not meet all the state regulations governing traditional nursing homes. TigerPlace, for example, has a smaller staff than is mandated. Even frail residents get to stay in their own apartments, all of which feature an exterior entrance and interior hall entrance, kitchenette, private bathroom and a patio or screened-in porch. Most also feature a roomy walk-in closet and a washer and dryer. Residents even have the option of renting a garage.
Sinclair Home Care, the school of nursing's home health care agency, provides for TigerPlace residents' health care through a program called TigerCare. TigerCare's key feature is a wellness center where residents receive ongoing assessments of their health care needs and where they participate in health-promotion activities, including exercise and health classes. Sinclair Home Care also helps residents with care-coordination between their primary physicians and other health care providers.
Rantz and her colleagues expect all the preventive care to help TigerPlace residents stay healthier and active longer, and they have begun studies to test this theory. They do not, however, expect all residents to stay in perfect health. In fact, some already need help for such tasks as getting up in the morning or filling their pillboxes. Residents who need this extra care must opt for a "personal service package" that provides extra attention from the Sinclair Home Care staff.
The cost for this additional care is added to TigerPlace's already hefty fees. Depending on size, apartments for singles range from $2,209 to $3,409 per month, a rate that includes two meals each day, housekeeping and a number of other services. Rantz says those rates actually compare favorably to those of other assisted living and skilled nursing facilities. It's common, she says, for individuals to pay $2,000 a month or more at a traditional assisted-living arrangement and twice that much for a skilled nursing facility.
At TigerPlace, few residents and their families are complaining.
"It's a lot cheaper than a nursing home," says Gene Taylor, who is not only the daughter of a resident but also the nurse care coordinator at TigerPlace. Her mother contracts with Sinclair Home Care for an hour of extra help in the morning and a half hour at night. With that care, she spends about $3,500 a month. In a nursing home, she would spend at least $5,000, Taylor says.
Published by the Office of Research.
©2006 Curators of the University of Missouri. Click here to contact the editor.