Transcript Managing Work and Care

CareAware Options for
Social Workers
Engaging and Supporting
Family Caregivers
for Optimal Client Outcomes
www.cicoa.org
Introductions
Kate Kunk, RN, CIRS-A
Lindsie Hammans, LSW, CIRS-A
(317) 254-3660
CICOA Aging & In-Home Solutions
Area Agency 8
www.cicoa.org
Introductions, continued…
You are:
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Fellow alumnus
Social worker/Colleague/Employee
Family member
Caregiver
Bystander, neighbor, fellow club member…
Taxpayer
Today’s message has broad application—
not only professionally, but socially as well
www.cicoa.org
Who’s a caregiver?
…some of your clients have caregivers,
and some of the family members of
your colleagues
your neighbors/friends
(and perhaps even you)
have caregiving responsibilities.
Caregiving happens regardless of where
we are in our lives.
In fact, most of us here today will be
caregivers in our lifetime.
www.cicoa.org
For our purposes today,
“caregiving” is...
…the providing of direct
(unpaid) assistance to a
loved one who has
a diminished ability or the
inability to successfully
perform tasks that he/she
normally would be expected
to perform independently.
www.cicoa.org
Key learning objectives
1. Identify the extreme social and economic
contributions of engaged family caregivers and
the necessary caregiver supports to ensure best
client outcomes.
2. Define the successful community-based care
team as a composite that includes family
caregivers and other lesser-considered entities.
3. Articulate barriers to caregiver engagement on
the team, as well as the opportunities for
overcoming these barriers.
www.cicoa.org
Benefits are Far-Reaching
INCREASED ENGAGEMENT
INCREASED PUBLIC AWARENESS + ACCESS TO “SOLUTIONS”
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REDUCTIONS
Caregiver stress + secondary conditions
Risks for abuse and/or neglect
Preventable injuries in the home
9-1-1 emergencies + NON-emergency calls
Hospital readmissions
Unnecessary + premature nursing home admissions
IMPROVED
QUALITY OF LIFE FOR ALL HOOSIERS, e.g. YOURSELF!
www.cicoa.org
Caregiving affects a lot of
people…everyone, in fact.
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Caregivers
Care recipients
Employers
Coworkers of caregivers
Taxpayers
All of society
are dramatically affected.
www.cicoa.org
Facts About Caregiving
• There are about
family
caregivers in the U.S. (29% of the
population, 31% of all households)1
• Family caregivers taking care of an elderly
person contribute an estimated
to the U.S. economy annually in
uncompensated time and services.2
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National Alliance for Caregiving, http://www.caregiving.org updated Nov, 2012
Chari, A.V. et al: “The Opportunity Costs of Informal Elder-Care in the United States: New Estimates
from the American Time Use Survey.” Rand Corporation: Health Services Research, Oct 2014.
http://www.rand.org/pubs/external_publications/EP66196.html.
www.cicoa.org
Family caregivers
…are a critical extension of
our formal healthcare system.
“Caregiving in the U.S.: Executive Summary,” National Alliance for Caregiving in Collaboration
with AARP. http://www.caregiving.org/data/CaregivingUSAllAgesExecSum.pdf Nov 2009
www.cicoa.org
For every person living
in a nursing home…
…there are at least two persons
with equivalent levels of disability
living in the community.
“Business, Caregiving and the Bottom Line,” National Caregivers Library. www.caregiverslibrary.org
Jun 2009.
www.cicoa.org
The Urgency of Encouraging and
Supporting Community-Based Care
 Average cost of nursing home care
per month in Indiana is currently:
$5,500
 Average cost per year, per person:
$66,000
(Most people entering a nursing home for
an extended period will eventually require
Medicaid for payment. Many of these people
would prefer, and be eligible for, communitybased care so that they can age in place.)
www.cicoa.org
America’s changing demographics
In 2009, the number of persons age 65+ years
in the U.S. was 39.6 million.
Very soon (by 2030), that number will nearly
double, to 72.1 million.1
Many of these will prefer to age in place, and
we need to make it possible for them to do so
by preventing injury and premature and
unnecessary nursing home admissions.
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SOURCE: Administration on Aging, Dept of Health & Human Services retrieved
from http://www.aoa.acl.gov/Aging_Statistics/index.aspx March 2014
www.cicoa.org
The first bottom line
This is not only an individual concern.
It is not only an individual and family concern.
It is an individual, family,
community, state,
and national crisis.
And it is in ALL our best interests to engage
family caregivers and provide them with the
support they need.
www.cicoa.org
The other bottom line
The question is not so much, “How can we
engage our clients’ family caregivers in
order to obtain their support?”
