| Policy Studies and Applied Research | |||||||
| General Publications and Research Topics | The Occasional Long Term Care Policy Paper Series | LTC Advances Newsletter | |||||
| <back Topics in Research, Training, Service & Policy Vol. 7, No. 4, Fall 1996 Duke University Center for the Study of Aging and Human Development THE ALAMANCE COUNTY EXPERIENCE:
FOUNDATIONS OF A TEACHING AND LEARNING COMMUNITY
"Foundations
of a Teaching and Learning Community" Teaching communities flow from the tradition of "teaching nursing homes" where modeling and mentoring have been key concepts. Teaching communities extend such ideas beyond the wall of any institution or agency to the communities that are necessary for building genuinely integrated long term care systems. When leaders in Alamance County describe what they are achieving with respect to community long term care systems, two guiding perspectives emerge: They are extremely proud of what Alamance ElderCare, the lead agency for systems building, has been able to accomplish. But, to a person, they will go out of their way to stress that the key to Alamance's success is the cooperative spirit amongst Alamance County's service providers. As the primary inspiration for the teaching communities concept in North Carolina, the Alamance County experience goes beyond any one service provider (see Exhibit A). This issue then intends to not only provide information on the development of Alamance ElderCare, which has been requested by many North Carolina readers, but also to describe the community context which created and sustains it. FOUNDATIONS IN ALAMANCE COUNTY Opened in April 1994, Alamance ElderCare is just over two years old; planning for long term care systems building in Alamance County began intensively four years before in 1990. Such a history of planning to meet the needs of frail older adults, particularly through grass roots community development work, underlies most successful community-based long term care (LTC) systems.The Alamance County Interagency on Aging Committee (Interagency Committee) has met for over ten years to share ideas and information among service providers, but in 1990 members realized that for all their cooperative efforts, most frail older adults and their families could not easily identify where to start to seek services. Unlike many counties in North Carolina, Alamance County had no council on aging. Further, while the over 30 member agencies could all answer basic questions about available services, there was often no time for follow-up to be certain that the person actually received the needed services. Based on these needs and as a part of a growing emphasis on county-based planning for aging services in North Carolina, fostered by the North Carolina Division on Aging, the Alamance County Planning Committee on Services For the Elderly (Planning Committee) was established in 1990 as a coalition of public officials, senior advisors, religious leaders, corporate leaders, representatives of service agencies, and community and consumer representatives. In that same year, the Interagency and Planning Committees worked cooperatively with staff leadership from the Piedmont Triad Area Agency on Aging to conduct eight community forums (with 180 older adults participating) throughout the county to determine the major needs as perceived by the elderly and their caregivers. In addition to the forums, 237 other older adults were surveyed by service providers. The findings were that most older adults were unaware of how to access services, or, if they were aware, they only knew how to access food stamps and Medicaid. Based on these findings, one of the top priorities indicated in a 1991 report to the Alamance County Commissioners was the need to create an easily identifiable starting point for older adults to obtain information and referral; case assistance and follow-up; and care management. In addition to the community needs assessment activities which were taking place in the early 1990's, other educational and organizational efforts were instrumental in laying the foundation for the initiation of Alamance ElderCare:
ALAMANCE ELDERCARE: INITIAL DEVELOPMENT From 1991 to 1993, there were concerted efforts among leaders in Alamance County on older adult issues to address the priority service need of a central point for information and access to services. Exhibit B presents visually the development of the community partnership to address this issue, and from that presentation, it is evident that the activities of those years set the stage for what was to come.Public/Private Partnership. One point that is important to emphasize further is that this effort was not only a community partnership but also a genuine public/private partnership. The core team of service providers who came together to write the initial concept papers and grant proposals included not only the Area Agency on Aging, the Alamance Regional Medical Center not-for-profit hospital system, the United Way, and county government but also the for-profit and not-for-profit home health care providers. The degree of consensus amongst home health providers related to both support for the basic concept of a central point for information and access and their willingness to work creatively on the technical aspects of implementation was impressive to local government and businesses and to funding sources outside the county. Resource Development. As indicated in Exhibit B, the team successfully applied for funding in 1993 to the Aging at Home Program, managed by Duke LTC, and to the Managed Access Demonstration Program, through the North Carolina Division of Aging. Financing for both of these programs came from the Kate B. Reynolds Charitable Trust, which has frail older North Carolinians as a target population. This funding facilitated the initial development of Alamance ElderCare as an agency in early 1994. Throughout this period both Alamance Regional Medical Center and the United Way, furnished much in- kind support, particularly