For nearly three years, Providence ElderPlace has served senior members of Seaside and surrounding communities with a system of managed care that takes a holistic, interdisciplinary approach to providing health.
When it comes to improving the quality of life for older adults, Providence uses a model known as PACE — which stands for program of all-inclusive care for the elderly — a federally recognized program that offers a seamless provision of total care.
ElderPlace is the only location through which a PACE model is offered in the North Coast, even though Oregon has one of the largest PACE programs in the country.
“We are the only rural site in Oregon,” said Carin Eling, the program’s nurse practitioner.
Since its establishment in 2014, Providence’s North Coast program has increased its participants from six to 65, including people from Astoria to Wheeler. The program services more than 900 square miles of rural area, including Clatsop County and the northern part of Tillamook, according to PACE Program Manager Pam Olsen, who has been with ElderPlace since its inception. The patients currently range in age from 57 to 104.
To participate, individuals must meet a number of criteria, including being age 55 or older; Medicare and Medicaid eligible (or willing to pay privately); in need of support services as defined by the state; and capable of living in their own home or an assisted-care setting.
Many people are referred to the program through Area Agencies on Aging; home health agencies; doctors’ offices; assisted living facilities where they reside; word-of-mouth; advertisements (including the buses used for transportation); and a variety of other means.
“Sometimes, you come to work and there’s a family member pacing in the parking lot who wants to know what this program is,” Eling said.
A holistic approach
The North Coast presents its own sets of challenges for providing care, according to Eling, who started as a temporary provider in January before deciding to stay long-term. She has a history of working in managed care in Minnesota.
Not only does the program serve a large geographic area, but about 60 percent of participants have significant psychiatric issues – not to mention various socioeconomic problems, such as homelessness. All of these challenges have to be addressed to provide thorough care, Eling said.
“We try to get people back on track, and we do that through a multi-disciplinary way,” she said. “We know people are holistic,” comprised of biological, psychological, social and spiritual aspects.
With combined care services, services can remain as active and independent as possible. Each patient receives care from a team of individuals, including Eling, Olsen, social workers, bus drivers, activity coordinators, home-care coordinators, dietitians, occupational therapists, physical therapists, pharmacists, and others. Some of these health care professionals are part-time or shared with Providence Seaside Hospital and other institutions.
ElderPlace services include primary care; specialty medical care; dental, vision, hearing and foot care; recreational and therapeutic activities; prescription and over-the-counter medications; physical, occupational and speech therapy; hospitalizations; medical and surgical procedures; emergency and urgent care; and lab tests and diagnostics. All authorized services are covered in full for PACE participants.
The day center, on North Roosevelt Drive and 12th Avenue, is the hub of the program. Since its beginning, the facility has increased the number of days it’s open from two to four: Tuesdays through Fridays. The hours are 8 a.m. to 5 p.m., with structured activities, events and lunch — catered by the Seaside hospital — taking place between 10 a.m. and 2 p.m. on open days. Staff is on-call 24/7, though.
“Our growth potential isn’t limited,” Olsen said. “We have the ability to serve so many more people.”
The program has a waiting list, and staff hopes to incorporate five new patients per month. Most importantly, Olsen said, they want to be “good stewards,” which means growing at a sustainable rate as resources are available and without over-crowding their physical location.
At the day center, participants have access to one of the most important components of the program: socialization.
According to Eling, socialization plays a positive role in people’s overall health. As individuals age or if they face significant health problems, they often “become isolated, and isolation leads to depression, cognitive impairment and all those things,” she said.
Staff encourages patients to stop by the center for appointments so they also can socialize, attend occasional outings, and interact with the staff and other participants while there. It is common, however, for Eling and other caregivers to make house calls or visit patients at their assisted living facilities, and also to transport them to appointments as far as Portland.
Part of what makes the program valuable is its capacity to meet people where they’re at – physically, mentally and emotionally. It provides the support necessary for some people to get out and go places, while at the same time allowing others to receive care in their homes, or helping them make a decision about whether they want to move into an assisted living facility, Eling said.
Most importantly, the staff provides “a clearing house” for all the data related to their patients’ care, Eling said. They synthesize that information to ensure patients aren’t receiving contradictory treatments for different afflictions and that their mental and psychosocial needs are being met, as well, to help reduce unnecessary hospital visits.
“It’s about juggling all the balls,” Eling said.