Community partnerships for nursing homes; a community outreach project developed for non-profits might also be useful to for-profits.
Long-term care, acute care, primary care and other providers will work in partnerships -- with one another, with government agencies and with other human service organizations -- to meet the needs of persons in their communities. These partnership relationships will be particularly important for high-risk persons, including the frail elderly, the disabled, and the chronically ill, and their families.
Federal and state government health care reform initiatives will, in part, drive these new relationships. But other factors, aside from mandated policy changes, are also reshaping the way providers work with each other and with their communities.
One factor is the unsustainable growth in the cost of health care. As health care inches over 14 percent of GNP, far in excess of any other nation, consensus is growing that we must find a less expensive way to deliver services. Preventive care, health promotion, coordination of care, and care in the most cost-effective (usually meaning community) setting are common sense ways to keep the cost of healthcare down.
Another factor driving change in the healthcare delivery system is that, despite the great sums of private and public money spent on healthcare, millions of persons have no health care insurance, millions more are underinsured and even more -- who are insured -- do not receive the coordinated and quality care they need. In addition, health status outcomes in the United States are worse than in countries spending much less. Critics of the current system complain: we're not getting our money's worth.
A final force compelling community-based partnerships is coming from health care organizations themselves, their governing bodies and their sponsoring organizations. Religiously-sponsored and other not-for-profit health care organizations are rebelling against the competitive environment and commercial values which have dominated health care for decades. They have reexamined their original purpose of service to the community and have embarked on deliberate paths to return to their tradition of service and their mission to serve persons most in need.
Last year, the American Association of Homes for the Aging (AAHA) and the Catholic Health Association of the United States (CHA) joined forces to develop a set of tools to help not-for-profit homes and services for the aging plan, carry out, report and evaluate their community service in light of their mission and values. The result was an award-winning document, Social Accountability Program: Continuing the Community Benefit Tradition of Not-for-Profit Homes and Services for the Aging.
The primary purpose of the Social Accountability Program was to help not-for-profit tax exempt homes become more responsive to the needs of the underserved elderly and disabled in their communities by providing a broad range of community benefit activities, both directly and collaboratively with other providers and community groups. Another purpose was to confirm for these organizations, their boards and sponsors, that their tax-exempt purpose was being served and to document to taxing authorities that the organizations' tax exemptions were justified.
However, the Social Accountability Program can be instructive to both for-profit and not-for-profit nursing homes as they move into the reformed health care system, form partnerships with other providers and organizations in their communities, and reach out to frail elderly and disabled persons beyond their walls. The document describes how long-term care organizations can review their mission statements in terms of collaborative community service and be sure that their activities are consistent with their values and mission. It uses the experience of AAHA and CHA members in presenting a process for long-term health care organizations to include community outreach services and collaborative activities in their planning and budgeting processes. It also gives guidelines for reporting and evaluating community service.
The Social Accountability Program suggests that a health care organization begin planning for greater community involvement with an examination of its original mission, a review of policies related to community service, an inventory of current outreach activity, and most importantly, an assessment of community health problems and unmet needs.
Once these planning steps are taken, the facility can make decisions about which community involvement and partnership activities to continue, add, or modify in light of community needs, the capacity of the facility and available opportunities for collaboration. Some questions to be asked include: Which needs are most serious and affect the most persons? What new activities would best fit in with existing facility programs and would build on its experience and expertise? Could the facility's efforts be enhanced by inviting involvement of other community groups, or could an existing community program be expanded by adding the facility's efforts?
To further help in determining the community service role of the long-term health care organization, the Social Accountability Program suggests a number of activities that might respond to community needs. Some of these include:
Services That Can Improve Quality of Life
* Offer intergenerational recreation programs.
* Open recreation services and performances to community members, especially elderly and disabled persons.
* Provide respite care.
* With local religious congregations, conduct pastoral care bereavement groups for families of residents who have died or other grieving elderly in the community.
* Become part of a community-wide recycling program.
* Encourage residents to volunteer in community charitable projects.
* Participate in community-wide Senior Olympics.
