Going beyond admission denials - Catholic Health Care Services' Catholic Care Options and Program for the Elderly project

Nursing Homes, August, 1999 by Ken Lewis

In 1994, following a board of directors meeting at one of the five nursing facilities owned and operated by the Archdiocese of Philadelphia, Reverend Monsignor Joseph P. Garvin, MSW, MDiv, then the secretary for Catholic Human Services of the Archdiocese, casually asked staff a basic question: "Whatever happens to those individuals and their families who seek our care but cannot be admitted?" From that simple query and subsequent discussions, and in keeping with the mission and vision of Catholic Health Care Services (CHCS) to minister to frail elderly with health-related needs, a novel service was created: Catholic Care Options and Program for the Elderly (CCOPE).

The fundamental purpose of the CCOPE Program was to ensure those individuals and their families who approached one of our homes for admission and were unable to gain placement that they would not be left to continue struggling to resolve their crisis sans any further assistance, support or service from CHCS.

The truth is, not everyone who applies can or will be admitted to a CHCS nursing facility. Reasons for not gaining placement can be that the admission is unwarranted, it might be inappropriate (e.g., for specific care needs) or because space is simply not available. No matter the reason, though, the applicant and his/her family will experience feelings of rejection, increased anxiety and even panic regarding what happens next; they might also express anger at being denied or feelings of hopelessness and futility. These mixed feelings simply magnify or exacerbate what is already an emotionally laden process, while frequently adding stress and confusion to often precarious client/family situations.

CCOPE was developed to purposely and constructively enhance CHCS's response to clients as they pursue a range of options to resolve their placement crisis (e.g., alternate nursing home care/living arrangements or some type of community-based support services within their home).

Thus, whenever a formal application to one of our facilities is denied, the Admissions Director (with client approval) forwards all relevant documentation to the Registered Nurse CCOPE Case Management Coordinator. The RN/CM, employing standard case management principles and techniques, works with the family and elderly person to resolve their immediate concerns. More specifically, the CCOPE RN/CM is charged with arranging, monitoring and evaluating the optimal combination of services and supports that the referred clients need to resolve their crisis.

As noted by Applebaum and Austin in their text Long-Term Care Case Management: Design and Evaluation,(*) the case manager maintains focus on such goals as:

1. assessing the services that are appropriate to the client's needs and the level of care that is most propitious;

2. simplifying access to needed supports and interventions;

3. maintaining close collaborative and supportive contact and relationships with the client's caregiver(s); and

4. recognizing that follow-up activities are important to ensure that original intervention plans have been effective.

Ultimately, resolution might be in the form of admission to another nursing facility, remaining at home with in-home supports, or admission to other configurations of congregate living (e.g., assisted living, personal care, boarding home). The RN/CM stays "on-line" with the client until an acceptable resolution is reached. The key to CCOPE's maintaining a record of successful outcomes is the assessment/case management skill of the RN/CM and his/her comprehensive knowledge of all community service resources available for the frail elderly throughout the Philadelphia area.

During the history of CCOPE services, the RN/CM caseload from the five facility Admissions Directors has generally averaged between 30 and 35 referrals each month. These formal referrals do not include the numerous monthly phone calls that usually require the provision of immediate support and detailed referral information. Very often, the RN/CM works in partnership with a Catholic Social Services professional to effect prompt, positive and appropriate outcomes (e.g., Visiting Nurses, Meals-On-Wheels, counseling, adult day care, minor home repairs, homemaker/home health, Protective Services, etc.).

Since January, CCOPE has been offered as a service referral option to all Catholic nursing facilities in the five-county Philadelphia area. As of this writing, CCOPE currently provides support, assessments and intervention on behalf of twelve Catholic nursing homes. A full-time secretary was employed in July 1998, to help manage the anticipated increase in office-related tasks, thereby allowing the RN/CM to continue to focus on conducting assessments (by telephone or on-site) and working with clients.

It should be noted that the CCOPE Program is funded entirely through the Archdiocesan Nursing Home Trust Fund to include all relevant salaries, benefits and operating expenses. Clients referred to the RN/CM from any of the twelve nursing facilities or who directly approach CCOPE for service do not incur a fee or charge for service of any type. The capability of CHCS to fully fund CCOPE in a manner that precludes assessing client fees is certainly unique and underscores the commitment of the Archdiocese to its mission of serving those most in need.