A U.S Administration on Aging-Funded Project (2001-2004)
The Maine Primary Partners in Caregiving project (MPPC) forged an innovative partnership among primary care practices, Area Agencies on Aging, and the University of Maine Center on Aging in five rural Maine counties. MPPC aimed to demonstrate that primary health care is an effective and efficient "upstream" point of caregiver intervention because caregivers will more likely utilize information, support and training when need is validated by a trusted health care provider and assistance is personally tailored to their needs.
A brief screen administered during routine health care visits identified patients burdened with caregiving responsibilities. An expedited referral pathway to the AAA was subsequently activated. Caregiver specialists assessed and respond to caregiver needs with customized services including education and training resources and a statewide hotline. An evaluation of MPPC outcomes was conducted gauging caregiver well-being, service utilization patterns, and the quality of community partnerships, and profiling caregivers. Products included model education curricula for rural caregivers and primary care providers and a best-practice replication guidebook.
The Maine Primary Partners in Caregiving project hoped to demonstrate that:
1. Rural primary health care practices are an effective point of early intervention for individuals who are caring for older persons;
2. Caregivers will accept/utilize information, support and training when the need for such is validated by their personal physician or other health care staff;
3. The combination of information, support, and training by MPPC caregiver specialists will be successful in ameliorating the multiple risks of rural caregiving; and
4. A productive community service partnership among a health care provider, primary care practitioners, AAAs, and a university center on aging can be established and sustained in service to family caregivers.
Goals and Objectives
There were four major goals and a series of subordinate objectives associated with the MPPC project:
Goal 1: To demonstrate that rural primary health care practices are an effective point of early intervention for individuals who are caring for older persons
1-a: To increase significantly the rate of primary care practitioner referrals of adult patients to participating AAAs during the course of the MPPC project.
1-b: To identify primary care patients involved in family caregiving at a rate equivalent to the estimated proportion of adult caregivers in the general population.
1-c: To document that 90% or more of eligible patient caregivers wishing information, support, and education interventions are served according to MPPC protocol.
Goal 2: To show that caregivers will accept/utilize information, support and training when the need for such is identified or validated by their personal physician or other health care staff
2-a: To document that the majority of patients who report feeling stress regarding caregiving and/or wish to change the nature of the caregiving arrangement (on the Brief Screen) will accept a referral.
Goal 3: To demonstrate that the combination of information, support, and training by MPPC caregiver specialists and field coordination/liaison efforts by a health care provider will be successful in ameliorating the multiple risks of rural caregiving
3-a: To record high levels of satisfaction by individuals receiving single contact service with rendered interventions.
3-b: To document that caregiver well-being is buoyed by receiving multiple contact service as reflected in positive changes over time in stress/burden levels, depression levels, life satisfaction/morale levels, satisfaction with caregiving arrangements, confidence/competence levels, isolation/loneliness levels and quality of family relations.
Goal 4: To show that a productive community service partnership among primary care practitioners, a health care provider, AAAs, and a university center on aging can be established and sustained in service to family caregivers.
4-a: To document compliance with protocol among all partners throughout the course of the project.
4-b: To document a low rate of withdrawal from the project by primary care practitioners.
4-c: To document an increase in the number of participating primary care practitioners.
4-d: To secure the necessary funds to sustain the project subsequent to the 3-year AoA funding period.
4-e: To have the MPPC model replicated in one or more parts of the country within 4 years of project implementation.
Training and Education
MPPCprovided two sequences of education and training: 1) caregiver education and 2) primary care practitioner training. The overriding philosophy driving the project's caregiver education efforts emphasized providing information that was locally relevant (i.e., rural Maine-specific), divided into small units, available on a continuous basis, delivered via personal contact whenever possible, accessible in moments of crisis, and was broad in scope yet specific in detail. Topics addressed included: accessing comprehensive, quality, and relevant information and services; dealing with financial pressures; legal quandaries; health problems; emotional turmoil; family conflict; and social isolation.
Primary care practitioner education focused on techniques for identifying caregivers; understanding what causes caregiver burden; providing empathetic support; and educating caregiving patients about illness and debilitation, future care needs, available community services, caregiving management strategies, safety issues, and stress management.
