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SF-GetCare is an online long term care resource in San Francisco that improves access to community and in-home services for older persons and adults with disabilities. Developed by the San Francisco Department of Aging and Adult Services (DAAS), the system has three distinct functions:
- providing consumers and other stakeholders with access to long term care information through an online resource directory;
- allowing providers to assess and enroll consumers for certain services using online tools; and
- enabling multiple service providers to share information about consumers they have in common.
A key goal of SF-GetCare is to reduce the need for institutional placement among consumers by providing better information about San Francisco’s array of home- and community-based services, and by facilitating better coordination among service providers.
Accessible Information—in Multiple Languages
At the SF-GetCare Web site, www.sfgetcare.com, community members can find easy-to-use data about the county’s long term care options, including general information about a range of in-home, day center and residential options. A searchable long term care database lists about 1,200 programs and services in the San Francisco area; local maps can be generated easily for each listing.
GetCare also takes into account language barriers, since an estimated 30% of the 146,000 at-risk adults who need assistance in San Francisco speak languages other than English. Language options in SF-GetCare’s online resource directory include Spanish, Chinese, Russian and Tagalog. (Language and large-text options are prominently displayed on the Web site’s home page.)
Moreover, to provide general training for users, DAAS worked through a technical consultant, RTZ Associates, and a consumer-advocacy organization called Planning for Elders in the Central City (PECC). Over a six-month period, PECC conducted more than 30 SF-GetCare Website Orientation and Training Presentations at senior and community centers, college adult education classes, churches, and technology sites. An estimated 315 consumers and 58 staff were educated about SF-GetCare, including how to search for and assess services.
PECC also facilitated access to the system at about a dozen community locales, with on-site training provided by mentors. The San Francisco Public Library, for example, agreed to provide access to SF-GetCare at its main library and 26 branches, and has used SF-GetCare as part of its consumer-oriented Internet training curriculum.
Not surprisingly, trainers found that personal attention was crucial in helping older adults become more comfortable with using a computer, and that smaller training classes generally worked better than larger ones. In addition, trainers made the experience relevant by asking consumers what issues were important to them and their families, and then looking for solutions on SF-GetCare.
Consumer Assessment, Referral and Enrollment (CARE)
Forty-eight providers that are county-operated or have contracts with DAAS have password-protected access to a SF-GetCare tool known as CARE (Consumer Assessment, Referral and Enrollment). CARE allows these providers—who operate 133 DAAS-funded programs serving around 21,000 people—to assess prospective consumers and enroll them electronically into county-reimbursed services. The first agency that enters a consumer’s information into the system becomes the Agency of Record, and is responsible for obtaining and maintaining in a secure location the consumer’s authorization to share data.
The CARE tool, which includes both functional and nutritional risk assessments, is used to determine eligibility for services provided through the DAAS Office of the Aging. These services include congregate meals, home-delivered meals, adult day services, case management, transportation, legal services, senior centers, family caregiver support, and information and referral services. All Office of the Aging programs and services are funded by the Older Americans Act and the San Francisco general fund for social services for seniors, and don't have financial eligibility requirements; for this reason, the tool does not have a financial eligibility component.
CARE is not used to determine eligibility for Medicaid-funded services, such as home- and community-based waiver services and personal assistance services. These services are provided by or through other county departments, such as the Department of Public Health (DPH) and the Department of Human Services, which maintain separate information systems.
Online Multi-agency Case Management
DAAS is currently testing an online, multi-agency case-management system. The system does not replace individual agency records, but creates a common place where critical coordination information about consumers can be shared easily.
Participating providers submit data to DAAS via the system, which streamlines submission for both parties, ensures uniform reporting that meets the requirements of state and federal agencies, and makes aggregation and analysis of data across providers far more feasible for DAAS.
DAAS developed confidentiality guidelines that participating providers must follow at risk of sanction, including dismissal as a county provider. The policy addresses state and federal confidentiality requirements, including those contained in the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Provider training was developed and implemented in collaboration with Planning for Elders in the Central City (PECC); the Internet Access, Content and Training Task Force (IACT); and county staff, providers and consumers.
Development Process
The planning phase for SF-GetCare began in January of 2001. Implementation was staggered, with online information available by the end of the first year. The CARE tool was added in the second year, and multi-agency case management was piloted in 2003, the project’s third year.
Launching SF-GetCare was not without controversy. County staff, as well as consumer and provider communities, expressed concerns about privacy and work load, while private sector agencies were concerned about losing access to consumers. Key to overcoming stakeholder concerns was bringing together a diverse coalition of service providers, consumers, software manufacturers and public agencies. RTZ Associates, a program development and research group, was selected as the SF-GetCare technical consultant and played a key role in the system’s development.
Start-up Costs
Nearly $2.6 million in cash was invested in the development of SF-GetCare, plus considerable in-kind contributions of time from the stakeholders. Development began with a $1.7 million Long Term Care Innovation grant from the California Department of Aging. An additional $899,000 was provided by the U.S. Department of Commerce's Technology Opportunities Program. Customized software and stakeholder processes represented a significant portion of the start-up costs, and about $136,000 was used for consumer and provider training. The county is pursuing additional funding from National Institutes of Health (NIH) to develop outcome measures for the online case-management system.
Evaluation
A three-part evaluation of SF-GetCare is under way. It includes:
- electronically tracking the system’s use by consumers and providers;
- assessing satisfaction among consumers and providers using satisfaction surveys and focus groups; and
- measuring consumer outcomes in the areas of access to services, equity of services and rate of institutional placement.
Results of the evaluation will be available in the summer of 2004.
For More Information
A detailed case study of SF-GetCare was prepared for the U.S. Administration on Aging. A Power Point presentation by Darrick Lam, Executive Director of DAAS, shows examples of SF-GetCare’s online information and CARE components.
SF-GetCare Web site: www.sfgetcare.com
Bill Haskell, LTC Principal Investigator, DAAS: 415-986-6700
Mike Zawadski, RTZ Associates (project consultant): 510-986-6700
Rating: based on 3 users
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