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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 in 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 from 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.
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 staff 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," notes Venohr.
The pilot programs had local variations, but each of the six sites developed models of Alzheimer’s care that include the following 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 Alzheimer’s patients.
"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," says Venohr. "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."
No one right’ way
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 and education.
One of the six sites included a senior volunteer program to 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," says Venohr. "The senior volunteers offer reassurance and support through weekly telephone calls and help us 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," says Venohr.
"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 notes. "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."