Creating single contact improves Alzheimer’s care
September 1, 1999 5 minutes read
Creating single contact improves Alzheimer’s care
MCO finds too many cooks spoil the broth
Alzheimer’s patients have wide-ranging medical, social, and psychological needs. But when too many providers are involved, with no single point of contact and coordination, the result is less than optimum care. Kaiser Permanente recently piloted an Alzheimer’s care project at six sites nationwide that shows great promise for eliminating barriers that often prevent Alzheimer’s patients from receiving appropriate, holistic care that addresses those diverse needs.
"What typically happens is that people with dementia and their family members think that the only source of information and care is the physician. They hesitate to make an appointment just to receive information about their condition, and we’ve found that information is the greatest need for both Alzheimer’s patients and their families," notes Ingrid Venohr, RN, PhD, director of senior programs for Kaiser Permanente Colorado Region in Denver and a senior researcher for the pilot program.
"Not all caregivers are receptive or quick to grab for help. They often struggle alone for months. In fact, one of our biggest problems with this grant was to simply identify members appropriate for participation and getting members to access the services available," says Venohr. Kaiser Permanente set out to design a new system of care for Alzheimer’s patients with a primary goal providing the information, resources, and support services necessary to prevent complications that lead to costs such as premature nursing home admissions. "An essential first step was to educate our physicians and their staffs about Alzheimer’s. We created a manual to educate physicians and their staffs about the components of appropriate Alzheimer’s care. The manual lays out what is core content that Kaiser sites must cover with providers, and what is optional material," Venohr notes. (The manual includes the new Alzheimer’s guideline developed by the California Workgroup on Alzheimer’s Disease Management. For more information on the guidelines and suggestions for Alzheimer’s training programs, see Case Management Advisor, August 1999, pp. 124-126.)
The pilot programs had local variations, but each of the six sites developed models of care that included these core components:
• member/caregiver education programs;
• provider education programs;
• caregiver support programs;
• formal links with community resources;
• single point of information contact for caregivers;
• mechanism for using volunteers and/or community health workers;
• mechanisms for identifying patients with Alzheimer’s.
"The most important component of the program is that single point of contact. Too many times, the diverse needs of Alzheimer’s patients go unmet because family members simply don’t know who to contact," Venohr says. "The six sites each had a telephone number staffed by social workers or nurses trained to refer family members to case management and other resources. The number can also be used by community agencies to ask us to look at a member more carefully or address a specific problem that has been identified by the agency."
To encourage caregivers to use the contact line, Kaiser provided physicians with preprinted prescription pads with the contact number printed on it. "It also included referrals for caregiver education and support programs," she says. "The idea was to make education, support, and community referrals appear like a physician’s order to increase the likelihood that caregivers would call us and use the available services."
Unfortunately, the system often breaks down over time. "It seems like for every project there’s a preprinted pad. Physicians stop using them after awhile. You have to be creative and keep coming up with new ways to attract attention to your programs," says Venohr. "The project director at one site went from exam room to exam room and attached sticky notes with the Alzheimer’s project contact number on it to the computer monitors provided in each exam room for electronic medi -cal records."
Venohr says one of the strengths of the program is that it allows each site to implement the core components in the most effective way, based on local variances. "For example, the program requires each site to provide caregiver support but allows each site to provide that support in its own way. In Colorado, we refer to existing caregiver support programs. In San Diego, they provide their own caregiver support programs," she says, adding that the Alzheimer’s Association is an excellent source of caregiver support programs as well as education.
"Learning from other caregivers is very powerful. Support groups work best when they include a mix of caregivers dealing with Alzheimer’s patients at different stages. In that way, caregivers learn what to expect when their loved ones reach the next stage. It helps them anticipate what’s coming and plan ahead," she says. "It also helps them recognize signs or clues that a behavior, such as wandering at night, is about to begin. Often those are the behaviors that lead to an admission. If the caregiver had only recognized the early signs, we could have prevented a crisis."
Senior volunteers offer support
One of the six sites included a senior volunteer program in its Alzheimer’s care program. "The site uses specially trained senior volunteers to call caregivers and ask them about their own health and whether they have any new needs," Venohr says. "The senior volunteers offer reassurance and support through weekly telephone calls and help the health plan detect problems earlier.
"The bottom line is that physicians have limited time to spend with patients, and families aren’t always comfortable turning to the physician for education and support services. We’re used to the physician being in a hurry. We don’t look for physicians to provide information or education," she says.
"We have to improve our system of care to link Alzheimer’s patients and their families earlier and more effectively with the education and support services that help them live longer, more comfortable lives in the community," she adds. "That means that insurance plans and health systems must be more proactive in linking patients with community-based services, and the key to making it work is providing a single point of contact — a number families can call to arrange all of the services and receive all of the education they need."
Kaiser now plans to interview caregivers to get a better feel for what their real needs include, notes Venohr. "Many of the programs health plans and health systems develop are simply not accessible to the majority of members. We need to have a better understanding of what caregivers need and how we can meet those needs. You must check in with your customers if you want to develop effective interventions."
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