administrative and financial management. Additionally, Alamance Regional Medical Center continues to serve as the host agency and provide space for the project. The basic services that are provided by Alamance ElderCare in cooperation with other community services providers are described below as well as other current initiatives, several of which relate to funding sources. Some funding streams relate to model projects funding, but Alamance ElderCare also has funding from North Carolina's Home and Community Care Block Grant, corporate pledges, county government and Medicaid waiver funding through an agreement with the Alamance County Department of Social Services to provide case management for the Community Alternatives Program for Disabled Adults (CAP/DA). Comparatively, Alamance ElderCare has been very successful in achieving a diverse funding base for its services; yet, it still remains challenged by resource development, particularly for low and modest income older adults who are not Medicaid eligible. A special committee of the Board, which includes business leaders, is dedicated to resource development. The degree to which Alamance ElderCare can be successful yet remained challenged with respect to resource development relates to the lack of a specific funding stream for these services at the state and federal level. BASIC SERVICES OF ALAMANCE ELDERCARE The basic services provided by Alamance ElderCare are Information and Referral; Case Assistance; and Care Management. Through Information and Referral inquiries are directed to a variety of services and agencies such as:
Examples of Information and Referral/Inquiries:
Case Assistance has become an even more important component to Alamance Eldercare's services than originally anticipated. Many older adults and their families need more help to link-up with services than simply receiving information but stop short of needing full care management. Case assistance bridges that gap by:
Examples of Case Assistance are:
Care Management Examples Example 1. Client diagnosed with mid-stage Alzheimer's Disease. At first, spouse just wanted information on agency. Mailed packet to her and explained care management services. Caller requested in-home assessment of spouse's needs. Was especially looking for assistance to help bathe spouse who frequently refused to bathe. Financial resources allowed this family to be able to privately pay for services. ElderCare worked with the family for two years providing a great deal of emotional support to the caregiver as well as technical assistance from staff and information from the Alzheimer's Association to address client's specific needs as he went through changes associated with his disease. Assisted in urgent situations (changes in caregiver's health and caregiver's short hospitalization). Helped caregiver through the process of placement when client could no longer safely stay at home. The caregiver is now a case assistance client and Alamance ElderCare continues to provide emotional support and basic information on how systems work when she feels she needs to address an issue at the facility where her spouse lives. Example 2. 90-year-old sister who is caregiver for her 88-year-old sister who has Alzheimer's Disease and Parkinson's Disease. Their nephew is power of attorney for both sisters and lives out of town. They need assistance to access the system and understand how certain agencies work, someone to monitor their situation and look for any changes in their needs, and someone to coordinate their needs with public and private resources. They privately pay for cleaning services, some transportation, and four hours of personal care services for the client, and, through the HCCBG, Alamance ElderCare is able to purchase eight hours of personal care services per week for the client. Example 3. Client has Alzheimer's Disease. Due to a dramatic change in caregiver's health status and a change in family support about three months later, client was no longer safe at home. Assisted family in securing placement. Caregiver was not able to lift or assist in many other ways due to heart condition and surgery. He continued to visit his wife daily in facility and very much wanted her to return home once he was more able to meet her needs. As caregiver's health slowly improved, Alamance ElderCare helped the family access CAP/DA services. These services provided the caregiver with enough help, particularly in lifting and bathing, to allow his wife to return home. RECENT INITIATIVES COORDINATED BY ALAMANCE ELDERCARE The past year has seen Alamance ElderCare move into four new initiatives:A Teaching/Learning Community. Through Duke's Long Term Care Resources Program, Alamance County has been named as one of three Teaching/Learning Communities in the state of North Carolina for the study of long-term care options for seniors. Alamance ElderCare and other area agencies which provide senior services will work closely with Duke LTC to implement this new program. As a Teaching/Learning Community, Alamance County will serve as one illustration of how communities can coordinate care for seniors. It will also receive technical assistance in the development of a management information system for senior services, access to visiting consultants and speakers, and student interns from social work or other related fields. The program will also allow the country to study other programs for coordinating services for the elderly. The first Teaching/Learning event, a long-term care workshop was held in Burlington for people from across the state on March 12 and 13. Marge Jameison, executive director of the Living at Home/Block Nurse Program of Minnesota, was the keynote speaker. The seminar gave participants a chance to explore what other states are doing in the area of senior care and to learn how Alamance ElderCare was developed. The two-day event, which was held at the Holiday Inn Burlington, also included a reception at Alamance Regional Medical Center (ARMC). "One of the reasons Alamance