Program Of All-Inclusive Care For The Elderly Research Articles

Quality, Spending, Utilization, and Outcomes Among Dual-Eligible Medicare-Medicaid Beneficiaries in Integrated Care Programs

Most dual-eligible Medicare-Medicaid beneficiaries are enrolled in bifurcated insurance programs that pay for different components of care. Therefore, policymakers are prioritizing expansion of integrated care plans (ICPs) that manage both Medicare and Medicaid benefits and spending. To review evidence of the association between ICPs and health care spending, quality, utilization, and patient outcomes among dual-eligible beneficiaries. A search was conducted of PubMed/MEDLINE (January 1, 2010, through November 1, 2023) and Google Scholar (January 1, 2010, through October 1, 2023) and augmented with reports from US federal and state government websites. Three categories of ICPs were evaluated: Programs of All-Inclusive Care for the Elderly (PACE), Medicare-Medicaid Plans (MMPs), and Fully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) and related models aligning Medicare and Medicaid coverage. The review included studies that evaluated beneficiaries dually eligible for and enrolled in full Medicaid; compared an ICP to a nonintegrated arrangement; and evaluated utilization, spending, care coordination, patient experience, or health for 100 or more beneficiaries. In all, 26 ICP evaluations met the inclusion criteria and were included in the analysis: 5 of PACE, 13 of MMPs, and 8 of FIDE-SNPs and other aligned models. Evidence generally showed associated reductions in long-term nursing home stays in PACE (3 of 4 studies) and FIDE-SNPs and related aligned models (3 of 5 studies) but was mixed in evaluations of MMPs. Four of 9 studies of MMPs and 2 of 3 studies of FIDE-SNPs found higher outpatient use, although other studies showed no difference. Evidence on Medicaid spending was limited, whereas 8 of 10 studies of MMPs showed an association between these plans and higher Medicare spending. Evidence was mixed or inconclusive regarding care coordination and hospitalizations, and it was insufficient to evaluate patient satisfaction, health, and outcomes in beneficiary subgroups (eg, those with serious mental illness). Furthermore, studies had limited ability to control for bias from unmeasured differences between enrollees of ICPs compared with nonintegrated models. This systematic review found variability and gaps in evidence regarding ICPs and spending, quality, utilization, and outcomes. Studies found some ICPs were associated with reductions in long-term nursing home admissions, and several identified increases in outpatient care. However, MMPs were primarily associated with higher Medicare spending. Evidence for other outcomes was limited or inconclusive. Research addressing these evidence gaps is needed to guide ongoing efforts to integrate coverage and care for dual-eligible beneficiaries.

The Effectiveness of Palliative Care Interventions in Long-Term Care Facilities: A Systematic Review.

The increasing elderly population is driving higher utilization rates of long-term care facilities, where residents often have multiple chronic diseases, making them potential candidates for palliative care. Timely palliative care interventions can improve their quality of life and medical autonomy. This study systematically reviews the effectiveness of palliative care programs in long-term care facilities. Databases such as PubMed, EMBASE, Cochrane Library, and Airiti Library were searched up to 31 December 2023, using PICO criteria and the following keywords: 'care home', 'nursing home', 'residential aged care facility', and 'long-term care facility' for patients; and 'Gold Standard Framework in Care Homes', 'integrated care pathway', 'care home project', and 'palliative care program' for interventions. Seven articles were included. The results indicate that the Program of All-Inclusive Care for the Elderly (PACE) intervention did not significantly influence overall quality of life but did improve the quality of death. There were no statistical differences in comfort or quality of death between the dementia and non-dementia groups. However, PACE significantly reduced healthcare costs. The implementation of the Liverpool Care Pathway (LCP) notably enhanced the control of terminal symptoms, while the Gold Standard Framework in Care Homes (GSFCH) effectively improved end-of-life care rates, do-not-resuscitate (DNR) signing rates, advance care planning (ACP) completion rates, and reduced inappropriate readmission rates. While palliative care interventions are shown to improve the quality of end-of-life care, their practical application should be adapted to fit the implementation conditions and capabilities of domestic long-term care facilities.

Program of All-Inclusive Care for the Elderly: an untapped setting for research to advance pain care in older persons.

