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Study seeks to curb hospital visits

Posted: Tuesday, March 30, 2004

ADEL, Iowa (AP) A health care model being tested at a nursing home in central Iowa may hold the key to alleviating overcrowded hospitals and reducing costs while improving long-term health care for frail seniors, doctors say.

The goal of the study, funded by the Centers for Disease Control and Preven-tion, is to reduce hospital admissions from Adel Acres Nursing Home by at least 30 percent in one year and show others how to do the same. The study, likely to last two years, will also attempt to determine how much money can be saved in the process.

''The question is: Can we improve how we take care of folks, decrease their suffering and at the same time cut costs?'' said Dr. Robert Bender, a geriatrician with Iowa Health System. ''If we can do that, that would be magic.''

The pilot program will study the care of 50 seniors at Adel Acres.

Bender and a physician's assistant working full time at the home ''apply everything we know about prevention'' in caring for the patients, who have long-term health problems such as dementia, heart disease and diabetes, he said.

The program already has prevented some visits to the hospital. A woman who fell on her head was treated on site, Bender said, as were others who developed pneumonia that might otherwise have required hospitalization.

Physician's assistant Dave Michael said his presence will prevent hospital visits and suffering by detecting health problems before they become a crisis.

That's why he spent a recent day telling 86-year-old Edith Reynolds to cut out the sweets in her diet so her diabetes stays under control; checking Ken Haw-baker's heart and weight to monitor his congenitive heart failure; and making sure the medicine he gave to 90-year-old Leona Brown for her sore throat helped.

''I think it's wonderful,'' Reynolds said of the program, even after she admitted to Michael she ate forbidden chocolate on Valentine's Day. ''He takes good care of us and we can ask him questions and he answers them.''

Bender said the study will develop a curriculum for exercise, with prevention in mind. To that end, Michael plans to give some residents ankle weights to strengthen their quadriceps in hopes of avoiding falls. Hip pads given to the residents aim to avoid broken hips if they do fall.

After the first year of the program, Bender said, health care economists will compare the number of hospital visits from the center to its average for the previous five years. Based on that information, they will try to estimate how much money the program saved.

A spokesperson for the Iowa Depart-ment of Human Services said hospitals spend many thousands of dollars treating each senior who breaks a hip and giving rehabilitation so they can walk again.

Nancy Whitelaw, the director of the Vital Aging Center at the National Council on Aging, said doctors elsewhere have considered this approach but never figured out a way to actually save money in the process.

The model is in demand because a body of new research shows ''even older adults who are quite frail can maintain and gain back some levels of function that we used to think were permanently lost,'' she said.

''People don't need to decline as rapidly as we generally let them,'' she said. ''But all of those things take ongoing attention, and thus don't happen in a traditional medical model.''

For their part, nurses at Adel Acres like having Bender and Michael around instead of having to contact as many as eight to 10 doctors a day for their residents. They say that frees up time to spend with the residents, who get better care than they would at a hospital.

Bender sees a potentially big impact of the program not just in Iowa, which has a large population of seniors, but the country as a whole, which is struggling to contain escalating Medicaid costs and soaring emergency room visits. The percentage of Iowa seniors 65-and-over is expected to increase from 15.1 percent of the population in 2000 to 22.6 percent by 2025.

Bender said the program will mean reduced suffering for seniors if in-house doctors can anticipate and fend off some disease and illness and keep seniors out of the unfamiliar environment of the hospital.

Americans are living far longer than in the past. By 2014, the population of those 65 and older will reach 44.6 million up from 35.6 million in 2002, according to the 2000 Census.

''We think that the system we have imagined is very applicable virtually anywhere in the United States,'' Bender said.

He said the study is part of the natural evolution of care from an acute system in which sick people are treated to a system built on preventing disease and illness among seniors. That is being made possible as doctors accumulate more knowledge on what illnesses seniors are likely to face as they age.

''We're just looking to be a part of that movement,'' Bender said.

On the Net:

CDC: http://www.cdc.gov/

Adel Acres Nursing Home: http://www.nursinghomecarecenter.com/



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