Please ensure Javascript is enabled for purposes of website accessibility

Older adults find gap between health needs, available care

Senior Care Services Scale developed by Johns Hopkins researchers

Before the passage of the Affordable Care Act in 2009, researchers found fewer post-acute services such as assisted living, home health services and intermediate care, were available to older adults.

Through the findings, researchers were able to develop a Senior Care Services Scale (SCSS) to show the difference between what is offered and what older adults need regarding their health.

“Post-acute care services are supposed to be there to help the older person continue the transition back to their normal state, and that might be at home or that might be at a facility; but the point is it is to help them continue their recovery,” said Dr. Alicia Arbaje, lead author of the research and director of transitional care research at Johns Hopkins Bayview Medical Center. “The challenge with hospital systems not offering a lot of these post-acute services, at least over the time period that we looked at, is that implies that they might not be prepared to help older people continue that recovery after they leave the hospital.”

Using data from the American Hospital Association, researchers analyzed services reported by 4,998 hospitals in 1999 and 4,831 in 2006. Their findings, published in September’s “Medical Care” — a journal for the American Public Health Association — show that inpatient and post-acute services were concentrated in the northern portion of the United States. The southern half ranked in the 25th percentile or below where large pockets of older adults reside.

“The last time that this [area] was really looked at in detail was back in the 1980s,” Arbaje said. “A lot has changed in health care since then so we really thought it was important to readdress ‘What are the special services that older adults need when they are in the hospital in order to become healthy and stay safe during their time in the hospital and when they get out of the hospital’. …I think this information can be used by the public to assess whether a health system is providing services that are important to them, and it can be used by health care systems to evaluate themselves on how they are organizing and integrating services relevant to older people.”

According to the U.S. Census, more people were 65 years and older in its 2010 report than in any previous data collections.

“In 2030, a quarter of Maryland’s population is going to be over 60 so we are definitely aging,” said Isabella Firth, president of LifeSpan, a senior services alliance. “We want as a population and, as a state we certainly want, to make sure that the health care providers out there get it, understand it and prepare for the unique care needs for an aging population. … I do think that [the scale] is a good thing for hospitals because they have a good reason for them to look at ‘Where are the gaps?’ and if there are gaps in their immediate care area, should they buy those services from other community based providers or post-acute care providers or should they build it themselves because they have greater responsibility now.”

Carmel Roques, CEO of Keswick, a Baltimore health care provider, believes the scale shows how important post-acute services are to older adults. “I think the thing that the Hopkins study really hones in on is that simply focusing the provision of health-related services, particularly to chronically ill older adults, inside the hospital as hospital-based or as we say acute care services, really doesn’t even begin to address the fundamental determinant and therefore outcome of good health and wellbeing for older adults living in communities,” she said. “We are certainly going to try to mine this new research for any kind of support it can give us in helping to plan, where to target our efforts.”

Since ACA’s passage, health care providers have been held more accountable for offering post-acute services. Arbaje and her team are continuing their research by studying how health services have changed since the passage “to see how hospitals have responded to this call for action,” she said. “I think when we do our update now my hope will be that hospitals will be offering more of these post-acute care services. That would be my hope in updating the data but I guess we will just have to see.”