The Program of All-Inclusive Care for the Elderly (PACE) is a community-based care model in the United States that provides comprehensive health and social services to frail, nursing home-eligible adults aged 55 years and older. PACE organizations aim to support adequate pain control in their participants, yet few evidence-based pain interventions have been adopted or integrated into this setting. This article provides a roadmap for researchers who are interested in collaborating with PACE organizations to embed and evaluate evidence-based pain tools and interventions. We situate our discussion within the Consolidated Framework for Implementation Research (CFIR), a meta-theoretical framework that considers multi-level influences to implementation and evaluation of evidence-based programs. Within each CFIR domain, we identify key factors informed by our own work that merit consideration by research teams and PACE collaborators. Inner setting components pertain to the organizational culture of each PACE organization, the type and quality of electronic health record data, and availability of staff to assist with data abstraction. Outer setting components include external policies and regulations by the National PACE Association and audits conducted by the Centers for Medicare and Medicaid Services, which have implications for research participant recruitment and enrollment. Individual-level characteristics of PACE organization leaders include their receptivity toward new innovations and perceived ability to implement them. Forming and sustaining research-PACE partnerships to deliver evidence-based pain interventions pain will require attention to multi-level factors that may influence future uptake and provides a way to improve the health and well-being of patients served by these programs.

Opportunities for Integration in the Dual Medicare-Medicaid Population: North Carolina Landscape Analysis.

NC Medicaid is amid a transformation to value-based care models. The transformation requires the consideration of models that may best serve the 1 in 5 NC Medicaid beneficiaries who are dually enrolled in Medicare. The lack of integration of Medicare and Medicaid administration, financing, and care may contribute to suboptimal health outcomes and care experiences. Integrating Medicare and Medicaid to improve care for dually enrolled individuals requires knowledge of the demographic, eligibility, and enrollment trends, as well as the medical needs of these individuals throughout North Carolina. We performed a cross-sectional analysis of 2019 NC Medicaid administrative enrollment data and 2015-2020 Medicare and Medicaid public use files. Nearly half of North Carolina's full-benefit dual-eligible (FBDE) population was eligible for Medicare due to disability. About one-third of the FBDE population lost full Medicaid benefits at some point during 2019; of these, 65% were under age 65. Most FBDE beneficiaries were enrolled in Medicaid fee-for-service, with 3.5% enrolled in Community Alternatives Program (CAP) waivers, 2% in Medicaid waivers for beneficiaries with behavioral health or intellectual and developmental disabilities (BH/IDD) or traumatic brain injury (TBI), and 1% in the Program of All-Inclusive Care for the Elderly (PACE). Enrollment in Medicare Duals Special Needs Plans (D-SNPs) increased from 7.3% of the FBDE population in 2015 to 32.5% in 2021. This descriptive, cross-sectional evaluation of North Carolina duals may not be generalizable to other time periods and contexts. Medicare-Medicaid integration presents an opportunity to improve the value of care for dual-eligible beneficiaries and aligns with the goals of NC Medicaid transformation. Integration strategies that leverage the current infrastructure may minimize disruption of services for beneficiaries and mitigate the impacts of unstable enrollment, particularly among working-age adults and disabled beneficiaries. The diversity within the dual-eligible populations requires a strategy designed to improve health equity across race, disability, eligibility, geography, and health care needs.

Joe's Story: How a Capitated Payment Model Lets Me Be the Physician I Want to Be.

For many years I cared for Joe, following him through diagnoses of strokes, end-stage renal disease, and metastatic prostate cancer. Gaining his trust, coordinating his care across specialist visits and hospitalizations, and helping him and his family clarify goals of care took an investment of time and relationship-building. I was able to spend this time with Joe, and all of my medically complex patients, because I had taken a job in a Program of All-Inclusive Care for the Elderly (PACE), a fully capitated model of care. With care organized around the patient instead of the visit, this payment model transformed my work life. As I reflect on the care that I provided for Joe over the years, I consider how health care organization and finance can either help or hinder our ability to provide patient-centered, coordinated, continuous care for our patients. Evolving payment models can help make space for family physicians to provide the robust primary care we are trained to deliver.