The MPPC project efficacy was assessed using formal process and outcomes evaluation of all program components. The evaluation focused on determining the extent to which the goals and objectives of the project are realized. In particular, the assessment focused on program results in the following domains:
1. Determining Caregiver Well-Being Levels. Change over time was measured in the caregiver's: stress/burden levels; life satisfaction/morale levels; depression levels; confidence levels; competence/skill levels; quality of family relations; social support levels; and degree of isolation/loneliness.
2. Determining the Integrity and Sustainability of the MPPC Partnership. Variables considered here included: practitioner/university/AAA satisfaction levels with MPPC policies and procedures; adherence by partners to project protocols and data collection procedures; commitment to continuing MPPC program at the end of the 3-year period; low withdrawal rates by primary care practitioners; and increased numbers of participating primary care practitioners over time.
3. Constructing a Presenting Profile of Caregivers Served. Variables considered include the caregiver's: physical health; functional status (ADLs); cognitive functioning; employment status; financial status; emotional status and behavior; social participation levels; areas of caregiving task performance; areas of caregiver competence and difficulty; and categories of services/assistance needed.
4. Determining Service Utilization Patterns of Caregivers. Change over time in services used was inventoried including: consumption and satisfaction levels with health/medical services, information and referral services, social/therapeutic services, and education and training services.
5. Documenting Best-Practice Program Procedures. The process evaluation provided details of preferred approaches to screening, referral, care planning, training, marketing, etc. presented in the MPPC program replication manual.
MPPC Organizational Partner
The Eastern Agency on Aging was designated as an area agency on aging in 1973 and incorporated as a non-profit organization in 1974. Eastern offers a comprehensive array of services to elders and their families including information and assistance, personal advocacy, congregate and home delivered meals, adult day services, assisted living and congregate housing services, employment training, volunteer opportunities and public education. Eastern employs over 100 full- and part-time staff and administers a $3.5 million budget. Since 1996, EAA has provided counseling, education, training, technical assistance and assistance in arranging supportive services to Alzheimer's participants and their caregivers as part of the Maine's Alzheimer's Disease Demonstration Grants to States Program. Services provided through the Alzheimer's Demonstration program are now supplemented by Maine's Partners in Caring program. Under contract with the Bureau of Elder and Adult Services, EAA provides information, counseling, education, adult day services and respite to families caring for Alzheimer's victims.
Primary Care Partners
Rosscare, an affiliate of Eastern Maine Healthcare, provides educational and health services to senior adults and their family members. Rosscare services include programs for senior caregivers, at-home reassurance and emergency response services, geriatric assessment, community education programs on senior health and wellness, and assisted-living and nursing-facility care options. Rosscare's Center for Healthy Aging, directed by Amy E. Cotton, performs ongoing field coordination and communication functions in relation to the primary care practice sites during all phases of project activity, including the field testing of data collection and evaluation protocols, service delivery, and primary care practitioner and caregiver education and training. Cotton is a highly respected geriatric nurse specialist and family nurse practitioner who has established exceedingly strong and positive relations with the broad network of participating primary care practices. She had a lead role in insuring that communication lines remain open at the primary care practice sites during the life of the project. She also participated in the delivery of the MPPC education and training program.
Norumbega Medical, the primary care division of Eastern Maine Health (EMH), involves more than 40 physicians, physician assistants, and nurse practitioners. The practice has offices in five area communities throughout Penobscot, Piscataquis, and Waldo counties emphasizing consistently high standards of care, dedication to customer service, and a belief in the patient as the center of the team.
Horizons Health Services is also an EMH affiliate and is one of the largest multi-specialty practices within the state of Maine. Horizons has health centers in Presque Isle, Mars Hill, Fort Fairfield, Washburn, Limestone, and Madawaska. The health care team consists of individuals who are part of the communities they serve, know the families they treat, and provide better care through that knowledge.
MPPC Advisory Panel
The MPPC Advisory Panel was composed of expert service providers and University of Maine faculty who met regularly to monitor and assess its development, implementation, and evaluation. They were also available as consultative partners and participated in program planning and sustainability functions. The following leaders in the gerontological community served on the MPPC Advisory Panel: