BOX 2-5

Case Study: Living Independently for Elders (LIFE)

Nurses Supporting Older Adults to Stay in the Community

In 2002, when Lillie Mashore was in her late 50s, she was diagnosed with multiple sclerosis. Just a year later her diabetes was so severe she had to be placed in intensive care. Too ill in December 2003 to return to the West Philadelphia home she shared with her husband, who had cancer, she entered a nursing home. She was greeted there with the words, “You’re going to leave here in a body bag.”

But Ms. Mashore defied that prediction. In April 2005 she went home and spent the last year of her husband’s life with him. With the support of the Living Independently for Elders (LIFE) program, she is still at home, receiving help twice a day from visiting nurses and aides and attending LIFE’s adult day care center 3 days a week.

“I’m limited to certain things,” Ms. Mashore, now age 66, said of her recovered independence. “But I can wash dishes. I didn’t think I could do that. I was so proud when I washed those dishes.”

Ms. Mashore is one of the nearly 700 elderly Philadelphians eligible for nursing home admission who have stayed in their homes with the help of LIFE—a program that provides all primary and specialty care services to low-income, frail, chronically ill older adults (age 55 or older). About 95 percent of members are African American. Nurse practitioner–led teams include nurses, physicians, social workers, physical and occupational therapists, dieticians, nurses’ aides, and drivers.

Although home care is available for LIFE members like Ms. Mashore who need help managing household tasks or medications, it is not the primary focus. Many services are provided at the LIFE adult day care center, and groups take outings, such as to Phillies baseball games or a nearby Dave and Buster’s restaurant. (Roughly 20 bed-bound members receive all LIFE services at home.) Also available are respite care for family caregivers, transportation to the center, and a “circle of care” for people with dementia. About 185 members are at the center each day.

The nurses are picking up subtle signs that could lead to deteriorating health—a slight fever or fluid retention—and because they’re seeing the patient two or three times a week, they act on it quickly and prevent a further problem.

—Eileen M. Sullivan-Marx, PhD, FAAN, RN, associate dean for practice and community affairs, University of Pennsylvania School of Nursing

As for outcomes, LIFE keeps nearly 90 percent of its members out of nursing homes, according to unpublished data. LIFE also reports reduced rates of falls, pressure

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