Statewide Implementation of BRI Care Consultation by Six Ohio Alzheimer s David Bass, PhD Salli Bollin, LISW Cheryl Kanetsky, LSW, MBA Jennifer Miller, LSW Branka Primetica, MSW Marty Williman, RN, BSN Association Chapters 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. Cleveland Alzheimer s Managed Care Demonstration, 1997-2001 2. Chronic Care Networks for Alzheimer s Disease, 1998-2004 3. Integrated Care Management, 2005-2007 4. Wellness Network for Older Adults with Depression and Their Caregivers, 2006-2009 5. Partners in Dementia Care for Veterans and their Family Caregivers, 2006-2011 6. BRI Care Consultation in Cleveland, Ohio, 2009-2011 7. BRI Care Consultation in Tennessee, 2009-2012 8. BRI Care Consultation in Georgia Area Agencies on Aging, 2010-2013 9. Ohio Replication of Partners in Dementia Care, 2011-2015
What problems prompted creation of BRI Care Consultation 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 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: 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: 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 Caregiver (n=681) Care Receiver (n=686) Gender % % Male 27.7% 42.2% Female 72.3% 57.8% Age % % < 50 13% 1.0% 50-59 23.8% 2.5% 60-69 28.5% 8.6% 70-79 24.3% 35.0% 80-89 13.5% 42.9% 90 or Older 2.0% 10.0%
Demographic Characteristics Caregiver (n=681) Care Receiver (n=686) Race % % White 83.0% 82.1% African-American or Black 15.2% 16.0% Other 1.8% 1.9% Education % % <12 th Grade 4.2% 13.2% High School Degree 26.8% 42.7% Vocational/Associates/Some College 29.7% 19.4% Bachelor s Degree 25.3% 18.7% Master s Degree 11.6% 3.6% Doctoral/MD/JD 2.4% 2.3% Veteran Status % % Veteran 10.7% 27.7% Not a Veteran 89.3% 72.3%
Demographic Characteristics Care Receiver Relationship to Caregiver (n=686) % Mother 32.0% Husband 28.3% Wife 16.7% Father 9.0% Sister 3.0% Brother 1.0% % Other 13.0%
Demographic Characteristics Caregiver Relationship to Care Receiver (n=681) % Daughter 32.3% Wife 16.7% Husband 28.3% Son 9.2% Sister 3.0% Brother 1.0% % Other 7.1%
Contact Types Contact Types (n=512) Mean % of Contacts Phone w/ Contact 5.1 68.3% Regular Mail 1.1 15.5% In-Person Meeting.6 8.6% E-Mail.5 7.3% Fax.0.4% Total 7.6 -- * There 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 43.5% Arranging Services 34.1% Anxiety 33.5% Dyadic Relationship Strain 23.4% Financial Concerns 22.6%
Caregiver Initial Assessment Top Five Problems Triggered for Caregivers during Initial Assessment (n=512) % Arranging Services 39.5% Emotional/Physical Health Strain 36.9% Capacity to Provide Care 35.8% Dyadic Relationship Strain 29.7% Anxiety 29.1%
Action Steps Action Step Description (n=512) Mean % Cases with No Action Steps Total Action Steps 6.3 5.7%
Action Steps Action Steps by Person Responsible Completing Action Step Action Steps (n=3,220)* % Care Receiver 1.8% Primary CG 84.6% Care Consultant 9.4% Other Support 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.
National Alzheimer s Project Act Dementia Capable Ohio Grant Application in Ohio
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 1. Training and Education 2. Community Education and Awareness 3. Evidence-Based Programs 4. Quality Assurance
Goals: Evidence-Based Programs 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 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 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 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 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 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
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 Please Visit Us at the ASA Booth! Thank You for Joining Us Today!