Program of All-Inclusive Care for the Elderly (PACE) Organizations Flip the Script in Response to the COVID-19 Pandemic

ObjectivesProgram of All-Inclusive Care (PACE) organizations faced unique challenges during the COVID-19 pandemic, particularly given PACE participants are frail older adults who often live with multiple disabilities and chronic conditions. This study describes how PACE programs leveraged their unique program flexibilities and adapted services to manage this crisis. DesignMixed methods. Setting and ParticipantsThis study leveraged 2 national surveys of PACE directors (with response rates of 71.2% and 67.8%) and 6 qualitative interviews. MethodsDescriptive and univariate analyses of survey response data and thematic analyses of qualitative data from interviews and open-ended survey questions were conducted. ResultsResults indicated that PACE organizations responded rapidly to the COVID-19 pandemic, implementing a range of adaptations that shifted the PACE model from primarily center-based to a home-based model of care. Most PACE organizations reported increasing the in-home services they provided, often accomplishing this through the redeployment of center-based staff. PACE organizations likewise leveraged telehealth and remote monitoring to increase support to beneficiaries in their home, implemented various COVID-19 vaccine and infection prevention efforts, increased food and nutrition services provided in the home, and took steps to address social isolation and boredom, among other initiatives. Most PACE organizations indicated they plan to continue delivering more services in the home, consistent with participant preferences. Conclusions and ImplicationsThe findings from this study indicate that PACE organizations continued to keep participants at the forefront as they transitioned to a home-based model during the COVID-19 pandemic. Key characteristics of PACE, including its strong emphasis on person-centered team-based care, its fully integrated service model, and its flexible capitated payment structure, contributed to the resilience of the program. These findings highlight PACE organizations' ability to empower nursing home–eligible older adults to remain living in their preferred residential setting and have implications for how best to serve this population.

Providing Behavioral Health Care in PACE – A Review of Federal and State Manual Regulations

ObjectivesPresent analysis of the federal and state regulations that guide The Program of All-Inclusive Care for the Elderly (PACE) operations and core clinical features for direction on behavioral health (BH). DesignReview and synthesize the federal (Centers for Medicare and Medicaid Services [CMS]) and all publicly available state manuals according to the BH–Serious Illness Care (SIC) model domains. Setting and ParticipantsThe 155 PACE organizations operating in 32 states and the District of Columbia. MethodsA multipronged search was conducted to identify official state and federal manuals guiding the implementation and functions of PACE organizations. The CMS PACE website was used to identify the federal PACE manual. State-level manuals for 32 states with PACE programs were identified through several sources, including official PACE websites, contacts through official websites, the National PACE Association (NPA), and public and academic search engines. The manuals were searched according to the BH-SIC model domains that pertain to integrating BH care with complex care individuals. ResultsAccording to the CMS Manual, the interdisciplinary team is responsible for holistic care of PACE enrollees, but a BH specialist is not a required member. The CMS Manual includes information on BH clinical functions, BH workforce, and structures for outcome measurement, quality, and accountability. Eight of 32 PACE-participating states offer publicly available state PACE manuals; of which 3 offer information on BH clinical functions. Conclusions and ImplicationsRegarding BH, federal and state manual regulations establish limited guidance for comprehensive care service delivery at PACE organizations. The absence of clear directives weakens BH care delivery due to a limiting the ability to develop quality measures and accountability structures. This hinders incentivization and accountability to truly all-inclusive care. Clearer guidelines and regulatory parameters regarding BH care at federal and state levels may enable more PACE organizations to meet rising BH demands of aging communities.

PACE AND FFS MEDICARE OUTCOMES BEFORE AND DURING COVID-19: A PROPENSITY SCORE MATCHED ANALYSIS

Abstract We compared outcomes of Program of All-Inclusive Care for the Elderly (PACE) participants and fee-for-service (FFS) Medicare, dually eligible individuals using a retrospective cohort study with propensity score matching on demographic, socioeconomic, and participant-specific acuity level variables. PACE participants in 132 PACE centers nationwide who were dually eligible, enrolled during the study period, and did not have end-stage renal disease were included. Over 80% of eligible PACE participants were matched with FFS beneficiaries during each period, bringing many covariates closer between groups. We assessed differences during each period using Wilcoxon signed rank test and over time using differences-in-differences analyses. PACE participants spent significantly more time in the community and less time in nursing homes and hospitals (all p< 0.01). PACE participants had fewer COVID-19 diagnoses and hospitalizations per member per month (all p< 0.01). Due to the blinding of data, we could not determine definitively which performed better in limiting severe pressure ulcers. However, the results indicate PACE performed better when the mean assumption for blinded data is used. For all-cause mortality, PACE participants continued to perform better than FFS both before and during the pandemic (all p< 0.01), but the rates were closer during the pandemic periods. The flexibility in the PACE model and its person-centered care delivery approach may have contributed to the positive outcomes compared to FFS before and during the pandemic. We should consider how best to leverage the PACE model of care to support older adults to remain in their homes and avoid institutional settings.

