This Week in FrailtyThe Alphabet Soup of Care Models

Today, older adults have many choices on where to live but their choice will be impacted by a number of factors. However, their fitness or frailty, independence or dependence, assets or deficits will be the primary factors dictating their future residence. with the finances close behind. Each setting in the alphabet soup of care models – from NHs and CCRCs to AL and from PACE to MA to I-SNFs — accommodates the needs of some older adults, but not others; and most models lack innovative approaches to healthcare while falling short of creating an atmosphere to improve outcomes and satisfy residents and beneficiaries. These challenges were magnified during the pandemic; and the lessons learned must be re-examined and incorporated into future healthcare for the entire population of older adults and those with chronic illness and frailty. 

Undesirable and Unsustainable 

This is how one writer characterized the current state of nursing home care. She further added “and no one wants to live there.” The pandemic exposed many gaps and shortcomings in this care setting, despite the best efforts of heroic practitioners and care teams. It has become painfully clear that the status quo must be changed not only to accommodate the deficiencies in the current facilities but also those in our understanding of what it will take to meet needs, avoid another crisis, and provide more than one vision of aging well, accompanied by living arrangements to accommodate those different aging trends.

Hard Truths from the Pandemic

#1 The traditional American nursing homes are designed for a medicalized approach to aging modeled basically as a small hospital. During the pandemic, the current medical care model was not sufficient to stem the flow of Covid-19 deaths where more than 1 in 5 of the nation’s pandemic fatalities occurred. Residents left facilities to live with their families, and the reluctance to return continues. Many influential organizations are diligently examining the findings and failures of the nursing home industry and sweeping change is anticipated. Modernizing the design is required and models exist for improvement.

#2 The pandemic highlighted how little we accommodate for the Social determinants of health in the nursing home setting. According to the World Health Organization, “Social determinants of health are the conditions in which people are born, grow, live, work and age.” Data on the impact of social determinants on health vary but one recent notes that as much as 80% of health outcomes are related to social factors. We witnessed frailty deficits increasing as a result of the psychosocial factors, imposed by the pandemic, that weren’t (and aren’t) adequately addressed:

  • Social exclusions or isolation Environmental factor related to mobility
  • Lack of control or autonomy Food – lack of culturally relevant choices
  • Not feeling safe Lack of understanding of plan of care
  • Loneliness from lack of social supports

Going forward, no matter the setting, these factors need to be addressed. Their impact on health outcomes is too great to ignore and so when we plan for environmental change we also need to plan for all the factors we can change, setting the stage for a less medicalized model where frailty is mitigated and managed and decline is slowed.

#3 Another concept mentioned more during the pandemic was that of Population Health Management. This is likewise an area of focus related to the health outcomes of a group of individuals, including the distribution of such outcomes within the group. It is an approach to health that aims to improve the health of a broader population-based on defining characteristics or geographies and recognizes that disparities often exist within groups based on race/ethnicity, socioeconomic status (or social gradient), geography, gender, other characteristics. Population Health Management recognizes the social determinants and incorporates them into programs in order to improve outcomes. 

FRAILTY and The Alphabet Soup of Care Models

As the number of older adults increase, as models of care are revised, as degrees of physiological decline vary, we will benefit from considering the needs of all populations and plan care that is both satisfactory and sustainable. With the industry in crisis, many options are on the table; and the time to act is now. There is a need for aging in place, assisted living, home care and nursing home care, and we owe it to the entire population needing or anticipating a need for services, to make every setting the best possible. The science behind Population Health principles and the Social Determinants of Health are real and carry consequences to millions. 

Our Takeaway Message

    • A virus has thrown healthcare for older adults into chaos, especially in nursing homes.
    • Innovative change is required and underway across the continuum of care.
    • New models of aging need to move away from the medicalized model for many.
    • An alphabet soup of care models will always need to exist for a heterogeneous group.
    • Accommodating Social Determinants of Health and Population Health must be considered.
  • Wherever we practice professionally we owe it to the setting to work towards change.

Immediacy and Precision

At Patient Pattern the proprietary algorithm for our Frailty Risk Score incorporates Social Determinants of Health, to complete a Comprehensive Geriatric Assessment. The analytics incorporate population health measures while the care plans follow the guidance of best practices in geriatric medicine and population health management. Our risk stratification, based on frailty, provides an immediacy in the assessment of vulnerability and supports timely person-centered decision making, framed by risk, designed to avoid harm.  The precision in predicting adverse outcomes is unique and beneficial for incorporating interventions to manage and mitigate frailty and improve outcomes for the population residing in any of the alphabet soup of care models. Contact us today for more information or a demonstration of our cutting-edge products.