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Thursday, March 22, 2012

COA pushing down the percentage of PASSPORT clients who go to nursing homes

Every month since October 2011, Council on Aging has hit the "optimal" mark or better in the percentage of PASSPORT clients who leave the program and move to a nursing home. Keeping that percentage as low as possible is central to COA`s mission to help seniors remain in their homes. It also reduces state Medicaid costs for taxpayers.

PASSPORT is Ohio`s in-home care program for low income frail adults age 60 and older. Council on Aging administers the program for residents of Butler, Clermont, Clinton, Hamilton and Warren counties.

As established by the Ohio Department of Aging, COA`s optimal level for PASSPORT disenrollments to nursing facilities is 35 percent or lower. For the first two quarters of the current fiscal year, COA`s average has been 33 percent.

Ken Wilson, Director of Program Operations and Cindy Fischer, Manager of PASSPORT and Caregiver Services, credit several factors for the improvement. They include care manager visits with clients who have been placed temporarily in nursing homes, care manager training, and a contract with Douglas Smucker, M.D. to be COA`s medical advisor. Smucker is a family physician specializing in hospice care and palliative medicine. He is a member of the faculty of the Department of Family and Community Medicine at the University of Cincinnati.

"Of course nursing homes are often the best choice, but to sustain our systems of health care and long-term care as the population ages, we must continually help people to stay in the lowest cost care settings for as long as possible," Wilson said.

Sometimes PASSPORT clients do go to nursing homes for recovery and rehabilitation after incidents such as a fall or surgery. The client can remain enrolled in PASSPORT for up to 90 days after entering a nursing home. During that time, PASSPORT care managers visit their clients in the facilities and attend care conferences. If the clients do not need 24-hour care, the care manager makes sure they understand they have the option to return home.

"We are bringing people back home from nursing facilities," Fischer said. "Care managers are maintaining the relationship with their clients when they go to a nursing home. We let them know that they have the right to make the choice to return home. We explain that we can increase services (in the home) if we need to, even if it`s just for a short period of time."

For most PASSPORT clients, close monitoring of their health is critical to being able to remain at home. Trained by Smucker and others, COA care managers and clinical consultants have gained understanding of ways that they can empower clients to better manage their chronic conditions. Reducing emergency room visits naturally reduces hospitalizations and, often, nursing facility placements. Sixty percent of long-term care residents on Medicaid in nursing facilities got there initially from a hospital discharge, Wilson said.

Factors such as family issues, home environment, mental health, and social supports also place frail seniors at risk for nursing home placement. COA staff are trained to offer interventions, such as caregiver support, that address these factors.

Although one-third of PASSPORT clients leave the program for nursing homes, about half are disenrolled because they have died, moved away or are no longer eligible for the program. Other less common reasons for disenrollment include prolonged hospital stay, needs met by other services, and client voluntary withdrawal from the program.

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