An Assessment of Information & Assistance Services For Seniors Needing Long-term Care in North Carolina: What has changed and what comes next for the Aging Network?
Abstract
Policy Question: How should North Carolina’s Aging Network provide information and
assistance services so that all older adults (and their caregivers) looking for long-term
care receive appropriate guidance?
Introduction:
Information and Assistance (I&A) programs inform, counsel and connect people seeking
long-term care with services that could meet their needs. The Older Americans Act
mandated that every Area Agency on Aging (of which there are 17 in North Carolina)
establish I&A programs in their region. North Carolina has 42 I&A programs registered
with the Division of Aging and Adult Services; more counties offer these services
without OAA funds. As the population ages, more people will need a well-informed,
local agency is critical to help them navigate the long-term care system and access
services. Older adults and their families face such a complicated array of choices
and decisions – about not only health care, but also housing, finances, and basic
household tasks.
Ten years ago, the North Carolina Institute of Medicine (NCIOM) delivered its report,
“A Long-Term Care Plan for North Carolina: Final Report” to the North Carolina Department
of Health and Human Services (DHHS). Early in its deliberations, the Task Force concluded
“one of its goals would be to propose a system that would allow consumers to find
their way into and through the system with ease.” Once the state was awarded a Real
Choice Systems Grant, these recommendations became a roadmap for North Carolina, which
launched two initiatives to improve seniors’ access to long-term care information
and counseling: a web-based resource system called NCcareLink and the regional Community
Resources Connections (CRC) program. My assessment focuses on how the Aging Network
and its existing I&A programs have responded to these initiatives and worked to create
a more accessible and understandable system. This report is especially relevant to
counties that are beginning the transformation to a CRC and to state policymakers
responsible for NCcareLink. s
Methodology:
I selected eight counties (Alamance, Beaufort, Forsyth, Henderson, Lenoir, Macon,
Mecklenburg, and Surry) and contacted the primary agencies that serve older adults.
The counties vary by geographic region, diversity, population density, and proportion
of adults over 65. I conducted a total of 28 interviews. In each county, my goal was
to identify and interview an organization that plays a central role in informing older
adults about their options. In five counties, this was an agency that receives state
or county-funding to provide information and assistance.
In addition to the main I&A provider, I interviewed other organizations at the regional
and local level that serve the same population. This allowed me to, first, gauge the
“No Wrong Door” model by discussing the skills and tools each agency used to make
accurate, effective referrals. Secondly, it spoke to a community’s recognition of
the designated I&A provider (e.g. how many people are relying on the Senior Center
instead of the Council on Aging, and for what reason).
Lastly, to gain some understanding of how other states have addressed the issues,
I interviewed employees at Departments of Aging in Oregon, Ohio, and Virginia, which
have also established online databases.
Key Findings:
Many of the key findings from my interviews are fundamental and already known to
providers and the state.
1. The role of the AAA and its staff is not clearly defined. The potential of AAAs
are tremendous, but the history of AAAs in North Carolina has led to weakly defined
roles that could impede easy entry into the system. In North Carolina, few people
know even what the AAA does. A clearer definition and articulation of roles could
help the staff members direct calls efficiently and reduce the number of inappropriate
calls in the first place. The state can change its management strategy and level of
supervision of the AAAs to promote certain roles and foster greater clarity.
2. Everyone in the Aging Network receives calls from older adults. Both in counties
that have formal I&A programs and those that do not, every agency in the Aging Network
is regularly contacted by older adults who do not know where to go for information
and assistance. Seniors have diverse and often specific needs; when providers respond
to these calls, it can be a time-intensive process and, if the provider is not experienced
in I&A, may not lead to the best match for the consumer.
3. Older adults have trouble identifying their needs. Older adults recognize one need
(e.g. help with light housekeeping) but they may not realize they also are struggling
to walk and need to install grab bars in their home to prevent falls. The reason I&A
is so valuable is that trained individuals can ascertain this information through
phone conversations; it is much harder – but not impossible – to gather the same information
online.
4. Older adults delay seeking help until they are in dire need. Information & Assistance
programs usually receive calls from older adults only when their functioning has deteriorated
to the point where they need immediate assistance. Culture plays an enormous role.
It is very difficult for the Aging Network to convince people to call at the first
sign of a need, rather than in a crisis. As the demands on the Aging Network increase,
the AAA may have less time and resources to promote services at health fairs or reach
out to pastors. Before the system is so strained that there is little or no time for
community outreach, the Aging Network needs to find more effective ways to promote
their services.
5. Caregivers are seeking out information online and being directed to many different
sites. Adult children looking for information are likely to begin with a Google search.
Even once NCcareLink is fully developed and being promoted by the Aging Network, policymakers
need to be aware of the websites that appear at the top of a Google search query,
such as private rehabilitation and home healthcare providers. Additionally, online
information needs to be integrated with off-line service delivery. People who are
searching for information online are often looking for phone numbers of service providers.
They may want the phone number to a provider of specific services (e.g. transportation,
personal care) or to a public office (e.g. DSS) that can screen for Medicaid eligibility.
Either way, these websites will play an important role in directing people to services,
so the way services are described and pathways are mapped online needs to match the
offline system
6. Changes to the long-term care system need to allow for county differences, while
also moving toward consistency. Every county has organized their services differently.
The CRC pilot projects and expansions demonstrate that every county will interpret
and implement programs in their own way. However, it would be unfortunate if these
variations prevented counties from sharing insights about what works or created additional
confusion for senior citizens and caregivers. Moving forward, the goal for the state
is to ensure information is readily available to all aging adults, without prescribing
a set of certain set of services that may be unrealistic for or incompatible with
a particular county’s current organization.
Recommendations
In keeping with the NCIOM’s initial recommendation, any new alternatives must advance
the three goals that information should be readily available and easily accessed,
understandable, and uniform for all in need.
Objective #1: Reduce the time it takes for older adults to find the services they
need
1. Identify at least one I&A program in every county.
2. Expand and modify online presence of all Aging Network agencies to make them consistent
and senior-friendly.
3. Prioritize good website design over expediency.
4. Work with Aging Network staff to collect and record data on caller demographics
(age, race, location) and level of functioning
5. Allow providers the opportunity to see the same software interface that Aging Network
agencies are using.
Objective #2: Make it easier for older adults to identify if they need information
or assistance
6. Learn from states that have implemented needs assessment tools.
7. Create a .pdf version of the state’s needs assessment tool that can be emailed
to or downloaded by interested caregivers.
Objective #3: Provide high-quality assistance services
8. Train I&A providers in options counseling.
9. Implement benefits or incentives that help recruit and retain exceptional staff
at I&A agencies.
Objective #4: Engage the private, for-profit sector to reduce the strain on the public
and non-profit Aging Network
10. Provide training to I&A programs to promote services provided in the private,
for-profit sector.
11. Expand or replicate the Forsyth Senior Services’ Elder Care Choices program, which
provides consultation and referral services to employees as part of subscribing companies'
employee benefits packages.
Type
Master's projectDepartment
The Sanford School of Public PolicyPermalink
https://hdl.handle.net/10161/3580Citation
Hayes, Ariel (2011). An Assessment of Information & Assistance Services For Seniors Needing Long-term
Care in North Carolina: What has changed and what comes next for the Aging Network?.
Master's project, Duke University. Retrieved from https://hdl.handle.net/10161/3580.More Info
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