Providers linked to respite care business
Providers must adhere to strict standards
As people live longer and the number of frail elderly increases, so does the number of stressed caregivers who need to take a break from their responsibilities. A care management organization in Connecticut has tapped into this need locally and through a national network, creating respite business for private duty home health providers who meet the organization’s strict requirements.
Connecticut Community Care (CCCI) in Bristol is a nonprofit organization that helps older adults, disabled individuals, and their families find solutions to long-term care problems through care management services. Although CCCI primarily serves older adults, it also helps a younger population, which includes ventilator-dependent children, clients with traumatic brain injuries, and clients with chronic illnesses such as multiple sclerosis, says Gayle Kataja, regional director of Connecticut Community Care in the Hartford area. CCCI services anywhere from 7,000 to 10,000 clients annually.
Assessing the need for respite care
When a client comes under CCCI’s care, a CCCI nurse or social worker care manager goes out to the client’s home and makes an intensive assessment of the client’s needs. The need for respite care may be identified during the assessment, Kataja says.
"The assessment takes about two hours to do, and it’s functionally based," she explains. "We evaluate the client’s support system to see what types of services the caregiver is providing and can continue to provide."
The care manager may find that the caregiver needs an intermittent respite, a more lengthy respite of a week or so, or someone else to totally take over the care, Kataja says. Clients also may need emergency respite. "What you plan for respite depends on the client’s functional abilities. You can have two clients with the same diagnosis and have two entirely different care plans. That’s why the assessment is so important."
"Ultimately, respite is for the client, but it’s really for the caregiver," says Donna D. DiBella, vice president of Homecare in Wallingford, CT. Homecare has been working with CCCI since day one. "I think respite care is wonderful people are beginning to realize that you can’t be everything all the time."
Linking clients to providers
After making the initial assessment, the CCCI care manager is responsible for developing a care plan for the client and for the coordination of services. Then he or she monitors the plan on a 24-hour, seven-day-a-week basis. If the care manager has identified the need for respite care, he or she then matches the client with a provider that meets the client’s needs.
"We maintain listings of resources through our Eldercare Network throughout the nation," Kataja explains. "We have about 7,000 entries in it, including informal and formal support services."
Kataja says she has developed contracts with about 145 formal providers in the Hartford region. CCCI works with about 600 providers on a statewide level, she adds. Some agencies offer just one service such as nursing. Others offer a variety of services and provide backup nursing supervision. The rate providers receive for the care depends on the level of care and where the client is located, Kataja says.
Homecare works with CCCI care managers, as well as the clients’ physicians, to see that clients get the proper level of care, DiBella says. "The care manager works as a link," she says. "We need physicians’ orders as part of our records to meet state regulations."
The agency then tries to match the client with the appropriate employee, she adds. "Sometimes family members want to meet that person beforehand; we’re happy to send the employee out to meet them to see if it’s a good match."
The funding for CCCI itself is provided through publicly funded programs, fee-for- service clients pay CCCI $85 an hour consultation fee for the care management services and philanthropic donations from organizations such as the Connecticut Jaycees and Newman’s Own Foundation. Local churches and synagogues also have provided donations that specifically target funds for respite care.
Choosing the providers
The availability of providing backup care is a primary concern for CCCI, says Kataja. "One of the key pieces of in-home respite, especially with the 24-hour respite for more than one day, is the backup.
If the care provider gets sick or there’s a snowstorm or some catastrophe, you want to make sure someone can get there. Or if something goes sour with the client, you want to make sure you can bring in proper support." To ensure backup for clients who need intensive skilled care, CCCI has contracts with facilities that will take the client in for a skilled nursing or intermediate nursing stay.
Assurance that they can provide constant access to service is just one requirement CCCI makes of its providers. Kataja evaluates at least one provider a week to possibly add to the network, either asking the provider to come see her if it is starting out in the business or going out and visiting its facilities.
"We sit and talk about the ideas that people have about serving older adults. Are they interested in serving the population or do they want to make a dollar?" Kataja also asks for:
• professional references;
• copies of liability insurance;
• copies of bonding;
• any citations from the health department;
• any violations from Medicare if skilled nursing is involved;
• rates, to see if they are competitive;
• various written materials, including a questionnaire providers fill out on an annual basis.
"It’s really about how they are going to meet the needs of the population," Kataja explains. "I also take a look at communication and their understanding of care management because it’s not always easy for providers to work with care managers who are in charge of the case. Are there turf’ issues about who is in charge? You have to make sure you have a good understanding about who is doing what."
CCCI offers contracts annually and renews them every July 1 at the start of its fiscal year.
Evaluations for quality assurance
The care provided by contractors also is evaluated through the organization’s quality assurance program. This includes:
• A utilization committee and internal and external committees do record reviews on a quarterly basis.
• A client satisfaction survey a random sample of clients are called every month by an objective person not working for CCCI, Kataja says. "We go through a two-page survey with the client or the supporter. Those results are sent to me, and I share them with the three supervisors who work with me. The supervisors then share the results with staff." Kataja’s staff numbers about 50.
• Clinical review of care "We talk about the providers’ service, the clients receiving care, what’s worked, and what hasn’t worked. All new providers have to come in and meet with the staff," Kataja says.
• An internal audit component CCCI does random samples of its smaller providers every one to two months but requires audits for any provider that contracts for more than $25,000 a month.
"We send out a clinical auditor and a financial auditor to the agencies. For example, they check the time slips with the service orders, which are our prescriptions for service. Providers also are required to send us monthly reports."
[Editor’s note: For more information about Connecticut Community Care, call (860) 571-7345.]
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