What Is Enhanced Care

Understanding Enhanced Care: A Comprehensive Overview

Enhanced care represents a pivotal shift in modern healthcare, focusing on comprehensive, personalized services that cater to individuals with complex needs. This approach encompasses a spectrum of care settings, from assisted living to hospital and community-based management, aiming to improve health outcomes and quality of life.

Distinguishing Enhanced Assisted Living Care

Features of Enhanced Assisted Living

Enhanced Assisted Living Care is designed specifically for seniors with unique health challenges, such as ALS, Parkinson's Disease, or Multiple Sclerosis. It provides:

• Higher staff ratios ensuring personalized care and 24/7 on-call nursing services.
• Comprehensive services like wound care, end-of-life care, and support during meals.
• Private living environments featuring apartments with kitchenettes and full baths, which foster independence.
• Restaurant-style meal service customizable to dietary restrictions.

Difference from Standard Assisted Living and Skilled Nursing

Enhanced Assisted Living differs from standard assisted living by allowing residents who need more care to continue living independently. In contrast to skilled nursing, which typically provides around-the-clock medical care in an institutional setting, enhanced assisted living focuses on personalized services that promote a greater lifestyle and independence. It blends elements of skilled nursing care with the comforts of assisted living:

• Assisted Living: Primarily personal care, with limited medical support.
• Enhanced Assisted Living: Offers tailored medical assistance while supporting daily living activities.
• Skilled Nursing: Continuous medical supervision primarily in a healthcare facility.

Benefits of Enhanced Assisted Living Care

Enhanced assisted living care offers numerous benefits that significantly improve the quality of life for residents. It combines the comforts of home with around-the-clock medical access, catering to individuals with complex health needs, such as dementia or diabetes. Personalized care plans ensure that each resident receives tailored support, promoting independence while assisting with daily living activities. Enhanced cognitive health and social engagement programs help foster a sense of community and reduce feelings of loneliness. Finally, the availability of diverse services and the capability to adapt to changing care needs provide peace of mind for residents and their families.

The Role of Enhanced Care in Hospitals

What is enhanced care in a hospital setting?

Enhanced care in a hospital setting refers to a comprehensive level of supervision tailored for patients who may pose risks to themselves or others. This approach prioritizes patient-centered care, providing safety, respect, and dignity through vigilant observation. Patients may require enhanced care due to various factors, including:

• Risk of falls
• Pulling out medical lines
• Mental health conditions or cognitive impairments

In this framework, registered nurses assess the patient's risk level every 12 hours. Depending on the findings, the monitoring intensity can vary from standard oversight to continuous one-to-one attention. Supportive frameworks such as John's Campaign and the Butterfly Scheme enhance patient involvement and promote family engagement, ensuring a holistic care experience.

Safety and patient supervision

Enhanced care units focus on safeguarding vulnerable patients by assigning additional staff to provide close observation. The staffing model usually includes trained professionals who are experts in managing challenging behaviors linked to:

• Learning disabilities
• Substance withdrawal
• Mental health crises

This strategic approach not only mitigates risks but also fosters a supportive environment where patients can build positive relationships with their caregivers.

Family involvement in hospital settings

Family participation is crucial in enhanced care settings. Involvement helps reassure patients, making their hospital experience more comfortable and personalized. Initiatives like John's Campaign encourage family members to play active roles in the care process, creating an atmosphere of collaboration that contributes to improved outcomes for high-needs patients.

Comprehensive Enhanced Care Management

ECM services and benefits

Enhanced Care Management (ECM) is a pivotal Medi-Cal benefit tailored for individuals with complex health needs. It adopts a holistic approach, combining both clinical and non-clinical support services to improve overall health outcomes. Members enrolled in ECM are assigned a dedicated Lead Care Manager who coordinates care across various providers. This ensures that their physical, behavioral, dental, and social service needs are addressed efficiently.

Through the program, members gain access to essential Community Supports that tackle social determinants of health, from housing assistance to nutrition services. As of Q2 2024, over 244,750 members have benefited from ECM, highlighting its significant impact on California's healthcare landscape.

