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Disruptive Innovators: Structured family caregiving

A new home care model being adopted in a handful of states is proving that home care saves dollars and helps families care for their loved ones.

Called structured family caregiving, the model supports seniors or disabled persons in homes rather than in nursing homes, reducing Medicare and Medicaid spending, and provides a stipend to the caregiver.

Currently, Massachusetts, Rhode Island, Ohio and Indiana are trying the model – which each state brands differently –and are seeing positive results.

"It is definitely cost saving," said Lisa Provencal, the Seven Hills RIte @ Home program coordinator. Seven Hills is one of two agencies selected by the state of Rhode Island to provide RIte @ Home (Rhode Island's brand name for structured family caregiving) services. "It's definitely beneficial for the state."

In 2012, Rhode Island spent more than $300 million on nursing homes, paying $165 a day for a nursing home bed, according to data the Rhode Island Department of Human Services provided as part of a segment about RIte @ Home on PBS' Need to Know, which aired in January. (Rhode Island's Executive Office of Health and Human Services did not return requests for comment for this story.)

As reported by the Need to Know segment, the RIte @ Home program saved the state more than $1.5 million last year because paying home caregivers cost about half as much per day as a nursing home bed.

In Massachusetts last year, Medicaid savings reached between $130 million and $140 million because of its structured family caregiving program, according to an analysis by SeniorLink, the second agency selected by the state of Rhode Island to provide RIte @ Home services. SeniorLink also provides structured family caregiving – which it has branded as Caregiver Homes – in Massachusetts, Ohio and Indiana.

Instead of paying a nursing home the Medicaid rate, which in Massachusetts is about $172 a day, said Tom Riley, president and chief operating officer of SeniorLink, the state of Massachusetts pays SeniorLink $83 a day per client. About 60 percent of the Medicaid dollars paid to SeniorLink by the state are given to caregivers as a tax-free stipend, equating to about $17,000 a year, Riley said. The rest of the money goes toward paying the clinical care team and operating costs.

The stipend to caregivers is one of the core innovations of the program, Riley said, because it allows a caregiver – such as a son or daughter or close friend of the client (spouses do not qualify for the program) – to work full-time as the in-home caregiver.

It's not a lot of money, Riley noted, but the vast majority of people participating in the structured family caregiving model are from low-income families, many of whom, when they were in the workforce, made about the same amount.

"They step out of the workforce. They get compensation that allows them to do the work, keep their family together, and give back to their mom in a way that she took care of them at the other end of life," Riley said.

At the heart of structured family caregiving model is the caregiving team, which consists of the in-home caregiver and the clinical team supported by a technology platform that allows for the exchange of real-time information.

The clinical team, which includes a nurse and a licensed social worker, create a care plan with the caregiver. Members of the clinical team regularly visit clients in their homes and keep in constant communication with the caregivers. Caregivers are trained and are responsible for keeping a daily journal of care provided that is transmitted to the clinical team.

Caregiving can be stressful and lonely, said Sue Burman, a Seven Hills RIte @ Home nurse, but the nature of the model creates a support network for caregivers. In addition to being able to talk to members of the clinical team, caregivers are given $3,000 a year for respite services so they can get a break occasionally, she said, and the clinical team can connect them to community support services, like support groups and adult day care services.

Another way the structured family caregiving model is innovative is that it indirectly saves money beyond the Medicaid program, Tom Riley said.

Because the clinical team and in-home caregiver work so closely together and clients get such personal attention, clients stay out of the hospital, thereby saving Medicare a lot of money, Riley added. Riley estimates that in avoided hospitalizations due to falls, SeniorLink has saved Medicare more than $10 million.

"Today, we get no credit for (saving Medicare money)," he said, but as more clients become part of managed care models, he's sure that structured family caregiving will get the credit – monetarily and otherwise – it deserves.

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