PROGRAM OF ALL INCLUSIVE CARE FOR THE ELDERLY ORGANIZATIONS FLIP THE SCRIPT IN RESPONSE TO COVID-19

Abstract The Program of All-Inclusive Care for the Elderly (PACE) is a unique care delivery model providing comprehensive, community-based, person-centered services to older adults. The COVID-19 pandemic posed unprecedented challenges for PACE organizations to continue providing services while mitigating infection risk, and they were agile and creative in their response. This study leveraged two national surveys and six interviews with PACE directors to examine how PACE organizations met these challenges. The response rate was 71.2% for the first survey and 67.8% for the second. Results revealed a rapid transition of the PACE model from primarily center-based to home-based care. To aid this transition, PACE organizations redeployed staff, repurposed day centers, and leveraged technology, among other strategies. Most PACE organizations plan to continue delivering more services in the home, consistent with participant preferences. The findings from this study indicate that PACE organizations continued to keep participants at the forefront as they transitioned to a home-based model. These findings highlight PACE organizations’ ability to empower nursing-home-eligible older adults to remain living in their preferred residential setting and could inform lasting changes in PACE service delivery.

THE IMPACT OF THE PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) CLOSURE ON SOCIAL ISOLATION AND LONELINESS

Abstract Social isolation and loneliness are public health problems seen in late adulthood that are associated with health risks (e.g., premature mortality, depression, and suicidality) and these issues are even more common among older adults with chronic illnesses (Nicholson, 2012). The Program of All-Inclusive Care for the Elderly (PACE) was developed to serve medical and behavioral needs and provide opportunities for social engagement for older adults with chronic illnesses. Budget cuts shut down Wyoming’s PACE program. This study aimed to (1) examine the impact of this closure on social isolation and loneliness, (2) identify how individuals have adapted to the loss of services that address social isolation, and (3) identify needs and preferences for future intervention to address social isolation. A concurrent mixed-methods design was used to examine these aims. Participants (n = 12; M = 74 years old, SD = 9.5) were predominantly White (n = 8, 66%), female (n = 6, 50%), and lived alone (n = 6, 50%). Caregivers of participants (n = 5; M = 63 years old, SD = 11) were predominantly Hispanic, Latino, or of Spanish origin (n = 3, 60%), female (n = 4, 80%), and lived with a partner (n = 4, 80%). Four central themes emerged: social isolation, emotional concerns, transportation loss, and care loss. Data showed decreases in social support and increases in loneliness. Results suggest programs like PACE greatly benefit older adults. Future directions may include developing community-based interventions to address service needs and social isolation concerns in Wyoming.

PRESSURED TOUCH FOOT CARE TO RELIEVE CHRONIC PAIN AND IMPROVE QUALITY OF LIFE

Abstract Background Chronic pain affects many older adults and is a leading cause of disability. It is often treated pharmacologically, but evidence indicates touch therapy modalities are beneficial. Purpose: To implement a therapeutic touch program for adults enrolled in a Program of All-Inclusive Care for the Elderly (PACE) to help reduce chronic pain and improve quality of life for those patients enrolled in this project. Method Twelve participants in an assisted living facility with chronic foot pain were initially selected by the PACE Family Nurse Practitioner (FNP) for home visits with this Doctor of Nursing Practice (DNP) student for a foot care and pressured touch intervention to occur once a month for 3 months. The McGill Pain and Quality of Life Scores questionnaires were administered before each intervention. Results Four participants completed all three interventions. Every participant experienced a decrease in pain pre- and post-intervention and month-to-month of 15% or more. Three participants had experiences of complicated grief and had a decrease in quality-of-life scores over the 3 months. The participant without complicated grief had an improvement in the quality-of-life scores with pain reduction. Conclusions This small home intervention project for chronic foot pain demonstrated that foot care and pressured touch may be a cost-effective adjunct therapy for reducing pain. Chronic pain can be complicated by grief, which must be considered when looking to support elder wellness and quality of life. Keywords: Chronic pain, therapeutic touch

