Caregiver Assessments

Focus on Texas

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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 :

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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

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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:

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What led Texas to identify and assess caregivers uniformly?

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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:

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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

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Tool Development Process

Plan Do

CheckAct

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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

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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

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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

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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:

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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?

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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

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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

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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

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Community Services Implementation of the Caregiver Status Questionnaire

Plan

Do

CheckAct

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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

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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

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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

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Intake staff…

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CSQ Caregiver Intake Script

CSQ Caregiver Demographics

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CSQ Caregiver Profile

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CSQ Caregiver Employment

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CSQ Caregiver Stress

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CSQ AAA Referral

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What were the challenges?

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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

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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

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Area Agency on Aging Implementation of the Caregiver

Assessment Questionnaire

Plan

Do

CheckAct

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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

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CSQ CAQ

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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

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CAQ Caregiver Skills and Training Assessment

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CAQ Caregiver Stress Interview

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CAQ Caregiver Priority Status

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What were the challenges?

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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

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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

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Implementation Highlights

Data Highlights

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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

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Caregiver Gender

FemaleMale

Caregiver Age Profile

Average Age: 63 Average Age Range: 53 to 78

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Do you have concerns about receiving caregiver support?

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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

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How has your employment been affected?

Which tasks do you assist the care recipient with?

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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

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Market

Purpose

Communicate

Instruct

Build

Monitor

Next Steps

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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:

Firstname.lastname@dads.state.tx.us

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: scoffey@caregiver.org