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Maine
Primary Partners in Caregiving project (MPPC)
A
U.S Administration on Aging-Funded Project (2001-2004)
 
The
Maine Primary Partners in Caregiving project (MPPC)
forged an innovative partnership among primary
care practices, Area Agencies on Aging, and the University
of Maine Center on Aging in five rural Maine counties.
MPPC aimed to demonstrate that primary health care
is an effective and efficient "upstream" point
of caregiver intervention because caregivers will
more likely utilize information, support and training
when need is validated by a trusted health care
provider and assistance is personally tailored
to their needs.
A
brief screen administered during routine health care
visits identified patients burdened with caregiving responsibilities.
An expedited referral pathway to the AAA was subsequently
activated. Caregiver specialists assessed and respond
to caregiver needs with customized services including
education and training resources and a statewide hotline.
An
evaluation of MPPC outcomes was conducted gauging
caregiver well-being, service utilization patterns,
and the quality of community partnerships, and profiling
caregivers. Products included model education curricula
for rural caregivers and primary care providers and
a best-practice replication guidebook.
The Maine Primary Partners in Caregiving project hoped
to demonstrate that:
1.
Rural primary health care practices are an effective
point of early intervention for individuals who are
caring for older persons;
2. Caregivers will accept/utilize information, support
and training when the need for such is validated by
their personal physician or other health care staff;
3. The combination of information, support, and training
by MPPC caregiver specialists will be successful in
ameliorating the multiple risks of rural caregiving;
and
4. A productive community service partnership among
a health care provider, primary care practitioners,
AAAs, and a university center on aging can be established
and sustained in service to family caregivers.
Goals and Objectives
There were four major goals and a series of subordinate
objectives associated with the MPPC project:
Goal 1: To demonstrate that rural primary health care
practices are an effective point of early intervention
for individuals who are caring for older persons
Objectives:
1-a:
To increase significantly the rate of primary care
practitioner referrals of adult patients to participating
AAAs during the course of the MPPC project.
1-b: To identify primary care patients involved in
family caregiving at a rate equivalent to the estimated
proportion of adult caregivers in the general population.
1-c: To document that 90% or more of eligible patient
caregivers wishing information, support, and education
interventions are served according to MPPC protocol.
 Goal
2: To show that caregivers will accept/utilize information,
support and training when the need for such is identified
or validated by their personal physician or other health
care staff
Objectives:
2-a:
To document that the majority of patients who report
feeling stress regarding caregiving and/or wish to
change the nature of the caregiving arrangement (on
the Brief Screen) will accept a referral.
Goal
3: To demonstrate that the combination of information,
support, and training by MPPC caregiver specialists
and field coordination/liaison efforts by a health care
provider will be successful in ameliorating the multiple
risks of rural caregiving
Objectives:
3-a:
To record high levels of satisfaction by individuals
receiving single contact service with rendered interventions.
3-b: To document that caregiver well-being is buoyed
by receiving multiple contact service as reflected
in positive changes over time in stress/burden levels,
depression levels, life satisfaction/morale levels,
satisfaction with caregiving arrangements, confidence/competence
levels, isolation/loneliness levels and quality of
family relations.
Goal
4: To show that a productive community service partnership
among primary care practitioners, a health care provider,
AAAs, and a university center on aging can be established
and sustained in service to family caregivers.
Objectives:
4-a:
To document compliance with protocol among all partners
throughout the course of the project.
4-b: To document a low rate of withdrawal from the
project by primary care practitioners.
4-c: To document an increase in the number of participating
primary care practitioners.
4-d: To secure the necessary funds to sustain the
project subsequent to the 3-year AoA funding period.
4-e: To have the MPPC model replicated in one or more
parts of the country within 4 years of project implementation.
Training and Education
MPPCprovided two sequences of education and training:
1) caregiver education and 2) primary care practitioner
training. The overriding philosophy driving the project's
caregiver education efforts 
emphasized providing information that was locally relevant
(i.e., rural Maine-specific), divided into small units,
available on a continuous basis, delivered via personal
contact whenever possible, accessible in moments of
crisis, and was broad in scope yet specific in detail.
Topics addressed included: accessing comprehensive, quality,
and relevant information and services; dealing with
financial pressures; legal quandaries; health problems;
emotional turmoil; family conflict; and social isolation.
Primary
care practitioner education focused on techniques for
identifying caregivers; understanding what causes caregiver
burden; providing empathetic support; and educating
caregiving patients about illness and debilitation,
future care needs, available community services, caregiving
management strategies, safety issues, and stress management.
