Model Proposals - Chinese American Service League (CASL)

VNA appreciates proposals that address the questions posed in the grant application yet are written in a narrative format that is both organized and clear. This proposal prepared by the Chinese American Service League or CASL, combines required information with a well-defined description of its program and the needs of the community it serves. CASL presents the information nicely, using text and tables in an outlined format that is easy to read and reference.

This proposal was approved in full by the VNA Foundation Board at its November 7, 2002 board meeting. We are pleased to offer it as the Proposal of the Quarter for the quarter ending December 31, 2002.

A. Background

1) Organization's Mission, history, goals, and/or objectives
Founded in 1978, the Chinese American Service League (CASL) is the largest and most comprehensive social service agency in the Midwest dedicated to serving the needs of Chinese Americans. Each year the agency's programs reach more than 14,000 clients who live primarily in the Chinatown, Armour Square, and Bridgeport areas of Chicago. In addition, clients from across Chicago, neighboring suburban communities, and adjacent Midwestern states utilize CASL's services. CASL's mission is to help individuals and families of all ages and backgrounds ensure economic opportunities, ease cultural transitions, enhance their physical and mental well-being, and attain self-sufficiency. This is accomplished by a comprehensive range of social, cultural, and educational programs. Housed in five facilities, with over 190 bilingual, bicultural professional and support staff, CASL's operating budget for FY'03 is over $5.7 million.

2) Description of current programs and activities. Please emphasize major achievements of the past two years.
CASL provides an array of programs: families and children benefit from CASL's Child Education Development Services, Family Learning and Resource Center, and School Age Center. Those seeking employment look to CASL's Chef Training Program and Community Employment Program, and all clients can benefit from CASL's counseling and social and health services. CASL's Elderly Services Department provides casework services, counseling, the highly successful Homemaker Program, and innovative Adult Day Care, and an effective senior advocacy group. CASL's programming is highly regarded: recently, CASL's School Age Center was accredited by the National School-Age Care Alliance, a distinction given to only four percent of after school programs nationwide. In addition, CASL's Family Learning and Resource Center (FALREC) received a certificate of recognition from the State of Illinois for its standard of excellence in service delivery. The United Way also awarded CASL's Youth programming its "Leadership Silver Award" for excellence in community involvement and support. Programming in the Employment and Services Department continues to grow, and the recent establishment of three Community Technology Centers-one in Employment, one in the Youth Center, and one for the elderly-enhances CASL's services to the community.

3) Description of formal and informal relationships with other organizations.
CASL, recognized as a leader in its community and the greater Chicago area, enjoys many collaborations with organizations whose goals and ideals are shared with CASL. CASL is a member of the Coalition of Asian, African, and Latino Immigrants of Illinois (CAALII). CASL also is a member of the National Asian-Pacific Center on Aging (NAPCA) and the Coalition for Limited English Speaking Elderly (CLESE). CASL also collaborates with a myriad of social service agencies in the Chinese community in the Coalition for a Better Chinatown (CBC), which strives to combine resources to better affect positive change in the Chinese community.

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B. Purpose of funding request

On behalf of the elderly served by the Community Care Program (CCP), or "Homemaker" Program, CASL is pleased to submit this proposal to the VNA Foundation for a renewal grant of $65,000 to support CCP program activities. Support from the VNA Foundation will allow the program to maintain a full-time nurse who, since August 2000, has strengthened the program's quality of in-home services, follow-up with clients, families, and medical professionals, educational workshops for clients and staff, program direction and planning, and the monitoring of clients' mental, physical, and emotional health status.

The community and/or agency needs or problems that this effort will address, including population served.
A common perception of Chinese Americans is that they are an assimilated, successful minority group. The reality is that many are newly-arrived immigrants struggling to gain a foothold in a new country, including a high percentage working in service industries at barely minimum wage with no benefits and little upward mobility. Isolated from mainstream society, they lack adequate health care and resources, and their children are lost in the public school system with little or no bilingual and cultural support. Many seniors need intense physical and medical attention; bilingual and cultural factors also play a significant role in the deterioration of the health of our community's elderly. Some may suffer from a variety of hard-to-detect ailments such as dementia, depression, Alzheimer's, and others may be placed in nursing homes or suffer alone. In cases of frail elderly at home without supervision, they are endangered daily.

