The Gerontologist
 QUICK SEARCH:   [advanced]


This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Yaggy, S. D.
Right arrow Articles by Yarnall, K. S. H.
Right arrow Search for Related Content
Right arrow PubMed Citation
Right arrow Articles by Yaggy, S. D.
Right arrow Articles by Yarnall, K. S. H.
The Gerontologist 46:271-276 (2006)
© 2006 The Gerontological Society of America

Just for Us: An Academic Medical Center–Community Partnership to Maintain the Health of a Frail Low-Income Senior Population

Susan D. Yaggy, MPA1, J. Lloyd Michener, MD1, Duncan Yaggy, PhD2, Mary T. Champagne, RN, PhD3, Mina Silberberg, PhD1, Michelle Lyn, MBA/MHA1, Fred Johnson, MBA1 and Kimberly S. H. Yarnall, MD1

Correspondence: Address correspondence to Susan D. Yaggy, MPA, Chief, Division of Community Health, Department of Community and Family Medicine, Duke University Medical Center, Box 2914, Durham, NC 27710. E-mail: yaggy002{at}

Purpose: To promote health and maintain independence, Just for Us provides financially sustainable, in-home, integrated care to medically fragile, low-income seniors and disabled adults living in subsidized housing. Design and Methods: The program provides primary care, care management, and mental health services delivered in patient's homes by a multidisciplinary, multiagency team. Results: After 2 years of operation, Just for Us is serving nearly 300 individuals in 10 buildings. The program is demonstrating improvement in individual indices of health. Medicaid expenditures for enrollees are shifting from ambulances and hospital services to pharmacy, personal care, and outpatient visits. The program is not breaking even, but it is moving toward that goal. The program's success is based on a partnership involving an academic medical center, a community health center, county social and mental health agencies, and a city housing authority to coordinate and leverage services. Implications: Just for Us is becoming a financially sustainable way of creating a "system within a nonsystem" for low-income elderly persons in clustered housing.

Key Words: Care coordination • In-home care • Subsidized housing • Sustainability

This article has been cited by other articles:

Home page
GerontologistHome page
R. I. Stone and S. C. Reinhard
The Place of Assisted Living in Long-Term Care and Related Service Systems
Gerontologist, December 1, 2007; 47(suppl_1): 23 - 32.
[Abstract] [Full Text] [PDF]

All GSA journals Journals of Gerontology Series A: Biological Sciences and Medical Sciences Journals of Gerontology Series B: Psychological Sciences and Social Sciences
Copyright © 2006 by The Gerontological Society of America.