Design of a Demonstration of Coordinated Housing, Health and Long-Term Care Services and Supports for Low-Income Older Adults. VII. Potential Targeting and Services Delivery Models

05/11/2011

Service delivery models could take numerous forms and focus on interventions at different points in a chronic health conditions/disability stage continuum. A more public health oriented model would target all low-income older adults in participating properties and the surrounding community with the goal of improving the health and quality of life of all, while a risk-based model would target resources to a smaller subset of high risk seniors. The demonstration could examine the relative cost efficiencies, benefits, and implementation considerations of broader and narrower models.

  Health Promotion and Chronic Care/Disability Management Across the Life Course and within Publicly Assisted Rental Housing*  
Stages Well Population At Risk Managed/ Controlled Chronic Conditions Complications or Exacerbations from Chronic Conditions
Level of Prevention Primary Prevention Secondary Prevention/ Early Detection Chronic Condition Management and Tertiary Prevention Chronic Condition Management and Tertiary Prevention
Nature of Intervention
 
 
 
 
 
 
 
 
 
 
 
 
  • Promotion of healthy behaviors
  • Promotion of health environments
  • Universal and targeted approaches
  • Public Health
  • Primary health care
  • Screening & case finding
  • Periodic health examinations
  • Early intervention
  • Self education & management to control risk factors (lifestyle & medication)
  • Promotion of healthy behaviors
  • Promotion of healthy environments
  • Treatment according to guidelines
  • Complications management
  • Rehabilitation
  • Self education & management of chronic conditions
  • Disease registries
  • Promotion of healthy behaviors
  • Promotion of healthy environments
  • Intensive case management
  • Intensive risk-factor management
  • Specialized services
  • Hospital care
  • Self education & management of chronic conditions/ disability
  • Promotion of healthy environments
Responsible Sectors
 
 
 
 
 
 
  • Public Health
  • Primary Health Care
  • Subsidized Housing
  • Other Sectors
  • Primary Health Care
  • Public Health
  • Subsidized Housing
  • Community Care
  • Primary Health Care
  • Acute Care
  • Continuing Care
  • Care/ Service/ Transitions Coordinator
  • Acute Care
  • Post-Acute Care
  • Long-term Services and Supports
  • Care/ Service/ Transitions Coordinator
Intervention Goals
 
 
Prevent movement to the "at risk group" Prevent progression to established disease and high use of medical care Prevent/ delay progression to complications disability and prevent hospitalization and post-acute care Prevent/ reduce unnecessary transfers to higher level models of care; e.g., assisted living, nrusing homes
Each start requires a greater level of sophistication and involvement with health care providers on the part of subsidized housing owners and managers.

* See the PDF version of this report for a graphic version of this table.

A decision point in terms of the service delivery models for the demonstration will be the extent to which they focus on integration of services across settings and systems. While there is no consensus on the definition of “integration,” key elements typically include: (1) broad and flexible benefits; (2) far-reaching delivery systems that include community-based long-term care and care management; (3) adoption of mechanisms that really integrate care (e.g., care planning protocols, interdisciplinary care teams, integrated information systems); (4) overarching quality-control systems with a single point of accountability; and (5) flexible funding streams with incentives to integrate dollars and minimize cost shifting (Stone 2011).

View full report

Preview
Download

"lioaDemo.pdf" (pdf, 1.35Mb)

Note: Documents in PDF format require the Adobe Acrobat Reader®. If you experience problems with PDF documents, please download the latest version of the Reader®