Providing residents with a “concierge” — a primary point of contact to assist them with their medical needs and care — can result in numerous benefits both to older adults and senior living providers.
The model can significantly improve residents’ overall health and quality of life, reduce health care costs and make care delivery more efficient, extend length of stay in senior living and help counter social isolation as they age.
This is according to recently released results of a two-year pilot study of a medical home care program at The Los Angeles Jewish Home, through its Brandman Research Institute (BRI). The study was funded through a $250,000 grant from the Jewish Foundation to evaluate if medical home principles applied to independent and assisted living residents could improve outcomes and quality of life, LA Jewish Home President and CEO Molly Forrest told Senior Housing News.
A licensed vocational nurse (LVN), supervised by a nurse practitioner, served as the main point of contact for the study cohort. The LVN effectively acted as a medical concierge, serving as the conduit between residents and primary care physicians, setting up medical appointments, and giving participants clarification on care options, BRI Executive Director Dr. Noah Marco told SHN. The residents could stop by the LVN’s office at any time.
Medical concierges typically grant patients more quality time with their physicians. But these services can be costly and patients often pay a monthly retainer for that immediate access to their doctors. The average age of LA Jewish Home residents is 90 years; 70% of residents rely on Medi-Cal (California’s Medicare program) for their insurance needs.
“We wanted to take a well-known process and see if we could duplicate it,” Marco said.
Positive results
LA Jewish Home wanted to gauge the effectiveness of a medical concierge to reduce falls at communities, as well as measure declines in emergency room visits, hospitalizations and readmissions.
BRI identified 50 people for the study, ranging in age from 68 to 103, with multiple chronic conditions and histories of emergency room visits and readmissions, and compared them to a control group of healthier residents. The study found no changes in the frequency of falls among participants, but they demonstrated better health outcomes throughout the length of the study. Hospitalizations fell by 24%, while clinic visits decreased by 75%.
The study participants had a lower rate of hospitalization (35%) than the control group (46%), and they were able to stay in the same level of care after two years (72%) at a higher rate than the control group (65%).
With an average participant age of 87, LA Jewish Home prioritized residents for the study to measure how a medical concierge impacted social isolation, which can become a major barrier between older residents and receiving the best care from their physicians. The LVN was able to develop direct relationships with participants and reduce their anxiety about clinic visits.
“[Most of the participants] don’t have a direct relative as a point of contact. You’re either dealing with a cousin, an in-law or a next-door-neighbor,” Forrest said.
In satisfaction surveys, residents praised having a medical concierge on hand who took their care concerns seriously, and helped them find the right treatment options for them, as well as reduce overuse of certain services, medication noncompliance and waste in the health care system.
“This study shows when you develop a strong relationship between clinician and patients, [you] reduce all of that,” Marco said.
The results of the study were so promising that LA Jewish Home is continuing the program for residents with managed care insurance plans, and is in negotiations with insurance providers to fund the program for all residents, including those on Medicaid and Medi-Cal.
“Models like this shine a light on what health care can be as we adjust away from doctor-centered approach,” Marco said.
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