County was chosen as a Teaching/Learning Community is that the area agencies have done a very good job of working together to meet the needs of seniors and their caregivers," says Brenda Porter, executive director of Alamance ElderCare. "For example, a son or daughter who lives six hours away but has elderly parents in Burlington can call Alamance ElderCare for help in locating needed agencies or services, or in some cases coordinating and monitoring care for their parents. Without ElderCare, the out-of-town child might have to make 10 to 20 phone calls to gather information on what's available and coordinate services." Already, the Alamance Teaching Community has served as the chief demonstration site for the automated version of the Duke Service and Service Outcome Screen (SOS) which will help Alamance ElderCare screen and track the outcomes for older clients. At a September 19 event at ARMC, the Alamance ElderCare staff were designated as "master trainers" for the SOS. Duke Endowment/Best Practices. Alamance ElderCare has also received a recent grant from The Duke Endowment. This grant touches on aspects of both the Teaching/Learning Community Programs and the Neighborhood Senior Care Program by emphasizing the development of "best practices". It also helps Alamance ElderCare continue and expand its mission of linking seniors to needed services so they can continue to live at home rather than move to institutional care. One part of the Duke Endowment grant will allow Alamance ElderCare to study options for best practices in the delivery of care management services in a variety of settings. "By studying best practices, we hope to demonstrate that the funding of in-home services is very cost-effective and helps federal and state government make the best use of Medicare and Medicaid funds," says John Currin, ARMC's vice president of operations. "If North Carolina follows the same track as other areas of the country, Medicare beneficiaries will have the option of enrolling in managed care programs. If ARMC has good resources for managing the care of seniors, we will be in a better position to handle this new trend among the Medicare population and meet the needs of our people." Neighborhood Senior Care Program/Business Initiatives. Another new program involving Alamance ElderCare is the Neighborhood Senior Care program in Mebane. Developed in conjunction with Caring and Sharing of Alamance County, this program is funded by a federal grant from the U.S. Department of Health and Human Services. Alamance ElderCare was one of only 12 sites nationwide to receive this grant. This program will use volunteers from within the Mebane community to create a support system for that area's elderly. Volunteers might provide transportation or run errands for an elderly neighbor, or offer respite care for caregivers. This program will also seek volunteers from Mebane-area businesses. A Neighborhood Advisory Board and a Business Advisory Board will both be developed and educational workshops will be offered for volunteer caregivers and the general public. "Employees who are also caregivers for an elderly family member may have added stress on the job. In fact, research shows that employees who double as caregivers can cost businesses an average of $3,000 per year in lost time and productivity," says Porter. "If their family member has a good care system in place, they will lose less time off the job and be more productive. So this program can actually benefit area employers as well as the elderly." Community Alternatives Program. The care management component of Alamance ElderCare was originally designed to provide those services to older adults who were not eligible for such services under Medicaid funding. The Alamance County Department of Social Services as the lead agency in Alamance County for North Carolina's Medicaid Waiver Program, the Community Alternatives Program, was already providing services to older adults who were Medicaid eligible and were very willing to accept referrals from Alamance ElderCare. However, the staff-time available for case management at the DSS was fixed, so the two agencies have worked together on a cooperative agreement which is expected to double the service capacity to CAP clients in Alamance County. REFLECTION ON A GOOD BEGINNING: LEADERSHIP AND COMMUNITY DEVELOPMENT MAKING A DIFFERENCE Alamance ElderCare is almost three years old, but, hopefully, the experience which has been described in this issue of LTC Advances reinforces how important all the community development work which occurred prior to its inception and the leadership which took that development beyond planning were. Communities can learn a great deal from one another related to long term care systems building, but perhaps the most important lesson is that nothing can replace the development of community leadership on this issue. At the inaugural event for the Alamance Teaching and Learning Community, Dr. John R. Kernodle, the first board chair of Alamance ElderCare, concurred that such work had made the difference.
Inaugural Events for Newest Teaching and Learning Communities *************************** The Teaching Communities Program of the Duke Long Term Care Resources Program Presents: *************************** "Building a Long Term Care System for Cleveland County: The ACCES Story" in cooperation with ACCES, Inc. of Cleveland County Teaching Community October 16, 1996, Shelby, North Carolina *************************** "The Down-East Teaching Communities Consortium: Enhancing Long Term Care in Beaufort, Hertford, Martin, Pamlico and Pitt Counties" in cooperation with the Down-East Teaching Communities Consortium Mid-East Area Agency on Aging and The Center for Aging at East Carolina University November 12, 1996, Williamston, North Carolina Pre-registration required for events please call (919) 660-7542 for more information
Send your comments and responses about Long Term Care Advances to: Dr. George L. Maddox at: glm@geri.duke.edu back to top |
|||||||