How Integrating Family Caregivers into the Care Team Adds Value to Value-Based Care

The benefits of recognizing and supporting the essential role of family caregivers in care delivery are many – and they include a boost to your organization’s bottom line. Learn how.

A Strategic Health Care Marketing member webinar for marketers, communicators, and strategists at hospitals, health systems, and physician groups

Presented on October 21, 2021 

About Your Presenters:

Transcript

0:00
Welcome to today's webinar, How Integrating Family Caregivers into the Care Team Adds Value to Value-Based Care.
0:07
I'm Jane Weber Brubaker, executive editor of Plain-English Health Care.
0:11
We are the publishers of eHealthcare Strategy and Trends andStrategic Health Care Marketing and producers of the eHealthcare Leadership Awards.
0:18
The hidden engine making care delivery work is the 50 million Americans who provide unpaid care.
0:24
Their loved ones valued at $950 billion annually, yet their contributions to reducing the total cost of care are often overlooked and undervalued by health systems.
0:35
Today, we're thrilled to have a distinguished panel of experts who will share how their organizations are bringing attention to this largely untapped resource, and by doing so, they were helping to improve the quality and cost of care for older adults.
0:48
So let me briefly introduce them to you right now, and you can learn much more about them by reading your full bios on our website.
0:57
They are with me!
1:01
Alexandra Drane is co-founder and CEO of Archangels, a National Movement and platform that uses a combination of data in stories to reframe how caregivers are seen, honored, and supported through public and private partnerships.
1:15
Archangels provides communities, including states, employers, healthcare providers, and payers.
1:21
With an omnichannel data driven engagement approach changes caregivers lives for the better and improves top and bottom lines.
1:30
Doctor Rick Martin is Chief Medical Officer for the Keystone Accountable Care Organization in Pennsylvania.
1:35
He serves as Medical Director for LIFE Geisinger, a program with specialized services designed to support seniors in living independently and he's also the Medical Director of Geisinger Urgent Care Services.
1:48
Rick has served Geisinger as Associate Chief Medical Officer for Population Health system wide Chief Medical Officer for Care Continuum and Department Director for Community Medicine.
2:00
Julia Evans Starris the president of Connecticut Community Care, the largest care management organization in Connecticut.
2:07
Dedicated to helping older adults and people with disabilities remain independent, living at home.
2:13
Leading authority on issues affecting older adults and people with disabilities, Julia led Connecticut's Legislative Commission on Aging for over 20 years and then served as an aging disability and health policy consultant and our moderator for today is Dan Ansel
2:30
Dan is the CEO of Active Daily Living, a comprehensive population health platform that identifies at risk seniors, and provides personal advice, including no cost and low-cost tips for aging in place.
2:43
Dan has over 35 years of experience developing successful healthcare related programs focused on senior services.
2:51
Today's presentation will be approximately 45 to 50 minutes, followed by a 10 to 15 minute Q&A.
2:57
To submit your questions, type them into the control panel and hit send.
3:01
We'll hold your questions until the end, but feel free to submit them anytime.
3:05
After the webinar, we will send attendees an e-mail with a link to the presentation slides, and some of the panelists have made available for you and you'll receive a second e-mail with a link to access the recording as soon as it's been processed and it's available for viewing.
3:19
And now, I'll turn it over to our moderator for today, Dan Ansel
3:22
Dan, please go ahead.
3:25
Good afternoon and maybe for some of you good, good morning. I'm very excited about the webinar that you're going to participate in today. In my years of working with older adults and their families, it has always been so interested in me that there's been a lack of caregiver engagement in terms of working with older adults, the ideas, and yet, what we're finding in healthcare, all aspects, is that caregivers are taking on an increasingly important role. They're sort of, like what I've seen in the last for pretty much in the last year, year and a half there has been a focus from everything from long term care insurers, the Medicare Advantage program, the home health that, how important it is to engage the caregiver.
4:15
and recognize that, how emotionally charged people are when they are interacting with the healthcare delivery system. And so the idea is, what can we do to engage people and create a valued relationship with caregivers as we provide care to their aging loved ones. Next slide, Jane.
4:44
So, if you think about research that's been done on caregivers, this is research that we did probably will be about 24 months ago, as we were bringing active day live in the market. And, what we heard, very common in terms of individuals and groups, that caregivers, particularly when they're interacting with the healthcare delivery system, did not feel appreciate it. Many people stated that, you know, they were taken for. Granted, they felt alone, not a lot of support. Often, even if there were siblings involved, usually, one person got designated as the caregiver, and everybody tried to stay out of their way, not various support, it. Certainly a nuance.
5:26
In fact, a lot of caregivers told us that when they interact with, particularly in, hospitalizations that, they thought they were being a nuisance to the nurses and other people who are providing care clearly anxious. And if you think about that, that really ties into the uninformed. If you know, the idea that, for a lot of people interacting with the healthcare delivery system, it's crisis driven. Often, they are prepared for it, off, alert and formed and kept very up to date when they're doing it. And what the thing that they, they sort of are presented again and again, is how they did not feel supported.
6:08
Next slide, Jane.
6:14
However, when you're dealing with caregivers and you ask them, what is their goal for their aging loved one, quite similar to what the older adult actually has for themselves Do. everybody's trying to say, I'm trying to maximize my health.
6:31
I want to maintain my loved ones, independence, I wanted to stay engaged with life to the maximum that they're able to do.
6:40
Clearly, the number one, for almost all of our caregivers, really in our research, was safety.