ADVANCED CARE PLANNING: LEVERAGING PARTNERSHIPS TO IMPROVE STATE-WIDE DISSEMINATION

Abstract Rowan-Virtua School of Osteopathic Medicine, The New Jersey Institute for Successful Aging (NJISA), in collaboration with the New Jersey Division of Aging Services (DoAS) and Respecting Choices, implemented a state-wide project training workforce professionals in Advanced Care Planning (ACP) conversations with older adults. The concept: proactively leverage the long-term care management relationships in community-based, high-touch programs. NJISA identified Respecting Choices, an evidenced-based program approved by the Administration for Community Living. Respecting Choices offers standardized certification for ACP facilitators and instructors, paving a pathway for workforce sustainability. To achieve state-wide penetration, NJISA partnered with NJ DoAS to target staff and professionals serving the state aging network. NJ DoAS provided access to county-level case managers serving the Jersey Assistance for Community Caregiving (JACC) program, Program of All-Inclusive Care for the Elderly (PACE) nurses and social workers, and NJ DoAS staff. Also included in training efforts were staff from select senior affordable housing sites. With funding support through the New Jersey Health Foundation, NJISA and Respecting Choices offered virtual, live training course for certification of First Steps ACP facilitators and instructors and Design and Implementation for state aging networks, and ACP Instructors. NJ DoAS modified the electronic documentation system utilized by JACC staff to capture on-going ACP conversations and outcomes. Despite barriers and mid-course corrections, training totals include (30) certified ACP Facilitators, (3) leaders for Design and Implementation, and (5) certified ACP Instructors. Response to curriculum was positive; participants indicating greater confidence navigating ACP conversations. Future plans to continue dissemination have been discussed.

Using Virtual Home Assistants to Address Vulnerable Adults' Complex Care Needs: An Exploratory Feasibility Study.

Harnessing technology has been proposed as one strategy to meet the social and health needs of older adults who prefer to age in place, but solutions remain elusive. In the current study, we evaluated the feasibility of using voice-activated virtual home assistants (VHAs; i.e., Amazon Echo "Alexa" devices) with older adults participating in the Program for All-Inclusive Care of the Elderly (PACE) over 4 months. Study methods included process evaluations, tracking participants' VHA use, and qualitative feedback from PACE participants and staff. The most common VHA activities were voice-activated smart lighting and asking for information. Participants infrequently used VHA activities that could promote physical or cognitive function (e.g., chair yoga, word recall game). Participants enjoyed using the VHAs, and PACE staff were enthusiastic about the potential for VHAs to facilitate aging in place and provided recommendations to increase participants' use of functional health activities. [Journal of Gerontological Nursing, 49(6), 33-40.].

Behavioral health integration in the Program of All-Inclusive Care for the Elderly (PACE): A scoping review.

The Program of All-inclusive Care for the Elderly (PACE) is a community-based care model that delivers collaborative care via an interdisciplinary team to meet the medical and social needs of older adults eligible for nursing home placement. Fifty-nine percent of PACE participants are reported to have at least one psychiatric disorder. PACE organizations (POs) function through an interdisciplinary model of care, but a behavioral health (BH) provider is not a mandated role on the interdisciplinary team. Published literature regarding how POs integrate and provide BH services is limited; however, the National PACE Association (NPA) and select POs have made significant contributions to behavioral health integration (BHI) efforts in PACE. PubMED, EMBASE, and PsycINFO were searched for articles published between January 2000 and June 2022; hand-searching was also conducted. Research articles and items involving BH components or programming in POs were included. Evidence of BH programming and initiatives at the organization and national level was summarized. This review reported on nine primary items addressing BH in POs from 2004 to 2022. It found evidence of successful BH initiatives in PACE and identified a gap of published information given an evident need for BH services in the PACE participant population. Findings also indicate the NPA works to advance BH integration in POs with a dedicated workgroup that has produced the NPA BH Toolkit, BH training webinar series, and a site coaching program. In the absence of PACE-specific BH delivery guidelines and guidance from the federal or state level for PACE programs, BH service inclusion has been developed unevenly across POs. Assessing the landscape of BH inclusion across POs is a step toward evidence-based and standardized inclusion of BH within the all-inclusive care model.

