As call centers for private sector disease management organizations move into a care coordination role with the Medicare population, materials are needed to help coaches assist elder caregivers in fulfilling and maintaining their roles as adherence facilitators for the patient. Furthermore, elder caregivers themselves often have chronic conditions, which they neglect in deference to the needs of their ill spouse. Low Literacy Elder Caregivers Support for Call Centers is a multi-level web application designed to train call center coaches in caregiver issues, as well as facilitate the requisition of follow-up media to be sent to the caregiver in a variety of low literacy formats (DVD-video, 4th grade reading level print media to be sent via email or post). The proposed system will integrate with existing call center software to help coaches assess the needs of elder caregivers in the domains of disease management, care plan adherence, personal coping with the caregiver role, and the caregiver's own efforts at self-care. Based on caregiver responses to surveys, coaches will be presented with an individualized menu of talking points and phone scripts pertinent to that caller. Coaches will also have the ability to requisition tailored educational materials to be sent to the caregiver based on caller-specific items. Since 59% of seniors function at Basic or Below Basic levels of health literacy, all materials will be developed following the Institute of Medicine's recommendations for individuals with low health literacy. Phase I will involve formative evaluation with elder family caregivers of persons with congestive heart failure, and an advisory council of call center professionals and leaders in the field of health literacy and eldercare research. A low literacy DVD and a booklet containing a collection of low-literacy articles will be prepared concerning select topics relevant to elder caregivers. The theoretical basis of this intervention is the Lazarus and Folkman stress and coping model. All summative evaluation instruments will be based on these constructs. The efficacy of the DVD and booklet will be evaluated in a quasi-experimental pre-post design with 36 African-American, Hispanic, Caucasian, and Asian Medicare-eligible elder caregivers providing assistance to a Medicare-eligible care- receiver with congestive heart failure. Outcomes measured in this study include caregiver self-efficacy, knowledge, and intention to change in the domains of caregiving skills and caregiver coping. Phase II will expand the caregiver materials to cover all domains, adding information on chronic obstructive pulmonary disorder and the staff modules needed for call center coaches, including training, surveys, talking points, and the requisitioning of DVD-video, print, and email support materials. In Phase II, the complete program will undergo a large scale randomized clinical trial involving elder caregivers, and a process and impact evaluation of the staff of participating call centers.
Elder caregivers are an integral part of the health care team, facilitating care plan adherence and enabling independent living. In addition, as seniors themselves, they have their own health challenges, which are often exacerbated by their caregiving role. This program is designed to assist disease management call center coaches in offering state-of-the-art support to elder caregivers in the domains of disease management skills, care plan adherence, caregiver coping, and caregiver self-care, including low literacy follow-up materials available on DVD-video, or as hard copy or e-mail articles.
