CCRCs Encourage Exercise, Proper Nutrition, and Social Involvement

Many of the CCRCs we visited promote good health for their residents by encouraging exercise, proper nutrition, and social involvement. They also said that the physical layout of CCRCs fosters social interaction and is an integral part of the CCRC model. These activities are carried out by nurses, social workers and physicians who may be either affiliated with or independent of the CCRC. Most of the CCRCs we visited encourage early detection of health problems through periodic medical exams and other health assessments. CCRCs Use a Multidisciplinary, Coordinated Approach to Manage Chronic Conditions

CCRCs we visited use a multidisciplinary, coordinated approach to manage care for their residents with chronic conditions such as hypertension and heart disease. Essential elements of this approach include a wide range of on-site services, coordination of services to ensure residents receive them in an appropriate and timely manner, and active monitoring of residents with chronic conditions. CCRC staff coordinate various services provided by both CCRC staff and other providers whether on site or off. Teams meet regularly to reassess needs and services. CCRC Practices May Provide Health Benefits but Effect on Costs Is Largely Undemonstrated

Many of the practices we identified in CCRCs for health promotion, disease prevention, and early detection of health problems are credited by experts and the literature with reducing the risk of disease and disability and improving health and functioning among the elderly. Education and counseling to encourage exercise and proper nutrition are also recommended. Experts told us that because care for older people with chronic conditions may involve many modes of treatment and disciplines, it needs to be organized, coordinated, and managed. While evidence exists for the effectiveness of many of the practices we found in these CCRCs, their effect on health care costs and use of health services has not been conclusively demonstrated. Scope and Methodology

We focused our work on practices that 11 continuing care retirement communities (CCRCs) use to maintain or improve the health and functioning of their elderly residents and to manage the use of health and other services by residents with chronic conditions. To address our study objectives, we (1) visited 11 CCRCs to examine care management practices, (2) reviewed the literature on CCRCs and on health and cost effects of CCRCs’ practices, and (3) interviewed experts on CCRCs and geriatric medicine as well as officials from HCFA’s Office of Managed Care.
Why GAO Did This Study

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.

What GAO Found

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.