The Program of All-Inclusive Care for the Elderly (PACE) in Improving Medical Surgical and Mental Health Care: a Literature Review

Models of care services for the elderly in terms of medical surgical care and mental health need to be improved. Elderly with disabilities are at high risk of adverse health outcomes, and the best model of care has yet to be determined. A good holistic care model to empower every individual in society to improve the quality of care needs to be recommended. For example, comprehensive health care programs such as the Program of All-Inclusive Care for the Elderly (PACE) for adults and the elderly. The research objective was to determine the effectiveness of PACE in improving medical-surgical care and mental health. The search strategy for English-language studies relevant to the topic was carried out using the ScienceDirect database, limited from 2011 to 2021. The keywords used were “PACE”, “Medical Surgical Treatment”, “Mental Health”, “elderly”. Article full text reviewed to select studies that fit the criteria. The inclusion criteria in this review are: the nursing service program model, namely PACE. The search used the keywords above with the ScienceDirect database that matched the inclusion criteria for only 7 articles. The PACE service model improves services in Medical Surgical and Mental Health care, and implement a collaborative care model using a comprehensive interdisciplinary team.

THE POWER OF RURAL PARTNERSHIP: MEETING NEEDS AND FOSTERING INNOVATION THROUGH THE WYOMING GWEP

Abstract The challenges of supporting the health and social needs of older adults and caregivers in rural and frontier areas are well-documented. It is common for rural older adults to experience barriers in accessing geriatric specialists, care coordination services, and caregiver support and education programs. The Wyoming Geriatric Workforce Enhancement Program (WyGWEP) is an innovative partnership comprising an academic geriatrics program, primary care delivery sites, single-unit on aging representing community-based organizations, and a tribal health program. This partnership, funded by the Health Resources and Services Administration, provides the infrastructure to assess needs, provide education and training, create programs to address gaps in care, implement practice innovation, and advocate for needs of rural older adults. This symposium includes five presentations detailing the unique projects of the WyGWEP partnership and the impact of this collaborative work on a variety of stakeholders. The results of a mixed-methods evaluation of the WyGWEP partnership will describe the benefits to the partners and areas for growth. A collaborative effort to assess the needs of older adults informs recommendations to support rural aging in place. Schenck et al. will describe the adaptation of the widespread ECHO model for use with dementia caregivers in rural and remote locations. Representatives from Wyoming’s only Program for All-Inclusive Care of the Elderly (PACE) will explain the cost of a recent decision to de-fund and close this important program. Finally, the impact of a novel Chronic Care Management implementation program will be discussed, including sustainable billing revenue produced by rural primary care clinics.

INTEGRATED CARE POLICY AND PRACTICE IN THE US: THE SCENARIO OF AGING IN CHINATOWN

Abstract Background Older Chinese adults, the fastest-growing population among older immigrants, experience multiple barriers to access quality physical and behavioral health care, including low English proficiency, low health literacy, and segregation between health care and social care sectors (Tsoh et al., 2016). While integrated care attempts to address these issues, there is still a lack of culturally sensitive integrated care practices to address the needs of older Chinese immigrants. Methods This article reviews the definition and history of integrated care policies in the U.S., and compares four integrated care models on the service user and community levels, including the Chronic Care Model (CCM), Program of All-Inclusive Care for the Elderly (PACE), Patient Navigation Model, and Delivery System Reform Incentive Payment (DSRIP) Program. Results Taking the community-dwelling older Chinese immigrants as the context, this article discusses factors that are essential to this group of older adults and proposes a framework to integrate social determinants of health in the development of integrated care practice with the infusion of cultural values and norms. Conclusion Integrated care for older immigrants asks for a complicated mass reconstruction of current care systems. We propose an innovative framework that fully takes advantage of CBO’s capacity in providing culturally appropriate services is proactive and preventive in nature by addressing social determinants of health directly, recognizes the role of family and community in older immigrants’ life and aging process, and provide equal attention to the older adults’ needs in health, mental health, and elderly care.

