1. Shalo, Sibyl


Helping the elderly to 'age in place.'


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In a 2007 telephone survey on attitudes toward "aging in place," researchers at Prince Market Research asked 402 community-dwelling adults over 65 years of age what they feared most as they aged. The two most frequent responses were losing independence (26%) and moving to a nursing home (13%). Only 3% responded that they were more afraid of death. So it's fair to say that, given the choice, most older adults would prefer living in their own homes than in a nursing home. Thanks to Eileen Sullivan-Marx, PhD, RN, CRNP, FAAN-and a team of primary care NPs, home care nurses, physicians, and therapists-a growing number of older Philadelphians are doing just that, and they're thriving.

Figure. Edge Runners... - Click to enlarge in new windowFigure.

As the Shearer Endowed Term Chair in Healthy Community Practice and associate dean for Practice and Community Affairs at the University of Pennsylvania School of Nursing, Sullivan-Marx has spent her career working to improve the lives of older adults. In 1980, after eight years in hospital and community nursing, she became a primary care NP. Over the next 20 years, she launched several geriatric NP practices that still operate.


One of her most celebrated achievements is her development and direction of the Living Independently for Elders (LIFE) Center, which is owned and operated by the University of Pennsylvania School of Nursing. One of approximately 50 Program of All-Inclusive Care for the Elderly-or PACE-programs around the country, it allows frail inner-city older adults to live in their communities instead of nursing homes. Although it operates as both a capitated Medicare Advantage Plan and a comprehensive health plan, the LIFE Center doesn't care only for members' medical needs. It also offers physical, art, and music therapy; meals; recreational activities; respite and home care; and personal services such as laundry and hair care. The LIFE Center even provides members with transportation.


Sullivan-Marx describes the LIFE Center as "a laboratory for us to understand better how to deliver the best care and a classroom for students." She says that the university and the center have a symbiotic relationship, combining education and service to the community. "And our university supports us 200% in this effort," she adds.


In 2006 the American Academy of Nursing (AAN) named Sullivan-Marx an "Edge Runner," recognizing the LIFE Center's embodiment of the AAN's slogan, "innovative experiments become permanent solutions." In its 2006 Edge Runners publication, the AAN described the center as "impressive in terms of both quality of care and fiscal performance: last year, the program saved the Pennsylvania Department of Public Welfare 15% to 20% in Medicaid reimbursement costs." Edge Runners is part of the AAN's "Raise the Voice" campaign, which aims to increase public awareness of nursing and its focus on patients, families and communities.


Wayne Pendleton, LIFE's executive director, says, "Eileen understands the day-to-day challenges of operating a health care entity that is also a managed health organization and the risks to an academic institution sponsoring such an organization. She knows what it takes to deliver quality care, efficiently and cost-effectively."


Pendleton supports that praise with Medicare-mandated data about falls resulting in fractures or hospitalization at the LIFE Center. The target is 0.8 falls per 100 member months, and the LIFE Center is at 0.5. The numbers are equally impressive for other quality measures such as skin integrity, use of ED and home health care services, member satisfaction, and use of antipsychotics.


Pendleton says that the LIFE Center is poised to grow to serve 500 or more eligible older adults in West and South Philadelphia. In the meantime, current members enjoy the benefits of round-the-clock care and the dignity that comes with maintaining their independence.


Sibyl Shalo