Senior Care Integrated Planning (SCIP) SCIP through the Golden Years Business Plan Chesapeake, Virginia Team Chesapeake Heidi Kulberg, MD, MPH, Chesapeake Health Department Stacie Walls-Beegle, ACCESS AIDS Care Elizabeth Reitz, MS, Chesapeake Regional Medical Center Ann Myers, MS, Chesapeake Public Schools (retired) Management Academy for Public Health Year 12, Cohort 25 April 1, 2011 i SENIOR CARE INTEGRATED PLANNING (SCIP) Table of Contents Executive Summary………………………………………………………..………………1 Definition of Plan…………………………………………………………..……………….2 Project Operations and Management……………………………….. …………………4 Target Market/Research………………………….……………………. …………………5 Marketing Strategy…………………………………………………………………….…...7 Industry Analysis…………………………………………………………………...………9 Partners/Competitors…………………………………………………………………….12 Risks………………………………………………………………………………………...14 Timeline………………………………………………………………………………….....16 Financials/5-Year Projections…………………………………………………………..17 Appendices A. Home Care Services Community Resource List………………...….21 B. Stakeholder Forum Results…………………………………………….24 C. Certified Geriatric Care Manager Criteria and Ethics Pledge….....26 D. Letter of Support……………………………………………………...…..29 E. Break-Even Analysis……………………………………………………..30 F. References and Resources………………………………………...…...32 ii SENIOR CARE INTEGRATED PLANNING (SCIP) Executive Summary America is graying at a very rapid pace and this is having a profound impact on communities and the services required by a senior population. Eldercare coordination is becoming an urgent need. Senior Care Integrated Planning (SCIP) will address this need by serving seniors, connecting caregivers and educating employers. Baby boomers began turning 65 years old on January 1, 2010 and every day 10,000 more Americans become senior citizens. Two-thirds of this population will require long-term care at some point in their lives. In prior decades, this care was provided in nursing homes or assisted living facilities. In the past decade an explosion of services aimed at assisting seniors in their home emerged and nursing home utilization has actually decreased. With these new services, it has become confusing for seniors and their caregivers to evaluate which services are relevant and appropriate. Senior Care Integrated Planning (SCIP) will employ Certified Geriatric Care Managers to assist seniors with comprehensive assessments, individualized care plans, and coordination of services. SCIP will help seniors and their caregivers navigate the maze of eldercare. The program will initially focus on seniors living in Chesapeake, Virginia. In Chesapeake alone, the senior population is anticipated to triple between 2000 and 2030 to over 56,000 people. SCIP will exist under the auspices of the Home Care Services department of Chesapeake Regional Medical Center, a recognized leader in community health care. Home Care Services does not currently offer a geriatric case management program. Throughout the surrounding metropolitan area of 1 million people, only two geriatric care management businesses currently exist. SCIP will greatly expand city residents’ access to services necessary for helping seniors to make the best choice for their living condition. A relatively new focus in the eldercare arena is that of the working caregiver. Studies reveal that 30% of employees have responsibilities for a parent. Caregiver responsibilities impact businesses with increased absenteeism and poorer health of the caregivers themselves. This results in business losing up to $47 billion a year. There is an opportunity for case management organizations to partner with employers to reduce caregiver stress. SCIP will educate employers and work with employees to create care plans in advance of a crisis. Access to eldercare services may become as important to employees in the future as child care is today. Revenue generation will be achieved through a private pay model for case management to include fees for the services of assessment of need, individualized care plan creation and implementation, and continuous care management. With initial in-kind support from Chesapeake Regional Medical Center and fee for service revenue, SCIP will become financially self-sustaining by the end of year three. It is rare to talk with someone who has not been affected by an aging family member’s health challenges. SCIP will help seniors and families understand, plan, and manage eldercare services. SCIP will help seniors live as independently as they choose. 1 SENIOR CARE INTEGRATED PLANNING (SCIP) Definition of Plan SCIP will utilize Certified Geriatric Care Managers (GCM) who will assist families with the understanding, planning and managing of health, social, and legal services for their elder family members. Coordinating care and quickly alerting families to problems will help decrease crisis and will also reduce the stress family members experience when trying to navigate a difficult system. Working with area employers, SCIP will provide educational seminars on the importance of long term care planning to help avoid crisis management. With rapid growth in the senior population, our local citizens are facing a need for additional senior services and help with navigating the maze of paperwork, explain unfamiliar terminology, and define the various levels of care. A navigation system will prepare seniors and their families for their future, ensuring that their children and those caring for them are informed and educated about this complex system. Through a team of three Geriatric Care Managers, SCIP will assist Chesapeake and surrounding area residents with elder care issues. A GCM is an expert in the field of geriatrics and understands the complex nature and interaction of medical, emotional, social and financial aspects of a senior’s health. Ultimately, the GCM will work with families and seniors who are either experiencing a crisis at the time or who are planning for future care. Services that will be provided or assessed for referral:  Assessment-Assess the senior’s physical, medical, social, functional, psychological, and financial status.  Planning-Develop a comprehensive plan for the client to include goal setting, care planning, service initiation, and resource allocation.  Service Coordination-Referral service including modification of service delivery as needed. Communication with various service providers and coordinating services of physicians, pharmacists, social workers, discharge planners, home health agencies, and other services agencies.  Monitoring-Client status, reassessment, service quality, and crisis management.  Personal Care Services-referring to personal care services that will provide companionship, light housekeeping, and personal service like bathing, dressing and feeding.  Education-Educational seminars on the importance of pre-planning for eldercare. SCIP will be housed under the Chesapeake Regional Home Care Services, an affiliate of Chesapeake Regional Medical Center. Chesapeake Regional is a 310-bed acute care community hospital with more than 600 primary and specialty care physicians and 2500 employees. CRMC Home Care Services is located off-site from CRMC and currently offers: skilled nursing services, diabetes services, IV therapy, rehabilitative services, palliative care services, and pain management services. They also administer the Lifeline program, which identifies seniors who are at risk. Home 2 SENIOR CARE INTEGRATED PLANNING (SCIP) Care Services utilizes a network of community resources (Appendix A); however, neither the Lifeline nor Home Care Services as a department have the capacity to follow through with the needed eldercare planning for their clients despite their identification of risk. At CRMC Home Care Services there is no program currently available to focus on the comprehensive approach to serving seniors and no personal care or activities of daily living services. Through discussions with the Home Care Director, other ancillary providers and input from a community stakeholder forum (Appendix B), SCIP has been identified as the missing piece that the health care staff and families need. The SCIP Geriatric Care Managers will work closely with other Home Care agencies to provide the experience and sensitivity to guide seniors and their families through the maze of financial, legal and medical issues. Three Geriatric Care Managers will be hired the first year. In the beginning their focus will be to market the program and educate the hospital staff, physicians, seniors, and businesses on the services offered by SCIP. The GCMs will have an office in the Home Care Services Department but the majority of their clients will be seen in the comfort of their own home. Each GCM will utilize a laptop for convenience to complete assessments and questionnaires while interviewing the client in the community setting. When a client is enrolled in SCIP, a comprehensive assessment will be completed by the GCM. Based on the need, a GCM may be hired for a single task, such as arranging all aspects of placement in an assisted living facility, or SCIP can take on long-term services of a client. For example, they can oversee the personal care service