Home First, Inc.
6323 Seventh Avenue
Brooklyn, NY 11220
Contact: Sandra Esner, RN
Director, Program Development
E-mail: SESNER@mjhs.org
Metropolitan Jewish Health System Website
Intervention Implemented: New York University Caregiver Intervention
Project Description: This program’s goal was to establish the NYUCI as part of the services of a home-based managed care system. As translation of the intervention into practice was the end goal, small numbers of caregivers were served during the implementation process.The NYUCI, developed by Dr. Mary Mittelman at New York University School of Medicine , has been demonstrated to lessen caregiver depression and delay nursing home placement of individuals with dementia.
Components of the NYUCI are:
• Scheduled individual counseling sessions
• Scheduled family counseling sessions
• Continuous participation in a support group
• Ad hoc counseling - telephone consultation on request of caregiver or family member
Target Population: The project was implemented to serve Alzheimer’s disease caregivers age 65+
Setting: Intervention delivered in caregiver’s home by a Master’s level Social Worker
Challenges:
• Nursing assessment missed caregiver challenges and cognitive impairment of potential participants.
• Nurses had a poor understanding of social worker’s role.
• Caregivers were reluctant to get help for themselves.
• 70% of eligible recruits were non-English speaking.
Translational Process:
Unlike the original NYUCI study, this was a multi-cultural, multi-lingual immigrant population with low socio-economic status. Participants were all Medicaid insured. Other significant differences were that the adult children’s jobs were not flexible, and all adult children shared responsibility for care of the person with dementia and support of the spouse caregiver. The nationwide economic crisis severely impacted this population. The average age of participating spousal caregivers was 78. The caregivers had significant medical co-morbidities and a high prevalence of frailty. A major obstacle in Year 1 was the inability to offer supportive counseling services to non-English speaking families due to the inability to secure a bilingual interventionist. An early lesson learned was that referring nurses needed training to see the value of social support, so training sessions with the RN Care Managers were implemented to help them identify signs of dementia and increase caregiver awareness of support services available. To combat reluctance of families to engage with the interventionist, nurses began accompanying them on their first visit, this "endorsement" from a trusted RN increased enrollment. Many of the spousal caregivers families were reluctant to accept services, unlike their adult children who were more willing to participate.
In Year 2, a enthusiastic bilingual English-Russian speaking Licensed Medical Social Worker was hired. This interventionist demonstrated a willingness to drive greater distances in an effort to provide services to those most at-risk in the outer boroughs of Staten Island and Queens. The interventionist was more successful in gaining acceptance by spousal caregivers of their individual need to express their needs and feelings. Through her communication skills, the successfully gained their acceptance to participate in supportive counseling interventions in order to retain the stamina to continue to care for their spouse by taking time for themselves.
Cultural differences noted between English and Russian-speaking caregivers:
• English-speakers: attach a “stigma” to acceptance of “Social Work Counseling services” yet open to accept visits from “licensed therapist”.
• Russian-speakers: retain views held in former Soviet Union of “psychotherapy” as admission of psychiatric illness yet accepting of social worker role to “primarily” provide assistance with concrete services and community resources. The supportive counseling services accepted as a “secondary benefit”.
Outcomes:
• Caregivers became more willing to accept help from their children
• 15 caregivers participated in the NYUCI; all but 1 continue to receive NYUCI in the 2nd year. The single withdrawal resulted from a care recipient's death, their widow is receiving bereavement counseling.
• Feedback from all participants was extremely positive.
• No participants placed their loved one in a nursing home during the project. One elderly male caregiver reports the sole reason he has not placed his wife in a nursing home, despite advanced progression of her condition, is the “strength he draws from monthly counseling sessions provided by his social worker and the comfort in knowing she is available whenever needed”.
Community Based Organization: HomeFirst, the Medicaid Managed Long Term Care Plan is sponsored by Metropolitan Jewish Health System and is funded by New York State Medicaid under authority of New York State Department of Health. HomeFirst provides an alternative to nursing home placement for individuals with chronic medical conditions. HomeFirst eligibility requires applicants to be age eighteen or older, financially eligible for Medicaid, reside in New York city and determined to require nursing home level of care according to New York State assessment criteria and require long-term care services for a minimum of 12- days.
Presentation:
The NYU Caregiver Intervention - From Efficacy to Effectiveness in 20 Years