...but rather, “How can we support our
family caregivers in such a way that they
are empowered to be consistently engaged
for the duration of the journey”
(without turning them into the next
generation of care recipients)?
www.cicoa.org
Barriers to caregiver engagement
 Overwhelmed with the concept of caregiving in light of
other life responsibilities
 Stress of family dynamics / personalities
 Caregiver’s denial of seriousness of the situation (or
unwillingness, or deliberate failure to be involved)
 Caregiver’s lack of confidence
Incomplete information on hospital discharge
Assignment of tasks by medical team without training
Frustration in navigating medical system
Care recipient’s resistance to care
 Care recipient’s limited ability / insight to articulate needs
 Logistics (distance from care recipient, etc.)
 Financial issues
www.cicoa.org
Barriers to caregiver engagement
 Caregiver’s own personal health*
*Over half (53%) of caregivers indicate that their
decline in health since becoming a caregiver
compromises their ability to provide
care...impacting quality of life.
“Evercare® Study of Caregivers in Decline,” Evercare® in collaboration with National Alliance for Caregiving.
http://www.caregiving.org/data/Caregivers%20in%20Decline%20Study-FINAL-lowres.pdf Sept 2006
www.cicoa.org
Caregivers Often Experience
Feelings + Issues Of…
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Loss/Sorrow/Grief
Isolation
Exhaustion
Powerlessness
Strained relationships
Resentment
Frustration
Anger
Guilt
creating quite a pool of STRESS!
www.cicoa.org
Caregivers represent
increased risk for…
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Depression
Hypertension
Heart Disease
Diabetes Type II
Stroke
Obesity
Autoimmune disorders (80+)
not to mention their respective
SECONDARY complications…
www.cicoa.org
Stress manifests in many forms
and the symptoms can be…
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Cognitive
Emotional
Physical
Behavioral
www.cicoa.org
Unfortunately, many Hoosiers don’t
know what resources are available
Often, the greatest reducer of caregiver
stress is that of respite—time away from
caregiving!
However, there is a huge deficit of
information for finding help.
www.cicoa.org
Overcoming barriers and
engaging/supporting caregivers
Introducing the
“P-SM-CR”
formula
for developing caregivers who are
strong, healthy, and engaged
www.cicoa.org
The
Formula
P+SM+CR = Successful Caregiving
1. Preventive self-care
2. Stress reduction and management
3. Awareness of (and access to) HELP!
via community resources, e.g. CICOA
www.cicoa.org
Keys for a strong, healthy
and informed caregiver
PREVENTIVE SELF-CARE
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Annual physicals and diagnostics
Fill prescriptions on time—and take them!
Proper eating, rest, and hydration
MD-approved exercise program
Avoid excesses and harmful substances
www.cicoa.org
Keys for a strong, healthy
and informed caregiver
STRESS REDUCTION AND MANAGEMENT
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Deep breathing
Hobbies
Humor!!!
Journaling
Camaraderie (formal & informal)
Ask for help
Accept help when offered
If you are a person of faith, utilize this
www.cicoa.org
Keys for a strong, healthy
and informed caregiver
AWARENESS OF—AND ACCESS TO
HELP!
 Services through the
Local Area Agencies on Aging
 Systems and services
in the community
www.cicoa.org
Programs
and
Services
www.cicoa.org
What is an “Area Agency on Aging”?
The National Association
of Area Agencies on
Aging provide support
services:
 information and referral
 in-home assistance
/services
to facilitate independence
and relieve caregivers.
http://www.eldercare.gov
www.cicoa.org
What is CICOA?
 Indiana’s largest
Area Agency on Aging
 Not-for-profit
 8 Indiana counties
 Founded in 1974
www.cicoa.org
CICOA’s Mission
CICOA Aging & In-Home Solutions
empowers older adults,
those of any age with a disability
and family caregivers
to achieve the greatest possible
independence, dignity and quality of life.
www.cicoa.org
Examples of Services Available
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Case management
Personal care assistance
Adult day service
Adult foster care
Home delivered meals
Transportation services
Medical monitoring system
Medication management system
Home and vehicle modifications
Care transitions
www.cicoa.org
Aging & Disability Resource Center
 Information + referral about almost anything!
(Database of 8,000 + programs and services)
Information + applications RE: public services
Applications for Medicaid “extra help” for copays
Medicare (SHIP) counseling
Free legal clinic
Lists of residential options, elder law attorneys,
food pantries, free clinics
How do I find…where do I go…how do I qualify…
www.cicoa.org
Aging & Disability Resource Center
 Eligibility assessments and
applications for CICOA services!
Personal care
Home-delivered meals
Transportation
Minor home modifications
Caregiver respite
 Family caregiver support,
www.cicoa.org
Family Caregiver Support
 Information and referral for caregivers
 One-on-one counseling
 Workshops for:
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Caregivers
Clinicians
Community leaders
First responders
Fall prevention
Medication safety
Grandparents raising grandchildren
www.cicoa.org
What issues do you encounter in
working with caregivers?
