Garden Grove nurses' house calls program helps seniors prolong independence
Nurse-navigators at the Acacia Adult Day Services center are participating in the Community Based Health Home program, a pilot which offers supplementary care to low-income seniors in Orange County. Acacia is one of roughly 240 centers around California offering "daily medical care, meals, occupational therapy and social services" that are helping reduce emergency department visits by about 23% while hospital readmissions are down to 2%. The Community Based Health Home program "reduces and prevents expenses associated with unnecessary hospitalizations or institutionalizations,” said Tennyson S. Oyler, president of the Pacific Life Foundation. In 2017, the state is set to launch Health Homes for Patients with Complex Needs, but as yet, there has been no word on whether the Department of Health Care Services is prepared to coordinate with the Community Based Health Home program.
GARDEN GROVE – Kelly Baik plopped two large plastic Tupperware containers in front of Nelson Tran and Loan Nguyen, who were seated at the kitchen island. Baik opened one, picked out an amber-colored bottle and rattled it.

“Lasix,” he said, referring to the pills that reduce fluid retention from congestive heart failure.

“You need to be taking this, not your wife,” he said, looking at Tran. “It has your name on it.”

Baik, 32, is a “nurse navigator” who has been helping Tran, 86, stay out of the ER and expensive nursing homes despite his heart problems and recent stroke. Baik is part of a team at the Acacia Adult Day Services center that is testing whether old-fashioned home visits may be the key to prolonging seniors’ independence.

If programs such as Acacia’s prove themselves, the resulting delays in admissions to institutions could save Medicare and Medicaid billions of dollars nationwide.

Acacia is one of nine centers around the state, and the only one in Orange County, participating in a pilot program called the Community Based Health Home, which dispatches registered nurses outside the centers.

In addition to treating patients at the center, the supplementary care may involve the nurse going to an attendee’s home, visiting him at a rehab facility or accompanying him to a doctor’s appointment. The nurse might also go to a pharmacy, pick up medical equipment or help a family find a new housing arrangement.

Since the pilot started three years ago, advocates estimate that emergency department visits by an original group of 55 participating elderly people have been reduced by about 23 percent. Hospital readmission rates – when patients are readmitted for the same medical condition – were only about 2 percent for seniors visited by the RNs compared with the national average of 20 percent.

“It’s a systems savings,” said Lydia Missaelides, executive director of the California Association for Adult Day Services.

Missaelides’ group estimates that the pilot saved $1 million in ER visits compared with the year before the pilot, and saved about $3 million in hospital visits. And that’s not counting potential savings to Medi-Cal from postponing nursing home admissions.

“It’s really extending the adult day health care services and expertise beyond the walls and into the home and the community,” Missaelides said.

That expansion could prove critical in California, where the number of impoverished residents age 65 and older increased by 85 percent between 1999 and 2014, according to U.S. Census data, and where the octogenarian population will grow by nearly 50 percent from 2020 to 2030, according to state projections.

Acacia is one of about 240 centers around California – including 19 in Orange County – that provide daily medical care, meals, occupational therapy and social services to low-income elderly and disabled adults who are at risk of needing institutional care. Acacia’s goal is summed up in its motto: “Acacia during the day, home at night.”

Tran and Nguyen, 82, credit their Acacia social workers and nurses for getting them the care they need to be able to keep living together, even if not as independent as they once were. They have been married for 62 years and have nine children. They now live in the home of their oldest son.

“Because of our medical issues, we are not able to live alone, as we want,” Tran said. Acacia, he said, “helps with health care and makes me feel stable. Our lives are good every day.”

“Acacia was able to help with my emotional and mental health,” Loan Nguyen said. “I feel much better and feel much support.”

During Baik’s recent visit to Tran and Nguyen, he checked Tran’s weight, blood pressure and medicine supply. He gave him a lecture on exercising, keeping weight on and reducing salt intake. He took notes on the carpet (potential tripping risk), inhaler location (hard to find) and bed setup (they need a hospital bed with an adjustable back).

The pilot, in its third and final year, was spearheaded by the Sacramento-based Alliance for Leadership and Education, a sister organization to California Association for Adult Day Services. The pilot is funded by a $2 million grant from the SCAN Health Plan Community Giving.

Acacia, the county’s longest-running adult day services center, beefed up the pilot with one of its own test programs.

Of its 100 center elderly and disabled attendees, only 10 are needy enough to qualify for the Community Based Health Home pilot. But Acacia identified 59 additional participants who need extra assistance, or who are on the cusp of requiring extra care.

Using funds from the Pacific Life Foundation, Acacia sends a nurse and social worker to help them and their families outside the center. Like the Community Based Health Home approach, this program is a supplement to the care patients receive during the day.

The program “improves health outcomes, and reduces and prevents expenses associated with unnecessary hospitalizations or institutionalizations,” said Tennyson S. Oyler, president of the Pacific Life Foundation.

Nelson Tran is part of the Community Based Health Home pilot program and Loan Nguyen is part of the second pilot program; she qualified for that because a stroke left the left side of her body limp.

No one has stepped forward to promise funding the outside-the-center visits beyond the pilot end-date in December.

On the surface, the two pilot programs seem to dovetail with a state initiative set to launch in 2017 to serve Medi-Cal beneficiaries with multiple chronic conditions who may benefit from enhanced care management and coordination. The state’s program even shares part of its name with the pilot: Health Homes for Patients with Complex Needs.

But the Department of Health Care Services, which runs Medi-Cal, is not raising hopes. DHCS spokesman Tony Cava said the agency is aware of the Community Based Health Home pilot, but it does not have any comment at this point about its compatibility with the new state initiative.

After about an hour with Tran and Nguyen, Baik left to take care of another Acacia participant. Before he left, Baik scribbled in the margins of a printout on congestive heart failure he had brought to share with Tran. He wrote down a list of people he would call on Tran’s behalf: the social worker, the physician’s office, the pharmacy, the physical therapist. And the couple’s son, who now keeps records for both parents.

“I might save more lives in the ER,” said Baik, who works three days a week at Orange Coast Memorial Medical Center. “But, I feel like I make the most difference here.”

Lauren M. Whaley is a journalist for the Center for Health Reporting at the Leonard D. Schaeffer Center for Health Policy & Economics at USC. The center receives support from the Gary and Mary West Foundation to report on senior issues.