Aging in Place Overview

A unique cutting-edge project is underway at the University of Missouri (MU) that will make it possible for seniors to truly “age in place.” While authors and health care providers have been talking about “aging in place” for many years, accomplishing this has been challenging and nearly impossible within federal and state regulations of long term care. Faculty at the MU Sinclair School of Nursing (SON) rose to the challenge of meeting consumer demands to “age in place” with this cutting-edge public-private partnership project that began in 1996 and is now fully realized. Legislation that enabled this project was passed in the Missouri legislature in 1999 and 2001. This legislation was needed to designate four “aging in place” demonstration sites in the state that are to be regulated by the Missouri Department of Health and Senior Services, but regulated differently from traditional nursing homes or residential care (assisted living).

In 1999, Senior Care (now called Sinclair Home Care) was created as a department with the SON to be a health care organization designed to provide the on-going health care needs of residents in the Aging in Place (AIP) project, other private congregate senior housing, public senior housing, and in individual community homes of seniors in Boone County. Sinclair Home Care is a licensed home health agency developed with the assistance of a $2 million grant from the federal Centers for Medicare and Medicaid (CMS) to conduct research and evaluation about the effectiveness of aging in place for frail older adults.

There are three remaining sites in Missouri participating in the AIP project: the MU SON, an elder housing project in Kirksville, and a retirement community in Springfield. The fourth site, a retirement community in Cape Girardeau, has withdrawn from the state-sponsored project and evaluation. For the SON, there are two project locations with current enrollees in the AIP project: TigerPlace, a cooperative project initiated by the SON and built by the Americare Corporation of Sikeston, Missouri, and the Maplewood apartments at Lenoir Woods.

Lenior was enrolled as an AIP location in 2003. Since that time, 88 total residents of Maplewood have participated in the project, 25 of whom have been discharged to other locations at Lenior or other senior housing, and 54 are current enrollees in the project.

TigerPlace opened in June 2004 and since its opening, all 64 residents have participated in the AIP project. There are currently 32 residents living at TigerPlace taking advantage of the AIP services of Sinclair Home Care.

A major goal of AIP is to develop a new approach for long term care services for on-going assessment, early illness recognition, health promotion activities, and services designed to meet individual needs when the person needs them in the privacy of their own apartment. It is the goal of the program to help older people stay healthier and active longer, avoid expensive and debilitating hospitalizations, and for most residents, avoid relocation to a nursing home.

A state evaluation of AIP participants is underway. A research team in the SON with collaborators from the School of Medicine and other MU schools and colleges is guiding the evaluation. Preliminary evaluation data are anticipated in 2008 for the TigerPlace and Lenoir locations. Data about functional status, hospitalization, emergency room use, and medication use are being evaluated across all three state sites as a part of the state evaluation.

A federal evaluation of AIP was funded by the Centers for Medicaid and Medicare Services (CMS) (Marek, PI). Most of the evaluation of the CMS-funded portion for AIP (conducted in 1999-2003) is complete. Final costs analyses are underway as cost data are becoming available from Medicare and Medicaid files. The outcome analyses revealed that AIP intervention clients had significantly better outcomes in cognition, depression, activities of daily living, and incontinence that a matched cohort of nursing home residents at 6, 12, 18, and 24 months. Results suggest that community based care with nurse coordination enhances clinical outcomes of long term care clients (Marek et al., 2005). Preliminary cost analysis indicate overal cost savings/cost neutral for health care costs. With delayed and prevented nursing home admission, nursing home costs are reduced for those older adults participating in Aging in Place.

In July 2006, operation of Sinclair Home Care was assumed by University of Missouri Health Care (UMHC). The SSON is collaborating with UMHC in education and research at Sinclair Home Care.

Articles about Aging in Place research:

Last Updated: Monday, February 11, 2008