Development of a Comprehensive Caregiver Assessment to be Used By a Medicaid Program

Background and Purpose: The primary goal of one state’s Medicaid Long-Term Care (LTC) program is to assist clients in continuing to live in their communities and to successfully transition clients back into their communities if they are currently living in facilities. Caregivers are integral to the successful transition of clients back to their communities. As such, comprehensive caregiver assessment tools are necessary for social workers to accurately identify needs and provide tailored supports for caregivers as well as clients. One LTC program currently has six managed care organizations (MCOs) that provide case management services for clients enrolled in the LTC program and all of these MCOs use different assessment tools. The purpose of this qualitative study was to identify the strengths and weaknesses of the current tools and provide recommendations for improving future tools by answer the following research questions:

1. How do the MCO’s LTC caregiver assessments differ in terms of content?
2. What are some ideas to assist MCOs in augmenting their assessment tools?

Methods: The caregiver assessment tools used to assure safe placement of LTC clients and appropriate supports for their caregivers were evaluated from five exemplar states (Ohio, Michigan, Tennessee, Texas and Wisconsin). Using the constant comparative method of content analysis, all items from the state-authored assessments were used to identify conceptual domains (n=33). Once the domains were finalized, appropriate domains were identified for the six MCO assessment items based on domain definition criteria. The domains were then assessed to evaluate which MCO assessments included items that fit the domain criteria and which MCO assessments contained no items that fit within the domains.

Results: This study found that the MCO caregiver assessments varied widely. Domains (n=33) were either related to the caregiver or the client and the majority of domains were caregiver-specific. The most comprehensive state assessment contained 52% of the identified domains and another state’s assessment contained 36% of the domains. However, the MCO assessments generally had fewer covered domains (12% to 39%). Notably, Plan-authored assessments did not include 33% of the domains (11 out of 33 domains) and most of those domains referred to care recipients (7 out of 11 domains) rather than caregivers (4 out of 22 domains). However, it is possible, though not documented, that Plan personnel use care recipient information available from other assessment tools.

Conclusions and Implications: Based on these findings, several recommendations were made to improve the MCO assessments. Importantly, all MCOs should be required to use the same caregiver assessment tool. In addition, MCOs should include more items describing client characteristics, so social workers are provided adequate information to determine if safe transition to the community for clients is possible. In order to achieve these goals, a comprehensive caregiver assessment instrument should be created that reflects the current caregiving literature, the findings of this report, and the needs of care recipient enrollees in the state. In addition, the caregiver assessment items should be periodically reassessed for their utility in receiving the appropriate services in the home.