title: Enhanced registered nurse care coordination with sensor technology: Impact on length of stay and cost in aging in place housing.
abstract: BACKGROUND
  When planning the Aging in Place Initiative at TigerPlace, it was envisioned that advances in technology research had the potential to enable early intervention in health changes that could assist in proactive management of health for older adults and potentially reduce costs.
  
  
  OBJECTIVE
  The purpose of this study was to compare length of stay (LOS) of residents living with environmentally embedded sensor systems since the development and implementation of automated health alerts at TigerPlace to LOS of those who are not living with sensor systems. Estimate potential savings of living with sensor systems.
  
  
  METHODS
  LOS for residents living with and without sensors was measured over a span of 4.8 years since the implementation of sensor-generated health alerts. The group living with sensors (n = 52) had an average LOS of 1,557 days (4.3 years); the comparison group without sensors (n = 81) was 936 days (2.6 years); p = .0006. Groups were comparable based on admission age, gender, number of chronic illnesses, SF12 physical health, SF12 mental health, Geriatric Depression Scale (GDS), activities of daily living, independent activities of daily living, and mini-mental status examination scores. Both groups, all residents living at TigerPlace since the implementation of health alerts, receive registered nurse (RN) care coordination as the standard of care.
  
  
  CONCLUSIONS
  Results indicate that residents living with sensors were able to reside at TigerPlace 1.7 years longer than residents living without sensors, suggesting that proactive use of health alerts facilitates successful aging in place. Health alerts, generated by automated algorithms interpreting environmentally embedded sensor data, may enable care coordinators to assess and intervene on health status changes earlier than is possible in the absence of sensor-generated alerts. Comparison of LOS without sensors TigerPlace (2.6 years) with the national median in residential senior housing (1.8 years) may be attributable to the RN care coordination model at TigerPlace. Cost estimates comparing cost of living at TigerPlace with the sensor technology vs. nursing home reveal potential saving of about $30,000 per person. Potential cost savings to Medicaid funded nursing home (assuming the technology and care coordination were reimbursed) are estimated to be about $87,000 per person.
  
  
  CONCLUSIONS
  Early alerts for potential health problems appear to enhance the current RN care coordination care delivery model at TigerPlace, increasing LOS for those living with sensors to nearly twice that of those who did not. Sensor technology with care coordination has cost saving potential for consumers and Medicaid.
authors.affiliation: Sinclair School of Nursing and Family and Community Medicine, University of Missouri, Columbia, MO. Electronic address: rantzm@missouri.edu.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Rantz
authors.affiliation: Sinclair School of Nursing, University of Missouri, Columbia, MO.
authors.forename: Kari
authors.initials: K
authors.lastname: Lane
authors.affiliation: Sinclair School of Nursing, University of Missouri, Columbia, MO.
authors.forename: Lorraine J
authors.initials: LJ
authors.lastname: Phillips
authors.affiliation: Sinclair School of Nursing, University of Missouri, Columbia, MO.
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Despins
authors.affiliation: School of Social Work, University of Missouri, Columbia, MO.
authors.forename: Colleen
authors.initials: C
authors.lastname: Galambos
authors.affiliation: Sinclair School of Nursing, University of Missouri, Columbia, MO.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Alexander
authors.affiliation: Department of Family & Community Medicine, School of Medicine, University of Missouri, Columbia, MO.
authors.forename: Richelle J
authors.initials: RJ
authors.lastname: Koopman
authors.affiliation: Health Management and Informatics, School of Medicine, University of Missouri, Columbia, MO.
authors.forename: Lanis
authors.initials: L
authors.lastname: Hicks
authors.affiliation: Electrical and Computer Engineering, University of Missouri, Columbia, MO.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Skubic
authors.affiliation: Sinclair School of Nursing, University of Missouri, Columbia, MO.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Miller
mesh_terms: D000203:Activities of Daily Living; D000369:Aged, 80 and over; D017046:Cost Savings; D005260:Female; D005851:Geriatric Nursing; D006707:Homes for the Aged / Q000191:economics*; D006801:Humans; D057187:Independent Living; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008923:Missouri; D018670:Monitoring, Ambulatory / Q000379:methods*; D012189:Retrospective Studies; D012866:Skilled Nursing Facilities / Q000191:economics; D055817:Telenursing / Q000191:economics* / Q000295:instrumentation*
keywords: Aging in place; Elders; In-home sensor technology; Length of stay; RN care coordination; Senior housing