Older Adult Health Care Program

Overview

The Wisconsin Special Care Initiative aims at providing services that are Medicaid covered as well as other additional services. Among the key areas of its focus is the provision of managed care services for frail adults who are Medicaid eligible recipients in Milwaukee and Wisconsin. Enrollees of this program are those who are beyond 60 years and definitely unemployed. Through special public and private agencies, these adults receive both home daycare as well as healthcare services. These homes offer specialized practitioners, multidisciplinary teams, and specialized clinics, which mainly focus on frailty management. This program was initiated in 1994. Moreover, it was a demonstration in developing primary integrated care models for older adults (ADRC, 2015).

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Furthermore, the Wisconsin Special Care initiatives have agencies that help create a home environment for frail adults. The program is focused on integrating medical and social services through adult health care. It employs a multidisciplinary team strategy with the care that is offered by the social workers, nurses, physicians, speech therapists, as well as transportation and health workers. The program is established under the belief that through rehabilitation and preventative services, the chronic conditions of these elderly populations could be stabilized and their health conditions prevented. In most cases, community living is largely the participant’s choice.

The Special Care Initiative is also determined to find the best approaches to long term coordination and acute care services. In addition, it focuses on advancing and facilitating a continuum of care that is beneficiary centered for the individuals who require long-term care. This goal is to provide the recognition that frail people have acute and chronic care needs. In addition, Since Medicare and Medicaid programs represent more than half of what is spent in long term care, the initiative recognizes the role that should be played by the program in establishing a central system that is more beneficiary. These initiatives have been found to maintain the functioning and health of these people (The Institute of Medicine Committee on the Future Health Care Workforce for Older Americans, 2008).

Advantages

Frail patients are at risk for the negative outcomes and are the most conspicuous consumers of the health resources in both the community and acute settings. Initiatives of long term care plans, such as the one initiated by Wisconsin, have the potential of enhancing the health of frail individuals across these settings. These could be though clinical practice, leadership, education, as well as research. Further, Long Term Care Plans are responsible for a comprehensive assessment and screening of frail patients. They facilitate access to the services and programs, empowering and educating the patients as well as their families about management and improvement of their health conditions.

Special care agencies are also responsible for coordinating the functions of the interdisciplinary team in healthcare, conducting, and applying the research. Further, they influence policy related to the wellbeing of the elderly and other special groups of people. Practitioners in specialized care have a leadership function while working with team members providing direct care to these patients and enhancing clinical outcomes, functional ability, and quality life for the patients (Sikma & Young, 2001).

The secondary prevention measures may include environmental modification for these people, coordination for social support and care provision, ensuring coaching to the patients regarding the use of assistive devices and other prosthetics that can enhance interdependence as well as a counteracting dependency for these people. Practitioners are aware of the significance of encouraging these patients in the various stages of frailty development. Additionally, they set goals for increasing physical activities and exercise (Rejeski et al., 2008).

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According to Rejeski et al (2008), Special and Long Term Care Initiatives have been found to improve individual management plans for the elderly and frail patients. Additionally, these programs provide strategies that could be employed during the implementation process. Moreover, the patient-centered strategies are aimed to curb the decline in functionality, especially during the transition process in management. Further, the program offers a protocol and technique of the frail patients’ identification, as well as those who face the risk of frailty.

There is also a scale in this program identifying individuals with the frail condition. These include: very fit group, consisting of people who are robust and very active, well, which involves those who are alright, but not as fit as those who are very fit, those who are fit, but with comorbid conditions, those who are apparently vulnerable, those with mild frail, moderate frail, and finally severe frail. Other assessment criteria include, but not limited to weight loss, impaired vision, inappropriate behavior, altered mental status, increasing consumption of alcohol, irrational fears, and increased number of falls, etc. (American Academy of Physical Medicine, 2012).

Another consideration of the implementation process includes support management for these patients, patient rehabilitation potential, and proper prevention schemes. The follow-up, monitoring, and re-evaluation processes should be implemented consistently by the health practitioners. This review and monitoring process should follow a specific schedule when the patient requests or when there is any transitional change, such as the change in the caregiver, change in the care locations, an insignificant change in the patient’s health.

The rationale behind this guideline is based on the assumption that, while many patients with the frail condition may appear active and robust, their capacity in response to stress is low. In addition, these are normally exposed to the high risk of morbidity and death. Therefore, it is very crucial to identify early frailty patients, especially those who are older and respond appropriately either to eliminate or reduce risks associated with this condition.

Therefore, it is necessary to design a common approach, which will enable health practitioners to evaluate patients with frail conditions. This common approach will allow the practitioners to do the evaluations based on the level of the actual risks and prioritize the medical needs of these patients. Additionally, this will enable practitioners to deduce whether the patients would require additional care or support in their care location. Finally, the undertaken approach enables the health workers to identify frail patients or those who are at risk and refer them for further assessment as may be required (Chan & Cheng, 2012).

