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Caregiver Assessments. Focus on Texas. Family Caregiver Alliance and the National Center on Caregiving. Bay Area Resource Center: Network of 11 state-wide Caregiver Resource Centers. Social workers meet and assess caregivers in their homes and administer a respite grant. - PowerPoint PPT Presentation
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Caregiver Assessments
Focus on Texas
1
Family Caregiver Alliance and the National Center on
Caregiving
Bay Area Resource Center: Network of 11 state-wide Caregiver Resource Centers.
Social workers meet and assess caregivers in their homes and administer a respite
grant.
National Center on Caregiving: Technical assistance, track research/legislation
affecting family caregivers, PolicyDigest.
Jeffery SeiderChief of Staff
Access and Intake Division
Presenters
F r o m t h e :
3
Patricia BordieManager
Special Projects Unit
Lisa Akers-OwenManager
Community Services Policy and Curriculum Development
Sue FielderManager
Contract Accountability and Oversight
Overview and History
Plan Do
CheckAct
4
Jeffery SeiderChief of Staff
Access and Intake Division
Legislative history
Development and implementation process
How the tool is used and administered
Challenges
Lessons learned
Future plans for assessing the program
Participants will learn:
5
What led Texas to identify and assess caregivers uniformly?
6
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Legislative Budget Board (LBB) recommendations – January 2009
S.B. 271 - 81st Legislature, effective June 2009
Informal Care in Texas: Aging Family Caregivers and Their Need for Services and Support - October 2009
1. Informal caregivers, those relatives and friends who provide unpaid care to older individuals and persons with disabilities, are the backbone of the long-term care system.
2. Identifying and meeting the needs of the estimated 2.7 million caregivers in Texas often determines whether the person needing care can remain at home or if they must enter an institutional care setting.
3. Information from a uniform tool could be used to tailor services and supports to informal caregivers.
Texas recognized:
8
1) raise public awareness;
2) implement a caregiver status form
Caregiver Status Questionnaire (CSQ)
3) standardize a caregiver assessment; and
Caregiver Assessment Questionnaire (CAQ)
4) submit a report to the governor and the LBB by December 1, 2012.
What does S.B. 271 direct DADS to do?
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◦ Access and Intake Division, Office of the Assistant Commissioner
◦ Community Services and Program Operations
◦ Area Agencies on Aging
◦ Special Projects Unit
Ad hoc workgroup members included:
◦ Community Services Regional Directors
◦ AAA Directors
DADS Workgroup:
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• Met to discuss SB 271
August 2009
• Community Services regional directors review of CSQ
October 2009
• Piloted the CSQ in five regions• AAA directors review CAQ
January 2010
• AAA piloted CAQ in the same regions
February 2010
• Developed the procedures for implementation of the CSQ & CAQ
June – July 2010
• Implementation statewide of CSQ and CAQ
August 2010
Development Timeline
11
Tool Development Process
Plan Do
CheckAct
12
Patricia BordieManager
Special Projects Unit
The tools developed will be used to:
Evaluate needs of informal caregivers
Measure the effectiveness of caregivers
Improve existing programs & develop new services to sustain informal caregivers
Determine the effect of informal caregiving on employment
13
Utilized to identify informal caregivers for referral purposes and to develop a profile of
caregivers
Utilized as a needs assessment to gather
data
Caregiver
Status Questionnaire
Caregiver
Assessment
Questionnaire
Two Caregiver Tools
Implemented by 28 AAAs
Implemented by 11 Community
Services Regions
14
Existing Texas area agencies on aging assessment tools
Existing tools from
◦ national caregiver information clearinghouses
◦ other state assessment resources
◦ National Family Caregiver Support Program technical assistance
resources
◦ evidence-based caregiver interventions
◦ university caregiver research studies
◦ caregiver stress/burden assessments
◦ caregiver risk assessment tools
Initial Development Phase: Research – Review Existing Tools
15
Focus on common data elements across assessments
Highlight questions that address SB 271 report
requirements
Review common caregiver identification questions
Identify elements addressing employed caregivers
Review stress/burden measurement tools
The review included:
16
Review
clarity
content
languageformat
processes
data element analysis
Question by question review/revision
Tools Revised in Weekly Implementation Workgroup meetings: September – December 2009
Stakeholder groups engaged for response to final draft and initial pilot
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What were the challenges?
18
Challenges
Defining “informal” caregivers – paid
vs. non-paid
Keeping it simple – language
considerations (English and Spanish)
Time constraints – for intake personnel
and at in-home assessment
Primary caregiver vs. multiple caregivers
Care recipient may be the caller who
identifies caregiverCould not include detailed risk assessment
elements
19
Implemented August 2, 2010 by Community Services
regional staff
Functions to identify informal caregivers for referral purposes and
to develop a profile of caregivers
Designed as a survey for individuals entering the agency’s intake system for long-term services and supports
Caregiver Status Questionnaire
20
Implemented August 9, 2010 by Area Agencies on Aging
The assessment goes a step beyond the purpose of the status
questionnaire by serving as a tool to identify needs and appropriate
services for caregivers accessing services through AAAs.