for a long-distance family member and be available in the event of an emergency. The average caseload for each Geriatric Care Manager will be 15-25 clients; depending on level of need of each client. One of the Geriatric Care Managers will dually serve as the Program Manager. This individual will be responsible for the administrative duties which include hiring and supervision of the staff, financial and performance reports, and marketing activities in addition to working with clients. This position will report to the Director of Home Care Services. The other two GCMs will see clients and work closely with referral agencies, case managers and hospital staff. They will follow up on referrals made for their clients and they will conduct new intakes as they enroll in the program. Finally, they will assist in conducting educational seminars to businesses to further generate referrals to SCIP. In the first year, SCIP plans to complete at least 60 initial screening assessments and enroll 50% of these clients into the program. Providing educational seminars on the importance of pre-planning for eldercare to 12 Chesapeake businesses will be one of the major annual objectives as well as a marketing tool. Working closing with CRMC, another objective is to decrease the number of non-urgent visits by our senior population to the emergency department by 50% thus reducing health care costs. A GCM is able to check on their senior clients and make sure they have the support, medicine, and care they need to stay healthy and avoid a crisis that requires hospital care. The GCM can provide this service for less than the cost of an ER visit or 3 SENIOR CARE INTEGRATED PLANNING (SCIP) hospital stay. More importantly, the GCM can help prevent hospital readmissions, creating a tremendous savings to the hospital. In year three, a personal care component may be added. Personal care provides the assistance with daily activities that a senior needs in order to stay in their home. These services range from light house work to bathing or assisting with meals. Personal care would be staffed with certified nurse’s aides that have been thoroughly screened, trained, insured and bonded. Staffing would be based on demand and may range from a few hours a week to comprehensive 24-hour care. While conducting our research for SCIP, a focus group with stakeholders was facilitated. It was determined personal care services is necessary for this population and staffing for that service can be a barrier to providing quality services. We will consider adding personal care services to our project, but at this point, we will work through referrals with other providers who are currently providing the services. Listed below are our measures of success: (these are annual figures) 130 screening assessments by three Geriatric Care Managers (by year four) 50% of those screened, enrolled in SCIP 90% good to excellent satisfaction rating (as reported by SCIP clients/families) 12 employers educated per year on the importance of long term care planning 25% decrease in geriatric hospital re-admissions of SCIP enrolled clients 50% decrease in non-urgent ER visits by seniors of SCIP enrolled clients Revenue generation will be achieved through a fee for services; including assessment of need, care plan development and continuous care management. With initial in-kind administrative support from Chesapeake Regional Medical Center and fee for service, we will develop an on-going and sustainable program. It is expected recruitment and marketing will be a priority for the first several months, therefore, program revenue will be limited. By Year 4, no in-kind expenses from CRMC are factored into the budget. SCIP is a service which will help families and seniors understand the medical and health related options available to them. There is an emphasis on pre-planning which will decrease the alternative of making choices under pressure during a crisis. Project Operations and Management The program will have the benefit of operating under an existing program, therefore start up costs and program implementation requirements will be minimized. For example, an IT system is already in existence, and while a SCIP specific program will need to be set up, it can be developed within the existing system. The same is true for patient billing. Home Care Services already has a system, but SCIP services will be added. This must all be done before services can begin. Daily operations will flow within the existing Home Care Services of CRMC. Existing systems are already in place for services that are compatible with SCIP. The first hire of the program will serve as a Certified Geriatric Care Manager/Program Manager. This person will be responsible for coordinating the integration of SCIP into existing systems (IT, billing, 4 SENIOR CARE INTEGRATED PLANNING (SCIP) etc). This staff member will be higher level and report directly to the Director of Home Care Services, who will manage the supervision of the entire SCIP program. Ancillary administrative support will be provided by the receptionist and other existing staff in Home Care Services. Referrals for SCIP will be made by hospital social workers/discharge planners, Chesapeake Dept of Human Service Adult Protective Services, Home Care Services staff, physician’s offices and self-referrals. All referrals will be coordinated through the GCM Program Manager. An initial screening will be completed and, if appropriate, the client will be assigned to a GCM and a comprehensive assessment will be completed. All tracking of referrals, assessments and intakes will be documented electronically. Tracking referrals into SCIP will help identify where the referrals are initiated and where they are not. Focus on additional networking or marketing efforts could then be re-directed to reach a larger audience. A benefit of co-locating SCIP at Home Care Services will encourage the staff to work as a team as the senior’s needs change levels of care. SCIP will become its own cost-center within Home Care Services, but it is expected the flow of patient services would be seamless to ensure a client no longer experiences a gap in service when there is a change in level of care. The information systems already in place can be adapted to ensure SCIP is able to electronically document client status and services. Quality improvement activities will be in accordance with existing systems already in place at the Home Care Services. Patient chart reviews will be completed at regular intervals. The supervisor will meet with each GCM regularly to provide review of the client files and feedback to the GCM regarding services that are provided. Billing reports will be compared to client file documentation to ensure consistency in appropriate documentation for client billing. To ensure the highest quality of services are provided by our personnel, the program requirements for SCIP GCMs will be a minimum of a baccalaureate degree, with a preference for a Master’s Degree in Social Work or Nursing or closely related discipline. We will require a minimum of five years experience with the geriatric/senior services. Through our research for this project, we identified there are only three Certified Geriatric Care Managers present in the entire region and none in Chesapeake. Therefore, it’s unlikely we will be able to recruit individuals who are already certified by the National Association of Professional Geriatric Care Managers (NAPGCM). The program will assist the staff in obtaining appropriate training and licensure to obtain the certification of Geriatric Care Managers. Target Market Definition / Research In 2008, the Chesapeake Health Department (CHD) completed a community-wide strategic planning process to identify resources and prioritize issues that the public health system can, and should, address. The tool used to guide this process was called MAPP - Mobilizing for Action through Planning and Partnerships. This assessment determined there was a need to improve linking people to needed 5 SENIOR CARE INTEGRATED PLANNING (SCIP) personal health services. Another needs assessment completed by the Chesapeake Task Force on Aging also found that knowledge of community services was limited. Educating our senior population on the availability of services in our community and linking them to these services is a need that SCIP will be addressing. An age wave of graying Americans is flooding the United States. In 2030 the senior population is projected to be twice as large as in 2000, growing from 35 million to 72 million. This represents 20 percent of the total U.S. population. In the state of Virginia, persons age 65 and older make up 12.2% of the population. In Chesapeake, the proportion of individuals over 65 years will double between 2000 and 2030, from 9% to 18%, while the actual number will more than triple, from 17,844 to 56,015. In the past 6 months, CRMC discharged 517 patients to nursing homes and skilled nursing placements. CRMC Home Care Services have over 300 Lifeline units in homes of at risk seniors. The average life expectancy in the US in 1900 was 47.3 and in 2000 it rose to 76.9. People are living longer and healthier