This is an evaluation report on InfoLine CARES, a registry and provider referral service (PRS) for elderly or disabled people in Sacramento County who need home care. The registry is a project of the Sacramento County Department of Health and Human Services, Adult Services Division, in collaboration with the Community Services Planning Council, which operates the registry under contract. The registry is funded at $129,000 per year; has two full-time specialists; a part-time manager; a secretary; and data processing support.
A. Service Use
InfoLine CARES began operation in March 1996. Both those who use home care services (called consumers or clients throughout the report) and providers have made extensive use of the service.
Nearly 800 provider referral lists have been sent to consumers using the service. By the end of January 1997, InfoLine CARES staff were aware that 251 providers had been hired through their efforts.
By February 28, 1997, the registry had over 800 registered providers. The plan was that within one year the registry would have 200 active, registered providers.
Provider recruitment efforts have been very successful. Indeed, with the cooperation and assistance of the Sacramento County Department of Human Assistance, in February of this year at least 300 registered providers were AFDC recipients.
B. Consumer Satisfaction
An effort was made to talk with all consumers who had been sent lists, through
November 1996, in an effort to measure registry performance and satisfaction with the service. Surveys of over 300 consumers indicate that:
95% of those who were sent lists of providers reported that such lists were sent in a reasonable amount of time, usually within 3 to 5 days;
93% of responding consumers stated that the information they received was helpful and easy to understand;
93% of respondents said that they were being helped by a Family Service Worker (FSW) or by registry staff;
99% of respondents indicated that having a FSW or registry staff help them was "important," as opposed to "unimportant;" and
97% of responding consumers to a subsequent follow-up survey (some weeks after the initial survey) reported that they would recommend the registry to a friend looking for a home care worker.
Consumers were asked: "Do you have any suggestions on how we can improve . . . [our service in helping you find a provider]?" A sizable number (31, to be exact) simply said: "No," or had no suggestions ("None"). Many others said "No," and went on to explain, or to indicate their happiness with the service. Here are some examples of the positive things consumers had to say:
No, "I think it's wonderful that you're following through like this."
No. [He/she] will use our services again if she needs another provider in the future.
I've been at this for 3 years, and your outfit is the best I've seen."
"I love your cheerful attitude."
She was impressed with information, so gave it to housing manager who posted it in recreation room.
"No, you're doing an excellent job. I think this got off the ground faster than expected."
"It works for me. If is ain't broke don't fix it."
"Can't think of anything;" response was prompt and helpful.
Liked the InfoLine CARES handbook -- size and information in it.
"No, you did an excellent job."
"I find this service very helpful. No change needed."
"I like the information on the provider."
"This is great; my name is even at the top of the list."
No, very happy with provider.
"No, I think it's fine."
"No, as far as I'm concerned, I'm satisfied."
"Don't move away."
"No, not at this time."
No, client has had her daughter as provider, and current provider is working out very well.
High-risk clients, in the Sacramento system, are those in need of support from Family Service Workers or Case Aides. Many expressed appreciation for the assistance rendered. Here are some notes from the FSWs who conducted follow-up interviews with high-risk clients:
Client stated it would be very difficult to obtain provider on their own because they do not know how to conduct interview. They like having FSW during interview and to monitor care worker.
Client states it was helpful to have FSW assist him and his wife, due to wife having speech problems.
Client informed me it was very helpful to have FSW assist her because of her speech problems.
Client can't locate providers on her own, too difficult to contact providers on her own, needs assistance from FSW staff.
FSW very helpful in locating a provider. Client states calling from the list was confusing and client states care worker did not want to work, and hard for care worker to locate client's home. Client also likes FSW to monitor case, feels more comfortable with FSW involved.
Client states "No," but she does prefer FSW involved to assist her in locating care workers.
"None at this time."
"No, I don't have nothing to say."
Client states having a worker help her is good.
The client states he needs a FSW due to not having a phone. The client did hire a care worker on his own, but only because he had a friend that needed work.
Client hired this provider on her own, but does like having a FSW assist and monitor case.
Client does not have a phone; cannot call from the list on her own.
C. Provider Satisfaction
Registries (and provider referral services) work when the needs of both consumers and providers are met. Both must find the service useful, for the service to be of significant value to either party. A focus group was conducted in February 1997, to learn from a small group of providers about their experiences. This group, ideally with two or three years of home care experience each, was selected to get at comparisons (and contrasts) between having a registry, and not having one. Unfortunately, despite arrangements in advance, a telephone reminder, a $25 stipend, and refreshments, only four (of the ten) came to the group session. Here are some of the things we learned from the four:
1.Each had clear restrictions (or preferences) on the type, amount, and timing (e.g., three said "no weekends") of work.
2.In response to the question "Has the registry made any difference in your decision to continue or to quit a job?," reactions were: (a) "Yes, I will keep my name in it;" (b) "Probably would if you lost your job, it's a security blanket;" and (c) "Yes, I think I'm less worried if I have to quit a job."
3.As to typical problems that would lead one to consider quitting a job, three of the four mentioned the person and their attitude (e.g., "being mean"), not the nature of the work.
4.Asked "What difference would it make if the registry were to disappear tomorrow?," three of the four said: (a) "It's good for workers to keep their names on it for future jobs;" (b) "It would be a hardship for some people because it's a security blanket;" and (c) "Might be good for some people, it helps you keep working."
D. Possible Improvements
Asked "What, if anything, about the registry could be better?," three of the four providers in the focus group had no comment. The fourth member said "Just make sure it keeps updated."
When consumers were asked to suggest improvements, 10 to 15% of those surveyed said they would like additional information on lists or help from FSWs/CAs to get additional information. Suggestions run the gamut from LARGER PRINT to helping providers with payroll issues and pay for travel. But, far and away, three matters were mentioned more frequently than others:
1.Several consumers wanted additional background information (e.g., relevant work experience) and more work references.
2.Several wanted to know whether the provider drives (or has a car).
3.Several suggested greater efforts to make sure the potential provider can be reached and that he/she is available to work.
Much of this third "problem," of course, is attributable to the fluidity of the home care job market, and the fact that providers change jobs (and take jobs) quite rapidly. For example, consumers in the survey report finding someone for their job openings within nine days (on average).
The evaluation consultant's suggestions can be summarized this way:
1.Continue to gather and analyze basic operating data (e.g., lists sent, providers enrolled, hires), along with information about satisfaction and other things from representative samples of both consumers and providers, with a view to continuous improvement (greater responsiveness to what people want; elimination of any inefficiencies).
2.Examine carefully what has been learned to date, and seek to make improvements now (as well as in the future). In this regard, consider (a) improvements in lists (e.g., car; work references); (b) more geographic targeting to enrich the provider base; and (c) ways to update information on the willingness and ability of providers to work.
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