Completed for all caregivers receiving Care Coordination through
the Older Americans Act Title III-E program
Caregiver Assessment
Questionnaire
21
Community Services Implementation of the Caregiver Status Questionnaire
Plan
Do
CheckAct
22
Lisa Akers-OwenManager
Community Services Policy and Curriculum Development
Purpose of the Caregiver Status Questionnaire (CSQ):◦ Collect data on informal caregivers◦ Provide referral to AAAs
Ideally, the CSQ will be completed at the time of the intake contact.
◦ The CSQ gathers data including: Caregiver demographics Caregiver profile data Caregiver stress Caregiver employment
23
Community Services Regional Intake Staff…
Provide information about DADS services
Determine what services are being requested
Complete the Caregiver Support Questionnaire
Make referrals to the appropriate resources
24
CSQ Process
Ask if there is an unpaid caregiver who helps and ask if he/she may speak to them
Ask for caregiver follow-up information if the caregiver is not available
Explain the purpose of the CSQ
Read the “CSQ Script” to set the stage for responding to the questionnaire
25
Intake staff…
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CSQ Caregiver Intake Script
CSQ Caregiver Demographics
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CSQ Caregiver Profile
28
CSQ Caregiver Employment
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CSQ Caregiver Stress
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CSQ AAA Referral
31
What were the challenges?
32
Challenges
Overcoming fears & issues relating to
increased amount of time required to
complete an intake
Resistance by regional staff to ask questions regarding race and ethnicity
Reluctance of some caregivers to provide information out of fear some responses could
affect eligibility
Convincing regional staff not to use the
information as a part of determining “unmet
need”No funds
appropriated
Reporting
33
Successes
Increased staff awareness of
caregiver issues and concerns
Collecting data to identify caregiver challenges --
working towards developing resources to
assist caregivers
Anecdotal evidence of increased
referrals to AAAs as a result of the survey
Anecdotal evidence of caregiver’s
appreciation of intake staff listening to their
concerns
34
Area Agency on Aging Implementation of the Caregiver
Assessment Questionnaire
Plan
Do
CheckAct
35
Sue FielderManager
Contract Accountability and Oversight
State Unit on Aging contracts with Area Agencies on Aging
28 Area Agencies on Aging in Texas
Majority with Councils of Government
Comprehensive array of services provided directly to
caregivers
State Unit on Aging and Area Agencies on Aging
36
CSQ CAQ
37
The Caregiver Assessment Questionnaire (CAQ) includes information from the CSQ, however, it also expands to assess caregiver needs on a deeper level.
CAQ Caregiver Needs Assessment
38
CAQ Caregiver Skills and Training Assessment
39
CAQ Caregiver Stress Interview
40
CAQ Caregiver Priority Status
41
What were the challenges?
42
Challenges
Resistance to add tasks to staff
responsibilities
Resistance to certain questions on the
Assessment
Concurrent implementation of a
new client management system
Reluctance of AAAs to implement the AssessmentNo funds appropriated
Staff changes coupled with hiring freeze
Differing data collection systems
within the state
43
Caregiver priority status included to assist AAAs in Older Americans Act targeting
Implemented project concurrently with establishment of statewide consumer tracking system
Developed data input tool within newly established system to collect AAA data
AAA required to enter Questionnaire responses into new system at “go live”
System has ability to generate reports on an “ad hoc” basis
44
Implementation Highlights
Data Highlights
45
3,925,859 individual
aged 60+ in Texas
475,000 consumers in
statewide database
As of 7/22/11 1,092
Assessments entered
Communication increased number of
Assessments entered
As of 8/18/111,334
Assessmentsentered
As of 9/8/111,696
Assessments entered
CAQPreliminary Data
46
47
Caregiver Gender
FemaleMale
Caregiver Age Profile
Average Age: 63 Average Age Range: 53 to 78
48
Do you have concerns about receiving caregiver support?
49
12% 8% 8%
Care recipient reluctant to
accept outside help
No one else can provide care as
well as I do
Do not trust service
providers in the home
Out of 1,696 assessments, the top five responses were:
◦ Takes leave frequently
◦ Difficulty concentrating
◦ Performs or manages caregiver
tasks at work
◦ Decreased productivity
◦ Lost wages
50
How has your employment been affected?
Which tasks do you assist the care recipient with?
51
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“Caregivers experience, for the first time, interest in them as a consumer.”
Le s s o n s Le a rn e d
53
Market
Purpose
Communicate
Instruct
Build
Monitor
Next Steps
54
Texas Inventory of Respite Services: January 2012
Take Time Texas Website: January 2012
Development of letter to caregivers surveyed in CSQ
Data analysis/evaluation
Legislative report: December 2012
Expand and develop new programs as funding becomes available
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You have reached the end of our presentation.
Thank you for your participation!
For more information regarding updates to the caregiver tools presented today,
you may contact presenters by using this format:
All of the slides, reports, materials, and an archived copy of the webinar will be
available on the FCA website: www.caregiver.org
(click on “webinars” in the middle of the home page).
You can also email us: [email protected]