Since 1991, CASL has provided bilingual homemaker services to Chinese elderly, the majority of which are disabled, economically disadvantaged, and have limited English speaking skills. The goal of the Homemaker Services Program is to offer preventative health services and companionship to reduce the number of inappropriate hospital and nursing home placements of Chinese elderly. CASL employs homemakers to assist with the daily needs of the frail and homebound elderly and to provide some levels of home health care. CASL strives to improve the lives of community seniors by monitoring their mental and physical health, reducing their feelings of isolation, encouraging them to retain their independence as much as possible. The healthy community seniors employed by CCP as homemakers also benefit, as they are given an opportunity to meaningfully contribute to their community.

Describe how the project addresses these identified needs
To address the needs of the community's elderly, the CCP nurse's service goals remain a response to the ongoing needs analyses of the homemaker client population. The CCP nurse will continue essential healthcare education and support to the homemaker staff and clients, while focusing energies on clients requiring more attention while maintaining control of the overall medical aspects of the program

At present, Helping Hands has one paid staff person. Joy Glazer, the clinic manager, was one of the founders of Community Health Clinic. Ms. Glazer worked at Community Health for ten years, first as a volunteer and then as clinic manager. In addition to overseeing the daily operations of the clinic, she established numerous programs, including the Neighborhood Referral Program with Cook County Hospital and resident, nursing and medical educational programs. Ms. Glazer is involved in community outreach in addition to supporting volunteer providers and responding to patient requests and concerns.

Program description to include strategies employed to implement the proposed project:
(1) goals and objectives;
(2) timetable for accomplishing stated goals and objectives; and
(3) program methodology

To achieve the above stated goals, four objectives have been identified for the CCP nurse during FY03. They are
1) the continued essential healthcare education and support to homemaker staff and the overall program;
2) the implementation of a new Immediate Needs Group program (ING) designed to help special needs clients,
3) to address needs in a newly identified group of clients who are facing osteoporosis; and
4) outreach to, screening of, and the monitoring of clients who potentially suffer from forms of dementia and Alzheimer's Disease.

1) The continued essential healthcare education and support to homemaker staff and the overall program.
The CCP program continues to greatly benefit from the nurse dedicated to the program. Out of the 276 current CCP clients, 145 clients have seven or more identified health problems. Fifteen percent of the clients are classified as "severely ill" by Community Management Unit (CMU) records, require multiple home visits, and require the advice and assistance of a trained medical professional. Clients need a trained, multi-lingual nurse on-staff to monitor their health. The nurse has a trained eye, and notices symptoms that a non-professional caretaker may miss.

The nurse makes between two and five home visits weekly with two purposes; first, the CCP nurse evaluates the client's health to be sure that existing conditions are not deteriorating. She observes that medications are being taken and are not causing unusual side effects, checks for persistent symptoms of potential disease, and acts as a liaison with primary-care doctors for any questions or concerns on the client's behalf. Second, the nurse monitors the homemaker's efficiency. Not only does the nurse act as a liaison between doctors and clients, but she also provides a system of checks and balances for the homemakers.

An example of the efficacy of having a nurse dedicated to the program occurred last year with a diabetic client. This client had just begun self-administered insulin injections as prescribed by her doctor. A home-visit by the nurse, however, revealed that the client did not know how to use the blood glucose test machine, did not know that blood glucose tests are a must before self-injection to prevent hypoglycemia, and was re-using syringes to save money. The nurse educated the client on the importance of blood glucose tests prior to insulin injection, signs and symptoms of hyperglycemia and hypoglycemia, and the importance of not re-using syringes to prevent infection. The nurse also instructed the client on how to use blood sugar test monitor, and the client demonstrated that she understood the instruction. Contact was made with the client's doctor and adjustments were made to the care plan. Three weeks later, the CCP nurse made a follow-up visit to the client and noted that the client was able to check her blood sugar herself, and recorded daily levels in a notebook.

The CCP nurse also trains homemaker staff. The two-hour homemaker training sessions are held ten times per year and are aimed at updating and educating homemaker staff on client monitoring techniques. These bilingual sessions cover special topics and often bring in outside health professionals and physical therapists. Sessions focus on topics requested by homemakers and clients and their needs, including Alzheimer's Disease, cataracts, high blood pressure, burns and frostbite, and osteoporosis. Training includes sessions on recognizing elderly abuse, hepatitis B, nutrition for the elderly, preventing common home injuries, and elderly depression.