lives; this creates a major social and healthcare challenge. Heart disease, cancer and stroke are the leading causes of death among older adults. About 80 percent of seniors have at least one chronic health condition and 50 percent have at least two. Diseases like hypertension, arthritis and diabetes are the leading causes of activity limitations among the senior population. Care for our senior population is changing. In the late 1960’s and early 1970’s longterm care choices were mainly limited to nursing homes which were modeled after hospitals. Over the past 10 years, the focus has changed to less institutional kinds of residential care, assisted living and home-based care. From 1987 to 1996, there was actually a drop in nursing home occupancy rates suggesting that the older population needs are being met outside of nursing homes. Traditional nursing homes now focus on caring for the oldest and frailest seniors. Between 1998 and 2003 there was an 80% increase in spending on home care and community-based services. Assisted living provides more privacy and independence but is not covered by Medicare and tends to focus on a higher economical status. The majority of older adults vehemently state that they do not want to end up in a nursing home. For many seniors, a nursing home may be seen as the only option. The changing face of eldercare and its financial implications represent a significant societal issue with the aging of the senior population. Ken Dychtwald, president and CEO of Age Wave, author of 16 books on aging, and a leading thinker in the field, recently completed a study for Genworth Financial that looked at America’s readiness for long life. Only 36% of the people surveyed think they will ever need long-term care. Current care usage demonstrates that 67% of the over-65 population will need long-term care at some point in their lives. This suggests that all of us need to do some serious planning and saving. Many seniors feel pushed into nursing homes due to lack of education concerning their knowledge of options, lack of finances for home care services, and limited family support. Many adult children, known as the “sandwich generation,” are unable physically or financially to care for their parents at home because they have to work 6 SENIOR CARE INTEGRATED PLANNING (SCIP) to support their families and also care for their own children. With the increase expected in the senior population, more will need to be done. The benefits of seniors aging at home are numerous. The older adults feel more independent and a sense of control. They are exposed to less contagious diseases and sleep better in their own homes. There is also a substantial cost difference. The annual cost of a nursing home in Chesapeake is $79,000 which is about $213 per day. Home care costs are less costly because it is paid by the hour and not around the clock. Seniors and their family members/caregivers are our major target audience. MetLife Mature Market Institute and the National Alliance for Caregiving have conducted a number of studies on the impact of family care giving on the workforce. Sixty-two million people (26.8%) in the US have served as an unpaid family caregiver to an adult. Up to 30% of employees have responsibilities for their parent/s. Sixty three percent of caregivers between the ages 51-63 are working and most full-time. The majority of the caregivers are working middle-aged women. Met Life found that companies lose up to $33.6 billion per year due to employee’s absenteeism, workplace disruptions and reduced work status of working family caregivers. Additionally, there is an 8% differential in increased health care costs between care giving and non-care giving employees, costing employers an extra $13.4 billion per year. Caregivers are more likely to report depression, hypertension, diabetes and pulmonary disease. In 2009 a survey determined caregivers want more information regarding:  Keeping a recipient safe at home= 37% (up from 2004, 30%)  Talking to doctors/professionals 24%  Choosing a home care agency= 23% (up from 2004 13%)  Choosing an assisted living facility= 19% (up from 2004, 13%)  Choosing a nursing home= 17% (up from 2004, 8%) SCIP will educate employers regarding the critical nature of long-term care preplanning. SCIP will effectively reach the caregivers through their employers due to the impact this issue has on businesses. Access to eldercare services may become as important to employees in the future as child care is today. Marketing Strategy This program will target the seniors, their caregivers and employers and as such the marketing strategies must also target all three aspects. Direct one on one encounters or personal presentations will occur at several different levels:  To reach seniors directly, we will approach senior groups or places where seniors gather (support groups, social clubs, health fairs, community events, etc) to conduct presentations and information sharing sessions. 7 SENIOR CARE INTEGRATED PLANNING (SCIP)   To reach caregivers, we will approach employers who may be struggling with loss of personnel hours due to caregiver responsibilities. We will present information through group level presentations (through human resources and through “lunch & learn” type presentations). To reach both seniors and caregivers, we will approach professional organizations serving seniors (physician’s offices, hospitals, rehabilitation centers, social service organizations, etc). This will facilitate third party referrals to SCIP. There are 15,599 companies in Chesapeake, Virginia; 12 employ 500 to 999 persons and three employ 1,000 to 4,999 persons. We will utilize traditional marketing strategies as well as the technology of today. Seniors themselves may not utilize the internet or other social marketing outlets, but it’s likely their caregivers or other family members do. Internet and mobile marketing efforts will be targeted towards caregivers and employers. Traditional print (brochures) and media marketing (television and internet) will be utilized. SCIP representatives will seek to publish free print articles in the following:  Clipper: Chesapeake specific publication that is included in the regional newspaper, the Virginian-Pilot and has a distribution of 137,880. The Virginian Pilot has a regional distribution of 542,471 weekly.  The Shopper: distribution of 84,896 and is delivered with regular mail to all single dwelling homes in Chesapeake.  Doctor to Doctor: a newsletter published quarterly and is mailed to 8,500 doctors, dentists, and medically related businesses.  Vital Sign: a medical magazine distributed online by the Marketing Department of Chesapeake Regional Medical Center, with distribution to 4,600 email addresses.  Doctor’s Page: newsletter with receiving audience of 523 physicians serving the Chesapeake Regional Medical Center. Brochures will be distributed at all speaking engagements. For organizations in which we have no existing relationship, a brochure will be mailed and followed up with a phone call or personal visit to request a presentation. SCIP will involve the faith community by making a presentation at the Hampton Roads Ministerial Association. Bulletin announcements will be sent to 500 institutions in the faith community to be reprinted in their bulletins and newsletters. Two speaking engagements will be requested on Chesapeake’s cable Channel 48 television. Existing shows Health Matters and Thinking Out Loud each reach an audience of 100,000. There is no advertisement fee involved for these public service programs. In an overt effort to reach the caregivers during their transit time to and from work, an advertisement will be placed on five outdoor billboards in strategic locations reaching over 200,000 commuters each day. 8 SENIOR CARE INTEGRATED PLANNING (SCIP) Industry Analysis Case management has been defined as a systematic process of assessment, planning, service coordination and/or referral, and monitoring through which the multiple service needs of a client are met. Five essential features comprise case management:  identification of eligible patients  assessment  development of an individual care plan  implementation of the care plan  monitoring of outcomes For individuals at high risk of adverse outcomes and excessive healthcare utilization, case management is an important intervention. Case management has been shown to decrease glucose levels in diabetics, reduce infant mortality in maternal-child health patients, and decrease emergency room use utilization, as well as increase days of life, in geriatric patients. In 1993, geriatric care management was declared the way to decrease unnecessary hospital costs. Geriatric care management has been defined as a service that assess an individual’s medical and social service needs, then coordinates assistance from paid service providers and unpaid help from family and friends to enable persons with disabilities to live with as much independence as possible. The long-term care continuum includes case management for seniors and their families. Nursing homes and publicly funded programs have traditionally been the primary provider of this management. In