6:46
The idea is that whether mom was in her own home, an assisted living facility, a nursing home, a memory unit, they wanted their loved one to be safe and aging in place. Sir, clearly, number one for our older adult populations. And number two, for what we've found and caregivers, So the idea is even though they shared the same priorities, the thing that, again, for the caregivers is, I want my mom, my dad, my neighbor my app to stay safe.
7:18
Next slide, Jane.
7:21
But here's an interesting thing, we found, we did a Google search, and we searched a variety of ways. now. You gotta realize, there's about 10000 hospitals in the United States. But if you back up all the specialty hospitals, the small hospitals, the bird hospitals, the children's hospitals, you're still talking over 4000 hospitals, and we did a search in terms of hospitals and caregivers, family, caregivers, and health care. In only 25 hospitals in the United States came up when you look some combination of family caregiver.
8:01
I thought it was interesting to a side note, when you put in hospitals, senior services, less than 230 hospitals come up. Again, You're talking it out of thousands. So, I think that what you're going to hear from today's panelists, is some great insights into their interacting with, with the family caregiver, and the impact that has on people being able to optimize those priorities of how they want to age. And perfectly have caregivers want their loved ones to age.
8:37
So, our first presenter today is Alexandra, who is again co-founder and CEO of Archangels, and I'll turn it over to her.
8:47
Oh, Dan, Everything you said, love, love, love, love, love. You just nailed it. And I love that, you put that data behind it. So specifically, around and I'm gonna go ahead and show some slides. I wanna make one more point for switches.
9:01
Um, therein lies the opportunity, right? We did a study that was published by the New England Journal of Medicine, a Report in collaboration with ... Shah, and we called it the 80 20 rule gone wrong.
9:12
80% of providers believe that the unpaid caregivers should have a seat at the table, but only 20% of providers say that they actually do this. I'm going to dive into some deeper data for you guys. Can everybody see my screen? Dan, Can you see that?
9:25
Yes, Head of It. So.
9:30
Archangels is a movement in platform, just like Jane described, so beautifully reframing how unpaid caregivers are seen, honored, and supported using a combination of data and stories.
9:39
And all of that is important, we do it in, in public and private partnerships.
9:43
Because so many unpaid caregivers, if you're only looking at employers or health care systems, a lot of unpaid caregivers never joined the workforce in the first place. Because guess what, they already had a job, the unpaid carrier.
9:54
Are they did that They had to quit. So we also work with states, and we work on on policy and advocacy as well.
9:59
And we always work with this notion of research that gives us data that drives data informed action, that then ultimately, hopefully creates, impact and then wash, rinse, repeat, wash, rinse, repeat. I'm gonna go through so much data quickly. If you want to see this low, they go to archangels dot me.
10:16
There's also an article McKinsey just did about 10 days ago that looked at the work that Archangels is doing. It will break down this data for you, so you can have it to refer back to. And I think Jane is going to send this out after the fact.
10:28
I'm going to focus on a study that was published.
10:30
We co-authored in partnership with the Coach COPPA Initiative, and it was published by the CDC mid June. And it looked at the impact of coded on mental health specifically. And it broke this down by some cohort, and I want to share some of this data at a high level. What is very surprising to a lot of folks, what what people remember in their head is a study that was published by AARP and National Alliance For Caregiving, That was amazing. Early, 2020 that tag that number or percent of adults in the US in this role at 21%.
10:59
As of Kobe, what we just published in June by the CDC put that percent of adults in the US Serving in this role at 43%.
11:07
The massive, massive massive number, 70% of these adults are experiencing at least one adverse mental health impact, specifically anxiety, depression, or suicidal ideation.
11:17
But I want to focus specifically on that sandwich generation. Part of the population is 23% of adults in the US.
11:23
Right now, who are serving as an unpaid caregivers, as A parent, or guardian to someone, or people under 18, at the same time, that occurring for someone, or people over the age of 18.
11:34
And any of you who've been in this role will not be surprised, to know that that is, 85% of us are actually experiencing at least one adverse mental health impact.
11:44
But I want to go a step further, and this data was also in the study, and I want to look specifically at what about suicidal ideation, which is defined as serious suicidal thoughts in the last 30 days.
11:55
If you are a sandwich generation caregiver, what percent of a percentage of our space in our situation have had serious suicidal thoughts in the last 30 days?
12:05
I'm gonna break this into four cohorts. Cohort one, not serving in any unpaid caregiver role at all across the US right now. 4.5% of adults have thought seriously about suicide in the last three days. Data published in June.
12:17
Cohort two, I'm serving as an unpaid caregiver as a parent or guardian to someone or someone people under 18, it jumps to 9%.
12:25
Cohort three. OK, I'm an unpaid caregiver, but I'm serving for the, in that role for someone or people over the age of 18, 10%.
12:34
Cohort four is those who are serving for both Unpaid Sandwich Generation Caregivers, Club Sandwich, whatever you wanna call it. I'll let you take one second in your own head, everybody. What number do you think?
12:46
What presented page?
12:48
It's 52%, 52% just let that number stay with you for a minute.
12:55
52% of sandwich generation caregiving adults across the nation. That's 23% of adults, 52% of them, do that. Now, that's one in ten adults in the US, right now. In the last three days, have had serious suicidal thoughts because of their role as a sandwich generation character.
13:09
Now, I know a lot of this audience is what we call double duty caregivers, right? So, your paid caregivers, and whatever role you're doing, caring for your, literally your patients, and or that the customers, patients who come through your doors.
13:22
But if you're also in that unpaid caregiver role, we call you double duty. And I'll tell you, on average, we see about a doubling of our metric caregiver intensity for anyone who's in both of those roles.
