Older Adult Health

The Horizon Foundation developed a major program in the area of Aging in Place in 2002.  The program’s highlights include:

• Re-treading case management for seniors using HorizonHelp  as the information backbone;
  
  
• A multi-year partnership between the Foundation and the Federal Administration on Aging to bring evidence based chronic disease prevention services to the county. This included the receipt of two Federal grants;
  
  
• The pooling of Foundation and Howard County Community Development block grant funds to enable home modification and repair services for needy seniors;
  
  
• Affordable in-home care and mental health pilots provided through cluster grants made by the Foundation to an array of nonprofits;
  
  
• Other service modifications developed by the Foundation in collaboration with the Howard County Office on Aging and the nonprofit community.
  

While the Aging in Place program is in maintenance mode, its services are now embedded in a number of local systems. In addition, the Foundation hosts a “Partner’s Group” that meets regularly. Composed of the leaders of older adult service organizations, hospital and nursing home representatives, university specialists and others, the group tracks older adult health trends and engages in problem solving around the county’s senior population.

Following is a summary of the Aging in Place Program.

AGING IN PLACE INITIATIVE

Howard County, Maryland, is located between two large and growing metropolitan areas  -  Washington, D.C., and Baltimore. In 1960, the County's population age 60 years and older was less than 3,400. By 1995, the number was 20,000, projected to increase more than 25 percent to 26,000 by 2000. The Howard County Commission on Aging estimates that the number will rise to 72,000 by 2020, an increase of 260 percent in 20 years.

A major portion of this growth will occur within the planned community of Columbia. Columbia creator James Rouse chose Howard County for the new town because of its strategic location between the two cities, a place that seemed inevitably destined for population growth as the East Coast megalopolis extended itself.

Like other Americans, most Marylanders want to remain in their homes as they get older. Surveys by the American Association of Retired Persons (AARP) in 1989, 1992 and 1996, found that more than 80 percent of Americans age 50 and older want to "stay in my own home and never move." Personal comfort and satisfaction with a familiar house or apartment, neighbors and community constitute powerful reasons to search for ways to make this possible.

The shifting structure of public financing of services for the elderly has also highlighted the importance of increasing options for aging in place. Publicly funded reimbursement for nursing home care has become more narrowly focused on patients who require the most intensive medical care. Coupled with the reality of a growing, aging population, these policy changes have increased the importance of developing community-based services for seniors who may be frail or have less acute needs, whether for personal care and treatment of chronic illnesses, or for rehabilitation services following an illness or an accident.

Any effort designed to enable older adults to remain in their homes must take into account the changes in physical and mental health that contribute to their reduced functioning. These changes result in predictable occurrences, including increased needs for: affordable home care (including personal care, help with chores and respite services for caregivers); homes that are safe and have modifications that accommodate the residents' reduced functioning; fall prevention; and identification and treatment of depression and other mental health problems.

Following extensive planning, in 1999, The Horizon Foundation's Trustees determined that the health and wellness of older adults would be a major, continuing priority. Both the Howard County Commission on Aging and the Maryland Department of Aging confirmed that, in light of compelling demographic trends, we should place high priority on enhancing the ability of elderly county residents to remain in their homes.

Meetings were held with the local Office on Aging to articulate the first phase of a long-term aging in place strategy. A group of public and non-profit agency leaders then met in the Foundation office to discuss the current service delivery system and to propose modifications intended to enable older adults to remain in their homes as long as possible.

In October 1999, we approved a grant of $450,000 for the 'Aging In Place Initiative.' The Office on Aging serves as the hub of this project. In addition, we made a series of coordinated grants to three local non-profits: Developmental Services Group, Family and Children's Services and Our House.

In support of the effort, the Foundation assembled faculty and clinicians from Johns Hopkins University and the University of Maryland to address state-of-the-art issues associated with aging in place. This involvement, in the form of three joint university task forces, is aimed at predicting the service demands of an aging population and developing effective techniques to facilitate aging in place.

In total, the Initiative was designed to weave the threads of community services - some already in existence, and some not - into a fabric of support enabling older adults to remain in their own homes and avoid institutionalization. It is a pioneering effort that we hope will serve as a viable and inspirational model. The project emphasizes three main areas: Affordable In-Home Care, Mental Health Services and Home Modification and repair.

