Talk About Teaching:

The College's Quantitative Skills Requirement (Baron)

 

The Penn Nursing Network: Two Initiatives at Work

At LIFE Center, Care for the Elderly

 

LIFE Begins at 41st & Woodland:

School of Nursing leaders at the new center's opening, left to right, are Dr. Lois Evans, professor of nursing and director of Academic Nursing Practice; Dr. Mary Naylor, associate dean and director of undergraduate studies; Chris Allen, executive director of LIFE; and Dr. Karen Buhler Wilkerson, professor of community health and director of the Center for the Study of Nursing History. Dr. naylor and Dr. Buhler-Wilkerson are faculty directors of LIFE.

 

The University's School of Nursing and the St. Agnes Medical Center/CHI have been awarded contracts by the Commonwealth of Pennsylvania to sponsor eastern Pennsylvania's first Long Term Capitated Care Assistance Program (LTCCAP). [The program, nationally known as PACE, for Program of All-Inclusive Care for the Elderly, is called PACE/LTCCAP in Pennyslvania, to distinguish it from the Commonwealth's prescription drug subsidy PACE program.]

PACE/LTCCAP is a congressionally-authorized managed care system for frail older people who are certified eligible for nursing home care. Based on the concept of capitated care, it uses interdisciplinary teams to provide elderly patients a full range of health, medical, and social services under one system. The program enables frail elders to live independently at home as an alternative to nursing home placements.

PACE/LTCCAP is modeled after the On Lok Program in San Francisco, a twenty-five year initiative widely recognized for providing comprehensive, cost-effective care for the elderly. Since 1990, the model has been replicated by over 70 organizations throughout the country. The Balanced Budget Act of 1997 established PACE/LTCCAP as a permanent provider under Medicare and allows states the option to pay for PACE/LTCCAP services under Medicaid.

In eastern Pennsylvania, PACE/LTCCAP is being implemented and operated under the sponsorship of the University of Pennsylvania School of Nursing and the St. Agnes Medical Center/CHI. Philadelphia's PACE/LTCCAP sites are being referred to as LIFE (Living Independently for Elders) Programs. The Penn School of Nursing LIFE Program is in West Philadelphia, at 4101 Woodland Avenue, and St. Agnes's is in South Philadelphia.

At the core of the LIFE Program is an adult day health center where teams of providers manage the complex medical, functional and psycho-social problems faced by elderly clients. Included in the care team are primary care nurses and physicians, physical and occupational therapists, social workers, recreation therapists, clergy, home health aides, dieticians, and drivers.

As needed, the team mobilizes the services of medical specialists, the laboratory and other diagnostic tests, and hospital and nursing home care to meet individual needs. The School of Nursing and St. Agnes Medical Center receive a fixed monthly fee for each person enrolled, and take responsibility for all aspects of the care the enrollee needs. Compliance with federal and state requirements and a close monitoring by appropriate agencies, a Nursing School spokesperson said.

According to the National PACE/LTCCAP association, the model of long-term care has succeeded in the following measures:

  • Although all PACE/LTCCAP enrollees are certified eligible for nursing home care, only 5-6% lived in nursing homes at the end of 1996.
  • Medicaid capitation payments to PACE/LTCCAP yield states an estimated 5% to 15% savings relative to their fee-for-service expenditures for a comparable nursing home certified population.
  • A study sponsored by the Health Care Financing Administration found PACE/LTC-CAP enrollment to be associated with improved health status and quality of life, including lower mortality rate, increased choice in how time is spent, and greater confidence in dealing with life's problems.

Penn's LIFE program is the only nurse-managed PACE/LTCCAP site in the country. It is part of the Penn Nursing Network, (PNN) which provides such services as midwifery, well-child care, pre-teen and adolescent care, family planning, women's health, primary care for children and adults, continence, gerontologic consultation, and rehabilitation and integrated acute and long-term services for older adults.

Penn-Macy: Spreading an Idea to Peer Schools

The Josiah Macy, Jr. Foundation of New York and Penn's School of Nursing have announced a new program to assist schools of nursing to advance academic nursing practices. Under a $500,000 grant from the Foundation, faculty and administrators from up to twenty schools of nursing in research-intensive environments will have the opportunity to attend one of two Penn Macy Institutes-week-long, intensive summer conferences with follow-up consultation by Penn faculty.

Since 1995, under the umbrella of the Penn Nursing Network, the School has successfully launched seven community-based clinical practices where advanced practice nurses provide a range of health services to clients across the life-span. The Macy Foundation's presdident, Dr. June E. Osborn, called the Penn Nursing Network "a strong example of how academic practices can serve as clinical laboratories for the development of knowledge through research, education, and evidence-based practice.

"The School's experience in establishing these practices within a University context, and the ongoing lessons learned, qualify Penn to lead a high-quality initiative to help develop the capacity of other research-intensive schools of nursing," she said.

Penn's Dean Norma Lang added that "As nurses assume greater responsibility for providing patient care and care in a broad range of community settings, it is critical that their clinical education provide exposure to academic nursing practices that also demonstrate the best evidence-based nursing models for health care.

"Exposure to clinical environments that incorporate the latest research on clinical care delivery is essential for the nursing discipline to prepare practitioners for the twenty-first century."

Since few schools of nursing now operate clinical practices, most have little control over the clinical context in which their students learn to be baccalaureate or advanced practice nurses, the Dean continued. Securing and maintaining clinical placements has become increasingly problematic as more of the education of nurses, physicians, and other health providers moves out of the hospital.

Collaborating with Penn and the Josiah Macy, Jr. Foundation is the American Association of Colleges of Nursing (AACN) and the Regional Nursing Centers Consortium of Delaware Valley (RNCC). For the past five years AACN has engaged in an effort to support academic practice and the integration of practice into the missions of schools of nursing through its annual conference on faculty practice. RNCC is an alliance of nursing centers located throughout Pennsylvania, Delaware, and New Jersey that works to ensure the fiscal sustainability of nursing centers, educate policy makers and payers, and obtain and disseminate outcome data that supports the effectiveness and efficiency of nursing centers.

The Josiah Macy, Jr. Foundation was established in 1930. In recent years, the Foundation has dedicated its resources to enhance and improve the education of health professionals, increase minority representation in the health professions, achieve better communication among and between health professions, and educate health professionals in primary care settings serving high-need populations.


Almanac, Vol. 45, No. 8, October 20, 1998

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