CJE Care Management—Maintaining Quality of Life Through a Personalized Care Plan

 


 

CJE is proud to announce the introduction of its new Care Management Program. Manager Helen Grimaldi explains that the program is special because it is designed 1) as a vital link for those who are not able to take care of their basic needs and are isolated in their homes; and 2) to assist those who are not financially eligible for state-funded programs or not able to pay privately. An individual’s eligibility is determined at the very beginning of contact when a person calls CJE. Our staff is trained to conduct an eligibility screening over the phone by asking some simple questions. If eligibility is determined, then potential clients are referred on to the Care Management Team. If not eligible, callers will be referred to another CJE program for assistance.
 

This unique program is available due to the generosity of the Albert and Lucille Delighter and Marcella Winston Foundation, Jewish United Fund/Jewish Federation of Metropolitan Chicago Fund for Innovation in Health, The Crown Family Foundation and the Bernard Heerey Family Foundation. It is indeed a godsend for many people who are often faced with very difficult decisions such as whether to eat or fill an expensive prescription.

There are five major components to the CJE Care Management Program:

  • Care Management Services: An assessment of a person’s needs and a written Care Plan.
  • The Friendly Visitor Program: Calls or visits from a volunteer.
  • Home-Delivered Meals: Nutritious, prepared meals and a wellness check.
  • Home Care: Assistance with basic personal care and housekeeping.
  • Consumer Assistance: Emergency funds.

Care Management Services is the core of the program. With this component, a comprehensive, holistic assessment is made in the client’s home. The Care Manager looks at an individual’s physical, emotional, social, household, legal and financial situation and determines what his or her needs are, or what vital necessities of life are not being met. Based on these needs, a Care Plan is developed that outlines the services our professionals can assist them with in order to provide a more stable situation.

Grimaldi emphasizes that the Home Care Program is what really takes care of those who fall in the “financial” gap for in-home services. For a minimal cost of either $4 or $7, they receive the same assistance with personal care or chore housekeeping that other people are getting, either through government-supported programs or private pay resources. She claims that “This is a unique part of the program because it’s not being done anywhere else in the State of Illinois—we are the only organization doing it. Persons receiving Home Care through CJE Care Management are referred to one of four licensed Home Care providers.


How does the program work?

According to Grimaldi, she usually is referred to persons requesting in-home care: “We then go out to their homes and we do our assessment by focusing on how they perform their personal care tasks, such as bathing, grooming dressing, toileting, eating and medications, as well as how they manage meal prep, transportation, housekeeping, laundry and shopping. Our goal is to determine: 1) to what extent they are capable of doing it themselves; 2) if they have a family member involved that does part of it; and 3) whether they might need to have an outside agency to come in and assist. Then we develop Care Plans together with clients and make the necessary referrals.”

Though people sometimes know to call and ask for “home care,” Grimaldi says they often just ask for assistance for specific needs: “Usually, they say something like ‘I can’t cook anymore,’ or ‘I don’t have any food,’ or ‘I can’t get out to shop,’ or ‘I’m having trouble doing laundry’ or ‘I can’t get into the shower anymore.’”

Grimaldi (or the Care Manager assigned to clients) will sit with them, and an assessment will proceed as she sensitively asks questions like: “Tell me about how you bathe yourself. Do you shower or take a bath? How often do you bathe? Do you have a shower chair? Can you step in the tub?” All homes are visited for all assessments in order to see the environment and how clients are functioning because, she says, “People will tell you ‘I can do all of it’ or ‘My refrigerator is full of food.’”

After a verbal assessment is completed, a walk-through of the home is made with these gentle requests: “Is it OK if I look at your bedroom to see if you have a bed to sleep in? Is it OK if I look at your bathroom to make sure you can use the toilet and take a shower? Is it OK if I look in your refrigerator to see if you have any food?” Grimaldi says that most people usually say OK, but she always asks permission. When she encounters resistance, Grimaldi very emphatically states to clients: “After being in your house for an hour, I don’t want to leave thinking everything is fine, when in reality you have nothing to eat tomorrow. So, if it’s okay with you, I’d like to look in your refrigerator and to make sure that you have a nice warm bed to sleep in.” She laughs, “When you put it that way, they agree.”

Those who receive the services of CJE Care Management are in good hands. Grimaldi is a Licensed Clinical Social Worker who has over 28 years of experience running care management programs, including her own home care agency. She did everything in her previous positions that she’s doing here and brings a wealth of personal and professional experience to the Program.

 

All but the Kitchen Sink?
A Care Management Story

In June, when Bruce Applebaum (above right) moved to an apartment in CJE’s Swartzberg House, he came up a little short on supplies. He had been living the previous 12 years in an assisted living community and receiving three meals a day. “This was a big change for me,” he noted. Also, Applebaum didn’t have some basic things, like cooking supplies. Plus he needed a new bed: “I had this old bed that was really worn out. If you sat on the edge it sank down. I rolled off of it and hurt myself not long ago.”

Applebaum was undaunted by the task of moving: “Initially,there was concern about whether I would be able toBruce Applebaum handle things, since I was moving to independent housing. The staff stressed that there was much less support, and I was under the impression that I’d be totally on my own. I’d asked about various services—not with the expectation that they’d be available—but to find out about them. Then I was contacted by the Service Coordinator, Rolf Friedlaender, who (working with CJE’s Consumer Assistance) referred me to the new CJE Care Management program.” Applebaum speaks highly of its Manager, Helen Grimaldi: “She did so many things for me!”

Grimaldi basically assisted him in navigating through social and health systems in order to stabilize his situation. Applebaum described the process: “Helen came to my apartment and did an assessment to find out what I needed. In addition to Care Management services, she arranged for Counseling as well as Consumer Assistance for a benefits checkup.” Using emergency funds, Grimaldi purchased a bed, sheets and blankets and she obtained other donations, like pots and pans, to assist in setting up his new home. Yes, it was quite a few things, but no, not the kitchen sink.

Bruce Applebaum, now 70-years-old, has dealt with debilitating medical conditions for over 30 years. He came to Chicago for undergraduate school at the University of Chicago and later returned to UC for graduate school. He had completed all the fieldwork (with a Fulbright Grant) and passed qualifying exams toward his PhD in Anthropology. However, he was forced to leave school with his Master’s because he began having severe, undiagnosed physical symptoms. After many years, doctors diagnosed him with several medical conditions, one of which was polyneuropathy. “That affects my walking and my hands,” said Applebaum.”You have constant pain. It’s a lot to deal with.”

Thankfully, the support Applebaum receives from CJE SeniorLife helps him to deal with some adversity.

Call CJE at 773.508.1000 to see if you are eligible for our new Care Management Program.