13:33
And we also looked in another study that we published in The Journal of Affective Disorders. And again, if you go to archangels, Daphne can get all this data yourself directly.
13:42
We looked at, OK, what if we look at other cohorts? So, we just looked at some general data for prevalence for unpaid caregivers across the nation, depending on what role you're playing as a caregiver.
13:51
Well, let's look more specifically. Let's look at, what if you are black or Hispanic? What do you do for a living with disability?
13:57
What if you were young And Floyd Majority are essential workers. So we see unpaid caregivers are more likely to be in these populations.
14:06
That we know or more at risk before coded and we know disproportionately bore the brunt and are continuing to bear the brunt of coded now.
14:14
So, if you look at this chart in front of you, what it's looking at, is, if we look at the mental health risk, in general, ask that straight line.
14:22
How is that risk impacted as you look through these additional cohorts?
14:26
What if you're non hispanic Black or Hispanic disabled? A new caregiver? What if you're younger? And you can see the percentage of increase of risk for each of those Over the baseline, depending on those different categorizations.
14:40
there were Archangels, has built after 25 years of banging ourselves against this wall of really trying to understand what drives unpaid caregiver intensity is what you can think about a metric called caregiver intensity that looks at the compound, impact of all of these things as they play together. It's a 24 question.
15:00
They don't call it a two minute, like therapy session.
15:06
A Cosmo quiz, we've been called all sorts of things, but it walks you through very quickly and beautiful language.
15:13
Getting a sense for what are you in the green, yellow, or red, and what are the two factors, driving and decreasing that intensity.
15:20
If we take into consideration, but what we, what we look at, the reason we develop that Caregiver Subsidy Index is because it's not just one thing, it's not just are you in a central worker? It's not just argue, black.
15:31
It is how these things play together to increase your risk of having significant mental impacts. If you look at the thought of two pieces there, two populations, if you are in, in the red, if you have the highest caregiver intensity, you can see that that makes you the most at risk for this, the ultimate impact of these compounding impacts in terms of your risk of serious mental health impact.
15:53
So, what I want to go through really quickly, because my slide is not going, Why is my slide, I go to the next one.
16:01
Let's see what's going on here.
16:04
My slide is frozen, which is great.
16:11
Dan, just tell me quickly he, I still hear me.
16:14
Yes, OK, well, then if you stop working, OK, there we go. So what we look at also is what drives being in the red and it's thing that anybody who is an unpaid care giver will recognize it.
16:31
Things like caregiving, related family disagreements, resentment, feeling unprepared, not having as much personal freedom having had to cut down and expenses due to your caregiving role.
16:41
Now, that's a lot of stuff about the stuff that's hard, but there's also stuff that's beautiful. So I want to talk about what's the single most important thing any of us can do for these unpaid caregivers. If you have greater support, you have lower risk of experiencing any of these mental health center, so back to what you were saying. So originally, Dan, there are resources that exist to address. Is unpaid caregivers, hey, provider systems, hospital across the world. Please, let's put in place a mechanism to recognize his MPH nervous and get them crosswalk over the support that exists.
17:10
So coming back to this platform, I'm going to run through really quickly, because I have exactly two minutes left, what is the example the state trying to make, I think, go forward. What we do at archangels is a combination of a campaign to generate engagement, to get people to get their score and then a crosswalk them over to these resources that often exists. Most caregiver.
17:27
Most hospitals, most associations, most employers, actively have a an EAP employee assistance Program that has resources that, if you unbundle it, these are the resources that unpaid caregivers need. Financial advice they need help with what's going on with needing support, any daycare, whatever else might be, I'm going to stop sharing, because this is just making me crazy.
17:49
Um, Yeah.
17:53
And so archangels is doing, is launching, launching campaigns, Dan, back to your point.
17:59
They use different language to get unpaid caregivers to be seen in this role, than to crosswalk them over to these resources that exist that otherwise they would never know that, that I've already it for these organization hidden. So we unbundle the EAP, and then our goal. You're in the green, yellow, or red. These are the two things, both driving your intensity. These are the two things most alleviating it. We then cross walk you over, those resources that are already paid for. By the way, States: every single state has resources that exist for unpaid caregivers.
18:28
So you can, if you have nothing, in your own organization, at least crosswalk people over to resources. That exist. for free, right now. And we're doing that, states like New York, a partnership with Blue Cross or sort of math, in collaboration with the Math Caregiving Initiative, which comes out of Massachusetts during worthwhile work with health systems. So, please, first and foremost, as you're listening to the Recipes, Super freakin', fantastic speakers.
18:51
Please, never to put your own air mask on before helping others. Please keep in mind that you are probably a double duty caregiver, that being an unpaid caregiver has intensity that intensity is real, it has an impact. And our job is to get you seen, and to help you feel supported and not alone. So you can make your avail yourself to some of these gorgeous resources that exist.
19:24
Good afternoon, everybody. I'm Rick Martin. I'm a family physician. And I worked for Geisinger for a long time, Alexandra. Those are somewhat significant but almost frightening statistics about the mental state of caregivers who are kind of a forgotten group.
19:42
To your point. Right?
19:44
I want to talk a little bit about our program at Geisinger called life, Geisinger. And life is part of a national program called pace Programs, which are sponsored by Medicare and Medicaid.
19:59
And pace stands for program for all inclusive Care of the Elderly.
20:05
And in Pennsylvania, they're called life programs because we already have pace that is involved with pharmaceutical assistance.
20:13
So to avoid confusion, Pennsylvania has adopted the acronym of Life Living Independence for Elderly.