the mid-1980’s “private” providers of case management began to emerge; practitioners who charged for case management as a separate service, not usually reimbursable by Medicare or Medicaid or other public programs. According to Marcie Parker, a research associate with InterStudy, a Center for Aging and Long-Term Care, this distinctive industry resulted from numerous factors including: “(a) converging growth trends in the older population; (b) increasing concern over the costs of services; (c) growth in the number and types of services targeted at the elderly and thus the complexity of the system; (d) the entrepreneurial spirit of human service professionals; and (e) a realization that public programs cannot meet the care coordination needs of all older persons and their families.” Surveys conducted in both 1988 (Parker) and 2000 (AARP) revealed that more than two-thirds of geriatric case management firms were independent and selfmanaged; those with affiliations were located within hospital, social service or nursing home systems. Regarding payment sources, 91% of firms report at least some of the payment comes from the client out-of-pocket, while 77% receive some out-of-pocket payments from the family/caregiver; only 17% receive any payment from insurance. The National Association of Professional Geriatric Care Managers (NAPGCM) defines the profession of geriatric care management as “a human service specialty provided by professionals from diverse background and academic preparations to a vulnerable and often frail population.” In 2000, the vast majority (75%) of the case managers held post-graduate degrees; additionally, two-thirds of the case managers were licensed, 37% in social work and 30% in nursing. In an attempt to provide high 9 SENIOR CARE INTEGRATED PLANNING (SCIP) quality standardization to the practice of care management for seniors, to ensure clients are getting the best care, the NAPGCM, in January of 2010, began requiring its active members to meet stringent criteria to be professionally recognized as a “Certified Geriatric Care Manager (GCM)” (Appendix C). The criterion include a minimum of a Baccalaureate degree with 2-3 years of supervised experience as well as certification in one of four vetted case management programs: Care Manager Certified, Certified Case Manager, Certified Advanced Social Worker in Case Management, Certified Social Work Case Manager. In addition to the core case management services, many private geriatric organizations began offering direct services such as counseling and nursing home placement. Over time, the addition of companion, homemaker, and home health aide services became integrated in many geriatric case management organizations. Two nationally recognized at-home, senior care organizations are SeniorBridge and LivHOME. Founded in 2000 and with 33 locations in 10 states, SeniorBridge is considered a leader in elder care. LivHOME, with 23 branches in 7 states was founded in 1999 “to enable older adults to remain in their home for as long as possible.” Both of these organizations tout Certified Geriatric Care Managers who oversee the assessment, care and coordination of services for the client. Additionally, both offer personal care, or caregiving, services to assist the client with activities of daily living. Neither of these organizations provides care in southeastern Virginia. Hampton Roads is a metropolitan region of SE Virginia boosting a population of over 1 million people. However, only three certified GCMs, working in two separate organizations, serve this area. Marilyn Fall is a certified GCM and founder and COO of Elder Care at Home, Inc. which provides case management and personal care services for an average of 50 clients at any one time. Mrs. Fall has chosen to limit her case load. Family Care Solutions employs two certified GCMs and over 200 other personnel to provide a broad spectrum of services including Geriatric Care Management, Home Health Services, Personal Services, Home Maintenance Services and Personal Monitoring Systems. Other long-term in-home care models in the area are run by managers without specific health training. Seniorcorp, a Virginia company dedicated to “changing the way America ages,” was founded by a business entrepreneur with the designation of a Certified Senior Advisor (CSA). There are no minimum educational or experience criteria to obtain the certification of CSA. Anyone who chooses “to enhance their ability to serve the senior community more effectively” can gain this certificate per the Society for CSA website; health care experience or education is not necessary. Another organization that has an office in Hampton Roads, Home Instead Senior Care, was created in 1994 by a man concerned about the care of his elderly grandmother. Home Instead provides companionship services, personal services and home helper services and the organization now boosts over 900 franchises in 14 countries. Only Home Instead is located in Chesapeake, Virginia. A relatively new focus in the elder care arena is that of the working caregiver. With up to 30% of employees have responsibilities for their parent/s and businesses losing up to $47 billion a year as a result, employers need to learn how to help their 10 SENIOR CARE INTEGRATED PLANNING (SCIP) employees. There is a niche for case management organizations to partner with employers to develop employer-sponsored geriatric care management programs. Keys to success for long-term care stem from the vulnerable nature of the individuals requiring the services, the senior. For the case management component of long-term care, certification as a Geriatric Care Manager is the highest degree of expertise that can be conferred to ensure quality assessment, coordination of care, and monitoring of the client. Ease of accessibility, strong communication skills, and access to the target market are also determining factors in the success of a geriatric care management industry. When adding personal care services to an organization, personnel that are trust-worthy, reliable, and well-trained are crucial to the success of an organization. The aides must undergo thorough background, criminal, and reference checks as well as pre-employment screening and drug testing. The organization and employees must be licensed, bonded and insured. The coordinator should take care to selectively screen and match each client with an appropriate health aide. The addition of continued training and education as well as a benefits package decreases turn-over in the care aide work force. A political trend that supports new industry in long-term care sprouts from the recent passage of the Patient Protection and Affordable Care Act in March 2010. Coordination of care is being emphasized in multiple provisions of the new law including the Community Care Transitions Program, which went into effect on January 1, 2011 and aims to coordinate care and connect Medicare recipients to needed services upon discharge from the hospital. Additionally, the Medicare Independence at Home demonstration project will be launched in 2012 to determine whether chronically ill clients will benefit from coordinated primary care in their home. The Community Living Assistance Services and Supports program (CLASS) provides the most important boost for in-home care service entities by creating a federally administered insurance program for individuals to purchase non-medical long-term services and support. Payment for case management services and lack of knowledge about the benefits of, and the need for, geriatric care management emerge as the two key stumbling blocks for this burgeoning industry. Regarding finances, long-term care has historically been paid for by the consumer or their family out-of-pocket. Long-term care (LTC) insurance policies cover skilled, intermediate, and custodial care in nursing homes and usually cover home care services. Many LTC policies are beginning to cover “alternative care”, including case management. Some LTC insurance requires an assessment of activities of daily living and/or of cognitive impairment, assessments that may be carried out by GCMs. An emerging trend in payment for long-term care comes from the employment sector via Employee Assistance Programs. A few employers are adding benefits that cover the cost of long-term care for the family member who needs care thereby allowing the employee to focus on their work. Regarding knowledge, an AARP survey of GCM professionals found that their “biggest challenge is lack of public awareness that geriatric care management even exists and what is can do for the consumer.” Another study revealed that between ¼ and ½ of the GCMs time was consumed by educating clients and family/caregivers 11 SENIOR CARE INTEGRATED PLANNING (SCIP) about their services. Additionally, many care givers, nurses and other case managers who work with seniors are used to Medicare and/or Medicaid providing nursing home and medical home health care services to their elder patients. They often do not think patients would be willing, or able, to pay out of pocket for care coordination services; consequently, they do not refer patients. Education to nursing and hospital staff and to employers is every bit as valuable as educating the clients and their caregivers/family. Partners / Competitors Despite a population of over 1 million people in the Hampton Roads region, only three GCMs are known to practice in the area. Multiple organizations within Chesapeake provide services or resources to the elder population; however, none specifically provide eldercare planning services and care management to assist the senior and their family members. Many partners have been identified as assisting the senior population on different levels. The goal of SCIP is to help seniors live as independently as possible while in a safe environment to meet their needs. When partnering with these organizations, cooperative strategies offer many potential advantages to the participant. A partner’s specific knowledge of the local market can be invaluable and open doors for additional assistance. SCIP has complimentary goals and objectives as the partners listed below.  