Coordination of services
"…You feel like a mule sometimes, like everything is on your back and just (doing) one thing (after) another is so hard…In a period of time of about five years, I honestly thought I was going to go insane, because all I was doing was this, just running from one spot to another. Doing this is tough."
"I think one of the most clear examples…is when you're on an airplane and they tell you, if the masks drop down, put it on your face first and then assist the person who's with you…we're so busy getting the mask on the other guy that most of us are suffocating under the pressure of what's going on because we either don't have time, can't find time, don't have the support, don't know about the support."
— statements from caregivers attending the Capital Area Council of Government focus group
Caregivers and providers participating in the focus group sessions indicated that they often found it difficult to obtain integrated information and to coordinate services for the care receiver. Many focus group participants indicated that they were often required to complete multiple forms and provide the same information for several agencies because agencies do not share information. They also reported that:
- Many employers and physicians were not familiar with community resources,
- There was often a lack of follow-up with referrals made by one agency to another, and
- The absence of a central clearinghouse of information on formal and informal community services is a barrier to effective service coordination.
In response to many of these issues, DADS is taking steps to help identify ways to improve coordination of services at the local level to ensure greater accessibility to DADS programs and other services and supports .
Aging and Disability Resource Centers (ADRCs)
In December 2005, working closely with community stakeholders, DADS began an initiative to design a new integrated and comprehensive service delivery system for Texans who are aging and/or are in need of long-term care disability supports and services. As part of this project, DADS staff applied for and received a three-year grant to pilot up to three ADRCs in Texas through a grant jointly funded by the AoA and the Centers for Medicare and Medicaid Services. The purpose of ADRCs is to organize, simplify and ensure access to aging and disability services for older individuals, individuals with disabilities and those with mental retardation, and the caregivers who care for them.
ADRCs provide information, referral and counseling for public and private pay individuals, community awareness of public and private long-term care options, help for individuals in assessing their eligibility for benefits, case management, coordination with Medicaid eligibility determination, and individual plans for long-term care needs. ADRCs can also provide short-term service coordination, working with individuals to develop a person-centered plan and to assist in the selection of services and supports and providers. DADS began with three ADRC pilot sites — one serving Bexar County, one located in Milam County that serves a seven-county area, and one serving Tarrant County. The project expanded in 2009 to include sites in five additional areas of the state; one each in Houston/Harris County, Dallas County, Lubbock County, East
Texas (serving six counties), and North/Central Texas (serving four counties). Also in September 2009, DADS received from AoA a new grant to expand the ADRC program. Funding will provide for the establishment of a new ADRC site (to be determined in
2010), as well as develop a five-year plan to make ADRCs statewide in Texas.
Beginning in 2007, staff from DADS' Access and Intake division worked with AAAs, mental retardation authorities, and regional and local services staff to plan and convene a series of community roundtables in 16 locations throughout the state.
The goal of these roundtables was to determine what can be done at the state and local level to integrate these agencies' services (and access processes) in a way that makes the most sense to consumers. The series continued throughout 2008 and was completed in the spring of 2009. The roundtables have assisted DADS in finding ways to coordinate services for shared stakeholders (including caregivers) between the participating agencies.
Examples of local commitments made by agencies at several of the roundtables included memoranda of agreement, which streamlined referral protocols among the DADS local partners, including:
- The use of electronically shared referral forms;
- Formal interagency training plans;
- Integrated marketing and outreach activities; and
- Employing the use of system navigators (similar to those in ADRCs) in each agency to assist consumers make their way across the DADS system of services and programs.
These initiatives should help increase consumer awareness of available services, and help Texas' state and local services become more accessible.
Similarly to the identified need for information, stakeholders participating in the focus groups recognized the importance of coordinating needed services for care receivers and caregivers. Experiences with repetitive application processes and lack of communication between service providers led participants to put forward the following recommendations:
- Minimize paperwork and other administrative barriers to obtaining services for caregivers.
- Encourage service providers to provide a full continuum of services, and explore incentives that might help facilitate this.
- Integrate existing services across programs and enhance coordination of long-term care activities.
- Encourage formal services as a support to informal services, specifically communicating the message that formal services do not have to be an "all or nothing" proposition, and ensure that formal services are compatible with and complementary to informal services.
- Continue to work on the "one stop/no wrong door" approach to service delivery: ensure that the referral system among agencies is responsive, reliable, and accurate; be creative in getting information about service needs and resources to the community by not simply targeting the obvious places; and ensure that caregiving coordination is a priority as part of system redesign efforts.
- Encourage a caregiver resource center as a part of the ADRC grants implementation.
- Consider creating a state-level caregiver advisory group that meets quarterly and is comprised of representatives from AAAs and personnel from the caregiver resource centers.
- Consider establishing a single point of contact at the state level to coordinate state caregiver support efforts and to develop model communication pieces and other materials to enhance training for caregivers.
- Explore ways to ensure program affordability for those who do not qualify for Medicaid and/or waiver programs. Private pay rates for in-home care are too high for many caregivers to pay on their own, creating a barrier to seeking and receiving assistance.
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April 11, 2012