New low-cost workforce extends primary care to homes of older adults
INDIANAPOLIS — A new study from the Indiana University School of Medicine and the Regenstrief Institute has found that person-centered dementia care, which involves both patients and their caregivers, can be effectively provided by an engaged low-cost workforce — care coordinator assistants.
Under the close supervision of clinical professionals, the care coordinator assistants, known as CCAs, work as integral health care team members conducting home and phone visits with dementia patients and family caregivers. CCAs, who typically have at most two years of post-high school education, are selected through a rigorous and innovative screening process. Once hired and trained, CCAs are assigned tasks focused on patient engagement and caregiver support that require less training and expertise than that of nurses or social workers.
As the number of older adults increases and health care resources cannot keep pace, the question of how to provide good care for this growing population has become increasingly pressing.
“We have shown that with good management, supervision, and support, CCAs can be effective primary care extenders enabling many tasks important to providing best practice care for older adults to be “shifted” down,” said social psychologist and Alzheimer’s disease educator Mary Guerriero Austrom, Ph.D., who led the study. “The key is screening to select the right people — people who are comfortable with older adults with cognitive issues — and then teaching and training them [CCAs], and giving them the resources and support they need to do the job. If you take care of your people, they will do an excellent job of taking care of patients.”
CCAs are the health care team’s eyes and ears in the community and the homes where patients and their caregivers live.
“If something happens — the CCAs handle it or, when appropriate, bring it to the team’s attention,” said Dr. Austrom, the Wesley P. Martin Professor of Alzheimer’s Education at the IU School of Medicine. “This is a bare-bones model that others can adopt and replicate. Care of older adults cannot be restricted to the clinic or physician’s office. CCAs, the least expensive member of the health care team, can extend best-practice care in a cost effective manner.”
During the period of the study, CCAs working for Eskenazi Health’s Aging Brain Care (ABC) Medical Home mobile memory care clinic were divided into teams under the shared supervision of nurses and social workers with whom the CCAs met regularly. Some CCAs were staff of CICOA, the local Area Agency on Aging. These CCAs provided expertise to others on accessing Meals on Wheels, identifying transportation options, procuring durable medical equipment and other services of critical importance to the population they serve. Over 1,200 patients received an average of about 16 home and phone CCA visits during a one-year period.
In addition to extending the reach of the clinic, task shifting to CCAs provided the medical team with a population health overview of all of the older adults with dementia and their caregivers in the study. The electronic tracking system in place at the ABC Medical Home supplied information on an individual patient who did not appear to be stable or a caregiver who was experiencing stress or depression. This allowed the medical team to provide timely patient/caregiver-centered care as well as giving the team a better perspective of what was working well across the entire population and what was not.
“Workforce Development to Provide Person-centered Care” has been published online ahead of print in the journal of the peer-reviewed journal Aging & Mental Health. The paper describes the development of an extremely competent workforce committed to person-centered care for patients with dementia or depression and their caregivers. The authors discuss the importance of providing person-centered care, the significance of support by hospital leadership as well as staff support and professional development of CCAs.
“CCAs are problem solvers – helping with access to needed services and problems that may be daunting to the older adult or their caregiver,” said study senior author Michael LaMantia, M.D., MPH, an IU Center for Aging Research and Regenstrief Institute investigator and an IU School of Medicine assistant professor of medicine. ”The CCAs also provide physicians and other members of the medical team with insight into how patients and their caregivers live and cope, helping the medical team provide high quality health care that addresses the specific needs and problems of each patient and their caregiver.”
The study was funded by Centers for Medicare & Medicaid Services grant
1C1CMS331000-01-00. Drs. Austrom and Goa also were supported, in part, by NIH P30 AG010133.
In addition to Drs. Austrom and LaMantia co-authors are Carly A. Carvell, M.D., and Sujuan Gao, Ph.D., of the IU School of Medicine; Catherine A. Alder, MSW, J.D., of the Regenstrief Institute, IU Center for Aging Research and Eskenazi Health; and Malaz Boustani, M.D., MPH, of the Regenstrief Institute, IU Center for Aging Research, IU School of Medicine and the Center for Health Innovation and Implementation Science.