Chesapeake Regional Medical Center provides comprehensive medical services to people throughout Hampton Roads, including many seniors. Their Home Care Services provide medical services; however, they do not provide long-term planning, comprehensive care management or personal care services. They accept Medicare, Medicaid, Tricare and private insurance.  Chesapeake Human Services offers a number of service and benefit programs for senior adults including Adult Protective Services, companion assistance, assessment for alternative living arrangements, and entitlement programs such as food stamps and Medicaid.  Chesapeake Health Department conducts nursing home screenings and facilitates a caregiver support group.  Chesapeake Task Force on Aging is dedicated to the well-being and overall concerns of the elderly. They work to identify the needs of the elderly population and investigate new and invigorating ways in which to enrich their lives.  Chesapeake Parks and Recreation provides Senior Programs and activities at two senior centers.  AARP Foundation Senior Services is a senior citizen service organization addressing senior activities and weekly clubs and volunteer opportunities.  Senior Services of Southeastern Virginia (SSSEVA) is the Area Agency on Aging serving residents of Chesapeake and Hampton Roads. They support and enrich the lives of older Virginians and their families through advocacy, education, information products and comprehensive services. They 12 SENIOR CARE INTEGRATED PLANNING (SCIP)  receive funding from federal, state, municipal, and private sources. Many of their services are free and they charge for others on a sliding scale based on income. Oast and Hook, “the experts in Elder Law” for Hampton Roads, is a legal service which has the potential for referrals to, and from, SCIP. It is expected these partners will serve as referral sources for the program. We will work together in a collaborative environment enabling each other to provide the needed services for the client. Workshops and seminars will be conducted with organizations with the tools and knowledge to help clients and will assist by raising awareness of senior issues. The partnership with CRMC adds significant validity to SCIP due to the quality reputation they already have established in the region. Competitors include organizations in Hampton Roads currently providing eldercare services. Only one senior personal care service provider is located in Chesapeake and they are limited to companionship services, home helper services and personal services: therefore, many residents travel to the other cities of Hampton Roads seeking these services. With the increasing population, additional service providers will be necessary to meet the demand. A focus group held with community agencies (including some competitors), identified a need for geriatric care management service in Chesapeake. The following companies are considered to be the competitors for SCIP.  Elder Care at Home, Inc. is located in Virginia Beach. Founded in 1990 under the direction of Marilyn Fall, the president and COO, they provide professional geriatric care management including comprehensive assessment of needs, personalized care planning, coordinated services, short and long term care supervision, counseling and education, legal and financial service referrals, medication monitoring, and household management. The proprietor of Elder Care at Home, Inc. is actually a competitor turned alliance. The team met with the owner to discuss services and local needs.  Family Care Senior Solutions, Inc. is located in Portsmouth, VA and has been in business since 1983. They advertise that they are the Virginia leader in healthcare and home services for families with a staff of 200 screened, bonded and insured employees. Their services include geriatric care management, home health services, personal services, home maintenance services, and personal monitoring services.  Care Connect of Hampton Roads, established in 2007, is located in Virginia Beach, Virginia 23462. Under the direction of Christina Boyd, a Certified Senior Advisor (not a GCM), they claim to be a full service geriatric care management firm. They offer health care, finance, legal, Medicare, Medicaid, assisted living, home care, and nursing care.  Seniorcorp, Inc. located in Norfolk, Virginia. They provide a personal care coordinator (not a GCM) who oversees advocacy for the client. It is a private pay establishment that offers basic services to seniors based on the level of need and the amount of time needed during the week to provide personal services. 13 SENIOR CARE INTEGRATED PLANNING (SCIP)   Senior Helpers (Caring In-Home Companions), founded in Baltimore in 2001, is located in Virginia Beach, Virginia and offers a full complement of services to ensure a continuum of care including companion care services and personal care services. They do not have a GCM. Home Instead Senior Care, founded in 1994, is located in Chesapeake, VA. They offer companionship services, home helper services and personal services. A Geriatric Care Manager is not employed and they are led by individuals who live, work and have a desire to impact aging related issues in their community. SCIP will offer a distinctive service from what is available in the city of Chesapeake. SCIP will offer an additional choice to the limited array of GCMs regionally. Because of the growing elderly population and booming market, we do not expect to take clients away from our competitors. Additionally, no other program is focusing on the employer aspect of elder care; therefore, it is anticipated SCIP will recruit new clients who are not currently utilizing any senior services. As we look at threats and future competition, companies that are interested in acquiring the professional practices of experienced, or entrepreneurial, private firms’ surface. LivHome has launched a franchise program and was named in the Inc. 5000 List of fastest growing private companies for the 4th straight year. They employ a credentialed care manager (not a GCM) with a specialty in social work, nursing or mental health. Another company, SeniorBridge Care wants to merge with or buy care management practices or home care companies. They are a geriatric care management team of nurses, social workers, and certified caregivers located throughout Florida and other states and with a national office in Baltimore, Maryland. Risks Creating a new business includes numerous risks; for SCIP, financial, staff, and organizational risks pose the major threats to the organization. The financial risk takes into account both expense and revenue sources. Regarding expenses, SCIP depends on integration, as a cost center, under Chesapeake Regional Medical Center’s Home Care department for its initial creation and start-up. The Director of Home Care shares the vision of SCIP and has written a letter of support (Appendix D). CRMC’s Senior Executive Team was educated about the benefits of SCIP, not only to the community but to their bottom-line, during a presentation of SCIP’s business plan. Specific metrics targeting reduction in hospital readmissions and unnecessary emergency room visits were cited. If CRMC decided not to integrate SCIP under its umbrella, the business plan could be re-written to create an independent, non-profit entity. Regarding risk and revenue, concern has been voiced about patients’ ability and willingness to pay out-of-pocket for case management and personal care services. Chesapeake’s indigent population is lower than the state average; additionally, the 14 SENIOR CARE INTEGRATED PLANNING (SCIP) senior population was the only age demographic category to reduce their rate of poverty last year. With home care costing less than nursing homes, it is a viable alternative to many seniors. Educating seniors and their families about the benefits of care coordination and contrasting the costs of nursing homes with in-home care will help enable seniors to make decisions that are best for them. Furthermore, many studies demonstrate that private care is often financed, in whole or in part, by family members or caregivers. Marketing will target