20:21
And these programs are designed to help the most frail and vulnerable elderly folks who otherwise would be living in a nursing facility, but who desire and have support mechanisms to stay in the community and stay in their homes. So these folks must be 55 years old and older.
20:42
They must live in the county or zip code that the pace program is licensed in via the state Office of long-term Living.
20:51
And they generally will have Medicare and Medicaid as their payers. There are few, if any, private payers that cover this program.
21:00
Some people will self pay as part of their spend down to become eligible for medical assistance, but predominantly it's Medicare and Medicaid.
21:10
I think of this program as a nursing home without beds.
21:15
Each of our centers consists of a large community room where people come and congregate and socialize partake of activities, Activities, exercise, they can play cards, play games with each other, so on and so forth.
21:32
And we have a medical clinic consist of a few exam rooms with several hospital beds and equipment so that we can do minder, surgical procedures, skin procedures, things like bad, joint injections, intravenous medications, nebulizer, treatments, etcetera.
21:50
Also in order, keep them out of the Emergency Department and maintain your care.
22:00
And then the third part is our therapy area.
22:03
Physical and Occupational therapy are a huge component of this program in an effort to keep people on their feet and the chain people want.
22:15
Down any questions you might have when we get to the end. We'll do that.
22:28
OK.
22:31
And the next.
22:36
Yeah.
22:40
I'm hearing an echo in, my speaker. I'm gonna just go ahead and keep on going down, We're gonna let Rick, Rick, continue. And hopefully, you can just send me a chat message if you're having problems with the audio.
22:55
OK, good, alright. So this sort of summarizes some of the care that we provide and some of our results for our dual eligible seniors. We really strive to keep them out of the hospital.
23:08
Most of these people don't want to be in the hospital, and we do everything we can to keep them out. I'll show you in a slider to some of our data around hospital utilization. The patient and caregiver satisfaction is 95%. And above rated, as good, an exceptional, we provide better comprehensive care for these folks. As we have our eyes and ears on them, even though the centers are open from 8 to 5. We actually have eyes and ears on july 24th.
23:39
We're able to capture and treat and deal with any and all of their diseases and medical conditions.
23:46
And most importantly, we give support to the patient's family and caregivers with home health aides and the ability to come into our centers and give the caregivers a little bit of reprieve during the day when they're in the center and so on and so forth. So, each program consists of an interdisciplinary team where we have physicians and advanced practitioners.
24:08
Social workers, a full nursing staff, home care staff, nutritionist, physical and occupational therapists. And every day, the entire team meets and reviews the program and the participants in need.
24:25
Next slide, please, Where we can provide most of the services within the centers. We also, although we're not licensed as a home health agency, but we can provide support services in folks homes, so many people need an hour or two of service in the morning to get them up and get them going. They might need somebody to come into the home to provide lunch if they choose not to come into the center that day and they might need somebody to come in in the evening to get them ready for bed. This slide indicates the Geisinger Service area overall and each of the stars indicates where one of our life Geisinger.
25:00
Sites is located, we are actually in the midst of planning and expect to open another center, another center in Center County within the next year to 18 months. So our program is growing, and we've got a timeline to develop some additional centers over the next several years as well.
25:20
So, it's a, it's a somewhat difficult program for people to qualify for, As I said, they've got to be 55, dual eligible, live in the service area.
25:29
and probably most importantly, B would be eligible for long term care placement and it's really their functional status that, you know, we all wish that we could get people qualified sooner in their decline.
25:43
We think that we would have more to offer people if they came to us before they really started on that downhill slope in late adulthood.
25:52
We have support from some legislators.
25:55
And we're trying to lobby to get the, the entry requirements changed, hopefully, in the future.
26:03
Next slide, please.
26:06
Um, I think this slide is going to show our hospital utilization. So, you know, we, we really, Yeah. So we really stress advanced care planning. When people join the program, everybody needs to have an advanced care plan. We want to know what matters to them. We want to know what their desires are. This actually is some data from, from our health plan.
26:29
That's our, our financial beneficiary that indicates how we perform with medical utilization.
26:40
So the red line on top indicates the cost of care for people who meet the criteria that I mentioned a few minutes ago, but who are managed in routine primary care practices.
26:51
And the blue line on the bottom indicates the cost of care per member per month of folks that are enrolled in the life programs.
26:58
So, we're really almost 50% less total cost of care than people that are, you know, what I refer to as in the wild State. And, you know, in regular primary care practices, that's kind of hard for me to say, as a family physician. For many years. I thought I did a good job with these folks, but I've learned that this program can actually do better and maintain them in a much happier and more content state. Next slide, please.
27:29
So this is just another demonstration of our hospital admission trend over the last couple of years. You know, we really shift, it's a little bit noisy because the number of participants is relatively low. But you can see that the trend is significantly down in terms of our inpatient admissions. And we really strive hard to keep people out of the hospital.
27:49
We have a number of programs that we can deploy into folks, homes and in our centers To keep them out of the hospital and keep them well, Next slide, please.
28:07
Hmm, hmm, hmm, hmm. Hmm. It's coming up. So, this shows our projections for growth.
28:13
So, you know, we've had steady growth in the program through the years. The, the, the, the top red line is our total capacity in all of our centers for the program, and, we hope someday to hit that. We never have, but, you know, we keep striving. And the blue line indicates people that are total white, Geisinger. And an adult day. Program that we offer at some sites, The green line is our actual life, Geisinger Census, and that's continued to grow steadily.
28:47
Almost up to 400, right now, as of this month.
28:51
Next, please.
