why the supermarket model

Adults living with serious mental illness die 25 years

earlier than other Americans due largely due

to treatable medical conditions.

(Manderscheid et al. 2007)

Katherine T. O’Hara, RN, MPH, CHESMary McLaughlin, RN, BSN, MSPamela Jackson-Malik, RN, PhD, MBAAlan Lorry, BS, RPHBeverly Velasquez, MSW, LSW

Philadelphia Veterans Affairs Medical Center, Philadelphia, Pa.

Case Management Team

It is essential to the Model to

have both a Registered Nurse and a Social

Worker (MSW)

Supermarket Model Concept

Identify Population

Persons with Serious Mental IllnessComplex Barriers to Care

Use assessment to identify

barriers to care

Needs AssessmentMedicalPsychiatricSocialFinancialLegalSubstance Use

Identify Resources

ProvidersFacilities

Medical and Mental Health Evaluation

Review current medication ordersEvaluate adherenceEvaluate system of delivery

Who gives medicationsHow are refills and re-orders processed

Verify address and update as indicated

Identify Pharmacy responsible for service

Medical and Mental Health Evaluation

Verify assignment of medical and mental

health providers Review pattern of scheduled appointments

Review pattern of attendanceFacilitate evaluation in a timely manner as indicated

Review history for violence, sexual misconduct, Megans Law Registration

Functional Evaluation

Level of judgmentMoney managementPublic TransportationNutritional statusMeal planningCooking

Functional Evaluation

Meal planningShopping for foodWearing appropriate clothesWearing appropriate shoesClothes shoppingSelf management of medications

Social EvaluationLiving environment

Safety factorsFreedom from abuse

(physical/psychological)Adequate supervision for level of care

Medications, appointments, meals, clothing, spending allowance

Fire and hazardsFamily/community supportHistory of living situations

Multiple moves versus stable environment

Financial EvaluationSource of income

Check for multiple sourcesCheck for presence of financial guardian/fiduciary

Supplemental income by family/friends

Eligibility for increased benefits

Financial fraud or abuse

Financial EvaluationPattern of spending

Amount of debtCheck for money owed to credit cards /loan sharks

Money borrowed from friends/familyHow far into the month do funds last

Check for gambling patterns and addictive behaviorLottery tickets, off track betting, sports betting, numbers

Legal Evaluation

Outstanding warrantsProbationParolePending court cases

Level of offenseOutstanding fines and legal feesLegal representationIs case in regular or mental health court

Substance Use Evaluation

Substance(s) of choiceHistory of usePattern of useLevel of interference in daily activitiesHistory of program attendance

Primary Intervention

If the individual is determined to be a danger to themselves or others, and does not agree to hospitalization an involuntary commitment needs to be

initiatedMedical

Life threatening conditionInability to provide basic needs for life

Mental HealthSuicide or Homicidal ideation or action

Based on evaluation

It is difficult to place an individual who is not stabilized on medications

SheltersFull financial Support

No funds availableHigh risk environment

Have data base of all shelters in the area specifying size and support level

Seek out smaller shelters with capacity of 10 to 20

Identify day programs for the homeless to offer structure and added assistance

Shelters are not a permanent placement. They are temporary until funds can be established or a housing program identified.

Boarding Homes with Services

Quiet stable environmentOffer meals, laundry cues, assistance with

appointmentsAssist with management of medications

Individual needs to be able to take own meds with cues

Recovery HousesOffer meals, laundry cues, assistance with

appointmentsAssist with the management of medications

Individual needs to take own medications with cuesOffer NA/AA meetings both in the facility and in

the communitySponsor general meetings of the residentsSupply options for next step in housing

Boarding home with servicesSupervised apartment

Supervised ApartmentsFully furnished apartment offering meals,

medication administration/supervision, house cleaning service, laundry cues, appointment attendance assistance.

Accommodates the following individuals:Stabilized individuals requiring supervision during

the transitional phase to apartment living.Individuals who cannot live in a group setting due to

violent behavior, poor response to high levels of stimuli, continuing substance use and inability to live with others.

The level of services is based on individual evaluations.

Independent Apartments with Case Management

Individuals who are independent in their activities of daily living

Individuals who are able to take their medications as

prescribed and manage refills and re-ordersIndividuals who can manage and attend

appointments as scheduledIndividuals who can food shop and provide

adequate nutritionIndividuals who can maintain a safe

environmentCase Management is provided as a safety net

Assisted Living/Personal Care HomesIndividuals who do not have the capacity to

manage medications with cues or be self directed.Individuals with complex medical and mental

health issuesMedication administration is supplied. Services: Meals, laundry, activities, hygiene

cues and assistance, attendance at appointments, house doctors, ability to assess medical and mental health problems.

Case Management provided

Design Support Plan Based on Placement

Determine level of careSchedule medical and mental health

appointmentsAssist with legal, social, financial,

substance use issues as identifiedDetermine pattern of visits by case

management team Monitor individual’s satisfaction

Design Support Plan Based on Placement

Scheduled collaboration visits with providers

Monitoring of the following:Medication/appointment adherenceFinancial payments to facility and

personal allowanceVisits to the Emergency RoomHospitalizations

•Individual satisfaction•Reports from facility staff•Reports from family/friends•Pattern of adherence with medications and appointments•Progress reports from medical and mental health visits•Results from diagnostic testing•Visits to the Emergency Room(s)•Hospitalizations

Evaluate Outcomes

Based on Evaluation

Continue PlanReview Process and implement Revisions

Contact Information

Philadelphia VA Medical Center, Phila., Pa

(215-823-5800)

Katherine (Kate) O’Hara, RN (267-761-1801)katherine.ohara@va.gov

Mary (Molly) McLaughlin, RN (215-823-4006)mary.mclaughlin2@va.gov

Pamela (Pam) Jackson-Malik, RN (215-823-4297)Pamela.jackson-malik@va.gov

Alan Lorry, RPH (215-823-6363)alan.lorry@va.gov

Beverly Velasquez, MSW (215-823-5800 ext 6134)beverly.velasques@va.gov