Wednesday, October 26, 2011

Hot Topics in Caregiving 3: Community Care Initiatives - Faith Community Nursing


Most caregivers are thrown into the heat of the caregiving fire by an emergency situation and have little time to look for what resources are available. Take time to look ahead and see if any of the community care initiatives, reviewed in the next few posts, are available in your community and how you can access their benefits.

Faith Community Nursing (FCN):  This concept has been, and still is, known by many names: Congregational Nursing and Parish Nursing and Church Nursing are just a few.  But in 2005, the American Nurses Association changed to this standard term to better reference the non-denominational nature of the concept.

The practice of FCN focuses on the protection and promotion of health, prevention of illness, injury and disease, and alleviation of suffering within the values, beliefs and practices of a faith community.

The FCN definition above means there is no set “picture” of any FCN program, which is actually a great thing. It means that programs can be tailored to each community; and they are.

A faith community is a group of individuals brought together by shared beliefs.They are similar to a family and come to know needs within the group. A faith community becomes a starting place to offer help to those in need. FCN programs are non-denominational and don’t always have ties to a specific faith group, yet may be housed in a church, synagog, or temple, offering space for the ministry.They are programs that intentionally minister to both the health and spirit of an individual, while being nondenominational.

There is an interesting relationship that has developed between faith communities and medical practitioners. I’ll illustrate this by giving you a brief picture of FCN in my own community. 

One of the two main hospital systems in our community realized that by having a link into the faith communities, they could help promote wellness, reduce unnecessary emergency visits (often by un or underinsured patients) and in turn, reduce costs, help the community, and let the community know how they can offer other services. Taking education and wellness initiatives door-to-door wasn’t where to start. But find a group of people already working together who know one another’s needs and you have a place to build a point of service within a community. Building service then builds reputation and then when medical services are needed, where do the patients go?  In its simplest form, from this top (hospital system) down (to community) approach, it can be a marketing tool. But read on - it’s much more. What I’ve learned about the leaders in any FCN program is that they are CONNECTORS, linking people in need with services, becoming a hub for information flow. They are embedded in the community and know what’s available, and even more importantly, know how to access those services. It works in other ways too, as doctors will refer patients to the FCN programs to help them find additional support for their ongoing care needs. 

Caregiver check:  Call your local hospital to find out if they are connected with a faith community nursing program and ask what services are provided. 

There are many FCN programs that do not have a connection to any particular hospital too.  Community leaders will start programs or partnerships to unite care providers in different specialty areas to reach out to faith communities and facilitate wellness. There are many interfaith initiatives that use faith networks as a way to get information to community members about services available to them, whether free blood pressure checks, mammograms, or other preventive services.

Programs also start within individual faith communities when members of that community identify a need and seek resources for filling it. It may be diabetes prevention, blood pressure checks, or other forms of health screening. They then look to the larger community and its resources to fill the need. For example, if a church leader has been ministering to a number of congregation members who are suffering with uncontrolled diabetes, he or she may seek resources within the community to help address the issue at that church, not just for that individual.

Caregiver check:  Call the church local to your caree, even if he or she is not a member, ask if they have any health ministries, what they are, and how you can plug into those services. If they don’t, ask if there are any that do. Don’t let a lack of connection to a place of worship hold you back.  Church communities do welcome the chance to minister to others as an outreach.  

Meals on Wheels, a nation-wide nutrition outreach program, finds its community home in many churches and reaches from there into the community regardless of any denominational or faith belief (or non-belief) of its meal recipients. Such is the same with faith community nurses. They realize that a faith community is a place to start in offering health and wellness services to others. In my community, the Mobile Meals program actually started a nursing ministry, hiring nurses to provide support to meal recipients. They are in turn, supported by the FCN leaders. In this case, the Mobile Meals nursing ministry has provided community case management services for 2,000 daily meal recipients.Though not all Mobile Meals programs do this, it's certainly a best-practice that is making a huge impact on many lives and one possible because of the FCN program.

Caregiver check:  If your caree is receiving meals, ask the delivery person or agency if there are any other services that can be accessed in the community through their service.

Whether it is one volunteer in a specific church, a team of nurses offering services in many faith communities, or a hospital led program that has dedicated staff to filling healthcare needs within a community, all the models work to make a difference. They’re not going to replace a doctor or become your personal home health aide during a medical crisis. But they will connect you to services in your community.

