Home Alone: Hospice Program Helps Elderly Who Don't Have Resident Caregivers
From 1996 to 1999, Samaritan Hospice, located in Moorestown, N.J., started the SOLO Live Alone Program to provide in-home services to elderly patients without resident caregivers in Camden, Burlington, Gloucester and Mercer counties.
- The program's social worker coordinated in-home services by working with the patient's own physician and an interdisciplinary team of hospice professionals to provide medical assistance, housekeeping and companionship to allow the patient to remain at home.
- SOLO provided daily in-home care to 189 patients in its first year, 248 patients in the second year, and 138 in the third year, with a daily census of between 26 and 52 patients.
RWJF supported this project through a grant of $230,078.
More than 43,500 people over age 65 live alone in New Jersey's Camden, Burlington, Gloucester and Mercer counties. In 1992, some 40,000 people in New Jersey over age 65 died from heart disease, cancer, stroke, cardiopulmonary disease, or pneumonia. Based on these statistics, it was estimated by the grantee institution that approximately 34,200 people in this four-county area who live alone would suffer one of these serious progressive illnesses.
One way to treat seriously ill elderly patients is through hospice care, which provides case management by an interdisciplinary team of clinicians and caregivers to bring the patient through the dying process. Under hospice guidelines that had been established by the field at the time of the grant, however, patients without a resident caregiver to attend to their daily needs were ineligible for hospice services.
Working with a community task force, Samaritan Hospice, one of the 15 largest hospice providers in the country, developed a pilot study whereby staff volunteered to take on added responsibilities and work extended days to test the effectiveness of providing in-home services, such as housekeeping, meal preparation, and companionship, to seriously ill elderly patients without a resident care giver. By providing the services that a resident caregiver would otherwise provide, Samaritan also was able to provide hospice services such as medical care and pain relief.
Samaritan found that these patients were able to remain at home, comfortable and secure with the service they were receiving and without the need for costly hospital care or extended medical care.
Based on the pilot program, Samaritan established the SOLO Live Alone program, providing in-home hospice care to patients without resident caregivers. The target population included patients with no family or friends, patients whose family and friends would not consent to serve as a caregiver, patients with family living out of the area, and whose potential caregiver needed to work outside the home.
The SOLO Live Alone program built on the pilot study by attempting to improve the quality of life of terminally ill patients and significantly reduce the cost of medical care. The project case manager maintained daily contact with and coordinated the patient's day-to-day needs. Operating in Samaritan's service area of Camden, Burlington, Gloucester, and Mercer counties, SOLO used a social worker serving as a care manager to coordinate the day-to-day needs of the patient. The care manager worked with the patient's own physician and an interdisciplinary team: a registered nurse, a certified home health aide, a chaplain, and a trained patient caregiver volunteer.
Samaritan initiated an educational program in which it expanded community relations efforts to inform the public, physicians, health care, and social service professionals about the SOLO program. These efforts included letters, phone calls, brochures, and videotapes, as well as routine contact with case managers in managed care offices. Other communications efforts for SOLO included news releases, print and radio advertising, professional and community presentations, special events, and maintaining a strong relationship with referring sources (e.g., physicians' offices and hospitals) as part of good customer service. In addition to strategies specific to SOLO, promotion for the program was incorporated into all other Samaritan marketing efforts.
The project planned to serve 100 patients daily, but increased competition in its service area and inconsistent referral patterns in the community cut into the projected numbers. Consultation with Foundation program staff during the second year allowed project staff to revise the projected estimates from 100 patients per day to 30 patients per month.
- The project served 189 patients in its first year, 248 patients in the second year, and 138 patients in the third year, with a daily census of between 26 and 52 patients.
SOLO produced a community education video, SOLO: A Special Kind of Care, and a slide presentation. The effort received coverage on www.HospiceWeb.com (no longer available). (See the Bibliography for complete details.)
AFTER THE GRANT
SOLO is seeking corporate support in each of the four counties it serves.
GRANT DETAILS & CONTACT INFORMATION
Hospice Program for Patients Who Live Alone
Samaritan Hospice (Moorestown, NJ)
Dates: July 1996 to June 1999
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
SOLO: A Special Kind of Care, a community education video. Samaritan Hospice, December 1997.
SOLO, a slide presentation. Samaritan Hospice, September 1997.
"SOLO," in Helping Hand, Fall/Winter, 1997.
Report prepared by: Robert Mahon
Reviewed by: Patricia Patrizi
Reviewed by: Molly McKaughan
Program Officer: Pamela Dickson