2) The implementation of a new Immediate Needs Group program (ING) designed to help special needs clients.
In order to focus the CCP nurse's medical expertise on the most needy clients, CASL has developed the ING program which will focus client-specific monitoring into four areas of health maintenance-nutrition, exercise, social interaction, and medication. With these foci, the CCP program aims to prevent further deterioration with detailed monitoring of at-risk clients to improve their awareness and knowledge. The CCP nurse will identify 40 at-risk clients within the four categories through a combination of sources, including client phone calls and statements, lead homemakers' reports, and from existing problematic client population. The CCP nurse will assess clients' condition; educate clients' individual homemakers and family caregivers as to client needs; and conduct personalized follow-up care. For each of the four categories, the nurse will create forms and scales to demonstrate ING program clients' improvements. The goal for the ING Program is that at least 75% of at-risk clients improve their health conditions. Implementation of the ING program will also allow the nurse and lead homemakers to better identify clients who require further support under objectives #3 and #4 outlined below. The program will begin during the first quarter of the year and be fully operational by the second quarter.

3) The CCP nurse will work within the CCP to address the needs of a newly identified group of clients who are facing osteoporosis.
Through successful establishment of the ING program, CASL expects to identify a segment of the CCP client population that face osteoporosis. Results from a separate study involving the program buttress this claim--over 50% of Chinatown Chinese immigrants aged 69 and over who live at CASL's Senior Housing Building have osteoporosis. Because osteoporosis affects such a large portion of the community, CASL will target this group and respond to community needs for increased osteoporosis education and awareness. The CCP nurse will develop and provide small group education sessions, targeting clients with osteoporosis, at each of the three Chinatown elderly buildings. One session will be held every four months for a total of three sessions per year, and it is estimated that 20 current CCP clients will attend each session. The topics will address the special health needs of people living with osteoporosis, including calcium supplements, exercise, new prescription medications, and dietary concerns. Informational pamphlets will be distributed to attendees. The purpose of the sessions is to instigate healthful changes in the daily lives of osteoporosis victims that delay deterioration. Additionally, the CCP nurse will conduct follow-up to these clients, as needed, to see that changes are implemented.

4) The CCP nurse will focus on the identification, screening, and monitoring clients who potentially suffer from forms of dementia or Alzheimer's Disease.
Current estimates within the CCP show that 15% of the current 276 CCP clients have dementia. As age increases, so does the risk of developing dementia and Alzheimer's Disease. This is particularly worrisome in CASL's community; over 61% of CCP clients are over age 80. With the results gleaned from the ING initiative and through the daily activities of the program, CASL will identify and provide support to these clients and their families.

Recognizing that dementia and Alzheimer's can be hard to determine-especially within Chinese culture which can honor its elderly to a point of potentially ignoring serious health considerations--the nurse will conduct ten home visits a month in order to identify these clients. Additional recruitment efforts will include contacting family members and caregivers, as well as distribution of informational flyers. The CCP nurse will use a Memory Problems Checklist to identify dementia clients; once a client has agreed to be participate, a client intake form will be completed, and both the client and a family member will sign consent forms. CASL expects some hesitation and resistance admitting to such a disease, but the initial objective is to identify and assist a minimum of 40 clients during FY'03. The second stage will be scheduling and, in most cases, escorting the clients to Northwestern Hospital, where patients will undergo a series of tests to determine whether or not they have Alzheimer's disease. Clients with Medicare or Medicaid can participate in this initiative with no fees. It is anticipated that 25 of the 40 identified clients will agree to take part in this stage. The third stage will be the special follow-up care provided to the Alzheimer patients. The medications prescribed for Alzheimer's disease often have serious side effects; thus, the CCP nurse will conduct several home-visits to each patient, monitoring the drug interaction. The CCP nurse will also provide Alzheimer care education to the clients' families and caregivers. Through this Alzheimer's Initiative, CASL hopes to improve the quality of elderly lives by creating awareness of the disease, identifying the individuals who have it, and assisting clients with treatment. It is estimated that 15 of the identified 25 who had agreed to be tested will take part in this stage. For a further description of the methodology used to complete the stated objectives, please see the charts below under C. Evaluation that corresponds these efforts to their outcome evaluation methods.

4) staffing
Ms. Anna Zhu is a multi-lingual registered nurse who joined the program in 2000. Her resume is attached.

