Center Tests Effectiveness of In-Home Health Care
The Santa Monica Senior Health and Peer Counseling Center is testing a theory proved in Europe but untried in the United States: that taking preventive health care to senior citizens in their homes is more effective than waiting for them to go to doctors for treatment.
The center has received a $657,143 grant from the W. K. Kellogg Foundation of Battle Creek, Mich., to launch a project that involves contacting hundreds of senior citizens in Santa Monica, providing free physical examinations and overall health assessments in their homes, helping them to get the medical care they need and following up on their progress for at least two years.
If the project is successful, organizers believe it could send a message to health maintenance organizations and government health-care policy-makers that an ounce of prevention is not only better but also less costly than a pound of cure.
Independence Is Goal
“We’re trying to show that by visiting people in-home we can prevent early institutionalization and frequent visits to emergency rooms or hospitals,” said Marcia Rossman, the center’s community relations director. “Our goal is to keep them independent for as long as possible.”
Modeled after a similar study conducted in Copenhagen, the Kellogg project was conceived by two professors at UCLA’s Multicampus Division of Geriatric Medicine--John Beck and Laurence Rubenstein--and by Bernice Bratter, director of the Senior Health and Peer Counseling Center.
The Copenhagen project found that a group of senior citizens who received in-home preventive health care had a significantly lower rate of hospitalization and death than a group that was not given any care, Rubenstein said.
Similar studies based in hospitals have been conducted in the United States, he said, but a program of in-home care is unusual in this country.
Expects 600 to Enroll
To get names, addresses and telephone numbers of elderly Santa Monica residents, researchers at the Senior Health and Peer Counseling Center checked voter registration records and found 2,700 Santa Monica residents 75 and older. They plan to send letters to all 2,700, explaining the project, then plan to follow up with phone calls asking if they are interested in participating.
So far, workers have mailed 250 letters and made about 100 phone calls, and about half of those contacted have agreed to participate, said Harriet Aronow, project director. She expects to enroll a minimum of 600 people in the program.
An agreement to participate, however, does not guarantee respondents that they will be directly involved. Half of those who agree to participate, about 300, will be a control group for which no services are provided. Their medical progress will be compared to the half of the group given in-home preventive health care.
At first, participants will be split into the two groups at random, but the process may later become more selective if too many of those chosen for in-home assessment are white, under 85 or in good health. Project coordinators want a large cross section of minorities who are over 85 and in fair or poor health.
A 1985 census found that 6,186 people 75 or older lived in Santa Monica, Aronow said. If that number is still accurate, the study will involve about 10% of the Santa Monicans in that age group, with 5% actually receiving preventive care.
By mid-January, those selected for in-home assessment will be visited by nurse practitioners--registered nurses with additional education and training in physical assessment, diagnosis and treatment.
Diane Israel, one of two gerontological nurse practitioners involved in the project, said participants will be given a complete physical examination and will be interviewed to determine whether they have mental or emotional problems, whether they are lonely and need friends, and whether they have a usual source of medical care. The nurses will also assess each participant’s home environment for any health hazards.
Weekly Reviews
If the nurses spot potential problems, they will suggest solutions and provide referrals if necessary. Once a week the nurse practitioners will meet with Beck and Rubenstein, who will review each case and make additional recommendations.
“One goal is to identify needs before they have to be treated professionally,” Aronow said. “If they do need professional care, we have a large network of services identified locally. For those people who have a usual source of care, we might just need to help them get an appointment.”
“The odds are that we’ll pick up on things at earlier stages,” said Kathyrne Barnoski, the other nurse practitioner on the project.
A case history on each participant will be compiled, along with a “problem list” and recommendations for each problem, Israel said.
After the first visit, volunteer workers will check back with each participant by phone as often as necessary, depending on the person’s health. After three months, participants will be visited by the nurses again.
If the project is a success, it will probably become one of the center’s permanent programs, Aronow said. Success would be measured by reduced mortality, reduced emergency room use, increased use of community social services and improved health and well-being among those seen by the nurses.
More significantly, success could mean changes in health care that reach beyond Santa Monica.
‘Revolutionary Effect’
If the project validates the theory that paying for prevention is more economical than paying for treatment, Rubenstein said, health maintenance organizations could begin hiring nurse practitioners to do in-home assessment. And government programs like Medicare could recognize that preventive health care for the elderly pays for itself in the long run, he said.
“I think it could have a revolutionary effect in terms of a push to provide better services for older people in the community,” Rubenstein said. “Older people have not been getting the kind of care they need to optimize their health outcome. For a long time, that’s been brushed aside because there has been a lack of data showing that they definitely would benefit from better services.
“If studies come out showing that, without a doubt, older people live longer . . . as a result of some kind of inexpensive intervention program like this, it could have really revolutionary consequences.”
