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Posted: August 04, 2004

Professional Caregiving

Making Differences Work in Partnerships

One morning not long ago, John Kerry announced his choice of John Edwards for running mate. Soon after, the Bush campaign television ads started popping out, focusing on the differences between the two Democrats, as if that negated their ability to work now as a team.

Sometimes the differences in a team and how that is parlayed is what makes a team stronger, even though the statement might seem counterintuitive. We expect team players to be more similar than not, but it?s often the differences that each bring to the plate that broadens the capacity to create a stronger impact.

Life and business are political in that they are defined by the relationships built and promises kept. Just like those running for office, our industries, those working with caregivers directly or indirectly through provision of care to their loved ones, can only grow when our partnerships with each other are developed, despite our differences From that, our ability to offer stronger, more seamless service delivery is achieved.

Two years ago, I was involved with a merging of two very distinct and disengaged industries into a collaborative, reciprocally referring relationship. The two industries are adult day services and home health agencies. We have a lot in common: we serve frail elders and disabled adults who are making choices to stay at home, avoiding at all costs, institutionalization.

We also have our differences, from the location where service is provided to the range of services offered. We share client markets, have similar caregiver markets, similar visions, yet offer different services, provision sites, reimbursement mechanisms. One provides care within the home of the senior, the other is designed to get the senior or disabled adult out of their home and back into the community while giving the caregiver some ?at home? respite or the ability to return to work.

The development of a working referral network between these two industries was innovative and generated media interest, industry- wide recognition and invitations to present on this ?innovative? effort. When you examine this more closely, it is surprising that instead of finding audiences intrigued by this novel approach, we probably should have been doing a lot of explaining why we hadn?t come together as a stronger force long ago!

Every industry has its territory, beyond which we feel like strangers or even invaded, depending on who is venturing where. Our two particular industries have been held apart in part, by some particular language put together in the Medicare Homebound Status guidelines that pit our industries against one another. Neither of us had anything to do with the language, but both of our industries felt disenfranchised by the other, suspicious of the other?s encroachment on our territory when in fact, we are a stronger entity when we work along side each other. This is what we discovered in our new relationship.

The Medicare Homebound Status rule, which is used to define which Medicare beneficiaries are deemed eligible for home health services, revised the definition of ?homebound? in 2001. To greatly simplify it, before that time, a senior who could not get out on his/her own was considered homebound, thus becoming eligible for services of a nurse, aid or therapist in the home when prescribed by the patients? physician. The home health agency then would be reimbursed for the provision of this service. The adult day industry, designed to work with frail elders and disabled adults, makes in most cases escorted transportation an integral service which allows adults who are otherwise homebound to get out of the home for meals, activities, therapy, medical care and so on. Until the definition was revised, the fact that the homebound person was getting out (regardless of the intensity of service required to accomplish this) they lost their homebound status, thus any home health they received would not be reimbursed to the agency by Medicare.

Because the old definition essentially forced elders to become isolated just to qualify for home care services, the definition was revised in 2001. Despite the change in legal definition, the two industries were not yet positioned to figure out how a referral collaboration could positively impact the shared clients of both services as well as the businesses serving this customer base. This was the impetus for the coalition of our two industries which we called the Home Health/Adult Day Care Network.

We discovered in our monthly meetings that lots of folks want some service in the privacy of their homes, like bathing and therapy, yet recreational programs, congregate meals, healthcare supervision out of the home could give them a new experience back into the world of their community, as well as provide their caregiver with respite in which they didn?t need to leave their home to get it. It is the combination of the two services, we theorized, that would meet the whole person, providing some care in the home, along with other choices out of the house.

We tried to understand each other?s industries. We asked questions of each other (that having been in the field for decades, we might not have admitted our ignorance), but in the sharing of care practices, services, referral procedures and more, we discovered that if we marketed each other?s services to our own clients, all could benefit.

The adult day client, for example, might come four days each week, but on the weekends or evenings, had no health supervision, so a referral to a home care agency might round out their care needs when the day center was closed. On the other hand, the in-home client, getting therapy twice a week, would still benefit from the socialization, interactions and programs out of the home on the other days. One was not exclusive of the other.

While we presented our collaborative experience in the network to many agencies, associations and organizations throughout our state (Missouri) and on the national level as well, we remained frustrated by the difficulty in merging the two industries in the ways we had hoped. Theoretically, the concept worked but we hadn?t succeeded in practice. The direct line staff at the centers, and in the homes of the seniors, needed more training and facilitation in the ways to blend the combination of services that provides the best of both worlds. We now need to decide if we can go this next step together.

Partnerships are not easy. Partners may disagree on some core elements of each other?s practices or goals. Partners may worry that the other is trying to take clients away from them. These concerns must be addressed but should not be barriers to taking these important steps.

The larger community benefits from collaborations that come from innovative, risk-taking efforts to create seamless service over fractured care options for which ( if you don?t already know,) our industries are known and criticized . It behooves all of us, providers and caregivers, to reinvent partnerships that blend care options, because the easier they are to access and use, the more likely our clients will stay our clients for the long haul.

What I know from my work over the past two decades is that there still is a demand for one-stop shopping -- a one-call system -- and only we can open the doors, breaking down the silos, so our customers present and future will get a better service package with less coordination on their end. This is exactly what caregivers I talk with want.


Sylvia Nissenboim is a licensed clinical social worker and who has been working in the field of adult day services in the St. Louis area. She is the director of four adult care and enrichment centers for the American Red Cross and also operates a personal and professional coaching firm, LifeWork Transitions, specializing in caregiving concerns, adult day care management and other aging services, such as virtual coaching and family care giving support groups. She co-authored The Positive Interactions Program, is a national speaker, and has served as president of the Missouri Adult Day Care Association and as a member of the Missouri Governor's Advisory Council on Aging..

© 2004 Pederson Publishing, Inc. All Rights Reserved.
Commercial use, redistribution or other forms of reuse of this information is strictly prohibited without the prior written permission of Pederson Publishing.

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