Implementation of ECM in healthcare

The implementation of ECM began in January 2022 and has rapidly scaled to 25 counties, transitioning more than 70,000 members from existing programs. By fostering cross-provider collaboration, ECM facilitates a streamlined healthcare experience, reducing the likelihood of avoidable hospitalizations. Enhanced access to healthcare services is expected to further improve following upcoming policy changes in January 2025, designed to simplify the enrollment process.

Role of care managers and interdisciplinary teams

Care managers play a central role in ECM, ensuring that members navigate their healthcare journeys seamlessly. These dedicated professionals form interdisciplinary teams that include doctors, nurses, and community health workers, crafting personalized care plans that reflect each member’s unique needs. This collaborative effort enables a robust support system, enhancing care coordination and promoting better health outcomes for those most in need.

Eligibility and Cost of Enhanced Care Programs

Eligibility for Enhanced Care Management (ECM)

Eligibility for the Enhanced Care Management (ECM) program primarily focuses on members enrolled in Medi-Cal with complex health and social needs. Key criteria include:

• Homelessness: Individuals experiencing unstable housing situations.
• Frequent Hospital Visits: High utilization of healthcare services.
• Mental Health/Substance Use Issues: Patients requiring support in these areas.
• Chronic Health Conditions: Such as diabetes, hypertension, or serious mental illness.

Individuals are assessed through a multidisciplinary approach to determine their specific needs and appropriateness for ECM services.

Cost Implications for Members

There are no out-of-pocket costs associated with ECM services, making it an accessible option for eligible individuals. The program covers a comprehensive range of services including:

• Care Coordination: Managing appointments and referrals.
• Social Services: Connecting members with resources like food and housing assistance.
• Health Support: Includes physical, behavioral, and dental services.

This approach ensures members receive holistic support without financial barriers, promoting overall well-being and health outcomes.

Enhanced Care Programs: Purpose and Impact

Objective of enhanced care across settings

Enhanced Care Programs aim to provide tailored support for individuals with unique and complex medical needs. This includes seniors with conditions such as ALS, Parkinson's Disease, and Multiple Sclerosis. Enhanced Assisted Living Care not only offers higher staff-to-resident ratios for personalized attention but also ensures access to on-call nursing services 24/7. The focus is on fostering independence while delivering necessary medical attention in comfortable environments.

Impact on patient outcomes and healthcare efficiency

The implementation of Enhanced Care Management (ECM) directly contributes to better health outcomes by coordinating care services that address both clinical and non-clinical needs. For instance, ECM’s comprehensive approach includes personalized care plans, managing medications, and connecting members to vital resources, helping individuals maintain their health and reduce hospital readmissions.

Coordination and collaboration in enhanced care

Collaboration among a multidisciplinary team is crucial in Enhanced Care Programs. Lead Care Managers coordinate between various healthcare providers, ensuring seamless transitions and support for patients. This structured communication model not only aids in the effective management of ongoing health challenges but also enhances the overall healthcare experience for patients, resulting in more effective care pathways and improved quality of life.

The Future of Healthcare with Enhanced Care

The integration of enhanced care across various settings marks a transformative phase in healthcare, designed to meet the intricate needs of diverse populations. By prioritizing individualized care, coordination among healthcare providers, and innovative management strategies, enhanced care not only aims to improve patient outcomes but also to foster sustainability and efficiency within the wider health ecosystem. As the demands of healthcare continue to evolve, enhanced care will undoubtedly play an integral role in shaping an accessible, comprehensive, and compassionate future for patients and caregivers alike.

References

• Enhanced Assisted Living Care - Brightview Senior Living
• Enhanced Assisted Living Care: The Alternative to Skilled Nursing?
• What Is Enhanced Care Management (ECM)? - L.A. Care Health Plan
• Enhanced Care PPO - ECP Plan - UAW Retiree Medical Benefits Trust
• Enhanced Care Management - Saban Community Clinic
• Enhanced Care and Coordination Providers Information - CMS
• [PDF] Enhanced Care – what does it mean for me?
• Enhanced Care Management | Medi-Cal Transformation - CalAIM