these populations, especially through their employers. SCIP will educate employers about caregivers in the workplace, explaining the stressors on the individuals as well as the resultant toll on the business and will offer ways to reduce the burden including adding long-term care benefits for not only the employee but their family members. Staff risk involves service providers. The inability to hire a certified Geriatric Care Manager could be devastating to SCIP’s success. To prevent this obstacle from occurring, SCIP will focus on hiring professional care managers with experience in the field of gerontology and will pay for their certification and recognition by the NAPGCM. Provision of competition wages with benefits will help entice high quality staff. CRMC will be expected to provide organizational support through name recognition and by access to potential clients, namely hospitalized seniors. Lack of support in these areas could results in the inability to create and maintain a sufficient client base. Integration into the discharge planning cycle would facilitate internal support. Cooperation with emergency room staff will assist with the introduction of SCIP’s services at the onset of a perceived crisis. An additional barrier is the mentality of health and social service staff who perceive the senior patient as unwilling or financially unable to acquire private services. Education for these staff about the benefits of geriatric care management programs, not only for the patients but also for the hospital, could help shift the paradigm regarding referrals to private pay entities. Marketing support from CRMC is also important as brand recognition associated with our community hospital will provide SCIP with enhanced community acceptance. Regarding regulatory restrictions, as SCIP will not be billing Medicaid or Medicare, it will not be beholden to the numerous restrictions and documentation challenges that come with these payor sources. SCIP will hire licensed case managers and will be insured and bonded under the auspice of CRMC. The long-term development plan involves expansion of services and education. Initially, SCIP will begin as a geriatric care management service under the umbrella of Home Care Services at CRMC. Within three years, SCIP will consider offering personal care services. Simultaneously, SCIP will educate local businesses about geriatric care coordination and encourage the integration of these services as a benefit to their employees and their family members. An exit plan could come in three main forms: merger, acquisition, or dissolution. SCIP could fully merge with the Home Care Services by dropping its independence as a cost center. This would entail regulatory changes as Home Care Services does bill 15 SENIOR CARE INTEGRATED PLANNING (SCIP) Medicaid services. Secondly, CRMC could choose to release SCIP. This would free it up to be acquired by a national geriatric care management firm such as LivHome or SeniorBridge. Both of these organizations have been actively purchasing small, independent firms. Lastly, in the event that SCIP is not financially viable, it would need to dissolve. Resources, such as space and equipment, would be absorbed by CRMC. Case management staff may be integrated into the Home Care Services staff. Most importantly, SCIP would work diligently with the patients and their families to ensure a smooth transition of care to one of the two existing geriatric care management organizations within Hampton Roads. Timeline Time Period March-September 2011 October-December 2011 January-March 2012 April-June 2012 July –September 2012 October 2012 and on-going Action 1. Present plan to Chesapeake Regional Medical Center. 2. Apply to local foundations for funding (Hampton Roads Community Foundation, Chesapeake Foundation, etc). 1. Recruit and Hire Program Manager to start January 2012. 1. Develop policies, strategies (billing, computer services, personnel, standards of care). 2. Design marketing materials (brochures, web presence). 3. Training and certification for Certification for Geriatric Care Manager/Program Manager. 1. Stakeholder engagement activities. 2. Distribute marketing materials, implement networking strategies (face to face appointments with employers, physician’s offices, hospital staff, etc) 3. Continued development of policies, procedures, program guidelines. 4. Recruit and hire 2 Geriatric Care Managers to begin July 2012. 5. Initiate employer education programs. 1. Training and orientation for Geriatric Care Managers. 2. Screen and enroll clients into SCIP. 3. Continue employer education program. 4. Continue marketing strategies (outreach to senior groups, community partners, stakeholders, etc). 1. Continue community education through presentations at community groups, employers, hospitals, etc. 2. Continue screening and enroll clients into SCIP. 16 SENIOR CARE INTEGRATED PLANNING (SCIP) Budget Narrative SCIP strives to be financially sustainable by the end of year three through revenue generation by fee-for-service initial and comprehensive geriatric assessments, plan creation and case management. Expenses in the initial three years will be subsidized by a start-up grant from the Hampton Roads Community Foundation and by in-kind donations from CRMC for salaries, fringe benefits, management fees, and rent/utilities. By year four, no further outside support will be necessary. Assumptions: Revenue Client assessment will being in month seven. A conservative estimate suggests 4 initial consults in month seven and enrollment into service of 50% of the consults. By the end of year one, 60 initial consults will have been conducted with 30 clients enrolled. The maximum number of clients a single full-time GCM can carry is 25. The supervising GCM will have a maximum of 15 clients, to allow for her .6 FTE status. Thus, the maximum client case load for SCIP will be 65; it is expected to be achieved by year four. It is assumed that a client will initially average six hours of case management per month for the first three months and then will require 2-4 hours a month thereafter. An average of 3.3 contact hours per client per month was determined to be the break-even number of hours needed and will therefore be an overall goal for hours of care management. The simple fee schedule is as follows:  Initial screening assessment = $ 80  Admission to service = $310  Continuous care management = $125 per hour Assumptions: Expenses During the first month, the GCM who will be the Program Manager for SCIP as well as a case manager will be hired with an annual salary of $60,000. In month seven, the other 2 GCMs will be brought on board with an annual salary of $45,000. Fringe is estimated at 30% of annual salary, based on CRMC data. Year 2-5 includes 2% increase for Salary and Fringe. CRMC “management fees” include wages for numerous shared positions including department supervisor, a receptionist, human resources, marketing, billing, audit, housekeeping, and insurance. An annual cost of $76,000 was provided by current CRMC staff. The figure for rent/utilities was also provided by current CRMC staff. Regarding marketing, in month six, five billboards will be purchased for a one month to lead up to the initial enrollment of clients; the cost is $4,000 for this single activity. Other build-up marketing will occur in months five and six. Travel reimbursement is set at $0.50 per mile and includes travel to clients as well to employers and for promotional activities. 17 SCIP: YEAR ONE BUDGET SENIOR CARE INTEGRATED PLANNING (SCIP) REVENUE Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12 Total CRMC In-Kind support Foundation grant Patient Pay Fees CGM Services Initial Consultation Admission to Services Continuous Care Mgmt. 14,533.33 15,000.00 14,533.33 14,533.34 14,533.33 14,533.33 14,533.34 16,783.33 16,783.33 16,783.34 16,783.33 16,783.33 16,783.34 187,900.00 15,000.