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Impatience? Frustration? Non-compliance?
Denial of the need? Indifference?
Too much “control?”
Long-distance caregivers?
Difficulty communicating?
Finding timely, relevant services?
Limited ability for following instructions?
can help!
www.cicoa.org
Care Transitions Team
 Social workers who work with hospital
personnel to assist with discharge and
client follow-up in the community
 Work with clients in need of services
related to safety, non-medical social
concerns, etc.
 Information sharing with hospitals—and
meeting these needs—can prevent and
reduce re-hospitalizations!
www.cicoa.org
Meals and More
MEALS (for 60+)
 Home-delivered meals for homebound persons
 Neighborhood meal sites (currently 26 sites)
(Nearly 18 MILLION meals served to date)
AND MORE
 Health education
 Farmer’s market vouchers
 Advocacy and awareness
 Elders At the Table
 Indy Hunger Network
www.cicoa.org
Transportation
 Way2Go – Marion County
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Taxi Discount Program
Essential Needs
Wheelchair Transportation
Grocery/Shuttle Service
 New Freedom Vouchers
– Serves persons with disability
– The only service in Central Indiana that
can cross county lines (all 8 counties)
www.cicoa.org
Minor Home Modifications
 Advocate for “elder friendly” and
accessible communities in 8 counties
 Assistance with home modifications
to facilitate the greatest possible
independence and aging in place
 Annual “Safe at Home” day
www.cicoa.org
Minor Home Modifications
Before
After
www.cicoa.org
In-Home Services
and Case Management
 Staff of approximately 60 care
managers (social workers) who visit
clients quarterly to coordinate and
monitor client services that are
provided by external agencies
www.cicoa.org
Funding In-Home Assistance
 Other:
 Private Insurance
 VA Aid and Attendance
 Medicare (short-term only, e.g. for rehab)
 “Money Follows the Person” (a Medicaid source)
 “Prior Authorization” (a Medicaid source)
www.cicoa.org
STATE Funding In-Home Assistance
Through CICOA
Eligibility is determined by:
1. Physical criteria
2. Financial criteria (income + assets)
www.cicoa.org
Physical criteria
3 for Waiver (or a skilled need)
2 for CHOICE
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Cognition
Medication management
Feeding
Toileting tasks
Mobility
Transferring
Dressing
Bathing
www.cicoa.org
Financial criteria
2015
Medicaid A&D Waiver
CHOICE
Total assets: $2000 (single)
(NOT inc. house/car)
Total assets: $500,000
(INC. house/car)
Total income max:
$2,199 per month
Income max:
None
(must use Miller’s Trust if
over the limit)
(client pays a cost share if
income is 151% or more
over the poverty level)
www.cicoa.org
There’s No Place Like Home!
94% of older adults want
to remain independent,
living in their homes and
communities as they age.
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Average monthly cost,
Indiana nursing home care
$5,500 ($66,000/year)
EXAMPLE of savings:
Average monthly cost for
CHOICE-funded care
(in-home) = less than $700
www.cicoa.org
What Can Social Workers Do?
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 Know your own Area Agency on Aging—develop
a good working relationship with them
o Know how to make a referral
o Call us for an in-service presentation!
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 Be a good neighbor, club member, faith affiliate
—share our contact information socially
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 Call your local AAA for information, referral, or
an eligibility assessment for your loved one
(be a proactive caregiver who is strong, healthy,
engaged!)
www.cicoa.org
*Involving an AAA is easy
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1. Obtain a supply of business cards and hand one
to someone who needs us (or to his/her caregiver).
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2. Call the ADRC to refer someone over the phone.
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3. (IF IN AREA “8”)—online:
Go to www.cicoa.org
Services
Aging & Disability Resource Center
 Professonal Intake Form
(Password protected – the password is 4755,
and usually must be entered twice)
www.cicoa.org
When is it appropriate to call…
(800) 992-6978
(317) 254-3660
ADULT
PROTECTIVE
SERVICES
Family & Social Services Admin
__________________________________________________________________
INFORMATION
ONLY
IMMINENT
DANGER
(Ideal for
information needs
unrelated to aging,
disability, and
caregiving.)
(for adults who are
“…physically or
mentally
incapacitated and
reported as abused,
neglected or
exploited.”)
INFORMATION
REFERRAL
TANGIBLE FORMS
OF ASSISTANCE FOR
INDEPENDENCE
(Anyone of any age with
a disability—long term
and duration of need.)
www.cicoa.org
The overall positive impact of
caregiving on American society is profound.
However, we know that no one person
can do it all for another.
It is time to recognize, include, support,
and lead this extremely valuable resource,
for all our mutual benefit.
The sooner we do this, the better.
www.cicoa.org
(317) 254–3660
Independence.
Dignity.
Quality of life.
www.cicoa.org
Q&A and
Discussion
www.cicoa.org