2013 Powerpoint Template - Blue - Benjamin Rose Institute on Aging

Statewide Implementation of BRI Care
Consultation by Six Ohio Alzheimer’s
Association Chapters
David Bass, PhD
Salli Bollin, LISW
Cheryl Kanetsky, LSW, MBA
Jennifer Miller, LSW
Branka Primetica, MSW
Marty Williman, RN, BSN
2016 Aging in America
ASA Conference, Washington, D.C.
Introduction to BRI Care Consultation
and Evidence-Based History
David Bass, PhD
2016 Aging in America
ASA Conference, Washington, D.C.
BRI Care Consultation
 A telephone-based information and support
service for adults with physical and mental health
challenges and their family caregivers
 Personalized coaching and advice to help
clients manage their own care situations
 Offers ongoing support and
assistance throughout the
caregiving journey
History
1.
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3.
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6.
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8.
9.
Cleveland Alzheimer’s Managed Care Demonstration, 1997-2001
Chronic Care Networks for Alzheimer’s Disease, 1998-2004
Integrated Care Management, 2005-2007
Wellness Network for Older Adults with Depression and Their Caregivers,
2006-2009
Partners in Dementia Care for Veterans and their Family Caregivers, 20062011
BRI Care Consultation in Cleveland, Ohio, 2009-2011
BRI Care Consultation in Tennessee, 2009-2012
BRI Care Consultation in Georgia Area Agencies on Aging, 2010-2013
Ohio Replication of Partners in Dementia Care,
2011-2015
What problems prompted creation of
BRI Care Consultation
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Fragmentation among services
Mismatch between professionals’ and consumers’ readiness
Lack of attention to caregivers
Difficulty with follow-through by consumers
Lack of coordination between formal and informal care
Care situation change, but services are static and short-term
Too much assessment; too few solutions
Lack of attention to planning and prevention
How does BRI Care Consultation
address these problems?
 Evidence-based method of coordinating healthcare and
community services
 Personalized coaching by telephone and computer
 Targets persons with health problems and their caregivers
 Linkages to and monitoring of services
 Facilitates involvement of family and friends
 Ongoing support throughout the “caregiving journey”
BRI Care Consultation Program
Description and Evidence-Based
Components
Branka Primetica, MSW
2016 Aging in America
ASA Conference, Washington, D.C.
Credit: Roz Chast, New Yorker Cartoonist
Four Types of Assistance
 Health- and Care-Related Information
 Empowers clients to manage their own situations
 Family and Friend Involvement in Care
 Supports and strengthens the informal network
 Awareness and Use of Community Services
 Helps clients learn about formal services
 Coaching and Support
 Coaches caregiver and provides
emotional support
Benefits
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Improved Care
Reduced Hospital Admissions
Delayed Nursing Home Placement
Fewer Emergency Department Visits
Decreased Symptoms of Caregiver Depression and Strain
Reduced Caregiver Stress and Burnout
Reduced Relationship Strain
Decreased Embarrassment and Isolation
Improved Access to Information
Key Components
Initial
Assessment
Action Plan
Maintenance
and Support
Advantages of Web-Based CCIS
 Guides the three evidence-based components of the program
 24/7 access to the CCIS from any location (in office/off-site)
 Improved design, user friendly layout, and functions:
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Improved accessing and processing speed
A “Dashboard” puts all the upcoming tasks in a convenient location
Easy to accommodate changes in who is the “primary caregiver”
Calendar with more detail and sorting capacity
Tools to modify logos, service and referral lists, drop-down menu items
Ability to transfer selected client data into the CCIS
Customizable organization-specific data elements
PLUS several other new features!
Easy ability to update and upgrade CCIS
Care Consultation Information System
(CCIS) Case Demonstration
Jennifer Miller, LSW
2016 Aging in America
ASA Conference, Washington, D.C.
CCIS Case Demo Summary
Case Scenario:
 Sophie is diagnosed with Mild Cognitive Impairment at
age 70; diagnosed with Alzheimer's disease by a
neurologist at age 73
 Annie, her daughter, is the primary caregiver for
purposes of BRI Care Consultation
 Sophie lives with her husband, Bob, who is the primary
caregiver for her care
 Bob continues to work full-time
 There are 4 adult children involved as secondary caregivers, as
well as in-laws
BRI Care Consultation – why the program became a
lifeline for this family
Areas of Concern:
 Safety, supervision of Sophie, responding to medical
changes, family communication, caregiver self-care
CCIS Case Demo
Care Consultation Information System
(CCIS) Descriptive Results
Branka Primetica, MSW
2016 Aging in America
ASA Conference, Washington, D.C.