In addition to our lead partner, the Office on Aging, other primary partners are Humanim, Family and Children's Services, and Our House. The latter organization trains youth in the building trades. Increasing contact between youth and older adults in the county is a side benefit of the provision of home repair and home safety improvement. The county reserved Community Development Block Grant funds to be pooled with Foundation dollars to implement the initiative.

Not only does the project enhance the safety of older adults living at home, it also provides affordable in-home care, home-based mental health services, and fall prevention activities. Office on Aging Director Phyllis Madachy and renowned aging researchers from Johns Hopkins University and the University of Maryland serve on an advisory committee established by The Horizon Foundation. In addition to its other activities, this committee is overseeing development of methods to streamline communication between health professionals and older adults living at home.

PROJECT COMPONENTS

The Foundation, working with numerous partners also developed the following Aging in Place program components:

• The Elkridge Aging Alliance
  Working with a Community Council organized by the Foundation, we are applying what we have learned from the initial phase of the Aging-In-Place initiative to address the needs of elders in Elkridge, a close-knit community of about 2,000 persons. Based at the Elkridge Senior Center, the project will develop a database on community needs and work to mobilize schools, churches and other community resources to provide necessary services. As a result of one study already completed, we learned that due to lack of transportation, many people have to walk along the highway to local health services. As a result, we have worked with the Urban Rural Transportation Alliance to purchase a van that will provide on-call transportation for health care appointments to anyone on a sliding fee basis.
  
  
• Johns Hopkins University/University of Maryland Aging In Place Technology Project
  The Foundation has provided a planning grant to departments of public health and gerontology at these two institutions to determine whether an electronic network communications system can enhance coordination of care for homebound older persons. The project will examine how medical and social services agencies communicate now, and how technology - including telemedicine - might be used to improve the system of care. As part of this project, the researchers will address issues such as how to maintain patient confidentiality and acceptability of this type of system to clients and their families.
  
  
• Interuniversity Aging In Place Workgroup
  Efforts to meet the needs of the county's growing older population will not succeed unless they are based on high-quality population projections and needs assessments. This project, being conducted by the Department of Epidemiology and Preventive Medicine at the University of Maryland, will provide the Foundation with an analysis of the composition of the county's future population and provide information that can be used by the county to make decisions on issues such as where to locate new services and how to modify or add to existing services.
  
  
• University of Maryland/Horizon Foundation Planning Workgroup
  To assist the Foundation in its efforts to further develop Aging-In-Place resources in Howard County, we have created an advisory panel made up of researchers and practitioners in geriatrics from two major universities in the area, Johns Hopkins and the University of Maryland, to work with us and with appropriate local officials.
  
  

NEXT STEPS

The Foundation and its partners are working actively to further develop the Aging in Place Initiative. Next steps include:

• The Development of an Aging and Disabilities Resource Center
  Funding received from the Federal Administration on Aging in late 2003 will provide consumers with a one-stop entry into the long-term care system, a system that is often cumbersome to navigate. The Center will have an interagency advisory structure and will emphasize a single point of entry. We will cooperate with local State Health Insurance Program (SHIP) counselors t provide information and training on a wide range of Medicare, Medicaid and MediGap matters, including MEDICARE+Choice health plan options. Importantly, the Center will empower consumers to exercise choice in the long-term care community and increase the capacity of informal caregivers to make adequate decisions.
  
  
• Development of an Enhanced Evidence Based Chronic Disease Management Capability
  Following a working visit to observe Denmark's long-term care delivery system, local partners began work to improve chronic care provision in the County. The emphasis has been on home- and community-based care. The emerging model, which is under development in tandem with the Federal Administration on Aging, will include the following components.
  
  
• Emphasis on evidence based chronic disease intervention models
• Intensive home medical care management
• Comprehensive care coordination
• Diminution of inappropriate hospital emergency department use
• Primary and secondary prevention
  
  
• Policy Reform to Remove Barriers to Chronic Disease Care
  The Foundation and its partners are mindful of the need to improve public policy development and implementation in this area. Unless reform is forthcoming, large number of older adults will be unable to receive the type of care that is needed for chronic disease management. Our goal is to achieve a policy framework that enables older adults to maintain maximum functional independence in relation to chronic medical conditions, thereby avoiding institutionalization until it becomes necessary.