Innovation in elders' homes, in ambulatory settings, in institutions.
As stated elsewhere in this issue, many (if not most) people prefer to remain in their own homes as they age, and communities can do much to ensure that this occurs. Nevertheless, many elders will also require long-term-care services, and it may eventually become difficult for them to stay in their homes. Aging-friendly communities can be innovative in the provision of long-term-care services in three broad ways- in elders' homes, in ambulatory settings, and, when needed, in institutional settings. In this article, we examine innovative long-termcare services and discuss how they can be part of successful efforts to make communities good places to grow old.
Our suggestions come from a review of promising practices used in hospital care and domestic and international demonstrations designed to create good community environments for elders. For inclusion here, we considered long-term-care practices that increased independence, created a sense of security, and enhanced the quality of life for elders in the home and in ambulatory and institutional settings.
Healthcare has begun to move from the institutional setting to the home (Karunanithi, 2007). Remaining at home can influence the "health, wellness, independence, and safety" of the aging population (Coughlin and Pope, 2008, p. 47). Yet, in many cases, the homes that people have lived in as they've grown older are not aging-friendly. Designers and architects have begun focusing on remodeling homes for older adults to allow them to age in place. (See the article by Pynoos, Caraviello, and Cicero in this issue for a full discussion of home modification and other housing-related concerns and solutions.)
Similarly, a number of products and technologies are available to help older adults stay in their homes and live safely and independently. The National Aging in Place Council (NAIPC) (2008) offers a top-ten list of such products (www.naipc.org·). For example, older adults and their family members can use full-spectrum light bulbs to improve visibility and can add hand rails to help with stability.
The Department of Health and Human Services (DHHS) (2008) defines home healthcare as that which helps older adults to live independently for as long as possible, given their medical condition. Home healthcare encompasses a variety of services, including nursing care; social services; and occupational, physical, and speech therapy.
The homecare industry has provided services to elders (and other groups such as people with disabilities) for decades, dating back to the late 1800s. Today's homecare industry can be divided into three distinct types of providers:
First are Medicare-certified home health agencies, which provide brief and intermittent skilled care such as nursing, physical therapy, occupational and speech therapies, and home health aide services. Second are private-duty homecare agencies and registries, which mostly provide nonmedical services such as help with activities of daily living (bathing, grooming, transportation, and meal preparation). Third are hospice agencies, which provide end-of-life care to individuals with terminal illnesses. While most hospice care is provided in private homes, hospice care is also provided in nursing homes, hospice houses, and inpatient hospice facilities.
The homecare industry is developing two innovative aging-friendly practices, use of the services of homecare physicians and telemedicine.
Homecare was initially developed to help patients make the transition from hospital to home (Fairchild et al., 2002). Until the 1960s, physicians made regular house calls as part of this transition, but with the development of Medicare and the growth of technology, house calls have been in dramatic decline (Boling, 1998).
Recently, however, Medicare reimbursement rates have been revised and physicians now have more of an incentive to visit patients in their homes (Fairchild et al, 2002). …