28:59
Yeah, And this just gives you an indication of where our referrals come from.
29:02
So, people need to be referred into the program. And that gets it's a little bit confusing. They can be referred by social agencies, churches, housing authorities, elderly high-rises, so on and so forth, and they can be referred by their medical providers.
29:22
So, we're fortunate at Geisinger that we have a large network of primary care practices.
29:34
That refer about half of our patients, and the other half get referred from external sources. That includes social media, as well as the agencies that I just mentioned. So multiple sources.
29:48
We're not allowed in our clinical practice. You know? we're not allowed to data dive and identify who are dual eligibles are and what zip codes they live in and then cold call them.
29:58
That's against regulation. But as long as our providers refer them, we do have a very rich source of referrals from our practices, and not only do they come from primary care practices, but a number of those referrals come from some of our specialty practices. And we actually market to, those practices were, in a cardiology practice, they may serve as primary care physicians, for some elderly folks, with end stage heart failure and stage heart disease, or lung disease. And so we actually talked to to those specialties, as well and get a fair number of referrals from those sources. So anything to build our program. Next, please.
30:39
This indicates satisfaction that I referenced earlier, you know, exceptional and good, 95%, very few readers poor, for whatever reason.
30:53
But exceptionally high satisfaction from both the participants and their caregivers.
31:00
Next slide, please. I think that's the last.
31:04
So that's a quick overview of the life program at Geisinger and what we do and how we manage it and the resources that we have to help to support the caregivers at home for these folks.
31:16
Thank you.
31:19
And I guess I'll turn it over to Julia.
31:30
Julia, you're muted.
31:39
The mute button is on the control panel, on the vertical bar, right underneath the orange arrow.
31:45
How many times have we heard? Lighter and OK, I'm sorry about that. But, I was enthralled and listening and didn't want to have any background noise. But, good to join you all today, really, this is an honor.
32:04
Just following up on the comments that were given, and the data, certainly one feature caregivers, we know that caregivers have been thrust oftentimes into the position of caregiving. Many stumble onto it, Oftentimes, as Alex had shared, with no training, little support, data, as well, commented on that. Certainly, we know that there is real beauty, and I'm sure, Alex, the stories that you tell, there's really there's a lot of beauty behind caregiving and the relationships that are built and enhance. But more notably, there are adverse effects as well, and I appreciate you underscoring those. The strain is not only on the caregiver, the caregiver strain, also adversely impact the person for which you are caring for, which is really counter to what we all want to see happen. I, if you don't mind, I stumbled into caregiving in my twenties.
33:03
I lived with my grandfather temporarily, He was, I could do the math, he was born in 18 98. He was probably 94 at the time. He was living alone. He had just lost his wife of 60 years and the caregiving aspect was unspoken. I got his mail.
33:20
I did the laundry.
33:22
I got some groceries for him. We didn't really define what it was. But we had a lovely time. And when we laughed, when I left, I didn't have that conversation with him about what kind of supports he may need. It was all really unspoken, so that family conversation wasn't had, and it wasn't too long after that. That, unfortunately, my grandfather, was sitting in his living room, saw the mail billowing out of his mailbox, and put on his winter boots in the middle of what was a bit of an ice storm, and of course, we know the rest: he slipped and fell. And he went from hospital, he had surgery, and then he ended up in a nursing home where he linger for a few years kind of lonely and confused, and in those days, they actually used physical restraints.
34:09
And so, the incidence of what happened, that one decision, why, without having those community supports, and without having that family conversation, was profound in his life, and I know it impacted me a great deal. As a matter of fact. I went back to college, I wanted to specialize in helping older adults and people with disabilities, And the main driver for me was really helping people live in their homes and in their communities, but with supports, and having those critical family conversations with the caregivers. So, that means they're not, are met, and you talked about safety, and that being the number one concern, And so, a lot of the conversation is about that. And I had the very good fortune of working in a public policy office, and promoting policies that would help us get there, and Connecticut has been a leader on what we call rebalancing the long term Care Services and Support System.
35:11
But what attracted me to Connecticut community care, about a year ago, I've known them for many years, is its mission.
35:19
And its mission is really to support people in their homes. We collaborate with government agencies, with community based organizations, hospitals, assisted living, and nursing facilities.
35:31
Our clients are people who have functional and complex health and social services needs.
35:37
And we work, as you can imagine, really closely with families and caregivers, primarily are our clients are older adults and people with disabilities, and we have if I divide vers, professional bank of Employees, those who serve the people in the communities in which they live, so, it's an amazing organization. We have our services are in the home.
36:07
We do interventions and and sometimes that work is supplemented through phone and video chat. And that's become really critical way to reach the caregivers and to engage them as part of their care plan. Oftentimes, caregiver might live at a state. They might be on vacation or simply at work. So, what we provide is a single point of access for older adults and people with disabilities and their caregivers. And these are folks who are primarily at very high risk, and our goal is to mitigate those risks and help them have a quality life. So, we conduct comprehensive assessments. We develop care plan and arrange for services to come into the home.
36:54
And then we connect them with a variety of community supports and you know I have to say I think what we learned throughout the pandemic technology is amazing. And we are seeking it out and capitalizing embedding it into the services. We provide it.
37:10
But I think what we learned throughout the pandemic is there there's really no substitution for seeing somebody in their home environment.
37:19
So Oftentimes, and then you see how they interact with caregivers. So when you're actually in somebody's home, you could see is their food in the fridge?
37:27
Do they have heat and running water? What's the condition of the house? So many collectables could cause mobility issues or even a fall.
