Insights From Seven Communities Improving Eldercare for Their Populations.

Abstract

Background: Older adults' experiences when living with disabilities largely depend upon fragmented, uncoordinated arrangements for medical and supportive services in their community. Many separate organizations provide these services in the U.S., but no overarching entity is responsible for assessing quality, equity, continuity, supply or cost - or for addressing shortcomings.

Methods: We initially aimed to aggregate data from care plans across local provider organizations; but inadequate care planning and digital documentation, and non-existent interoperability of records across providers, made this impossible. We proceeded to partner with seven communities to test improving eldercare community-wide through collaborative efforts guided by data. We provided a readiness assessment, technical assistance, and eventually insights from Medicare administrative data and other national datasets.

Results: Descriptive narrative data elucidated overarching themes, lessons learned, challenges, and areas for future research. From 57 applicants, seven selected organizations developed local collaborations and improved some aspect of eldercare. Organizations faced challenges in finding useful whole-population data and faced uncertain authority and limited sustainability of their coalitions and interventions. We ultimately developed geographic eldercare metrics from Medicare data and other sources to support these communities and future efforts.

Conclusions: Implementing eldercare improvement for geographically defined populations is possible. Future demonstrations should test this approach more broadly, and those demonstrations should facilitate data access to guide interventions and should establish the authority of a respected entity, broadly representative of stakeholders, to take responsibility for the performance of local arrangements.