Archstone Foundation has recently revealed our new strategic plan to embark on a different way of shaping our grantmaking, while still holding true to our mission of improving the health and well-being of older Californians and their caregivers.
As our President and CEO, Christopher A. Langston, stated in his blog post announcing the plan, Archstone Foundation seeks to meet our mission through the integration of health and social services. We will strive to accomplish this by building more effective cross-sector Teams, providing appropriate Training for new and current roles on teams, and supporting the development of appropriate Technology for efficient teamwork (the Three Ts).
As the first in a series of three blogs to introduce our three new core grantmaking strategies, let’s dig a little deeper into why we chose Teams as one of our Three Ts, and what we aim to fund.
In our strategic planning process, we took a step back and thought about how we envision the care of older people and good examples of that kind of care. We concluded that successful projects funded by Archstone Foundation have focused on person- and family-centered care, and were also models of Team-based care.
Examples of previously funded projects that focus on Team-based models include Elder Abuse Forensic Centers, with the use of multidisciplinary teams, the Alzheimer’s and Dementia Care program at UCLA, and the Community Aging in Place – Advancing Better Living for Elders (CAPABLE) model, which improves safety and independence in older adults living in the community.
One can see how we value teamwork and how no single health or social service professional has all the essential skills to meet the needs of older adults and their caregivers. We want to support projects that can advance these models of care teams, demonstrate improved outcomes for older adults and their families, and are structured to achieve more cost-effective care. Teams must also place older adults and their family at the center of the team to ensure that their care preferences and goals are met.
The Foundation will particularly focus on adapting tested models to ensure that they respond to the needs of diverse older adults and communities underserved by traditional care systems. This is particularly important to us in California, which is the most culturally diverse state and ranked as the second most racially and ethnically diverse state in the U.S.
Team Care is Comprehensive
We have seen that well-trained teams that integrate social supportive services with health care can deliver better care at a lower cost, such as the Programs of All-Inclusive Care for the Elderly (PACE), which provides comprehensive medical and social services to frail, community-dwelling older people through an interdisciplinary team (IDT) of health professionals providing PACE participants with personalized and highly coordinated care.
IDT members include primary care providers, nurses, pharmacists, social workers, dieticians, physical/occupational therapists, home care staff, activity staff, and transportation staff. Working with the patient and family, an individual care plan is created and managed daily by the team. PACE participants receive meals, recreation time, medical care, and spend the day in a social setting. For most participants, the comprehensive service package enables them to remain in the community and in their homes rather than receive care in a nursing home.
The PACE program's primary goals are to maximize each frail elderly participant's autonomy and continued community residence, and to provide quality care at a lower cost than Medicare, Medicaid, and private-pay participants, who pay in the traditional fee-for-service system.
The benefits of IDTs have shown that PACE participants have reduced and/or delayed institutional care, controlled use of medical services, achieved high patient and family satisfaction, and resulted in cost savings to public and private payers of care, including Medicare and Medicaid. Financing for the program is capped, which allows providers to deliver all services participants need, rather than only those reimbursable under Medicare and Medicaid fee-for-service plans.
As a program under Medicare, states can elect to provide PACE services to Medicaid beneficiaries as an optional Medicaid benefit. The PACE program becomes the sole source of Medicaid and Medicare benefits for PACE participants.
Team Care is Collaborative
We have also seen how Team care can be financially viable, especially with Centers for Medicare and Medicaid Services (CMS) Collaborative Care and Care Management Codes, and through the Chronic Care Act expansion of benefits. The Foundation’s work for the past six years in partnered Collaborative Care for depression, known as Care Partners, is built around the concept of high-quality team care.
Collaborative Care is a patient-centered approach in primary care that treats mental health conditions—such as depression and anxiety—in an environment where older adults are comfortable and already have secure, ongoing relationships. Effective collaborative care teams use established principles of chronic illness care and draw upon shared knowledge and care plans as they work toward patient goals. They work together using a shared dataset and task matrix to make sure treatment protocols are followed and that nothing falls through the cracks.
According to Jürgen Unützer, MD, MPH, MA, Professor and Chair, Psychiatry & Behavioral Sciences, University of Washington, and part of the technical assistance and evaluation leadership team for Care Partners: “The quality of the care depends on the quality of the team—one can certainly imagine both high functioning and highly skilled team care, as well as a team that is not working well together. For example, an orchestra is a highly skilled team. If they are working well together, they can create the most beautiful music; however, if they are not, it can make for an awful noise.”
Team Care Places Clients and Family at the Center of the Team
Effective Team-based care utilizes the varying expertise of team members and places the interests of the client and family at the center. Archstone Foundation’s early investments in Elder Abuse and Neglect include the innovative Vulnerable Adult Special Team (VAST), a multidisciplinary medical response model of collaborative care review. Effective remediation in situations of abuse require intervention from professionals across intersecting social service, medical, legal, and mental health systems.
The VAST model, initiated by Laura Mosqueda, MD, a professor of family medicine then at the University of California, Irvine (UCI), features medical response teams comprised of a geriatrician, gero-psychologist, researcher, and gerontologist. This team concept was later expanded upon to create the Orange County Elder Abuse Forensic Center to respond to complex cases of adult mistreatment.
Prior to the team approach, agencies typically involved in cases of elder mistreatment often had discrepant perspectives and procedures. With the Forensic Center model, Adult Protective Services, law enforcement, long-term care ombudsman, prosecutors, VAST members, older adult services, victims’ advocates, and guardianship representatives each had a seat at the table, a stake in the process, and a compelling view to contribute.
Forensic practices included in-home assessments, medical review, victim interviews, and evidence preservation to collectively evaluate facts, develop case-specific action plans, and coordinate services. The insights and expertise exchanged offered a best practice approach to assure elder safety and remedy criminal harms. The team’s approach always kept the elder victim at the center of their consideration. By design, the Forensic Center worked closely with victim advocates, which offered domestic violence prevention programs, ensured that any results considered the survivor’s voice and wishes, and followed up with services and social resources.
Our Future Work in Teams
Archstone Foundation’s past investments through priority areas continues to inform our future investments and partnerships. We know that future grants in Teams can help to promote best practices that are comprehensive, utilize collaborative team care innovations, provide additional resources to incorporate prior learnings, and speed the development and spread of effective and affordable person-centered team care models.
We look forward to working with future collaborators and want to hear from you about potential ways we can partner. We’re keeping our lines open through Letters of Inquiry, phone calls, and emails to begin these conversations. Let’s do this work together to improve the health and well-being of older Californians and their caregivers!