37:37
During a recent home visit, one of our care managers witnessed that a client was sleeping in a bathtub because they later learned the mattress had bedbugs and was soiled. And that was something that the client didn't bring forward through a phone call.
37:54
You really have to be in the home to see how they're doing, and, of course, that impacts their health significantly. So, throughout our work, we really help people avoid nursing homestays, hospital stays.
38:11
They avoid frequent use of the ER, and we also play a pretty paramount role in helping people transition back from a nursing home, stay back into their homes.
38:22
And our goal is, really, to help them live their best lives. We are a major contractor, the state of Connecticut.
38:28
We work primarily with Medicaid waiver programs, and some services within Medicaid proper, and, of course, the Money Follows the Person program.
38:37
And on our private side, are non-governmental payer on our private side of care management? We're seeing pretty significant growth and demand from families, and older adults, primarily.
38:50
And so, we're working with a collective and an eclectic group of partners to help provide, really, I don't like the word boutique, but completely tailored to the needs of the individual in their families care management services.
39:07
We know that health happens at home, right, Health happens at home, and, And in hospitals, of course, but it's, it's so very important when we look and address the social determinants.
39:26
Mental health and throughout the pandemic Alex gave some statistics that show, you know, caregivers are or in very great demand.
39:35
We at Connecticut Community Care, we've been around for over four plus decades. And you know, we have a lot of experiencing in in managing care for older adults and working with their families. But this pandemic has transformed significantly how we provide the care and what the landscape looks like. And the paradigm shift for long term care services and support has been significant. So one of the shifts is that caregivers, family, caregivers, those informal caregivers, really stepped up in a time that they were needed.
40:10
More older adults were leaving the nursing home and preferring care in the community. At the same time, the formal workforce was struggling with pretty significant capacity issues.
40:23
So, you know, we're hearing now that there's an urgent need to address family caregivers, that they're struggling. But those of us that have been in families, those of us that have been working on these issues for years and years, know, that the need has always been there. The caregivers have always been there. And they've been somewhat unrecognized and unsung.
40:45
But, perhaps, I don't even know that I want to state these words, but, if there is a silver lining of the pandemic, perhaps, it is that we're shining a spotlight, really significant spotlight on the need and necessity of our family caregivers. And in Connecticut, we are using our ARPA funds are American Rescue Plan Act, investments are ... stimulus package on informal caregivers.
41:15
There's going to be an infusion of a lot of energy and recognition and and dollars to address the needs of informal caregivers, and at the same time, I think it needs to be said that the formal caregiving network also needs attention and the funds will be invested there to create some more sustainability. And so, I think Connecticut is brilliant to do so.
41:43
one thing that Connecticut hopes to do is to roll out a new service, and I think that the first state government in the country to embrace the cope model into its Medicaid program.
41:58
We heard that Australia as a nation has embraced coat, but Connecticut is taking on this model. It involves caregiver assessments, dementia tools, additional respite services, and critical on the ground training for the caregivers to be able to adapt to, not only their needs of the caregiver, but to also be able to provide better care and take some of that strain off the caregiver.
42:26
So, again, we're completely grateful that Connecticut is using its funds to move in this direction to recognize these caregivers who have been here all along and are exceedingly important and have been put in the spotlight. We look forward to working with the State, hopefully, will make connections today. And I just appreciate this opportunity. And, once this is over, I'm going to look at everybody's slides, and, hopefully stay in touch with you.
42:57
So, I wanted to thank you.
43:00
Thank you.
43:04
We have a little bit of time for questions right now, and I'd like to start out with one that actually, one of the panelists submitted, it said, Why do you think the healthcare delivery system is so far behind other types of organizations in understanding the importance of the caregiver. Whether it be ace Hardware, or Lowe's or Home Depot, which have aged and in place initiatives marketing towards the caregiver.
43:36
Many Medicare Advantage programs are actually setting up or prioritizing communications with the caregiver over the actual member.
43:48
And yet, even though Medicare represents, for most health care providers, the majority of their revenue, very, very few healthcare providers, whether that be in the hospital systems or among physicians, have anything in place that is formalized to really assist caregivers when they're dealing with an age loved one.
44:12
Why, why, so far behind?
44:18
First of all, I have to start by saying, Julia, what you just said. I literally like, I'm taking notes while you guys are talking, and I'm, like, oh, I cannot wait to meet with each of you. Like, I'm so excited about what you're doing, and, you know, Dan, That's an awesome panel. When a panelists is. Like, can we just keep talking? Because this is amazing? Why don't we work with Native antique offline, and she is at Blue Crush of Mass.
44:40
And she said she was in a meeting once, and she almost started to cry out of frustration.
44:46
Because what she realized is, because unpaid caregiving crosses so many components of the traditional definition of health care and the clinical perspective, although everybody knew in their bones that it was an issue, nobody owned it, there was nobody who was responsible for the unpaid caregiver.
45:05
So, everybody had another responsibilities. So, they're focusing their time and energy on that responsibility.
45:11
And, the reason she almost cried meaning, if you know Anna Nagar, she was so frustrated. She's like, you guys understand everything you're talking about. The root cause of that is having been an unpaid care.
45:22
So I think it's an important point into Julio and Federal data. And you said, here's the good news. People are beginning to take notice. This is finally something that's like, oh, good, Lord this matters and rec, Shout out to the life program. Looks gorgeous.
45:38
Could I also add that in Connecticut, at least, from a public policy perspective? A lot of the on the CBO side and the public policy side, a lot of the momentum and energy around rights was driven by the disability community.
45:54
And it's completely person centered, as it should be, And you're in the driver's seat.
