Presentation is loading. Please wait.

Presentation is loading. Please wait.

MedStar Washington Hospital Center Geriatric Medicine—Medical Housecall Program Julie Beecher, Director of Strategy & Operations Ruth Shea LICSW, Social.

Similar presentations


Presentation on theme: "MedStar Washington Hospital Center Geriatric Medicine—Medical Housecall Program Julie Beecher, Director of Strategy & Operations Ruth Shea LICSW, Social."— Presentation transcript:

1 MedStar Washington Hospital Center Geriatric Medicine—Medical Housecall Program Julie Beecher, Director of Strategy & Operations Ruth Shea LICSW, Social Worker ©AAHCM

2 Non-profit academic hospital Serve 9 zip codes in DC; housecall census 618 patients Team-based care (20 FTEs) 90% Medicare FFS & 40% Medicare/Medicaid ©AAHCM

3  74 yrs old  Multiple chronic diseases  2009: hospitalized, then to SAR. In process, his toes were amputated; lost his housing; limited mobility; and would have been institutionalized in LTC  Became our patient in January 2010 Mr. RM

4 ©AAHCM Programmatic interventions for Mr. RM  Use of the state Elderly & Persons with Disability (EPD) Waiver  Philanthropy for uncovered services and subsidy of social work FTEs  Screening & Intake process  Linkages to other community resources

5 ©AAHCM 5 High Spending on Health Care Per capita data downloaded from OECD.StatExtracts. Available at stats.oecd.org

6 ©AAHCM Inclusion of social service spending Source: OECD, Health at a Glance 2009: OECD Publishing

7 ©AAHCM How the money flows for elderly supports Federal Programs Agriculture Health & Human Services Housing & Urban Development Social Security Administration Veterans Affairs Medicare Medicaid Home Energy Assistance Administration on Aging Subsidized senior housing & Section 8 housing vouchers Low-interest loans & rehab grants Reverse mortgages Supplemental Security Income Food stamps (SNAP) Pioneer in home-based primary care teams!

8 ©AAHCM More on money… Most federal $ thru state/tribal governments State Health Finance Division State Aging Services Division State & Local Housing Authorities Food programs Caregiver assistance Adult Protective Services Legal Aid Transportation Burial Assistance Medicaid (budget match & administration; for low income) Medicaid waivers Programs of All Inclusive Care for Elderly (PACE) Long Term Care Ombudsman Senior housing assistance (for low income; long wait lists) Good link http://www.eldercaredirectory.org/state-resources.htmhttp://www.eldercaredirectory.org/state-resources.htm

9 ©AAHCM The Basics of Elderly & Persons with Disablity (EPD) Waiver  What is a state waiver? Mechanism for states to test new ways to deliver and pay for services within Medicaid  How do I find out what’s in my state? Search by your location  Benefits to our program http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By- Topics/Waivers/Waivers.html?filterBy=1915%20(c)#waivers

10 ©AAHCM Philanthropy  501c3  Families often want to give back  Volunteers—staff capacity  Demonstrate need  Oversight & Reporting  Use of non-traditional vendors & contractors  Outcomes

11 Intake Team approach Program Expectations Patient/caregiver engagement - ©AAHCM

12 Who benefits from social work services  Socially isolated  Complex family/social systems  Frail elders  Burdened caregivers  The community

13 ©AAHCM Our approach Social Work Services Stabilize Crisis Intervention Conflict Resolution Strengthen Care Coordination Counseling Empower

14 ©AAHCM Key tools & skills  Culturally sensitive psycho/social/spiritual assessment  Develop a comprehensive plan  Knowledge of resources and how to access  Advocate for patient/family benefits  Monitor needs

15 ©AAHCM Caregivers- the silent patient Assess  Caregiver’s support system  Caregiver Burden Interview  Depression screening if indicated Interventions  Respite  Support Groups  Counseling

16 ©AAHCM Outcomes of Social Work Intervention Patient’s perspective  Quality of Life Caregiver’s perspective  Empathic ear  Supportive resources Team’s perspective:  Reduce psychosocial barriers to care  Improved coping

17 ©AAHCM How to integrate social work services into your practice  Waiver program case manager  Geriatric case manager-private pay  Collaborative partnerships  Grant opportunities

18 ©AAHCM  If it takes a village to raise a child, sometimes it takes a village to keep a senior in his/her own home. Home at last

19 ©AAHCM Housing Food resources Medicaid Waiver Advocacy Equipment Bereavement Counseling Transportation Interventions for Mr. RM

20 ©AAHCM

21 “ I would rather die than live in a nursing home… You have a good little club with a whole lot of love. And when there ain’t no love, there ain’t no home. Your people have given me a home.” RM

22 For CaregiversFor Housecall Providers  www.alz.org www.alz.org  http://www.aarp.org/ home- family/caregiving http://www.aarp.org/ home- family/caregiving  http://www.caregivin g.org http://www.caregivin g.org  http://caregiveraction.org http://caregiveraction.org  www.n4a.org (National Association of Area Agencies on Aging) www.n4a.org  www.eldercare.gov www.eldercare.gov  www.benefitscheckup.or g www.benefitscheckup.or g  www.ncoa.org www.ncoa.org  www.caremanager.org (National Association of Professional Geriatric Care Managers) www.caremanager.org  http://www.aoa.gov http://www.aoa.gov ©AAHCM

23 Julie Beecher MS, MPH Julie.a.beecher@medstar.net 202-877-0577 Ruth Shea LICSW Ruth.s.shea@medstar.net 202-877-0576 ©AAHCM


Download ppt "MedStar Washington Hospital Center Geriatric Medicine—Medical Housecall Program Julie Beecher, Director of Strategy & Operations Ruth Shea LICSW, Social."

Similar presentations


Ads by Google