Providing all-inclusive care for frail elderly veterans: evaluation of three models of care.

Frail elderly veterans aged 55 and older who met state nursing home admission criteria were enrolled in one of three models of all-inclusive long-term care (AIC) at three Veterans Affairs (VA) medical centers (n=386). The models included: VA as sole care provider, VA-community partnership with a Program of All-inclusive Care for the Elderly (PACE), and VA as care manager with care provided by PACE. Healthcare use was monitored for 6 months before and 6 to 36 months after enrollment using VA, DataPACE, and Medicare files. Hospital and outpatient care did not differ before and after AIC enrollment. Only 53% of VA sole-provider patients used adult day health care (ADHC), whereas all other patients used ADHC. Nursing home days increased, but permanent institutionalization was low. Thirty percent of participants died; of those still enrolled in AIC, 92% remained in the community. VA successfully implemented three variations of AIC and was able to keep frail elderly veterans in the community. Further research on providing variations of AIC in general is warranted.

Collaborative learning: a focused partnership.

This paper describes a collaborative project that joins academic perspectives and clinical practice perspectives in a focused clinical experience. This activity involves 3rd quarter associate degree nursing students in a medical-surgical course. Instructors identified the need to provide an activity to develop intravenous therapy skills and provide increased opportunities, thus increasing technical skill and assessment skills. This led to the development of the focused clinical experience. During this clinical rotation, the students rotate through either a Same Day Surgery unit or an endoscopy unit for one of their clinical days. The primary objective of this clinical day is to provide intravenous therapy. The duration of this project was a 10-week quarter of the curriculum and involved 38 students in the 2002 class and 30 in the 2003 class. Results indicate a very positive learning experience for the student, as well as a collaborative and contributing effort by the students for the staff. The staff, on the other hand, assists in providing a mentoring role in shared expertise. Collaborative partnerships between academia and practice can help bridge the gap by providing opportunities to share perceptions, creating an environment for shared knowledge, and networking opportunities, leading to further enabling preparation for potentially future staff.