A WHOLE NEW WORLD: EXPLORING VIRTUAL REALITY USE AND PERCEPTIONS WITH COMMUNITY-DWELLING OLDER ADULTS

Abstract Virtual reality (VR) is an emerging technology that can facilitate and support active engagement and social interactions through shared immersive experiences. While limited evidence suggests VR can improve the health and well-being of older adults in residential and clinical care settings, research has not examined the potential benefits of a shared VR experience with community-dwelling older individuals despite their increased risk for social isolation. This exploratory, longitudinal study used a mixed-methods approach to assess the impact of VR programming among persons 65+ years of age with limited mobility attending a Program of All-Inclusive Care for the Elderly (PACE) and participating in a group-level VR intervention (n=9). Quantitative measures pertaining to health, well-being, social isolation, and comfort with technology were collected at baseline, six weeks, and twelve weeks. Qualitative, semi-structured focus groups were also conducted to assess participants’ perceptions of the VR intervention. Paired sample t-test results indicated improvements over time in participants’ pain level, well-being, and comfort in relation to using VR technology (p <.05). Qualitative data illustrated that participants were extremely receptive to using VR and found the experience pleasurable, realistic, and exciting. The most common themes suggested VR programming was regarded as a highly immersive, stimulating experience that can bolster camaraderie and positive feelings. Moreover, participants felt empowered by the experience. These findings demonstrate that utilizing VR programming with community-dwelling older adults can provide interactive and engaging experiences. The potential benefits of this intervention provide a basis for developing programming that can improve well-being and connectedness.

A LONGITUDINAL INQUIRY OF PATIENT-PROVIDER RELATIONSHIPS AMONG AN UNDERSTUDIED GERIATRIC POPULATION

Abstract Patient-provider relationships have a direct impact on patient outcomes. This study explored patient-provider relationships among an understudied geriatric population of color— foreign-born Latinos¬ participating in an all-inclusive specialized program aimed at controlling patients’ costs and enhancing access to care. Thirteen older adult Latinos with multimorbidities from nine Program of All-Inclusive Care for the Elderly (PACE) centers in Southern California were recruited. Researchers conducted three in-depth interviews in Spanish with each participant (39 interviews total) over 13 months. The first interviews were conducted face-to-face and lasted one hour on average. Subsequent interviews were conducted over the phone (Range: 60-90 minutes). Data were analyzed using codes, identifying categories and themes. The concepts of time and trust were used to analyze the process of relationship development and to capture changes over time. The patient-provider relationship developed on a continuum across time and trust, establishing three stages to the patient-provider relationship. In the first stage emerged the concept of el buen doctor (the good doctor). In the second stage, trust was perceived to have been established, and was only strengthened as the doctor continued to demonstrate trustworthy characteristics over time. The third stage embodied all that a person of trust was plus an additional advocacy dimension. The longitudinal and specialized geriatric program design illuminated the nature of quality of care and patients’ perceptions on relationship development over time. Controlling patient/provider costs and enhancing access to care in an all-inclusive program are beneficial in enhancing patient-provider relationships.

Patient‐Provider Relationships in an All‐Inclusive Specialized Geriatric Program: A Longitudinal Qualitative Study among Older Foreign‐Born Latinos with Multimorbidities

AbstractObjectiveThe quality of patient‐provider relationships (PPR) is directly related to delivering patient‐centered care and improved healthcare outcomes (e.g., adherence to medical treatments) and differs across types of patients to the point of health disparities. PPRs are further complicated when factoring in multiple chronic health conditions, language barriers, and limited time. This qualitative longitudinal study explored the perceived acquiring of high‐quality PPR among older foreign‐born Latinos over time.MethodsWe recruited 13 patients with multi‐morbidities from nine Program of All‐Inclusive Care for the Elderly (PACE) centers. Researchers conducted three rounds of in‐depth interviews in Spanish (N=39 interviews) over 13 months. The first interviews were conducted face‐to‐face and lasted one hour on average. The second and third were conducted over the phone and ranged from 60 to 90 minutes. Data were analyzed using line‐by‐line in vivo coding, identifying categories, and themes.ResultsPatients reported their perceived PPR as a continuum across time, establishing three hypothesized hierarchical developmental levels to the PPR: the good doctor, the doctor of trust, and the advocate. The layers of levels built upon each other. The first level, the good doctor, was the most superficial as it focused on the physicians' technical expertise. The second level, the doctor of trust demonstrated trustworthy characteristics over time. The third level, the advocate, embodied all that a person of trust was plus an additional advocacy dimension.ConclusionUnique study characteristics allowed for an exploration of PPRs. Findings elucidate factors (e.g., expertise, trust, advocacy) that contribute to the development of strong PPRs. To enhance PPRs, strategies should be considered to develop trust and advocate for patients' needs.