Frail Elders Project


In 2012, a small group of primary care practitioners began to discuss ways primary care practitioners in Vermont could better serve our most vulnerable seniors.  The Frail Elders Project grew out of those conversations.  Diverse practitioners from across the state, as well as state policy makers and subject matter experts all contributed.  The Project Team now offers recommendations for retooling primary care in Vermont in ways that will improve the health and security of our seniors. The Project has had funding from the Vermont Health Care Improvement Project between November 2015 and June 2016. Earlier support was generously offered by the Physicians Foundation of Cambridge, MA and Vermont’s Green Mountain Care Board.

The Project’s research and recommendations focus on seniors, but contains relevant improvements that could improve health care for most Vermonters. The recommendations are based on five complementary research arms designed to highlight the priorities of seniors themselves regarding their health and the quality of life. The Project Team chose to focus on frail and high risk seniors knowing: 1) care could be better; 2) improvements could potentially effect multiple practice and community services; and 3) recommendations could be generalized to other patients and communities. The Project Team purposely did not choose to focus on a  single or specific cluster of diagnoses. They wanted a broader impact. They wanted to foster a rethinking of primary care. They wanted to create a reform paradigm in which payment innovation serves practice innovation; with things that matter to patients as the paramount driver of reform.

Nine themes are remarkably consistent across all project findings:

  1. There are mismatches between what gets paid for and what’s important to seniors;
  2. Today’s payment policies create significant inefficiencies and harm Vermont’s seniors;
  3. Personal finances matter; many seniors get caught “in the middle” between eligibility for public support and sufficient personal resources;
  4. Physical health matters to seniors, but remaining at home, retaining autonomy, social engagement and feeling useful and valued matter at least as much;
  5. Care should go to patients rather than patients having to come to care;
  6. Control over health care budgets needs more community level influence;
  7. Primary care is in critical condition, and we all need to rethink how to support it;
  8. There are proven examples of how to do it better; and
  9. There is a lot that can be done right now!

Five sets of research findings guided the Project Team’s recommendations:

  1. A literature search in partnership with the University of Vermont Dana Medical Library;
  2. Key informant interviews with medical providers and community service practitioners in two rural primary care service areas;
  3. Key informant interviews with state policy and subject matter experts;
  4. Structured interviews with frail elders and their caregivers including home bound individuals; using both individual interviews and focus groups; and,  
  5. Comparative analyses of the Vermont Household Survey and the Medicare Current Beneficiary Survey.

Recommendations are based on the key findings from the five research arms. There is no existing system of care exactly like the proposed model; however, every component exists elsewhere, and most have been rigorously evaluated by independent qualified experts.  Taken together, the Recommendations outline a new model of care that is driven by the priorities identified by the seniors in our communities. 

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