Continuing care at home

When the staff of the Alexian Brothers Live At Home Program talk about the services they provide in Greater Chattanooga, Tennessee, the word

help peppers their conversation. They help adults to embrace wellness as they age, they help with essential services such as transportation and homemaking, they help with personal care, they help to prevent a move to a nursing home.

Live At Home—part of Alexian Brothers of the Southeast in Chattanooga—is designed to provide aging adults with the opportunity to live and age in their own homes rather than in a facility, and its primary goal is to help people enjoy quality of life at home for as long as possible. Alexian Brothers has a more than 700-year history of taking care of the socially rejected and needy. One of the organization’s first documented works was in Germany during the Black Plague, caring for the sick and bury-ing the dead when no one else would.

That philosophy has traveled through time to Chattanooga, where Alexian Brothers wanted to provide not only residential care, but also care for those who wanted to remain in their homes. “We took the continuing care model that’s in a CCRC and found a way to adapt and repackage those services so that we could deliver them to people in their own homes,” says Program Director Jane Kelley, CHE. Accepting its first members in April 2002, Live At Home has grown from approximately 40 participants in its first year to 224 at the end of 2006. The program provides services throughout each member’s lifetime for an initial payment and a monthly membership fee. The 3½ full-time staff members who operate the initiative are Kelley; Cindy Sesher, RN, service coordinator; Jennifer Eubanks, MSW, service coordinator; Karen Sawyer, RN, service coordinator (the newest member of the team); and Debbie Baker, RN, coordinator of home care services. “As service coordinators, we are the link between the member and our program and the services that we provide,” Eubanks says. “But we’re much more than the link—we are relationship builders.”

Service coordinators use an eight-page assessment tool developed by a team of geriatricians (the Alexian Brothers Chattanooga system employs three fellowship-trained geriatricians), physical therapists, social workers, registered dietitians, and Brothers from the Order. The assessment evolved from research the team consulted and data compiled and refined over time. “The service coordination that you receive from day one is truly the glue that pulls all this together,” Kelley says. “The team walks with you through dealing with crises and eases your transition.”

Live At Home members receive services at one of four levels:

Level I—Wellness by Design.Based on widely accepted best practices that improve physical ability and mental acuity, the first level includes an annual comprehensive wellness assessment and a home safety evaluation by an occupational therapist. If a structural change—such as moving a washer and dryer to the main floor—is advised during the home safety evaluation, staff will recommend a reputable company to the member. (Current membership and staff provide referrals.) Level I also features social, intellectual, and physical activities through the Alexian system, including ballroom dancing, a film and supper series, and walking groups.

Level II—Intervention by Design.The second level adds transportation to essential services, including medical appointments, the pharmacy, the grocery store, and the bank, and homemaking assistance, including housekeeping, changing linens, vacuuming, and taking out the trash. Level II also addresses medication prompting and nutritional needs.

Level III—Support by Design.The third level brings personal care services to members, including assistance with bathing, dressing, eating, toileting, continence, and transferring. Services at Level III could be equated with those in assisted living. This level includes those members who are “starting to show some cognitive or physical decline and now need some assistance in one or more activities of daily living,” Sesher says. Level III includes all services in Level I and Level II, as well as visits by a CNA. “This level could include someone who had a hip replacement, and as the member recuperates we can move him or her back to Level I,” she adds. Benefits of Level III also include enrollment in a day program and a comprehensive geriatric assessment by a physician, social worker, registered dietitian, physical therapist, neuropsychologist, and pharmacist. A pendant or bracelet emergency call device is provided.

Level IV—Care by Design.The fourth and most intensive level of care helps to prevent a permanent move to a nursing home and provides access to the Alexian Brothers Program of All-inclusive Care for the Elderly (PACE). “We have members at Level IV who are successfully remaining at home with transportation and CNA services, frequent visits from service coordinators, and occasionally partnering with other organizations, including hospice,” Sesher says. If a member can no longer live at home, he or she can move into an Alexian Brothers facility at no additional cost.

In the near future, Live At Home will partner with an older-adult program in Milwaukee to launch a telehealth initiative in which one of the program’s members will receive an iMac computer with videoconferencing capabilities. The member’s family (who lives out of town) will establish an online calendar that the family and Live At Home staff can access and manage daily. Videoconferencing will allow service coordinators to check in not just by phone but also visually. “From a service coordinator’s perspective, what has made this program work and what continues to make it work is our flexibility,” Eubanks says. Care and services are customized to each member’s needs. “People talk about thinking outside the box, but we work outside the box every day,” she adds.

As Live At Home embraces telehealth, staff will eventually have tablet PCs so that they can conduct assessments and input data in the field. Data will then be uploaded into a database where they can be analyzed by staff to determine what indicators predict decline and what preventive measures to take.

The program has received a strong initial response, even as it competes with long-term care insurance; both target a healthy population that has money to pay for future care. The staff members educate the community—especially baby boomers—about what to look forward to, what to prepare for, and what to prevent as they age. “Like everybody else out there,” Kelley says, “we’re eager to meet the needs of the baby boomers.”

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