46:00
And so, I think it's a cultural shift to be able to accept the role of the caregiver as a care partner, perhaps. And not the one driving the care for the individual, because that's up to them.
46:12
OK.
46:13
Yeah, And, you know, I would add from, from the physician perspective, you look at our medical education process. I net now. You know, I'm in the Twilight in my career. It was a long time ago that I was in medical school and residency, but never ever.
46:28
Was anything mentioned in my training programs about including Caregivers Alexandria. has come in in the beginning. 80% of the time caregivers are not at the table.
46:38
And, never in my education only did I learn about caregivers as I got old and my practice got older, and I got involved in our life program.
46:45
Now, I'd now, like, you know, if they're first and foremost, Richard, you raise a very interesting point.
46:53
The other person asked me, not too long ago about physician training, and they said the two groups that they noticed that physicians liked to deal with the least are the mentally ill and older people.
47:09
That's why we have so few physicians that go in to become Board and gerontology. And we don't have a huge number of physicians knocking on the door to get boarded in psychiatry and they said, is it is it a fact of ageism?
47:24
You know, we do about sexism and racism, and everything.
47:27
But is it ages that there's a natural prejudice that whether it's society created her and turtle, that keeps physicians who are really addressing what tends to be the largest patient cohort?
47:45
Ah, well, you know, again, we'll get medical education during my training years, and I think this is appropriate today, as well. You know, I had six weeks or maybe a month of psychiatry training training in behavioral health.
48:01
Besides what I got in my primary care education, but, you know, minimal training, so many physicians are just uncomfortable and don't have the confidence to deal with behavioral health issues. And, similarly, to geriatric, General, you might get a rotation in, Medical School, or in residency in geriatrics of a month or two.
48:21
And, you know, it encompasses so many different aspects besides just how to prescribe medications for the elderly are, you know, ordering tests for the elderly, but encompassing, you know, all of their needs, their social needs, which are probably more important than their medical needs in some cases, in many cases.
48:40
OK, thank you Julia, in Alexandria, I'd like you to ask a question. I do a lot of work with the Area Agencies on Aging.
48:49
Hot hot topic now is social isolation.
48:53
Lot of money is going towards it, a lot of focus on it And what this ties into a question that we got is do you think the pandemic is really a driver of the recognition of the importance of caregivers.
49:08
And without the pandemic we would have just kept moving slowly along and the, the idea of social isolation, would it be adress like it is being now because of the pandemic.
49:27
Either one of you want to address that.
49:31
Alex is trying. But it looks like she's on mute.
49:34
Let's just not worry.
49:36
Yeah.
49:39
Julia, I'll start with you. Do you think the pandemic has changed How we view caregivers and the attention being focused on caregivers and would it be a significant if the pandemic could not have happened?
49:53
So, I think absolutely. It would not have been as significant. I think it just would have gone on as the way it has for the last year since the beginning of time. So, I think it is part of what you said, it.
50:13
Thank you, Alex.
50:16
I'm delayed.
50:18
Having a tough time with audio. So I think that's absolutely right. I think without it, we would have just gone along. And so it has raised the visibility. And one thing I wanted to mention about the previous question was you asked about physicians being maybe not having it be their most favorite exchange with me.
50:40
And I'm sorry, I have a little background. And I wanted to point out there and 2 1, 2006, we did a statewide comprehensive needs assessment. It was actually the Yukon Health Center Center on Aging, and they found that if you had a question about Community supports, who would be the trusted person you go to to get that information? And it, by and large, I mean, people said they want to go to their physician and find out.
51:06
So that, they, it's, it feels different from the older adults perspective. I just wanted to kind of raise that.
51:15
I'll add from the, from the life perspective, you know, our, our, our community rooms, I describe the three parts of our life centers, you know, the medical clinic is probably third in importance. But our community rooms are, first, we need to get these people out of their homes into the Center socializing.
51:35
And that does the more good than anything that I can prescribe any tests that I can order.
51:40
And, you know, maybe therapy is certainly up there to keep their legs strong and keep the mobile, but the socialization is absolutely huge. And we had a close our centers during the heat of the ... epidemic.
51:53
And, you know, we had to move all of our services into their homes. So, the folks who came into the centers for their meals, for their hygiene, et cetera, et cetera. That was all done in their homes. And you could see the difference in many of these, These people, they became much more depressed, much more anxious, they were scared, or, you know, getting sick.
52:12
They were depressed because they were, you know, in their homes, for so long, and not really getting any stimulation.
52:19
Um.
52:28
No, audio trouble.
52:35
All right, Jane. I did not know that any questions that came in.
52:41
Actually, we did, Yeah.
52:42
Let me turn my video back on I will join you.
52:48
Um, Yes, we did. So, let me take a look at the questions.
52:56
1, one second, I'm having a hard time accessing them.
53:00
How?
53:01
Here's a question, We're about life, How are patients and caregivers routed to the life program?
53:08
And how do caregivers learn about the options available to them?
53:12
What's driving the growth you've experienced?
53:16
That's a good code.
53:18
That question, you choose to append that a little bit.
53:21
It's really about how did the family caregivers find out how to help their elder relatives loved ones, get the resources that they need, because it's just seems like it's kind of a black box sometimes.
53:33
Jane, can I jump in? I'm so sorry. Can you guys hear me now?
53:36
Yes. OK. So this is a computer that I'm going to throw out the window because it kept killing me.
53:42
So Dan, back end point, I think it addresses question.
53:45
That question, Jane, goes back to what Julia said. And Richard said, is a culture change?
