Nov. 1, 2010

For older adults, there's no place like home

For most older adults in long-term care, nursing homes are the last places they will ever live, and many give up hope on ever returning to home.

However, a Cornell evaluation project finds that a person-centered approach shows great promise in helping nursing home residents move back to the community, allowing nearly 60 percent of study participants to successfully return home.

Researchers in the College of Human Ecology evaluated Project Home, a pilot program in Syracuse, N.Y., funded by the New York State Department of Health. They report on their findings in an upcoming article in the Journal of Case Management.

"It's very common for older adults to express their desire to return home," said co-principal investigator Rhoda Meador, associate director of outreach and extension in the College of Human Ecology. "The idea with Project Home is that, with extra support and focus on an individual's unique needs, those wishes can become possible."

Project Home staff worked to overcome the usual medical, psychosocial and logistical hurdles that keep people in nursing homes for the long term, offering intensive case management to 60 residents in long-term care. Every detail of the transition -- from finding adequate and affordable housing, to filling prescriptions and planning for medical needs, to a stocked refrigerator -- was accounted for by a team of social workers and administrators. "Project Home is part of a growing effort in long-term care settings to put the needs of individuals first," Meador said. "It shows what great success is possible when you become an advocate for people and take extra steps to get them back in the community."

The study also detailed the most common barriers in the transition from nursing homes to community settings. For one, individuals receiving Medicaid were significantly less likely to be discharged, suggesting that financial hardship hampers one's ability to return to the community. Other obstacles: poor physical health, especially conditions that require rigorous, round-the-clock care; lack of social support to aid in daily living; and limited housing options.

Despite such challenges, "few barriers are insurmountable," said co-principal investigator Karl Pillemer, associate dean of outreach and extension in Human Ecology. "Entry into a nursing home does not have to be a one-way street, and this project shows you can help people return to the community by dedicating staff to their individual needs and cutting through the usual institutional red tape."

Prior studies have estimated that 5 percent to 12 percent of the nation's 1.4 million nursing home residents are "low-need," meaning they can live in the community with minimal care. Therefore, Meador and Pillemer noted, getting people out of institutional care could net a significant cost savings for seniors, their families and taxpayers.

Ultimately, Meador said, Project Home succeeded in raising the quality of life among many older adults. "Later in life, it's very important for people to live at home if at all possible," she said. "Even if their medical care is not the level it would be in an institutional setting, there's a feeling that they are happier and more at peace."

Other Cornell collaborators on the study, funded in part by a grant from the Community Health Foundation of Western and Central New York, included Charles Henderson, senior research associate in human development; graduate student Emily Kahoe Chen in the field of human development; and Leslie Schultz, research support specialist at the Cornell Institute for Translational Research on Aging.

Ted Boscia is assistant director of communications for the College of Human Ecology .