Services That Can Improve Health Status
* Screen blood pressure and other health conditions at health fairs and other special events.
* Teach sessions on health promotion and disease prevention utilizing the nursing staff, medical director, attending physicians, and consultant pharmacist.
* Provide immunization services (pneumonia and flu vaccinations).
* Sponsor or help with Meals on Wheels program.
* Hold lecture series on various chronic conditions.
* Make space in facility available for stop smoking clinics and other self-help or support groups.
* Participate in community-wide efforts to prevent suicide among elderly.
* Open meal programs to elderly in community who are at risk of poor nutrition.
* Make residents' fitness program available to elderly in the community.
* Host Alcoholic Anonymous program for older persons.
* Arrange wellness programs, such as nursing or pharmacy consultants teaching "Medicine Cabinet Safety."
Services That Can Improve Accessibility to Needed Services
* Open adult day care for elderly and disabled in community.
* Initiate physician referral program for geriatric medicine or other medical specialties or for physicians who participate in Medicaid.
* Develop in-facility services for AIDS patients.
* Provide information and referral services to persons on waiting list.
* Offer comprehensive assessment services to elderly in the community.
* Support mobile clinic for senior health services.
* Hold health screening with follow-up referral services.
* Work with other community groups to provide primary care for homeless elderly.
Services to Help Contain the Cost of Healthcare Services
* Offer free or discounted services for those unable to pay for services not covered by Medicaid.
* Furnish high technology services, such as care of ventilator dependent patients and others who might otherwise need hospital services.
* Donate unneeded equipment or food to homeless shelters or other programs.
* Help residents be part of telephone reassurance programs for shut-ins or latch-key children.
Services That Reach Out to Minorities, the Poor, Persons with Disabilities and Other Underserved Persons
* Encourage staff and resident participation in holiday season food and gift baskets for poor families in neighborhood.
* Arrange free dental care for residents unable to pay.
* Open child day care program for neighborhood families who cannot pay the full cost.
* Provide internships for disabled individuals from sheltered workshops.
* Team up with community school programs to develop self-esteem programs for learning disabled children.
* Provide food or meals to a homeless shelter.
* Make facility vans available to disability groups.
* Create volunteer programs involving minority adolescents in residents' activity programs.
* Establish "Adopt a Grandchild" program with neighborhood children of single parent families.
* With other community groups, operate legal clinic for community elderly on advance directives, program eligibility and other legal matters.
Services that Demonstrate Leadership and Role of the Facility
* Offer rotations for medical, nursing, rehabilitation and other health professionals.
* Conduct research on innovative ways to care for Alzheimer's disease and other patients.
* Participate in community-wide efforts to reduce the problem of over-medication among the elderly.
* Identify health problems in the community by analyzing patient assessment information from admissions.
* Provide incentives for facility personnel to take a leadership role in community organizations, such as the nursing director serving on the advisory board for the local nursing school or the administrator sitting in on Area Agency on Aging meetings.
* With other community groups, sponsor a volunteer opportunities fair.
* Provide a polling place on election days.
* Sponsor radio/TV talk shows on senior issues.
* Develop a resident-community oral history program.
* Encourage advocacy for and by elderly and disabled persons.
In summary, there are many reasons for long-term care facilities to embark on programs of greater involvement in meeting the long-term health care-related needs in their communities. The most important and basic reason is that community-dwelling frail elderly and chronically ill have significant health care needs which could be met if long-term care providers worked with other public, private and voluntary groups in the community to address them.
Responding to community needs would help nursing homes demonstrate to community members and policy makers that they are indeed service organizations, not operated solely out of self-interest, but to serve the community. Such an understanding helps not only the public image of the institution, but the morale of staff, the well-being of the community's elderly and disabled, and the future role of the long-term care facility in a reformed healthcare system.
To order the Social Accountability Program, write to: CHA, 4455 Woodson Rd., St. Louis, MO 63134; or AAHA, 901 E. St. NW, Suite 500, Washington, DC 20004.
Julie Trocchio is in the Washington office of the Catholic Health Association of the United States.
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|Date:||Nov 1, 1993|
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