CCIS Descriptive Data
CCIS data abstraction from six Ohio Alzheimer’s
Association Chapters about 1-1.5 years after
implementation:
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Demographic Characteristics
Contact Types
Initial Assessment Domains
Action Steps
Note: There were 39 Ohio Chapter Care Consultants/Supervisors who were
trained in delivering the program, including use of the CCIS, up until the
time of the data abstraction,
CCIS Descriptive Data
Purpose:
 To identify how clients used BRI Care
Consultation
 In addition, to begin identifying how the service
utilization elements (CCIS data) affect the longterm success of BRI Care Consultation
implementation
Demographic Characteristics
Gender
Caregiver
(n=681)
%
Male
Female
27.7%
72.3%
42.2%
57.8%
%
%
13%
23.8%
28.5%
24.3%
13.5%
2.0%
1.0%
2.5%
8.6%
35.0%
42.9%
10.0%
Age
< 50
50 - 59
60 - 69
70-79
80 - 89
90 or Older
Care Receiver
(n=686)
%
Demographic Characteristics
Race
White
African-American or Black
Other
Education
<12th Grade
High School Degree
Vocational/Associates/Some College
Bachelor’s Degree
Master’s Degree
Doctoral/MD/JD
Veteran Status
Veteran
Not a Veteran
Caregiver
(n=681)
%
83.0%
15.2%
1.8%
%
4.2%
26.8%
29.7%
25.3%
11.6%
2.4%
%
10.7%
89.3%
Care Receiver
(n=686)
%
82.1%
16.0%
1.9%
%
13.2%
42.7%
19.4%
18.7%
3.6%
2.3%
%
27.7%
72.3%
Demographic Characteristics
Care Receiver Relationship to Caregiver (n=686)
Mother
Husband
Wife
Father
Sister
Brother
%
32.0%
28.3%
16.7%
9.0%
3.0%
1.0%
Other
%
13.0%
Demographic Characteristics
Caregiver Relationship to Care Receiver (n=681)
Daughter
Wife
Husband
Son
Sister
Brother
Other
%
32.3%
16.7%
28.3%
9.2%
3.0%
1.0%
%
7.1%
Contact Types
Contact Types (n=512)
Phone w/ Contact
Regular Mail
In-Person Meeting
E-Mail
Fax
Total
* There
Mean
% of Contacts
5.1
1.1
.6
.5
.0
7.6
68.3%
15.5%
8.6%
7.3%
.4%
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were an additional 1,292 attempted phone contacts
Care Receiver Initial Assessment
Top Five Problems Triggered for Care Receivers during
Initial Assessment (n=512)
Memory Problems and Difficult Behaviors
Arranging Services
Anxiety
Dyadic Relationship Strain
Financial Concerns
%
43.5%
34.1%
33.5%
23.4%
22.6%
Caregiver Initial Assessment
Top Five Problems Triggered for Caregivers during
Initial Assessment (n=512)
Arranging Services
Emotional/Physical Health Strain
Capacity to Provide Care
Dyadic Relationship Strain
Anxiety
%
39.5%
36.9%
35.8%
29.7%
29.1%
Action Steps
Action Step Description (n=512)
Mean
Total Action Steps
6.3
% Cases with No
Action Steps
5.7%
Action Steps
Action Steps by Person Responsible Completing Action Step
Action Steps
(n=3,220)*
Care Receiver
Primary CG
Care Consultant
Other Support
%
1.8%
84.6%
9.4%
4.2%
Ohio Council and Alzheimer’s
Association Chapter Implementation
Marty Williman, RN, BSN
Salli Bollin, LISW
2016 Aging in America
ASA Conference, Washington, D.C.
Application in Ohio
 National
Alzheimer’s
Project Act
 Dementia
Capable Ohio
Grant
National Alzheimer’s Project Act
Focus Areas:
 Research
 Services
 Quality
 https://aspe.hhs.gov/national-alzheimersproject-act
Services and Quality
 Examining Models of Dementia Care
 Care Coordination for People with Alzheimer’s
Disease and Related Dementias
 https://aspe.hhs.gov/report/care-coordinationpeople-alzheimers-disease-and-relateddementias
Dementia Capable Ohio
 By the year 2025, 25% increase of Ohioans with
Alzheimer’s disease
 69% of nursing home residents have some degree of
cognitive impairment
 51% of these individuals rely on Medicaid for care
 28% of individuals dis-enrolled from ODA administered
waivers had dx of dementia
 Delay of institutionalization stay by one month, potential
savings is ~ $6.5 M
 Delay of hospitalizations and ER visits
A Dementia Capable System
Model dementia-capable Aging Network and LTSS
(Long-term Services and Supports) are able to
address the unique needs:
 of persons with dementia who are losing their ability to
communicate and take care of themselves
 their family caregivers who take on progressively more
responsibility for managing and coping with the needs of
their loved ones
A Dementia Capable System
When persons with dementia
or a family caregiver use the
aging network or the LTSS
system, they need
information and programs
tailored to their unique
needs.