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 320.00 620.00 1,500.00 640.00 1,240.00 4,500.00 800.00 1,550.00 8,250.00 960.00 1,860.00 12,075.00 960.00 1,860.00 15,225.00 1,120.00 2,170.00 18,787.50 4,800.00 9,300.00 60,337.50 Total revenue: 29,533.33 14,533.33 14,533.34 14,533.33 14,533.33 14,533.34 19,223.33 23,163.33 27,383.34 31,678.33 34,828.33 38,860.84 277,337.50 EXPENSES Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12 $0.00 $0.00 0.00 16.67 350.00 70.00 200.00 100.00 0.00 0.00 0.00 $0.00 $0.00 500.00 16.67 0.00 70.00 160.00 200.00 10.00 0.00 0.00 $0.00 $0.00 250.00 16.66 0.00 70.00 160.00 250.00 10.00 0.00 0.00 $0.00 $0.00 250.00 16.67 0.00 70.00 160.00 250.00 10.00 0.00 0.00 $0.00 $0.00 500.00 16.67 0.00 70.00 160.00 250.00 30.00 0.00 0.00 $0.00 $0.00 5,000.00 16.66 0.00 70.00 160.00 250.00 200.00 0.00 0.00 7,500.00 $0.00 250.00 16.67 350.00 210.00 333.35 340.00 10.00 0.00 0.00 7,500.00 $0.00 250.00 16.67 0.00 210.00 333.33 580.00 10.00 0.00 0.00 7,500.00 $0.00 250.00 16.66 0.00 210.00 333.33 880.00 10.00 0.00 0.00 7,500.00 $0.00 250.00 16.67 0.00 210.00 333.33 1,200.00 10.00 0.00 0.00 7,500.00 $0.00 250.00 16.67 0.00 210.00 333.33 1,400.00 10.00 0.00 0.00 7,500.00 $0.00 250.00 16.66 0.00 210.00 333.33 1,800.00 10.00 0.00 0.00 45,000.00 0.00 8,000.00 200.00 700.00 1,680.00 3,000.00 7,500.00 320.00 0.00 0.00 2,700.00 350.00 100.00 2,500.00 6,386.67 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 956.67 0.00 756.66 0.00 756.67 0.00 1,026.67 0.00 5,696.66 4,400.00 650.00 200.00 0.00 14,260.02 0.00 8,900.00 0.00 9,199.99 0.00 9,520.00 0.00 9,720.00 0.00 10,119.99 7,100.00 1,000.00 300.00 2,500.00 77,300.00 Salaries: GCMs Fringe Benefits: GCMs Mgmt Fees Rent/Utilities Total In-Kind expenses: 5,000.00 1,500.00 6,333.33 1,700.00 14,533.33 5,000.00 1,500.00 6,333.33 1,700.00 14,533.33 5,000.00 1,500.00 6,333.34 1,700.00 14,533.34 5,000.00 1,500.00 6,333.33 1,700.00 14,533.33 5,000.00 1,500.00 6,333.33 1,700.00 14,533.33 5,000.00 1,500.00 6,333.34 1,700.00 14,533.34 5,000.00 3,750.00 6,333.33 1,700.00 16,783.33 5,000.00 3,750.00 6,333.33 1,700.00 16,783.33 5,000.00 3,750.00 6,333.34 1,700.00 16,783.34 5,000.00 3,750.00 6,333.33 1,700.00 16,783.33 5,000.00 3,750.00 6,333.33 1,700.00 16,783.33 5,000.00 3,750.00 6,333.34 1,700.00 16,783.34 60,000.00 31,500.00 76,000.00 20,400.00 187,900.00 SUMMARY Month 1 Month 2 Month 3 Month 4 Month 5 Month 6 Month 7 Month 8 Month 9 Month 10 Month 11 Month 12 Total Total revenue 29,533.33 14,533.33 14,533.34 14,533.33 14,533.33 14,533.34 19,223.33 23,163.33 27,383.34 31,678.33 34,828.33 38,860.84 277,337.50 Total expenses Revenue less expenses: 20,920.00 15,490.00 15,290.00 15,290.00 15,560.00 20,230.00 31,043.35 25,683.33 25,983.33 26,303.33 26,503.33 26,903.33 265,200.00 8,613.33 -956.67 -756.66 -756.67 -1,026.67 -5,696.66 -11,820.02 -2,520.00 1,400.01 5,375.00 8,325.00 11,957.51 12,137.50 Salaries: GCMs Fringe Benefits: GCMs Marketing IT - Computer support Training Cell Phones Office Supplies Travel Reimbursement Postage Mgmt Fees Rent/Utilities Start-up Computer equipment GCM certification/training Phone Furniture Total expenses: Total In-Kind Expenses CRMC - 18 SENIOR CARE INTEGRATED PLANNING (SCIP) FINANCIALS SCIP 5 Year projection     REVENUE         Year 1 Year 2 Year 3 CRMC In-Kind support 187,900.00 110,750.00 10,000.00 0.00 0.00 Foundation grant Patient Pay Fees CGM Services 15,000.00 6,400.00 9,600.00 10,400.00 10,400.00 4,800.00 Initial Consultation Year 4 Year 5 9,300.00 12,400.00 18,600.00 20,150.00 20,150.00 60,337.50 198,000.00 297,000.00 321,750.00 321,750.00 Total revenue: 277,337.50 327,550.00 335,200.00 352,300.00 352,300.00             Admission to Services Continuous Care Mgmt. EXPENSES Year 1 Year 2 Year 3 Year 4 Year 5 Salaries: GCMs 45,000.00 153,000.00 156,060.00 159,180.00 162,364.00 0.00 31,550.00 46,818.00 47,754.00 48,709.00 8,000.00 8,000.00 8,000.00 8,000.00 8,000.00 200.00 210.00 220.00 230.00 240.00 Fringe Benefits: GCMs Marketing IT - Computer support 700.00 700.00 700.00 700.00 700.00 Cell Phones 1,680.00 2,520.00 2,520.00 2,520.00 2,520.00 Office Supplies 3,000.00 3,000.00 3,000.00 3,000.00 3,000.00 Travel Reimbursement 7,500.00 17,500.00 20,000.00 23,400.00 23,400.00 320.00 320.00 Training 350.00 350.00 350.00 Mgmt Fees 66,000.00 76,000.00 76,000.00 Rent/Utilities 20,400.00 20,400.00 20,400.00 324,068.00 341,534.00 345,683.00 0.00 0.00 Postage Start-up 12,680.00 Total expenses: 79,080.00 216,800.00 In-Kind Expenses CRMC Salaries: GCMs 60,000.00 Fringe Benefits: GCMs 31,500.00 14,350.00 Mgmt Fees 76,000.00 76,000.00 Rent/Utilities 20,400.00 20,400.00 Total In-Kind expenses: 187,900.00 110,750.00       10,000.00 10,000.00       SUMMARY Year 1 Year 2 Year 3 Year 4 Year 5 Total revenue 277,337.50 327,550.00 335,200.00 352,300.00 352,300.00 Total expenses 266,980.00 327,550.00 334,068.00 341,534.00 345,683.00 10,357.50 0.00 1,132.00 10,766.00 6,617.00 Revenue less expenses: 19 SENIOR CARE INTEGRATED PLANNING (SCIP) APPENDICES 20 SENIO OR CARE IN NTEGRATE ED PLANNING (SCIP)) Appendix A: Health Care Services Com mmunity Resource Listt 21 SENIO OR CARE IN NTEGRATE ED PLANNING (SCIP)) Appendix A (contiinued) 22 SENIO OR CARE IN NTEGRATE ED PLANNING (SCIP)) Appendix A (contiinued) 23 SENIOR CARE INTEGRATED PLANNING (SCIP) Appendix B: Community Stakeholder Forum Results On November 8, 2010 a community stakeholder forum was held with experts in health care, senior services and finance. After a brief presentation about our concept of SCIP, we posed many questions to the participants. What follows is a brief summary of the results. 1. What are the gaps in senior services in Chesapeake? 1. Adult Daycare 2. Transportation- (possibly the care assistances can assist with this component. Or possibly use volunteers with stipends. 3. Homemaker services- Household chores, dishes, cleaning, laundry 4. Companion services- reduces isolationism 5. Supervision in the home environment. 6. Educate caregivers. Literally teaching them to take care of their spouse. 7. Caregivers support- education, respite. Make sure focus is on the caregiver in the home. 8. Legal assistance before a person is compromised 9. Al a carte type services 10. Housing options. 2. How could we reach the people that need this service? SENIORS 1. Word of mouth 2. Support groups 3. Churches 4. Chesapeake Redevelopment and Housing Authority 5. “Live a full continuum of life” Need eldercare to be considered as important as childcare. Should be included in marketing materials. CAREGIVERS 1. Churches 2. Support groups 3. Need to make sure you reach people who don’t identify as “caregivers”. Need to teach them to self-identify. EMPLOYERS/BUSINESSES 1. “Lunch & Learn” type of presentations. Discuss Return on Investment for this service. “How to identify financial resources” as they age. 2. Veteran’s Administration (has a great program to look at 3. Ford- type of program to educate employees 4. Community Services Boards 24 SENIOR CARE INTEGRATED PLANNING (SCIP) Appendix B (continued) 5. 6. 7. 8. Advertising- Public Service Announcements. Get ahead of the crisis with these families. Encourage PRE-PLANNING. Business partnerships. Get in the phone book 3. What makes a good company successful in the following services (Personal Care and Case Management)? CASE MANAGEMENT 1. Good evaluation systems so you can SELL your program to people who will buy it….or buy into it. Even sell it to the insurance companies. 2. Evaluation from clients and care givers. 3. Employee satisfaction. Wage and benefits make it worthwhile to good staff. 4. Able to connect with the population (peer based services) 5. Knowledgeable of services. PESONAL CARE 1. Competent, reliable staff, 2. “Likeable” staff 3. Competitive pay 4. Must be able to connect with population 5. Not intimidated or afraid of elderly. 4. Pitfalls 1. Doing too much in the beginning. 2. Possible lack of interest. 3. Lack of cash flow (Medicaid)…but being part of CRMC could assist with that issue. 4. Not valuing employees. Make sure you train them and help them stay trained. 5. Need a niche’ and Certified Geriatric Care Managers can be it. 6. Lack of passion for the cause. 7. Auxiliary grants are not enough…..for those who need alternate housing options. 8. Commonwealth’s perspective on elder issues. 9. Advocacy of lack of advocacy for issues. 10. People who already work in the field that put up barriers because they don’t “think” someone will take advantage of services (Lifeline example) 25 SENIOR CARE INTEGRATED PLANNING (SCIP) Appendix C: Certified Geriatric Care Manager Criteria and Ethics Pledge Certified Geriatric Care Manager (CGCM) The National Association of Professional Geriatric Care Managers (NAPGCM) is an organization of practitioners whose goal is the advancement of expert assistance to the elderly and their families. NAPGCM is committed to maximizing the independence and autonomy of elders and strives to ensure the highest quality and most cost-effective health and human services. Through education, advocacy, counseling, and service delivery, NAPGCM members assist older persons and their families to cope with the challenges of aging. NAPGCM promotes the highest standards of practice. Membership in NAPGCM as a Certified Geriatric Care Manager is open only to qualified individuals with specialized degrees and experience in human services, including social work, psychology, gerontology or nursing, and who hold one of four NAPGCM-approved certifications. Requirements for Certification A. Education and Experience 1. 