Bridging the Gap

[Audio] Good afternoon. I'm LaToya Hartsfield, I am a Professional Coordinator, and I currently reside in Columbia, South Carolina Today I'm presenting my capstone proposal: Bridging the Gap—a practical framework for integrating alternative caregiver support services into our existing system. Every example comes from real situations I have witnessed or was in close proximity at SCDHHS, and every solution is backed by research and designed for actual implementation. Let me show you the reality we're facing..

[Audio] These numbers tell a story. Forty percent of South Carolina's Medicaid recipients live in rural areas. Family caregivers spend an average of $7,242 out-of-pocket annually to keep loved ones out of institutions. Here's what that looks like: I've seen a diabetic patient hospitalized with ketoacidosis after his car broke down. He had insurance. He had a prescription for insulin. What he didn't have was transportation to pick it up. That preventable hospitalization cost tens of thousands of dollars. I've watched mothers postpone critical diabetes education because bringing three young children to a medical appointment costs $200 per child for childcare they can't afford. These aren't edge cases. This is how our system fails caregivers every day. Through my research, I have identified three critical service gaps..

[Audio] First: Transportation barriers. SCDHHS only covers emergency medical transport. Rural caregivers travel 35 miles or more for specialty care with zero support for routine appointments. Twenty-five to thirty percent of appointments are missed due to lack of transportation. Second: Financial instability. Caregivers exhaust savings and leave jobs to provide care. We offer emergency assistance when families are in crisis, but no financial literacy programs, no job training, no pathway to economic empowerment. Intensive caregiving reduces labor force participation by 12 percentage points—hitting women and minorities hardest. Third: Childcare coordination. It's the second most common reason people miss appointments. No childcare subsidies. No coordination. Parents with childcare barriers have 40% higher rates of uncontrolled chronic diseases—because healthcare doesn't work if you can't physically get to it. Now, I didn't just identify problems. I reviewed the research to understand what works..

[Audio] The evidence is overwhelming: integrated approaches addressing social determinants of health consistently outperform fragmented service models. Transportation research shows that transportation deserts disproportionately impact Black communities, worsening healthcare access and reinforcing generational disparities. Financial stability research demonstrates that financial education integrated with social services produces significant improvements—far better than repeated emergency assistance. And childcare research confirms what we see daily: parents with childcare barriers have 40% higher rates of uncontrolled chronic diseases. Here's the critical finding: Prevention costs significantly less than crisis intervention. Comprehensive caregiver interventions reduce depression, delay institutionalization, and produce net Medicaid savings that exceed program costs. So, I designed a solution grounded in this research..

[Audio] My methodology combined expert interviews with SCDHHS Program Managers, document analysis of policies and appointment data, professional observation from six months of steering meetings, and systematic literature review. This mixed-methods design ensures my recommendations reflect both empirical evidence and operational realities. I'm not proposing something that sounds good on paper but can't be implemented. I'm proposing solutions that work within our existing constraints. Here's what I'm recommending..

[Audio] The Integrated Caregiver Support Network is built on three principles. First: Coordination over creation. We're not building new programs requiring massive infrastructure. We're leveraging existing community organizations through formal partnerships. Second: Prevention over crisis response. We're investing in support services that reduce the need for expensive emergency interventions. Third: A whole-person approach. We're addressing interconnected needs simultaneously rather than isolating single issues. This isn't about building something new. It's about connecting what already exists into a cohesive support system. Strategic partnerships. Shared referral protocols. Coordinated outcome measurement. No major infrastructure required—just the will to do things differently. Let me show you the three components..

[Audio] Component One: Expanded Transportation Access through partnership with Ride to Care Columbia. We extend non-emergency medical transportation to respite appointments, caregiver support groups, and caregivers' own medical visits. Dedicated vouchers for rural caregivers traveling more than 15 miles. Component Two: Financial Empowerment Programming through partnership with The Village Focus Community Development Corporation. Quarterly workshops at SCDHHS offices. Individual financial coaching for caregivers in crisis. Connections to matched savings programs and workforce development. Component Three: Childcare Coordination through partnerships with YMCA programs and faith-based providers. Childcare vouchers subsidizing care during caregiver appointments. Drop-in childcare at SCDHHS during peak times. Subsidies for families below 200% poverty level. Each partnership includes formal agreements, shared referral protocols, and coordinated outcome measurement. Now, I know what you're thinking—what about the obstacles?.

[Audio] I have anticipated four major obstacles with specific mitigation strategies. Collaboration barriers? Formal partnership agreements with shared outcomes. Early adopter case managers as ambassadors. Resource scarcity? Diversified funding combining Medicaid administrative claiming, federal grants, healthcare foundations. We'll document institutional placements prevented and present them as net Medicaid savings. Organizational resistance? Involve frontline staff in design from day one. Hire a dedicated Network Coordinator. Create simple electronic referral processes. Measurement challenges? Use brief validated measures. Leverage existing administrative data. Build measurement into partnership agreements. These obstacles are significant, but they're absolutely surmountable. And here's why it's worth it..

[Audio] Prevention costs significantly less than crisis intervention while dramatically improving quality of life. We're measuring outcomes across four domains: caregiver health—reduced depression, improved physical health. Healthcare utilization—fewer missed appointments, reduced emergency visits. System cost savings—delayed institutional placements, preventable hospitalizations avoided. Health equity—reduced disparities for Black communities, rural populations, low-income families. Look at this cost comparison. Average nursing home placement: $7,500 per month per person. Comprehensive caregiver support—transportation, financial coaching, childcare coordination: $200 to $400 per month per caregiver. That's not just fiscally responsible. That's a dramatic return on investment that also happens to be the morally right thing to do. Let me bring this home..

[Audio] Family caregivers sacrifice their health, their finances, and their employment to keep vulnerable South Carolinians out of institutions. The systems that benefit from their work owe them more than crisis response. We have a choice. We can continue responding to preventable crises, watching caregivers burn out and families break apart. Or we can invest modest resources in preventive support that honors caregivers' contributions and keeps families together. What does success look like? Caregivers accessing their own healthcare without impossible choices. Families building financial stability instead of exhausting savings. Community-based care becoming sustainable rather than crisis-driven. South Carolina demonstrating that supporting caregivers is both morally and fiscally responsible. This proposal requires no major infrastructure investment. Just the will to connect what already exists into a system that works..

[Audio] Thank you for your time and attention. I'm LaToya Hartsfield, A Professional Coordinator in Columbia, South Carolina, and I'm ready for your questions..