Innovative programs help caregivers cope

Alert systems, community nursing fill gaps

(Editor’s note: This is the second of a two-part series that looks at family caregiver issues such as education, stress, burnout, and support. Last month, experts talked about the educational needs of family caregivers and how a home health nurse can recognize caregiver burnout. In this month’s article, different programs to support caregivers and different approaches to offering care to home health patients are discussed.)

The spouse used to be so calm with the patient. The caregiver isn’t purchasing the patient’s medications on a regular basis. The wife doesn’t help the patient out of bed to use the toilet. Does any of this sound familiar?

Caregivers experience burnout for a number of reasons ranging from emotional to financial and physical stresses, say experts interviewed by Hospital Home Health.

One of the first steps a home health nurse should take when there are signs of caregiver burnout is to find community resources that can provide needed support, says Nancy Stallings, MAM, program manager for caregiver support for Salt Lake County Aging Services in Salt Lake City. (For assessment tips, see "Is your caregiver starting to experience burnout?" Hospital Home Health, April 2003, p. 42.)

One of the best resources is your local area agency on aging, says Stallings. "We offer federally funded caregiver support by providing classes on coping with stress and dealing with issues related to caregiving, and we offer short-term respite for family caregivers," she explains.

The area agencies on aging also will fund moderate home modifications that are needed for older adults with mobility or stability problems, she adds.

Because the financial aspect of caring for a homebound person can mount quickly, it’s also important to offer counseling and advice about bills, claims, and financial resources, Stallings says.

"There are programs that offer either discounts or underwrite the cost of certain medications." she adds.

Even if a home health nurse or aide brings in a social worker to offer referrals to community resources, the nurse or aide should know about the resources so the caregiver can be reassured that there is help, she explains.

Other good resources for caregivers are local churches, says Stallings. "Many churches have programs that may provide someone to sit with the patient for a short time while the caregiver goes shopping, to a hair appointment, or to his or her own doctor’s appointment.

"Even a brief period of time for themselves gives caregivers a much needed break," she points out.

Alert systems can provide peace of mind

Another service that provides peace of mind to family members who are concerned about elderly homebound patients and elderly spouses who are caregivers are alert systems that enable patients and caregivers to quickly summon help.

"We’ve been using a personal alert system for many of our patients since the late 1980s," says Carol Ortiz, intake coordinator for Fishkill Home Care in Beacon, NY.

"Most of our patients are elderly with elderly spouses as caregivers, or they live alone," she says. "Because we are in a rural area, it’s important that the patients be able to easily and quickly call for help," she adds.

Personal alert systems are designed to automatically call a monitoring center that will send an ambulance when the patient pushes a button that is either on the unit, a necklace, or wristband. Telephone service is necessary for the unit’s operation, and all units come with battery backup in the case of a power outage.

Although Medicaid patients’ personal alert systems are covered, Medicare patients and private-pay patients must pay for their own systems, Ortiz says.

Most often, other family members who don’t live with the patient and caregiver will choose to pay for the system for the peace of mind it offers, she adds. 

If you are considering offering personal alert systems as an added service, Ortiz has the following suggestions:

  • Plan to keep between four and 10 units in your agency to send out on the admission visit.

"It’s best to have the units available on the first visit so the nurse or another staff member doesn’t have to make a second trip," she says. "It also gives the patient a sense of more security because they do have a way to call for help if needed," she explains.

  • Prepare your nurses to handle installation.

"The installation is simple, but be sure the company that provides your personal alert systems is available to educate your staff initially and be available if a nurse encounters a difficult installation," says Ortiz.

  • Insist monitoring is 24 hours, seven days a week.

"In addition to full-time monitoring, make sure the company updates information about emergency assistance in the patient’s area on a regular basis," Ortiz suggests.

  • Choose a unit with which your patients are comfortable.

"A couple of years ago, we tried a really neat unit that talked to patients to remind them to take medications, check blood sugar, or other actions," says Ortiz.