Collaborations include volunteer partnerships with Mr. Wing Chui, a Walgreens pharmacist, who, since 1999, has provided home visits and consultations to CCP clients and staff every other week through collaboration with the Area Health Education Consortium (AHEC); Mr. Frank Wappel, a physical therapist from Palos Community Hospital, who provides lectures to homemakers and one on one consultation; Ms. Mimi Moore, a nutritionist who provides lectures to homemakers; Ms. Tracy Leung, a psychotherapist from Asian Human Services, who provides one on one consultation to clients; and Dr. Gabriel Leger, a neurologist from the Alzheimer's Disease Center of Northwestern Hospital, who provides "Routine Dementia Work-Up" tests to clients with memory loss.

To prepare for the ING initiative, the nurse has been working with Ms. Monica Castillo, a doctoral candidate in Psychology at Illinois Institution of Technology, to conduct research in the assessment of dementia with individuals who receive CASL's homecare services. The program also consults with Ms. Victoria Kuohung, a research coordinator for the osteoporosis project at the University of Chicago. CASL and the Illinois Eye Institute also work together to conduct the Vision of Hope project, which provides complete eye examinations to homemakers and CCP clients. Seventy clients and homemakers have thus far been arranged for complete eye examinations.

If this request is for a specific program, explain how it will be supported after termination of the grant:
The financial well being of the agency and the CCP Program depends upon its ability to maintain a healthy source of funding. As all grants from public and private sources are subject to delay, term conditions, and limits, funding for all programs within CASL's programming is subject to constant review and a search for alternative sources of support. The President and Executive Director play a major role in fundraising activities, and the Development Department, the staff arm in charge of maintaining and increasing the flow of foundation and corporate income, continues to search for funding in support of the CCP Program. This search for funding is divided into both foundation and special event income. Revenue from agency foundation and corporate giving support for fiscal year (FY) 2003 is projected at $585,000. Elderly Service programming is supported by a diverse blend of funders, CASL programming fees, CASL special events, and foundation and corporation support.

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C. Evaluation

1) Explain how you will measure the effectiveness of your activities;
2) Describe your criteria for success, and
3) Describe the results you expect to have achieved by the end of the funding period.

Achieving set outcomes is one way to measure the effectiveness of the CCP program; the outcomes will lead to accomplishing overall goal of the program: to promote client wellness through health education, disease prevention, and home based support services. Another way to determine the effectiveness of the CCP program is to observe the patterns of repeat clients. For example, CASL currently has 92 elderly clients that have been utilizing the CCP program for six years or longer. This impressive service history demonstrates that CASL's intervention has delayed early and unnecessary admission to nursing homes for these clients, allowing them to remain in the Chinatown community that they love. The fact that these clients choose the program year after year also suggests that clients realize that their healthcare is closely monitored, and appreciate the unique one-on-one home visits that provide friendship as well as assistance.

From the four set objectives outlined above for the CCP nurse, CASL expects to achieve the following results: 1) CASL will continue its essential healthcare education and support to the homemaker staff:
The CCP nurse will provide ten homemaker training sessions during FY03 held each month except during Christmas and Lunar New Year, and will hold health-related meetings with the lead homemakers monthly. This ongoing, up-to-date healthcare training will improve the homemakers' support services to CCP clients. The following is a chart with outcomes and data for the CCP nurse's role in the larger CCP program:

2) The implementation of a new Immediate Needs Group program (ING) designed to help special needs clients:
The CCP nurse will implement the ING, targeting 40 clients per category who are at-risk for poor health conditions. Through a system of identification, education, and home-visit follow-up, an estimated 75% of ING clients will show health improvements. During the first quarter of the year the ING program will begin its implementation. By the second quarter, the program will be fully developed and will feed into objectives #3 and #4. The following is a chart detailing implementation and program objectives for the ING facet of the CCP:

3) The CCP nurse will work within the CCP to address the needs of a newly identified group of clients who are facing osteoporosis:
Over the course of a year, the osteoporosis project will have conducted three small group education sessions to a total of 60 osteoporosis sufferers.

4) The CCP nurse will focus on the identification, screening, and monitoring clients who potentially suffer from forms of dementia or Alzheimer's Disease:
Throughout the course of FY03, CASL will recruit and identify 40 clients with Dementia/Alzheimer's Disease in the Alzheimer's Initiative. This effort with the Northwestern University's Alzheimer Disease Center will improve the quality of life for victims by focusing on disease detection, treatment, education, and at-home follow-up care.

Chinese American Service League (CASL) Community Care "Homemaker" Services Fiscal Year 2003

*Program cost includes program expenses, office and program supplies, telephone and faxes, postage and delivery, meetings, marketing, and promotion.

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