Evaluation
The MPPC project efficacy was assessed using formal process and outcomes
evaluation of all program components. The evaluation
focused on determining the extent to which the goals
and objectives of the project are realized. In particular,
the assessment focused on program results in the
following domains:
1. Determining Caregiver Well-Being Levels. Change
over time was measured in the caregiver's: stress/burden
levels; life satisfaction/morale levels; depression
levels; confidence levels; competence/skill levels;
quality of family relations; social support levels;
and degree of isolation/loneliness.
2. Determining the Integrity and Sustainability of
the MPPC Partnership. Variables considered
here included: practitioner/university/AAA satisfaction
levels with MPPC policies and procedures; adherence
by partners to project protocols and data collection
procedures; commitment to continuing MPPC program at
the end of the 3-year period; low withdrawal rates by
primary care practitioners; and increased numbers of
participating primary care practitioners over time.
3. Constructing a Presenting Profile of Caregivers
Served. Variables considered include the caregiver's:
physical health; functional status (ADLs); cognitive
functioning; employment status; financial status; emotional
status and behavior; social participation levels; areas
of caregiving task performance; areas of caregiver competence
and difficulty; and categories of services/assistance needed.
4. Determining Service Utilization Patterns of Caregivers.
Change over time in services used was inventoried
including: consumption and satisfaction levels with
health/medical services, information and referral services,
social/therapeutic services, and education and training
services.
5. Documenting Best-Practice Program Procedures.
The process evaluation provided details of preferred
approaches to screening, referral, care planning, training,
marketing, etc. presented in the MPPC program
replication manual.
MPPC Organizational Partner
The
Eastern Agency on Aging was designated as an area agency
on aging in 1973 and incorporated as a non-profit organization
in 1974. Eastern offers a comprehensive array of services
to elders and their families including information and
assistance, personal advocacy, congregate and home delivered
meals, adult day services, assisted living and congregate
housing services, employment training,  volunteer
opportunities and public education. Eastern employs over
100 full- and part-time staff and administers a $3.5 million
budget. Since
1996, EAA has provided counseling, education, training,
technical assistance and assistance in arranging supportive
services to Alzheimer's participants and their caregivers
as part of the Maine's Alzheimer's Disease Demonstration
Grants to States Program. Services provided through the
Alzheimer's Demonstration program are now supplemented
by Maine's Partners in Caring program. Under contract
with the Bureau of Elder and Adult Services, EAA provides
information, counseling, education, adult day services
and respite to families caring for Alzheimer's victims.
Primary
Care Partners
Rosscare,
an affiliate of Eastern Maine Healthcare, provides educational
and health services to senior adults and their family
members. Rosscare services include programs for senior
caregivers, at-home reassurance and emergency response
services, geriatric assessment, community education
programs on senior health and wellness, and assisted-living
and nursing-facility care options. Rosscare's Center
for Healthy Aging, directed by Amy E. Cotton, performs
ongoing field coordination and communication functions
in relation to the primary care practice sites during
all phases of project activity, including the field
testing of data collection and evaluation protocols,
service delivery, and primary care practitioner and
caregiver education and training. Cotton is a highly
respected geriatric nurse specialist and family nurse
practitioner who has established exceedingly strong
and positive relations with the broad network of participating
primary care practices. She had a lead role in insuring
that communication lines remain open at the primary
care practice sites during the life of the project.
She also participated in the delivery of the MPPC education
and training program.
Norumbega
Medical, the primary care division of Eastern Maine
Health (EMH), involves more than 40 physicians, physician
assistants, and nurse practitioners. The practice has
offices in five area communities throughout Penobscot,
Piscataquis, and Waldo counties emphasizing consistently
high standards of care, dedication to customer service,
and a belief in the patient as the center of the team.
Horizons
Health Services is also an EMH affiliate and
is one of the largest multi-specialty practices
within the state of Maine. Horizons has health
centers in Presque Isle, Mars Hill, Fort Fairfield,
Washburn, Limestone, and Madawaska. The health
care team consists of individuals who are part
of the communities they serve, know the families
they treat, and provide better care through that
knowledge.
MPPC Advisory Panel
The MPPC Advisory Panel was composed of expert service
providers and University of Maine faculty who met regularly
to monitor and assess its development, implementation,
and evaluation. They were also available as consultative
partners and participated in program planning and sustainability
functions. The following leaders in the gerontological
community served on the MPPC Advisory Panel:
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