Creating Documents to Promote Patient & Family Guidance: A Recipe for Sucess

Title: Where do I find….? Creating Documents to Promote Patient & Family Guidance & Support: A Recipe for Success

By Dori Rogers, RN, MSN

Where do I find…? How do I get…? Where do I start…? These are the questions we’re asked by families and caregivers every day in our geriatric practice. Fill in the blanks with anything from home care services, to support groups; we’re always pointing the way. Over the years we’ve become successful at keeping our seniors living at home. One tool that we use is a Resource Manual which was created by our nurse case managers. Similar resources can be created in other offices, clinics, and hospital departments to support caregivers and increase customer satisfaction. We would like to share our experience.

Numbers of Caregivers Growing
In November 2008 the AARP Public Policy Institute published Valuing the Invaluable: The Economic Value of Family Caregiving, 2008 Update. Their research found that during 2007, approximately 52 million family caregivers provided care to adults who needed assistance with many activities such as bathing, dressing, medication management and paying bills 1.

As our geriatric population grows, it has become apparent that it is more cost effective to keep seniors at home and out of hospitals and skilled nursing facilities. Two government initiatives created to propel this are the Independence at Home Act (http://www.aahcp.org/iahsummary.pdf) , introduced in Congress on September 26, 2008 and the Money Follows the Person Rebalancing Demonstration (http://www.cms.hhs.gov/DeficitReduct..._FactSheet.pdf). The success of these and other programs will depend heavily upon the support given to patients, families, and caregivers.

Evolution
Our team of Physicians, Advance Practice Nurses, Nurse Case Managers and Office Administration staff provide primary care to 250 homebound geriatric patients and assessments and support to approximately 900 geriatric outpatients. The practice also provides inpatient hospital consultations, senior community outreach and primary care in over 20 skilled nursing and assisted living facilities.

A large part patient and family contact includes referrals to services. Caregivers and family members navigating this territory are often overwhelmed and tell us they don’t know where to turn for help. Many of our caregivers report feelings of emotional and physical fatigue, guilt, anxiety and depression. These self reports mirror what is occurring with caregivers nationally.

Prior to the creation of the manual, we provided sheets of information as needed. When we decided to consolidate this information in to a booklet form, we started with what we had on hand which consisted of lists of local visiting nursing agencies; podiatrists who conducted home visits; Medicare certified 24-hour home care providers; area adult day care centers and brochures from the Agency on Aging. We searched our rotating files for frequently used information and polled all staff for the most common requests for services and added those resources as well.

As we listened more to our patients and families, we learned that they needed Elder Law Attorneys, Geriatric Care Managers, and lists of area skilled nursing facilities, assisted livings and senior housing. National web sites for these services provided on-line search engines that gave us names, addresses and telephone numbers. We compiled lists of these services in our territory and categorized them. Each category has more than one referral source to not show favoritism. An online search of the Connecticut Agencies on Aging and the United Way 2-1-1 Infoline system provided many contacts.

As the Resource Manual grew, one nurse case manager volunteered to gather the information in a logical order, create a table of contents and paginate the manual. The manual is distributed during office appointments and placed in our caregiver binder for all new homebound patients. Additional packets and brochures on topics such as living wills, dementia care, and Alzheimer’s Association’s services are available for anyone needing this supplementary information.

Benefits
Families and caregivers have expressed appreciation for having information at their fingertips. We hear many positive comments such as, “This is wonderful”, “What a treasure”, and, “May I have one for someone I know?” When on consult service at the hospital, our Physicians frequently tell families that they are welcome to stop by and pick up a manual, which they eagerly do.

The doctors and advance practice nurses use this tool extensively. When visiting patients in their homes, or during office visits, they will mark pages specific to the patient's needs. Nurses report that it is helpful to have the information organized in one place.

Beata Skudlarska, MD, Director of the Center for Geriatrics stated:
"The resource manual has greatly helped in dealing with our patients and their caregivers. It is ready to use, pertinent information which can connect struggling families of the frail patients with the local resources, organizations and professionals. We have been able to affect lives of these patients and we gave their loved ones options for different modalities of help. This enhances their care giving potential and makes them better prepared for every day struggles. Having options minimizes anxiety and makes families feel "protected" by members of our practice. This is crucial since the fear of abandonment in face of the difficulties is very real.”

Our time spent listening to our patients, families and caregivers and effort compiling the manual has given us many returns. As providers struggle to increase market share for their respective service lines, a project that streamlines access to care and increases client satisfaction is a worthwhile undertaking. We hope that sharing our recipe for success encourage others to discover ways to support their own unique patient population.

If you would like a copy of the Center for Geriatrics Resource Manual to use as a template, please email Dori Rogers, RN, MSN at ndroge@bpthosp.org

1. Houser, A.N. and Gibson, M.J. (2008). Valuing the Invaluable: The Economic Value of Family Caregiving, 2008 Update. AARP Public Policy Institute. Accessed 11/3/09 at
http://assets.aarp.org/rgcenter/il/i13_caregiving.pdf

Resources:

USA.gov for Seniors site helps users access all government sites that provide services for senior citizens.
Web Site: www.USA.gov/Topics/Seniors.shtml
Phone: 1-800-FED-INFO

Department of Health & Human Services Eldercare Locator
http://www.eldercare.gov/
Phone: 1-800-677-1116

United Way Infoline
http://www.211.org/
National Family Caregivers Association
http://www.nfcacares.org/
Toll Free: 1-800-896-3650
Phone: 301-942-6430


Money Follows the Person Rebalancing Demonstration
http://www.cms.hhs.gov/DeficitReduct..._FactSheet.pdf


What is the Independence at Home Act (S. 3613, H.R. 7114)?
http://www.aahcp.org/iahsummary.pdf