So we know that FCN programs can look different, but what do they do? Let’s look at some scenarios:
  •  In one case, a woman’s husband was dying and she needed respite care. Through the FCN program, volunteers in a local church willing to help were identified and trained through the FCN program. The volunteers then took the lead on scheduling visits to the home to sit and visit with her husband so that she could have a couple hours break time a few days a week. All were volunteers, yet it was the FCN coordinator who knew where to start calling to get the woman’s need filled.  
  • A church member became concerned about the possible spread of flu with so many people gathering for worship during the height of a terrible flu season when vaccines were limited. The FCN program was able to get her educational materials about prevention techniques that could be shared throughout the church.
  • The Universal Medication Form (UMF) became available and used as a tool for reducing the number of errors in medication usage by individuals that was causing avoidable emergency room visits. FCN nurses worked within 100 different faith communities in their county to distribute the forms and teach people how to use them.  
  • The FCN coordinators trained community volunteers willing to teach a teen pregnancy prevention program within faith communities. 
Looking for Faith Community Nursing programs may be an answer to quickly connecting to resources within your community, and especially for long distance caregivers, may be the most efficient way to determine what is available when a loved one needs care.

The International Parish Nurse Resource Center offers a worldwide LIST (by State) of program coordinators.

Many thanks to Georgia Lanford and Jenny Holmes, leaders of the Spartanburg Regional Congregational Nursing program for providing me a wealth of information that I in turn have shared with you.

Thursday, October 6, 2011

Hot Topics in Caregiving 3: Filling The Donut Hole

Simply glazed, iced, or with sprinkles… donuts have holes. Education may help you keep from falling into a very sticky and expensive one or help you climb out of it sooner.  

One hot topic for both caregivers and seniors is the Medicare Prescription Coverage “Donut” Hole. The simplest explanation is that this is the point at which coverage from Medicare part D supplement stops paying for prescription costs after a certain limit is reached and then the point at which it starts to cover them again. According to multiple sources, the amount not covered can be about $1400. Some patients never reach the hole. Others discover they’ve fallen into it when they go to pick up their medications from the pharmacy receiving a bitter pill to swallow. But it’s no joking matter. This can be a life threatening issue when seniors have to decide whether to pay their rent, buy groceries, or stay on preventative meds they can’t afford if they plan to eat. About.com offers a general overview of the issue in a June 30th ARTICLE.  

The bottom line is self-education and self-awareness. Sometimes it’s the caregiver that must be the one to step in and increase awareness in order to help prevent problems. If you’ve never asked your caree about his or her insurance coverage and limits, now’s the time. If you’re a caregiver who is not involved in the financial issues of your caree, then at least make the recommendation that all insurance coverage issues be reviewed with the goal of preventing unexpected bills.  

Start with a copy of the insurance policy. Find out what’s covered, what’s not, and when there are any holes in coverage. If you don’t know the coverage benefits and limits, you or your caree can request that a copy of the policy (if one can’t be found) be sent to you so that you have the facts. Find out if the policy runs on the calendar year Jan-Dec, or some other term. If there is more than one insurance policy, find out where the coverage overlaps, and which company is responsible for the bill first. Check to see how this affects prescription coverage too. If two policies renew at different times then paying deductibles becomes confusing. Sort through these issues before you end up with an unexpected bill.

Next, review your (or your caree’s) medications. Find out what the policy you have does and doesn’t cover. How much do those meds cost monthly? Can generics be substituted to reduce cost? Do the drug companies offer discounts, coupons, or other support for patients with financial need? If so, what is the process for proving need.

Next look at an EOB: Explanation of Benefits. They come in the mail from insurance companies and they let you know where you stand. Compare your numbers to theirs and keep records. Keep receipts of what is spent both at the doctor’s office and the pharmacy in copays and deductibles. Find out what the dollar amounts are for the limits of coverage and when any gap is likely to occur. Some policies have higher premiums which reduce the size of the donut hole, but it’s often still there. Will you reach the hole before your coverage year renews? If so, can you put aside some money now to cover the gap?

A few things to consider:
  • Even if you review your current medications and feel you’re unlikely to hit the gap, consider the costs of medications that may be needed should a hospitalization occur - are you prepared?
  • It takes time to prove financial need when asking for aid from a drug company. The sooner you know what your need level is and what documentation is needed, the sooner you can get help.

  • Talk to your doctor about the issue. A standard medication for preventing certain health conditions may have alternatives. Don’t expect your doctor to anticipate your financial needs. He or she is there to treat you medically. Although some may ask about your coverage and be sensitive to the issue of medication cost, it’s not likely to be foremost on a doctor’s mind when writing your prescriptions.     

Caregiver’s Golden Nugget 1:  While you’re reviewing insurance coverage issues for your caree, look over yours. Whether or not you qualify for Medicare yet yourself, it’s important to understand your own insurance issues and what kind of coverage you'll need when you have those decisions to make.

Golden Nugget 2:  While the terminology for deductibles, limits, and non-covered items are fresh in your mind, apply that knowledge to a review of all your policies - homeowners, renters, vehicle and long term care.