"All of our staff thought it was a great idea but our patients said it drove them crazy. We learned that sometimes more sophisticated technology makes our older patients uncomfortable," she adds.

Another way to support caregivers and patients is to provide a service that continues after the Medicare episode is over, according to Lisa M. Zerull, RN, MS, program director at Valley Health System in Winchester, VA.

"Our community nursing program grew out of a need by our acute care hospital to find a way to help patients manage chronic conditions after they no longer qualify for Medicare home health coverage," she says.

A community nursing program that enables RNs to continue visiting patients who are no longer homebound to ensure that they comply with medication schedules, blood sugar monitoring, or other recommendations for managing their disease was the answer, she says. 

Cutting hospital admissions

By offering patients an option for follow-up beyond a Medicare home health admission, Valley Health System has cut hospital admissions, emergency department visits, and critical care days, she says.

"We looked at the hospital use of patients in our program and saw that pre-community nursing, they had 499 hospital admissions, 70 emergency department visits, and 67 critical care days," she explains.

"After they were enrolled in the community nursing program, the number of hospital admissions dropped to 219, emergency visits dropped to 48, and critical care days dropped to 20," she adds.

At this time, Valley Health does not charge patients for community nursing care, but a fee structure is being evaluated, says Zerull. "The health system determined that the cost avoidance that results from a longer period of follow-up to ensure compliance with things like medication schedules was worth the expense of creating a community nursing program," she says.

The department has three full-time RNs and one part-time director. The RNs’ salaries and other costs total $65,000 per nurse, but each nurse has a caseload of approximately 35 patients, Zerull says.

"When we took a look at what our patients typically cost the hospital in terms of admissions or emergency department visits, we found that potential cost avoidance to the hospital ranged from $350,000 to $1 million per year as a result of community nursing," she adds.

No matter which way a home health agency chooses to help caregivers find the support they need or bridge the gap in coverage by Medicare or insurance, Ortiz points out that it is important to find a way to offer reassurance to patients and caregivers that they are not alone.

"We have to find nonclinical ways to make sure our patients are getting the assistance they need, even when the nurse is not with them," she says.

[For information about helping caregivers address different issues, contact:

  • Nancy C. Stallings, MAM, Program Manager for Caregiver Support, Salt Lake County Aging Services, 2001 S. State St., Salt Lake City, UT 84190-2300. Telephone: (801) 468-2454. Fax: (801) 468-2852. E-mail: nstalling@co.slc.ut.us.
  • Carol Ortiz, Intake Coordinator, Fishkill Home Care, 22 Robert R. Casin Way, Beacon, NY 12508. Telephone: (845) 831-8704, ext. 827.
  • Lisa M. Zerull, RN, MS, Program Director, Community Nurse Case Management, 333 W. Cork St., Winchester, VA 22601. Telephone: (540) 536-5344. E-mail: lzerull@valleyhealthlink.com.]

Resources for caregivers

For information about services for older adults, go to: www.aoa.gov/directory/default.htm. This directory was compiled by the Administration on Aging and the National Institute on Aging and contains a comprehensive list of all community-based programs and organizations that offer services to older Americans. Contact information, locations, and links to individual web sites are included.

For information about prescription drug assistance programs, go to: www.needymeds.com. The web site offers a description of all assistance programs offered by drug manufacturers and other groups. The listings are available by manufacturer and by specific drugs.

For information on personal alert systems, contact:

  • LifeFone Personal Response Services, 16 Yellowstone Ave., White Plains, NY 10607. Telephone: (800) 882-2280. Web site: www.lifefone.com. Costs for LifeFone are $75 for the initial programming fee and $26 to $29 per month.
  • Lifeline Services, 111 Lawrence St., Framing-ham, MA 01702. Telephone: (800) 543-3546. Web site: www.lifelinesys.com. Initial programming fees range from $50 to $100, and monthly fees range from $35 to $45.