2. A person who holds a Baccalaureate, Master's or Ph.D. degree with at least one degree held in a field related to care management, i.e. counseling, nursing, mental health, social work, psychology or gerontology; --is primarily engaged in the direct practice, administration or supervision of clientcentered services to the elderly and their families; and --has two years of supervised experience in the field of care management following the completion of the degree. OR Non-degreed RNs and other individuals with a Baccalaureate, Masters or Ph.D. degree; --are primarily engaged in the direct practice, administration or supervision of clientcentered services to the elderly and their families; and --have three years supervised experience in the field of care management. AND B. Additional certification Certified Geriatric Care Managers must hold at least one of the four certifications listed below. Care Manager Certified - CMC National Academy of Certified Care Managers (NACCM) Certified Case Manager - CCM Commission for Case Manager Certification (CCMC) Certified Social Work Case Manager (C-SWCM)* National Association of Social Workers (NASW) Certified Advanced Social Worker in Case Management (C-ASWCM)* Membership Fee Application Fee $25 Membership dues $345 26 SENIOR CARE INTEGRATED PLANNING (SCIP) Appendix C (continued) Pledge of Ethics For NAPGCM Members PROVISION OF SERVICE I will provide ongoing service to you only after I have assessed your needs and you, or a person designated to act for you, understand and agree to a plan of service, the results that may be expected from it, and the cost of service. SELF-DETERMINATION I will base my plan of service on goals you, or a person designated to act for you, have defined, and which enhance the decisions you have made concerning your life. LOYALTY My first duty is loyalty to you. I will always provide services based on your best interest, even if this conflicts with my interests or the interests of others. TERMINATION OF SERVICE I will end service to you only after reasonable notice. I will recommend a plan for you to continue to receive the services as needed. SUBSTITUTE JUDGMENT I will not substitute my judgment for yours unless I am acting in the role of your guardian, appointed by a Court of Law, or with your approval, or the approval of someone designated to act for you. CONFIDENTIALITY I will hold in trust any confidence you give me, disclosing information to others only with your permission, or if I am compelled to do so by a belief that you will be seriously harmed by my silence, or if the laws of this State require me to do so. REFERRALS/DISCLOSURE I will refer you only to services and organizations I believe to be appropriate and of good quality. I will fully explain to you any business relationship I have with any service I propose, and give you information on alternatives, if at all possible, so that you, or a person designated to act for you, can make an informed decision to accept or reject the services I recommend to you. 27 SENIOR CARE INTEGRATED PLANNING (SCIP) Appendix C (continued) COOPERATION I will strive to ensure cooperation between all of the individuals involved in providing service and care to you. QUALIFICATIONS I am fully qualified in my profession to provide the services I undertake. I continue to improve my skills and knowledge by participating in professional development programs and maintaining certification and licensing in my profession. DISCRIMINATION I will not promote or sanction any form of discrimination. 28 SENIO OR CARE IN NTEGRATE ED PLANNING (SCIP)) Appendix D: Lette er of Suppo ort March 16, 2011 om It May Concern: C To Who Chesapeake Region nal Home Caare Services is pleased too support thee Senior Carre Integratedd Plannin ng (SCIP) program propo osed by Team m Chesapeaake. We fullyy recognize the need forr the coordination off care for a veery vulnerab ble senior poopulation in tthis area. ncy offers sk killed home health h care sservices, hosspice care, paalliative caree Currenttly, this agen and LiffeLine® emeergency response system m. We have aagreed to houuse, managee and assist w with the stafffing of SCIP P, integrating g it into the menu m of servvices alreadyy existing att the agency. Please contact c me at a Vickie.hun [email protected] or via ttelephone at (757) 3743227 iff you have an ny questions regarding our o participattion in SCIP P. Sincereely, Vickie R. Hunt, R.N N. Directo or of Home Care C and Hosspice 29 SENIOR CARE INTEGRATED PLANNING (SCIP) Appendix E: Break-Even Analysis Break-Even Analysis: Billable Hours TR = P * V = FC + (VC * V) Total Revenue = Price * Volume = Fixed Costs + (Variable Costs * Volume) Key question: How many hours (volume of hours) of continuous case management need to be billed to “break-even”? Total Revenue = (P1 * V1) + (P2 * V2) + (P3 * V3) P1 = $80.00 for an initial screening evaluation V1 = 130 clients screened P2 = $310.00 for admission to service V2 = 65 clients admitted P3 = $125.00 per hour for continuous case management V3 = The numbers of hours needed break-even FC= $322,283 for year five VC= $360 per client (the cost of mileage) (P1 * V1) + (P2 * V2) + (P3 * V3)= FC + (VC*V2) (80 * 310) + (310 * 65) + (125 * V3)= 322,283 + (360 * 65) 10,400 + 20,150 + (125 * V3) = 322,283 + 23,400 30,550 + 125V3 = 345,683 125V3 = 315,133 V3 = 2521.1 = total hours per year for all clients Next, we need to determine the number of hour per client per month that is needed. V3 / V2 (volume of clients) / 12 (months in a year) 2521.1/65/12 = 3.2 billable hours per client per month To exceed the absolute minimum break-even number of hours, it was determined that the GCMs of SCIP should strive for a minimum average of 3.3 contact hours per client per month. 30 SENIOR CARE INTEGRATED PLANNING (SCIP) Appendix E (continued) Break-Even Analysis: Cost per Client and Billable Hours TC = FC + (VC * V) Total Cost = Fixed Cost + (Variable Cost * Volume) Looking at different volumes of clients, how much does it cost to serve each client? How many billable hours of case management would be needed? 50 clients: TC= 322,283 + (360 * 50) = $ 340,283 Divided by 50 clients is 340,283 / 50 = $ 6,805.66 per client V3 = (340,283 – 30,550) / 125 = 2477.86 total hours in a year Billable hours per client per month = 2477.86 / 50 / 12 = 4.13 hours per client per month 65 clients: TC= 322,283 + (360 * 65) = $ 345,683 Divided by 65 clients is 345,683 / 65 = $ 5,318.20 per client V3 = (345,683 – 30,550) / 125 = 2521.06 total hours in a year Billable hours per client per month = 2521.06 / 65 / 12 = 3.23 hours per client per month 75 clients: TC= 322,283 + (360 * 75) = $ 349,283 Divided by 75 clients is 349,283 / 75 = $ 4,657.11 per client V3 = (349,283 – 30,550) / 125 = 2549.86 total hours in a year Billable hours per client per month = 2549.86 / 75 / 12 = 2.83 hours per client per month 31 SENIOR CARE INTEGRATED PLANNING (SCIP) Appendix F: References and Resources “Best Practices in complex Chronic Care Management at Home”, a White Paper presented by the Professional Advisory Board of SeniorBridge and a panel of leading aging and chronic care experts. www.SeniorBridge.com Accessed 11/28/2010. “Caregiving in the U.S.”, Executive Summary, November 30, 2009. Funded by MetLife Foundation with AARP. http://caregiving.org/data/CaregivingUSAllAgesExecSum.pdf Accessed 8/29/2010. “Developing a Geriatric Care Management Business”, draft copy from Mary Kay Krokowski, a GCM and Board Member of the NAPGCM. Additionally, conducted two telephone interviews with her in September 2010. Duke, Cheryl. “The Frail Elder Community-Based Case Management Project”, Geriatric Nursing, Vol. 26, No. 2, p122-127, 2005. Dychwald, Ken. Compilation of research found at http://phx.corporateir.net/phoenix.zhtml?c=175970&p=irol-newsArticle&ID=1490340&highlight= “Geriatric Care Managers: A Profile of an Emerging Profession”, Data Digest, No. 82, AARP, 2002. www.research.aarp.org/ppi. Accessed 8/29/2010. “Guide to Long-Term Care Insurance”, a paper by America’s Health Insurance Plans (AHIP). www.ahip.org. Heiss, David W. “Geriatric Care Management Reduces Medicare Losses”, Healthcare Financial Management, October 1, 1993. “Hiring a Geriatric Care Manager”, Dynamic-Living. www.dynamic-living.com. Accessed 8/30/2010. “How Health Care Reform Affects Seniors”, a White Paper presented by the Society of Certified Senior Advisors, 2010. www.society-csa.com Accessed 11/28/2010. National Association of Professional Geriatric Care Managers. http://caremanager.org/ Martin, Aya. “At A Certain Age”, Market Watch, December 10, 2009. www.marketwatch.com/story/story/print?guid=C7559CE2-... Accessed 8/30/2010. “Older Adult Survey Report”, Chesapeake Committee on Aging, September 1997. Parker, Marcie & Secord, Laura J. “Private Geriatric Case Management: Providers, Services, and Fees”, Nursing Economics, Vol.6, No. 4, p165-172 & 195, July-August 1988. http://web.ebscohost.com.chekov.evms.edu Accessed 12/3/2010. 32 SENIOR CARE INTEGRATED PLANNING (SCIP) Appendix F (continued) Picariello, Gloria et. al. “Impact of a Geriatric Case Management Program on Health Plan Costs”, Population Health Management, Vol. 11, No. 4, 2008, p 209-215. Appendix F (continued) Scott, Lisa & Sharkey, Candace. “Putting the Pieces Together Private-Duty Home Healthcare and Geriatric Care Management: One Home Health Agency’s Model”, Home Healthcare Nurse, Vol. 25, No. 3, p167-172, March 2007. http://ovidsp.tx.ovid Accessed 12/3/2010. Sisk, Jennifer. “Home Sweet Home- Sizing up Senior Home Care,” Social Work Today, Vol. 7, No. 1, p14. Statistical Profile 2009. City of Chesapeake Department of Planning. Accessed on 8/29/2010 at www.chesapeake.va.us/services/depart/planning/pdf/2009StatisticalProfile.pdf The MetLife Study of Working Caregivers and employer health care costs, MetLife Mature Market Institute, Feb 2010, p1-33. Whitlock, Angela. ”Why Should Employers Be Concerned With Eldercare?” Virginia Pilot Newspaper, May 23, 2010. www.payscale.com Accessed on 8/30/2010 for Geriatric Care Managers. 33
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