ICS’ Rachael Stacom Talks about Preserving Independence

Rachael, along with Inspired Memory Care (IMC) Co-Founders Nettie Harper and Kelly Gilligan hosted “Role of Care Management in Preventing Institutionalization and Maintaining Health in Those Living with a Physical Disability and a Cognitive Impairment.” The webinar educated participants about predictors of institutionalization and evidence-based frameworks for supporting clients living with physical disabilities to remain in the community. Rachael also discussed the ICS Health Home Program and how it supports members to live safe, fulfilling lives in the community.  

Presenters began by defining what it means for a person to have a physical disability or a cognitive impairment. Disabilities can range from those that affect a person’s vision, mobility or thinking. According to the Centers for Disease Control and Prevention (CDC), 26 percent of adults in the United States have a disability. Some, disabilities that cause a functional impairment including multiple sclerosis, can result in a cognitive disability as well.

“When defining cognitive impairments, we are looking at changes in learning and memory, executive functioning, such as planning, organization, or problem solving,” Kelly said, noting that there are numerous factors.

A person can have both a physical disability and cognitive impairment. Studies have shown that having a physical disability can be a major risk factor for mortality and that risk increased when cognitive impairment was present.

“Things that may be simple for an able-bodied person take so much more for a person with a disability,” Rachael said.

The ADA, institutionalization, and nursing home predictors

Rachael discussed the significance of the Americans with Disabilities Act, the U.S. Supreme Court’s ruling in Olmstead v. L.C. and how people in institutions had to right to return to the community and to reasonable accommodations. Unwanted placement has been shown to decrease overall autonomy and quality of life. Nettie discussed predictors of people with disabilities being placed in nursing homes, including bathroom use, inability to dress, bowel incontinence, cooking, as well as sociodemographic factors, including increased age, living alone, as well as ethnicity.  

Rachael explained that people living with MS face an increased probability of admission to nursing homes with risk factors including poor health status, MS symptoms interfering with daily life, and worsening bowel dysfunction. Kelly noted that people with traumatic brain injuries and spinal cord injuries also risk early institutionalization for a number of factors, including age, gender, living status, and severity of injury, among other reasons.  

Care Management and supporting people with disabilities

All three presenters noted the importance of care management in supporting people with disabilities, as the approach is a patient-centered one that allows professionals to assist patients and their caregivers in effectively managing medical conditions. Care management helps to identify populations with modifiable risks, align services to support those populations and identify, prepare and integrate appropriate personnel to deliver services.

“We want people to be healthy,” Rachael said. “To be mobile in and out of their homes and have independence within their community.”

The benefits of the ICS Health Home

Rachael spoke about ICS’ Health Home program, and how it ensures people with disabilities achieve positive health outcomes and remain independent through coordinated, comprehensive care management and disability expertise that assures access to appropriate services. Reducing preventable hospitalizations and emergency room visits is crucial, but more is needed for quality of life, she said.

Rachael also explained how ICS works to decrease predictors for institutionalization, with prevention and early detection being a key. Partnering with hospitals and primary care practices to deliver disability competent healthcare; employing teams of specialists who understand the complex needs of people with disabilities; and increasing the knowledge of health care providers and members about how conditions can cause immobility and cognitive impairment are important tactics.  

One participant asked if one can be in both the health home and a managed long term care plan.

“Yes, you can,” Rachael said. “People can have straight Medicaid or be in Visiting Nurse Service of New York (VNSNY) CHOICE. We are growing and hope soon to be able to work with additional locations and plans soon.”

Click here to view the full presentation.