Metropolitan Jewish Health System – Brooklyn, New York

This program will evaluate caregiver counseling as a plan benefit under Medicaid managed Long-Term Care, an important and emerging strategy of Medicaid Programs nationwide. Medically complex adults and their caregivers will be provided the NYU Caregiver Intervention as part of managed care. The population in New York City consists of a high proportion of Spanish, Russian and Chinese-speaking immigrants who have traditionally had very little access to caregiver supports. Dr. Mary Mittelman, New York University, will be assisting with the implementation of this program.

In caregiver/recipient home and in health center

Very low income, immigrant and ESL patients age 50+ with Alzheimer’s Disease

Spousal caregivers of very low income, immigrant, ESL patients 50+ with Alzheimer’s Disease

• 20 patients / 20 caregivers

• 1 dedicated social worker

• 6 caregiver counseling sessions

• Follow-up educational and assessment session

• Weekly support groups

• Specific counseling provided as needed.

NYU staff will provide clinical training and ongoing consultation to the social worker.

Principal Investigator: Dr. Mary Mittelman

Investigator's Web Site

Site Director: Sandra Esner

Agency Website

Project Update – July 1, 2008

The J&J/RCI team visited Metropolitan Jewish Health System (MJHS) in New York recently, and met with Caryn Daniels and Sandra Esner. Sandra serves as the current Site Director and Director of Program Development for HomeFirst. HomeFirst is the managed long-term care plan provider that delivers the NYU Caregiver Intervention through MJHS. Caryn and Sandra gave the J&J/RCI representatives an overview of HomeFirst and the Caregiver Intervention.

Recruitment and enrollment has been a challenge for most of the five QCC grant sites, and MJHS has found recruitment challenges as well. Support for caregivers is a concept which is new to many people, and caregivers are often reluctant to identify themselves as people who need services.

In MJHS’s case, caregivers were pinpointed through the database of HomeFirst clients. In this database, 200 Alzheimer’s patients were identified. Earlier in the project, 32 potential program candidates were considered from the 200 patients. The latest count determined that only 14 of the HomeFirst Alzheimer's patients have living spouses who serve as primary caregiver. From the 14 eligible recipients identified, MJHS has had an admirable 50% enrollment rate.

Mail-out to Identify other Potential Caregivers

Staff believes that, among the HomeFirst clientele of nearly 2,700 people, there are actually many more than 200 patients suffering from cognitive impairment. Staff is producing a mailing to all HomeFirst clientele in an attempt to identify current patients who may suffer from dementia, but have not been tagged as “Alzheimer’s patients” in their database.

Adult Children are Important Champions for the Program

Caryn Daniels made an important discovery that impacts program recruitment and enrollment. The clientele of MJHS represents many ethnic and cultural backgrounds. Many of the clients do not speak English well, and many live in multi-generational households. In addition, many of the caregivers are extremely frail themselves. With this in mind, Caryn found that the adult children of the Alzheimer’s patients and caregivers are important champions for the intervention. Many of these older adults depend on their children to advise them with regard to their participation in the program, so it’s necessary to secure the adult child’s support from the very beginning.

By employing a mass-mailing to the entire HomeFirst database, and securing the support of adult children of caregivers, MJHS hopes to increase enrollment in the NYU Caregiver Intervention.

Look for our next report from NYC, as we show how the Caregiver Intervention is impacting the lives of caregivers there.

Project Update - April 1, 2008

In Brooklyn, we've initiated the delivery of counseling services to spousal caregivers of dementia patients. Many steps have been completed, leading us to this point. Below is a brief description of the steps which led up to the delivery of the caregiver support services.

1. We staffed the Caregiver Counseling position with a Masters-level Social Worker, who is responsible for both the project management aspects of this new program and the delivery of counseling services, drawing on her experience as a social worker and as a manager.

2. We successfully completed an IRB (Institutional Review Board) application through NYU Medical School. The final approval, encompassing a detailed project plan, research methods, and consent documents, was granted in January.

3. We developed an Educational and Counseling Curriculum: We integrated materials from NYU together with our own training materials (used with professional caregivers) and materials from our Quality Care Connections partner agency in Vermont. Based on these sources, we structured a curriculum for use over the course of the formal counseling period. We have tried to leave flexibility within this structure for the counselor to help caregivers deal with their immediate concerns and needs in each session. We hope to disseminate this curriculum within the Quality Care Connections network and beyond.

4. We identified eligible participants in the pilot project. HomeFirst mined its member database to identify 32 members with dementia diagnosis who have spousal caregivers.

5. We contacted and recruited pilot participants.

6. We began delivery of counseling services. The spousal caregivers are currently receiving in-home counseling and dementia education.

Keep checking this page to stay up-to-date on the Metropolitan Jewish Health System Project.

Also, visit the Quality Care Connections web site: www.qualitycareconnections.org for podcasts and implementation blog.