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Jewish Home Lifecare System Share The
Care An Innovative Model for Informal
Caregivers Laura Radensky LCSW Associate
Director Of Social Work CSD
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Jewish Home Lifecare System

• The Jewish Home Lifecare System provides a
  continuum of aging services
• Housing
• Home Care Services
• Medical and Social Adult Day Health Center
• 3 Skilled Nursing facilities for both short
  long term care.
• Research Programs
• We service Manhattan, the Bronx and Westchester,
  with over 10,000 clients per year,
• 60 of whom live in the community.

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Lifecare Plus

• Lifecare Plus is a Medicare Coordinated Care
  Demonstration Project designed to evaluate a
  variety of Care Coordination interventions to
  measure their impact on reducing
  hospitalizations and improve health care outcomes
  for clients in Manhattan the Bronx .
• Six Clinicians (RN/SW) provided Care Coordination
  to 330 frail elderly clients. Our goal is to
  keep clients out of the hospital, thereby
  reducing Medicare costs.

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Share the Care

• Share the Care is an innovative model of care to
  assist clients and their primary caregivers to
  widen the circle of informal supports that they
  can depend on for their caregiving needs.
• Share the Care staff provided training to the
  Lifecare Plus Care Coordinators to enable us to
  adapt the program to fit our needs.

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Challenges

• The Share the Care model was created in response
  to the needs of younger people diagnosed with an
  acute, terminal illness. These individuals were
  not typically socially isolated people.
• Our population is one of elderly Medicare
  recipients with long term, chronic care needs and
  limited family and social contacts.

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Adaptations to the Model

• The model and expectations needed to be adjusted
  to work with a variety of issues
• Caregivers for the elderly need to be available
  less intensively but over a much longer period of
  time.
• Elderly clients usually have a much smaller
  caregiving network
• The Lifecare Plus staff would provide support and
  help the network

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Challenges for the Staff

• Lifecare Plus staff needed to adjust their
  perspective from being the main support provider
  to being a facilitator who ensures that the
  caregiver group can function as the main support.
  
• Lifecare Plus staff and the clients had
  difficulty identifying a more broad support
  network.
• Elderly clients did not want to impose on
  neighbors or friends.

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Status of Lifecare Plus Program

• Lifecare Plus was part of a group of providers
  participating in a pilot research project for
  CMS.
• Despite tremendous advocacy, in December Congress
  did not renew the funding for these research
  projects and so the pilot programs across the
  country are all ending within the next few
  months.
• Lifecare Plus will close its doors in May, so
  the model was affected by the termination
  process.

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The Model Choosing the Clients

• All Lifecare Plus clients are frail elderly,
  living in their homes, dealing with multiple
  chronic illnesses. These clients may or may not
  have had an acute episode.
• Every Lifecare Plus staff reviewed their clients
  to select a list of people at risk for a major
  acute episode, needing significant Care
  Coordination and who would most benefit from
  assistance in organizing a network.

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Assisting Clients to Identify Caregivers

• Introducing the program involved discussing
  potential care needs with the client
• The next step was to assist the clients in
  identifying possible caregivers to participate.
• We asked them to expand the list beyond the
  emergency contacts that had been provided upon
  admission to include other family and friends.
• We then looked at neighbors, current as well as
  from the past, and building staff.

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Choosing Caregivers

• A variety of sources are used to access
  caregivers
• Address books, holiday card lists and other lists
  of contacts
• Church/synagogue contacts including the priest,
  minister or rabbi
• People from senior centers, community centers,
  clubs, volunteer groups or political
  organizations.
• A trusted housekeeper or private aide.

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Other contacts to involve

• Long-distance people who can participate through
  phone calls to do research, advocacy or
  socialize.
• Groups that clients are involved with now or
  before, including union or retired professional
  groups.
• Discussions took place about important people in
  their lives who we could contact, including past
  business associates.

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Organize a Meeting

• The client or Lifecare staff member then
  contacted people on the list to inform them of
  the need for a group that the client can rely
  upon when needed. A meeting in the clients home
  was set-up which included those contacts who
  express interest as well as the client and
  Lifecare staff person.
• It is clearly communicated that the people
  joining the group are volunteering to do exactly
  as much as they are willing and able to do -
  there will be opportunity to talk about what they
  can and cannot do.
• Family members and primary caregivers are assured
  they are not being replaced, just helped.

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Content of the Meeting

• Lifecare Plus staff followed the format in the
  literature provided by Share the Care to educate
  the group about the many different categories of
  caregiving needs.
• Share the Care provided valuable exercises to
  use for the first meeting.
• Caregivers have the opportunity to identify areas
  of expertise and/or tasks that they are not
  willing or able to do.

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Categories of Needs

• Health care Assistance with scheduling medical
  appointments, asking questions of the physician,
  medication management, Health Care Proxy,
  insurance assistance.
• Errands Food shopping, banking, library visits
• Financial assistance such as money management or
  back-up person, being POA
• Pet care, plant care, help during hospitalization
• Emergency people neighbor w/extra key, person to
  assist to go to ER

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Sharing the Care

• While some needs are addressed right away, in
  many cases the meeting is for the purposes of
  education and future planning.
• The role of the Lifecare Plus staff is to assist
  the client to access this group as needed and to
  facilitate the roles that they will play.
• It is important that no one person is unduly
  burdened.

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Benefits to Clients

• Initiating the service provided opportunity for
  discussions with clients regarding
• Long-term planning
• What the client sees as their possible future
  options
• Identifying current and future unmet caregiving
  needs
• The main benefit is allowing the client to have
  the security of a group of social supports.

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Benefits for Clients, Staff and Caregivers

• The first meeting is a powerful message of
  comfort and support.
• Clients have a structure for receiving help
  instead of the burden of having to ask.
• For caregivers it gives them a structure to
  provide caregiving while still being able to set
  limits as needed.
• Allows our agency to spread its resources
  further.

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Case example

• Client agreed with the idea and added the piece
  that others who participated in the meeting would
  also form Share the Care groups for themselves.
  
• Meeting provided education of possible scenarios
  and how to meet them.
• Health care proxies and Share the Care forms
  were made use of by more than just the client
  initially identified.

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Case example

• Another client had numerous health issues who
  needed to have the supports in place.
• Solid social support system existed but not one
  that had truly been mobilized to be of
  assistance.
• Client resistance to allowing for the social
  worker to make initial contacts.
• Meeting to be held soon before program closing.

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Case example

• Elderly couple with one adult daughter. Other
  social supports were not included due to concerns
  for privacy.
• In planning meeting, social worker discovered
  that this well-off couple had not included their
  daughter in any financial planning.
• Also, support during emergencies needed due to
  functional disabilities of husband, so building
  staff involved.

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Agency Approaches

• Possibility of implementing Share the Care with
  acute care cases only.
• Option of attempting to do groups with all
  clients in order to jump-start long term
  planning.
• Provides another tool to be able to begin the
  difficult process of planning for the future for
  our clients as well as new ways to support the
  caregivers.

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Resources

• Share the Care How to Organize a Group to Care
  for Someone Who Is Seriously Ill by Cappy
  Capossela and Sheila Warnock.
• Website www.sharethecare.org and DVD of Share
  the Care available.
• Staff trainings provided as well by Sheila
  Warnock-646-467-8097.