The Queen's Medical Center - Foster Family Community Care Program

Overview

The foster family program began in 1979 to assist frail individuals at least 55 years old who are no longer able to live independently. The Community Based Programs staff trains and supervises caregivers. Initially, the program’s staff consisted of a team of a nurse case manager and social worker who visit the foster homes regularly to oversee the care and assist as needs arise. Staff is available via pagers to assist with after-hour emergencies. The program is responsible for providing 24-hour care and for meeting the daily needs of each client in their home. The homes are private residences in the community with a maximum of two clients in each home. To ensure privacy, each client has his/her own bedroom. Clients are matched with a caregiver who can best meet their care needs.

Eventually, with federal support, the state had oversight over the program. Over the years, the state expanded and modified the program. Around 1986, the program lifted its age restriction and opened the program to all adults who are at nursing home-level of care and who are no longer able to live independently, if a state-approved home capable of caring for them were available. The program now includes services rendered by other residential care facilities and case management agencies that are either certified or licensed by the state. With increased demand, the state legislature made into law the possibility of these homes caring for up to three nursing home clients, providing they meet state requirements. At least one of two or two of three clients must be covered by Medicaid. The latest major change by the state is transferring the foster family program to managed care, along with other Medicaid waiver programs.

Impact

A 1986 study conducted on this program showed that clients in foster homes were maintained at 40 percent lower cost than clients in nursing homes, even though the clients in the foster homes had more frequent hospital admissions and used more services. Other studies conducted locally showed consistently that community-based options to nursing homes were less costly.

Challenges/success factors

The use of private funds made it possible to be creative and implement a program designed by staff, but continued use of private funds for sustainability was impractical. The state expanded the program and ensured sustainability, but brought in competition and more regulations.

Future direction/sustainability

The program has developed seasoned case managers over the years. With growing demand for cheaper alternatives and more acceptance of case management services, program staff is exploring other areas of need. For example, to help with the medical center’s goals regarding length of stay and to address the problems created by stricter Medicaid eligibility and state government slowdowns due to furloughs, the staff is currently using its expertise and working collaboratively with inpatient staff to get patients back into the community.

Advice to others

Staff needs to be flexible and modify as changes occur while maintaining safe, quality care. It is important that staff possess computer skills to be efficient and be able to protect confidentiality according to HIPAA guidelines.

Contact: Cedric Yamanaka
Director, Corporate Communications
Telephone: 808-691-4975
E-mail: cyamanaka@queens.org