53:49
And I think, like what Archangels is working today, what we're all working to do is it's not enough to de stigmatize.
53:56
It's not enough to normalize, we actually have to transition all the way over to celebrating these individuals, ask the backbone of our society. And I think what Archangels, it sounds like, what Connecticut is doing is, you actually need to have a concerted like advertising type, approach, and use different language to defund paid caregiver, or 50% of caregivers don't know what that word is. Where they find it? Confusing, Or they don't want to be associated with it. The CDC study page 54% of caregivers of that 10000 person study were men.
54:25
Now I don't know if that's necessarily true.
54:27
Maybe it's 45% but so much healthcare marketing. It's essentially a nurse on the phone someone eating an Apple. I'm jogging on the beach, like our marketing. You saw me do social media when we do campaigns. It is aggressive, Lean on. healthcare is about life, it's about celebration, your warrior angel, and we can get eight times the level of engagement. When we use our approach it, as opposed to any, we use the approaches of our partners, if you can't get them engaged, you can't connect them to the resources that exist.
54:56
If they don't see themselves in that role, they're not gonna go use the EAP, They're not going to click on your Caregiver Support Program, because you're, like, stouffer caregivers stinks, or more more, usually, I'm not a caregiver, so it's not relevant for me.
55:11
Alex, here's a question for you about your platform. You said that states, use your platform. How do they actually use it? What did they do with it?
55:19
Well, I'll give the example of what we're doing in the State of Massachusetts. So we've launched a campaign. This is sponsored by Blue Cross Blue Shield of Massachusetts.
55:27
Co-sponsor is Mass Caregiving Initiative at a state quasi how they use it is, they are locked into multiple channels, whether it's through social or QR codes. I'm gonna go walk the streets with a bunch of other folks and go to festivals and, affairs me, pass these little things out.
55:47
And we have conversations about, or they got an e-mail, that they see themselves reflected in it, right across the state. They click through. They get their intensity score. They're in the green, yellow, or red.
55:59
The two things most driving it, the two things most alleviating it. And then they get crosswalk to over the resources that the state it has already paid for.
56:08
And, by the way, you would need more foot traffic, right? Because how do you get funded funding by having foot traffic, so it's a win win-win.
56:15
So what we do is we launch the campaign, get someone to get their intensity index.
56:19
All that data, by the way, also goes back to the state. So we can say, here are the things that are causing the most issues. Here are the things that alleviating it. And Julia, I am, because we are super working together on Connecticut, because I love Connecticut, your next. Great. People, OK.
56:41
So Julia, there is a question for you. Oh, now. How do you connect with and co-ordinate with hospitals?
56:49
Yeah. That's a really good question. So we help some hospitals with transition services. So if somebody's going to be discharged an older adult or a person with disabilities, and they happen to be on one of the programs that we provide care management for, if they are transitioning back into the community, we help ease that transition for successful outcomes. So it's a care management like glide path that we we provide, but more and more, we want to build that, that we want to integrate it. We don't want it to be a one-off. We want it to be a natural woven together integration, because when we talk about care management on the hospital side, it seems like it's a very different animal versus what we're talking about, we provide in the community.
57:35
Anybody else have anything to that?
57:39
OK, so we have one other question, actually, several others, but we're going to probably get this, maybe our last one, um, has to do with mental health, hollen's are going to go to find the question again.
57:50
Um.
57:53
Jay, while you're looking, I'm gonna say one other quick thing. Let's be, let's be thoughtful about care at home.
57:58
You gotta make sure somebody has a home, and they have someone at home who can step in and play this unpaid caregiver role. There is an interpretation of care at home that's basically just a cost shifting. It was what the hospital is paying for, and now it's on me, right? And that means I got to stay awake overnight.
58:13
I actually quit my job really important also, looking at the disproportionate impact on black latin X, right, living in multi-generational households. So Hey, hospitals, as you're thinking about this, be sure that the person you're sending home to get care at home, there's someone there who is ready to take that role equipped to take that role, wants to take that role.
58:31
Can. I can relate to the completely as a former family caregiver, because it's like, there's a, it's only you know, OK, So this is about mental health spending info about mental health effects on caregivers. What types of resources are most impactful to mitigate this?
58:49
If you have a, no, top 1, 2, or three.
58:54
So, I'll just go quickly.
58:56
I mean, for me, the number one thing is, whether it's a community health worker, or that you're talking to on the phone, or that you're texting with a lot of time, unpaid caregivers, they don't have the luxury of getting on a phone, because they're sitting right next to the person they're caring for. So, they can't really talk about the things that are having a hard time. So, in that experience, we say, get you to a community health worker, to any channel possible, because if you go back to those, the intensity, and let's go back to archangels, dot me and look at it, it's a combination of family disagreement.
59:26
Lack of understanding of benefits, I don't have any time for me, write these drivers of intensity really vary. If you've seen one caregiver, you've seen, one Caregiver, you gotta be supporting the underlying factors in ways that these community health workers, behavioral health specialists, are trained to do.
59:42
Using the intensity level changes over time, it's a very, very dynamic number, as the situation changes. So, we're right at the top of the hour, so I think we're going to close it out.
59:52
So I'd like to thank everybody for joining us for Alex, Rick, Julia, and Dan, for an excellent discussion and presentation, so much information.
1:00:00
And just a reminder to our audience that you'll receive an e-mail with a link to some of the presentation slides later today, and a second e-mail with a link to access the webinar recording as soon as it's been processed and it's available for viewing.
1:00:11
So, thank you for attending today's webinar, and we hope you enjoy the rest of your day.
1:00:15
Thank you, Jane.

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