(“Making the LTSS Work for People with Dementia and
the Caregivers” issue brief, p. 5)
Dementia Capable Focus in Ohio
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Training and Education
Community Education and Awareness
Evidence-Based Programs
Quality Assurance
Evidence-Based Programs
Goals:
 Examine and expand evidence-based programs,
which can help maintain independence and reduce
early institutionalization for families impacted by
Alzheimer’s disease and related dementias
 Pilot an evidenced-based, high impact program in
Ohio statewide
Alzheimer’s Association Chapter
Administrative & Organizational
Strategies
Cheryl Kanetsky, LSW, MBA
2016 Aging in America
ASA Conference, Washington, D.C.
Adopting the Program
Cleveland Chapter’s Path to Service Delivery
 Mapping program within current service mix
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Where it fits
How it fits
Other Ohio Chapter’s Path to Service Delivery
 Service mapping
 Flexibility & finding the common
denominator
Promoting the Program
 Branding Considerations
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Naming the program
Fliers/advertisements
Correspondence letters
Business cards with pictures
Promoting the Program
 Challenges
 Staff and others understanding the program to
refer to it
 Phone-based – not meeting face-to-face
 Caregivers reluctant for help/too overwhelmed
for help
Promoting the Program
 Lessons Learned
 Shift in how we talk about the program
 Creating face-to-face opportunities
 Ongoing marketing plan
Evaluation Results from the Ohio
Chapter BRI Care Consultation
Implementation
David Bass, PhD
2016 Aging in America
ASA Conference, Washington, D.C.
Chapter Staff Survey
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Understand all staffs’ experiences & perceptions
Some questions only for Care Consultants
Surveyed twice: 3 and 9 months after beginning
125 sent 3-month survey; 87 sent 9-month survey
• 89 (71.2%) completed 3 month survey
• 57 (65.5% completed 3 and 9 month survey
Questions and Benchmark Goals
 Familiarity & knowledge (all staff)
 Benchmark – 70% ‘complete information’
 Perceptions of impact on outcomes (all staff)
 Benchmark – 70% ‘at least agree’ to positive impact
 Challenges to the success (all staff)
 Benchmark – less than 50% ‘even a minor problem’
 Experiences delivering (Care Consultants only)
 Benchmark – 75% ‘complete information’
 Benchmark – 85% ‘satisfied or very satisfied’
Benchmark Reached
Familiarity & Knowledge
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Program purpose
Program software
Interface with other Chapter services
Knowing families who are appropriate
Referral procedures
Knowing how Program helps
Benchmark Exceeded
Positive Impact on Outcomes
 Strengthen family support
 Increase family community-resource knowledge
 Reduce caregiver depression
Benchmark Reached
Positive Impact on Outcomes
 Improve quality Chapter services
 Improve caregiver satisfaction with Chapter
services
 Increase family use of community services
 Adds to types of services Chapter offers
Below Benchmark
Low Impact on Outcomes
Improve person-with-dementia satisfaction with
Chapter services
 Reduce person-with-dementia depression
 Reduce person-with-dementia hospital, ED, and
nursing home use
Benchmark Reached
Implementation Challenges Successfully Met
 Chapter leadership support
 Deciding which families are appropriate
 Describing Program to families and
professionals
Below Benchmark
Ongoing Challenges for Implementation
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Getting enough referrals
Marketing to families and professionals
Enough staff time devoted to the Program
Continued Program funding
Benchmark Exceeded or Reached
Experiences Delivering BRI Care Consultation
Overall Program quality
Quality of relationships with families
Quality of training, manuals, & support by BRI
Computer resources at Chapter
Using clinical components of software –
(assessment, action plan, ongoing monitoring)
 Working with caregivers by telephone and computer
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Below Benchmark
Experiences Delivering BRI Care Consultation
 Adding educational materials to the resources
 Using reporting features of software
 When and how to disenroll families
Please contact the Benjamin Rose Institute on Aging
for More Information on How to Become a Licensed
BRI Care Consultation Site:
bprimetica@benrose.org
216.373.1662
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