Home Care Hospitalization: An Experiment with Promise


November 11, 2016; Forbes

As the cost of healthcare, particularly in hospitals, continues to skyrocket, a few are exploring alternative methods of providing high quality care for lesser costs. One nonprofit in particular is reintroducing a method of care from decades ago: home visits from doctors.

When Dr. William Terry arrived at Boston’s Brigham and Women’s Hospital with violent chills and a high fever, emergency room staff determined he needed hospital care. Instead of being admitted, however, Dr. Terry became part of a study where he would receive the same care at home, including at least one home visit from his doctor plus two nurse visits every day.

The Brigham and Mass. General studies are limited to patients living within five miles from the hospital who present with heart failure, pneumonia, chronic obstructive pulmonary disease, or infections. (Terry’s chest x-ray showed a “suspicious spot.”) The study is focusing on these conditions because patients do not normally require intensive care or major procedures.

The preliminary results of the Brigham study were published in a recent issue of JAMA Internal Medicine. Patients were found to suffer from lower infection and readmission rates. The cost savings was an average of $2,000 per patient as compared to a hospital stay. More importantly, patients receiving care at home reported feeling happier. Perhaps that is not surprising, given hospitals’ reputations for awful food, harsh lighting, loss of privacy, snoring roommates disturbing sleep, and nurses on a schedule that works for the hospital system rather than the patient. The list goes on.

The study is part of a larger movement led by Hospital at Home, a program created by the Johns Hopkins School of Medicine and Public Health. Their research found the model lowered costs by almost a third and reduced complications of hospital stays. Surprisingly, the first study of these types of programs was conducted in 1997, leaving a supporter to describe the treatment plan as the “most studied innovation in health care.”

Although common in England, France, and Australia, in-home care is not widespread in the U.S., mainly because most insurance companies and Medicare do not cover it. Many of the treatment providers, such as Brigham and Women’s Hospital, are picking up program costs. New York City’s Mount Sinai Hospital is part of a $9.6 million, three-year similar study funded by the Centers for Medicare and Medicaid Services.

Overall, due to technology and revolutionary research, plus the emerging population health and wellness reimbursement structure of the Affordable Care Act, medical care is shifting. As research and technology has disrupted once-deadly diseases like HIV-AIDS and we continue to live longer and healthier, some are describing the hospital of the future as a “NASCAR pit-stop.”—Gayle Nelson

Original cite: https://nonprofitquarterly.org/2016/11/16/home-care-hospitalization-experiment-promise/


Nonprofits Challenge Age Segregation: Rebuilding Multigenerational Communities


The end of summer signals more than the end of bathing suit and suntan season. For more and more Americans, it signals the return to age-segregated living. College students return to universities, working adults return from summer vacations to environments where they only interact with their peers, and children return to schools where they are separated by grades. Additionally, many senior citizens are living in exclusive gated communities.

Age segregation is becoming more and more of a reality. In one study measuring a six-month period, only a quarter of Americans over the age of 60 reported discussing “important matters” with people younger than 36—and if relatives were excluded, the number dropped to six percent.

A growing number of nonprofits are bucking this trend by building intergenerational communities. These communities focus on the needs and strengths of seniors and young families, encouraging them to depend on each other to succeed.

Several years ago, Whitney Gossett went from being a family of one to being a mother of four. She adopted four siblings in foster care, ensuring they were not separated from one another. Now the children are ages 7 to 13, and they are getting ready to welcome Gossett’s fiancé.

Not surprisingly, families like the Gossetts need a lot of support. The Gossetts found it in the Hope Meadows community. Located in Rantoul, Illinois, about two hours south of Chicago, Hope Meadows consists of roughly 40 rental homes where ten families like the Gossetts live among seniors. The seniors receive a break in their rent for volunteering six hours a week helping their neighbor families, but many do much more.

The founder, Brenda Krause Eheart, a former University of Illinois professor, created the community 21 years ago to support the foster children. The seniors were merely an afterthought. Looking back, she realizes the idea would have “collapsed” without the seniors. She is “convinced that we have to do so much more to utilize the time and talents of older adults to address these social problems.”

This community was the model Sister Claire LeBoeuf used to build New Life Village. Sister Claire understands firsthand the insecurities foster children face. At the age of 13, she faced the sudden death of her mother and subsequently moved in with her godmother. Although Sister Claire was loved and cared for by her godmother, she did not feel like she belonged. This feeling continued until she entered the Congregation of the Sisters of the Holy Cross four years later.

That sense of not belonging is the same feeling foster children face, and Sister Claire has dedicated her life to creating permanent homes for them. She created New Life Village for older foster children, who have the least likelihood of being adopted. When families move to New Life, they adopt older foster children. They live among other foster families as well as with seniors serving as extended family.

Although these intergenerational communities were revolutionary two decades ago, today they serve as models for others in Oregon and Massachusetts. A half-dozen more are on the way, including one community modifying the idea to support adults with developmental disabilities and another for veterans with traumatic brain injuries.

In Northwest, Washington, D.C., a nonprofit called Genesis is putting the concept to use to build a community to support young women aging out of the foster care system with young children of their own. Both the twenty-one-year-old moms and the seniors will volunteer a minimum of 100 hours every three months to help each other. For example, the young moms will drive the seniors to doctor’s appointments and the seniors will look after the children while the moms are working or in school. The founder describes the community as offering “meaningful purpose” for the seniors as well as assisting the young families, thereby severing the pipeline of poor children into the foster care system.

Overall, families in these intergenerational communities resemble extended families of our past demonstrating that as much as our world has changed the needs of children and their families are remarkably consistent.

Original cite: https://nonprofitquarterly.org/2015/08/11/nonprofits-challenge-age-segregation-rebuilding-multigenerational-communities/