Health Care Services:

How Continuing Care Retirement Communities Manage Services for the Elderly

HEHS-97-36: Published: Jan 23, 1997. Publicly Released: Jan 23, 1997.

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Pursuant to a congressional request, GAO reviewed the processes of managed care in continuing care retirement communities (CCRC), focusing on: (1) CCRC practices for promoting wellness; (2) practices for managing care for elderly people with chronic conditions; and (3) evidence regarding the possible effect of these practices on health status and costs.

GAO found that: (1) to serve their elderly residents, CCRCs GAO examined manage care to meet the needs of both healthy individuals and those who have chronic conditions; (2) they use active strategies to promote health, prevent disease, and detect health problems early by encouraging exercise, proper nutrition, social contacts, immunizations, and periodic medical exams and assessments for all residents; (3) many of these CCRCs also have multidisciplinary teams of nurses, social workers, rehabilitation specialists, physicians, dieticians, or others to plan and manage residents' care; (4) these teams meet periodically to discuss residents' health and functional status, determine whether services are needed, and decide on the types of treatment, services, and supports that will be provided; (5) CCRC staff coordinate a wide range of health and other services, whether provided on or off site, to enhance their benefit to the individual resident; (6) active monitoring of the health and functioning of residents who have chronic conditions, such as arthritis, hypertension, and heart disease, is an integral part of this coordinated, multidisciplinary approach to managing care; (7) many of these CCRCs' practices are considered to be effective in improving the health and functioning of the elderly, although their effect on health care costs is largely undemonstrated; (8) regular medical exams and health assessments, immunizations, and counseling to encourage exercise, proper nutrition, and social interaction are all recommended by experts and the literature as effective health promotion and disease prevention strategies for the elderly; (9) in addition, geriatric experts recommend a coordinated and multidisciplinary approach to manage chronic conditions among the elderly because their care may involve many modes of treatment and disciplines; and (10) while the health benefit of these practices has been demonstrated, little evidence exists to demonstrate health cost savings from either the CCRC package of services or most of the practices individually.

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