Many other studies have demonstrated that frailty condition increases with age. In the US, for example, 30% encounter frailty by the age of 90. The Cardiovascular Health Study states that 7% of residents have frailty conditions. On the other hand, the women’s health initiative study used a sample of 40,000 women who were 60 years and above. The study established that the rate of frailty among these women was 16.3%. Among the men folks, who were estimated to be 6,000 in total, the rate of frailty was 4%, while 40% were considered pre-frailty.

 

A study by the American Academy of physical medicine (2012) defined that in the USA, frailty was more prevalent among Asians and African Americans than Caucasians or Hispanics, for example. According to this study, the rate of mortality among frail men was more than two times. This initiative, therefore, appears at the right time when the number of frail patients is constantly rising.

A randomized control study for improving geriatric frailty was conducted by Cheng and Chan (2012). The respondents included 117 patients above the age of 65 in Toufen. The interviewees were provided with educational booklets. In addition, they were also assigned random interventions. Moreover, they were consulted on their nutrition and had to exercise training programs three times per week. Follow-ups were made on these subjects at 3, 6, and 12 months respectively. The adjustment and treatment model was the equation one.

The results were that there was a short-term improvement of the frailty status due to the three-month intervention program. The long-term impact of vitamin D and bone mineral was noted among the elders in the Taiwan community. The study concluded that proper nutritional management and corresponding exercises could improve the frailty process, level of vitamin D as well as the bone mineral density.

The Institute of Medicine Committee on the Future Health Care Workforce for Older Americans (2008) reported an impending crisis to face the healthcare sector as the number of elders was expected to increase in the coming twenty years. The institute’s recommendation, which was generated after an extensive study, stated that clinicians and other health practitioners were in dire need of serious training in order to deal with geriatric and the increasing number of people with frailty. This training could be enhanced through various programs or curriculum. Evaluation should then be done through demonstrations of these competencies by these professionals. Another recommendation is that the certification of these health professionals should be based on experience and competence.

Coker, Kaasalainen & Fisher (2013) observed that an inclusive care program for the elderly, whereby the patient community care centers receive basic care from an interdisciplinary team, would be very beneficial. This team may include a specialist in geriatric medicine, therapists (both physical and occupational), nurses, and social workers. The patient-centered services for these people will include occupational and physical therapy, home nursing, transportation, adult day care, home adult aid services, and adult care. The goal is to overcome environmental challenges, enhance function, and prevent institutionalization.

The research has shown that depression is prevalent among the US citizens at the age of 70 and older at that rate of 11%. Generally, major depression among elderly adults occurs in 1% to 3%. Additionally, 8% to 12% exhibit symptoms related to depression (Coker, Kaasalainen & Fisher, 2013). Depression among these adults results in risk factors, such as disability, sleep disorder, and bereavement. Other risks include living alone, poor health status, and cognitive impairment. According to Taenzer, Melzack & Jeans (2008), depression has been connected with increased mortality among frail patients after a coronary artery bypass graft. Frailty and depression are both problems associated with disability and morbidity aging persons.

A study by Merck (2012) was conducted to establish the connection between frailty and depression. Data from this study was obtained from a Baltimore Epidemiologic Catchment Area Study in 2004-2005. The respondents included 683 adults at the age of 40 and older. Depression was tested through Interview Schedule, while frailty was indexed by using Fried measurement criteria.

From this study, it was established that depression and frailty were interrelated concepts, though the criteria for their operations could be identified as overlapping the subpopulations. This generally implies the prevalence of implications for understanding the factors, which contribute prognosis and etiology of depression and frailty to the old age. Therefore, the Long Term Care Measures and the special care initiative will be beneficial for alleviating these problems among the elderly.

Disadvantages

The studies have consistently indicated that the elderly like to involve themselves in the activities they find significant as a form of maintaining their physical health, mental acuity, and emotional well-being (Gerdt, 2012). However, the nursing home model for frail patients endeavors to offer such stimulation, most of the operations at these entities are organized by the staff without any involvement of the residents or, in this case, “patients”. Therefore, they become a set of required tasks for all those who are concerned. Thus, the patients could feel alienated from their actual homes.

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Moreover, there is a great concern for the residents in assisted care facilities as well as their facilities and the state for the wellbeing and safety of the elderly sick in these residences. This owes to the fact that it may not be possible to ensure that each client in the healthcare agencies is secure from all forms of risks and injuries. Some patients may only feel safe while at home (Taenzer, Melzack & Jeans, 2008).

Conclusion

Although the number of the aging population continues to rise on a daily basis, the special needs of these populations had been neglected for a long time. Moreover, this group of people had to face a number of services while trying to access their healthcare needs. The Special Care Initiative by Wisconsin is, therefore, a good move that is poised to ensure that the health and wellbeing of the elderly are maintained. This paper has shown that the benefits of such initiatives are immense. Through this program, one may conclude that the lifespan of the elderly and frail patients is elongated.

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