Annals of Long Term Care

INTRODUCTION
Nevada continues to lead nationwide with the fastest growing age 65-and-over population. The number of seniors residing in Nevada increased by 72% between 1990 and 2000, and this population is estimated to grow another 20% between 2000 and 2004.¹ Between the aging population and migration of older seniors, the rates of disability are increasing significantly. Disability, though not caused directly by age alone, increases in frequency with age. In 2003, 39% of the age 65-and-over population in Nevada reported a chronic condition that limited function. 8% of these seniors stated that their disability limited the performance of daily activities in a major way.² The age 85-and-over age group, the fasting growing segment in Nevada, experiences an even higher prevalence of disability, with 64% reporting the presence of a disability.¹ If one includes multiple morbidities, which occur in over three-quarters of the age 70-and-over population, the numbers of vulnerable elders in Nevada reaches into the tens of thousands, and continues to grow at an alarming rate.

From a financial perspective, Hoffman and Rice³ have estimated the costs associated with chronic illness and disability to our healthcare system. For every $1.00 spent on acute care services, a person with one chronic condition spends an additional $2.00, and a person with two or more chronic conditions spends an additional $6.00 for every acute dollar expended. These costs are significant, and generally not covered by the current healthcare system.

The early identification and care management of disabled, frail elderly persons is being addressed by Nevada’s Sanford Center for Aging and Office of Geriatric Medicine, Chronic Illness and Disability Management through a statewide Geriatric Resource Team (GRT). The GRT provides screening, assessment, service procurement, and monitoring to a targeted population of disabled elderly persons within their home setting. The objective is to maintain the individual’s independence and reduce institutionalization within acute and long-term care facilities. The GRT works closely with clients and families/caregivers to help with their short- and long-term goals. This plan of care, known as the Medical Action Plan (MAP), provides an added resource to the primary care physician and other healthcare providers involved in the clients’ care.

The GRT targets those disabled elderly persons, and directs them and their caregivers to the most appropriate and cost-effective care in the community. Within the state of Nevada, a connection between acute/chronic medical care and community services for an at-risk elder population has not existed prior to implementation of the statewide GRT.

To the authors’ knowledge, this program is one of a kind, given that it has been totally funded through a portion of the state of Nevada’s share of the national Master Settlement Agreement with the tobacco industry. The Fund for a Healthy Nevada was created in 1999 under NRS 439.605, and holds statutory authority to allocate these funds and to develop policies and procedures for the administration and distribution of grants targeting tobacco control, children’s health, and disability services. The statewide Geriatric Resource Team has received funding through a competitive application process since 1999.

METHODOLOGY
Referrals to the GRT are received from family members, provider offices, home health agencies, community programs, and individual clients themselves. This is accomplished by the completion of the Vulnerable Elders Survey (VES-13).⁴ The VES-13 is an easy-to-complete function-based tool for the screening of a community-dwelling population at risk for health deterioration. Clients can complete the VES-13 themselves, or health professionals may complete the VES-13 with the client. Often, a client will complete the VES-13 with a home health nurse during a routine home visit.