Accreditation in Person- Centered Long-Term Care Nursing Home Communities

(1)

Accreditation in

Person-Centered Long-Term Care

Centered Long-Term Care

Nursing Home Communities

Susanne Matthiesen

Managing Director of Aging Services

CARF International

(2)

Commission on Accreditation of

Rehabilitation Facilities

An international accreditation and standard setting organization

1966 – 42 years old

Private, non-pro

fi

t, independent organization

Customer Service Units represented

Aging Services

Behavioral Health

Child and Youth Services

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

Employment and Community Services

Medical Rehabilitation

Field driven standards developed with input from providers, payers,

consumers

Moral owners of CARF-CCAC are the persons served in accredited

organizations

(3)

CARF

Accredits over 39,000 programs, at over 17,000 sites, in

over 4,950 organizations in U.S., Canada, Europe,

South America

Over 6.6 million people served annually

Peer review process

Process emphasizes person served, performance

improvement, business of human service delivery, and

good management

Aging Services accredits:

Adult Day Services

Assisted Living

Aging Services Networks

Continuing Care Retirement Communities

Person-Centered Long Term Care Nursing Homes

(4)

Why PCLTCC?

Expansion of Aging Services

Did not want to recreate what already

exists (regulation, JCAHO)

It is “happening” whatever you want to

call it…culture change, transforming

LTC, person centered, Greenhouse,

etc.

Consumers need information to make

informed choices

(5)

Standards Development

Hosted an International Advisory

Committee which developed standards

for Person Centered LTC

Leading innovators in PCLTC

US, UK and Canada

Conducted a focus group in a nursing

home embarking on PCLTC

Field Review with nearly 300

responses

(6)

Accreditation

The Person Centered Long-Term Care

Community standards were published in

January, 2006

Are applied to nursing homes

Freestanding

Within a continuum

Nursing homes achieving accreditation

differentiate themselves by demonstrating

they meet an international standard for

(7)

CULTURE

The uniqueness of an organization or

an institution

Its “personality”

The way an organization/institution

does things

The values, the lifestyle, the goals

which are unique to an organization or

an institution

(8)

The culture of a NH is like an individual’s personality

Your personality makes you unique

Personality is a sum total of your

• character and status

• values and beliefs

• likes and dislikes

• style and disposition

Its culture makes a NH unique

Culture is a sum total of its

• history and traditions

• organization and systems

• commitment to quality

• rules and relationships

Aggressive romantic moody

“Excellent”

“Cheerful”

“Caring”

“Friendly”

“Mediocre”

“Depressing”

“Cold”

“Disorganized”

(9)

Culture change is a process, its goal is a

person-centered quality home

Culture change aims at a change in goals

Change from traditional emphasis on

quality of care to a new focus on quality of

life

Quality of Care can be attained in

traditional institutional culture of a facility

To attain and sustain Quality of Life we

need a cultural shift

Standards focus on both quality of care

and life

(10)

Quality of Life

Is best assessed by the

customer:

Resident, Family, Staff

Quality of Care vs Quality of Life

Quality of Care

Is best judged by

Experts in the field

Satisfaction surveys capture

customer’s expectations &

satisfaction

QIs were invented by

experts. They measure

success in care-giving.

Heavy resources are spent

on refining QIs

Few resources are spent on

advancing satisfaction surveys

(11)

Quality of Life

flows from

a culture of care-giving.

It adds the element of caring to QoC

Quality of Life Adds TLC to Quality of Care

Quality of Care

is the result of

• adequate knowledge, competence & skills

• proper procedures & protocols

Where high QoL flourishes, good QoC is assured.

But good QoC is no guarantee of a high QoL.

(12)

Traditional

Traditional vs

vs Person Centered Care

Person Centered Care

Treatment based on

medical diagnosis

Schedules established for

convenience of staff

Work is task-oriented –

easily transferred from

person to person

Decision making is

centralized

Care based on individual

s

needs

Schedules established

around resident need

Work is relationship

centered and staff have

consistent assignments

Decisions made by

residents and those

closest to them

(13)

Facility belongs to

staff

Structured activities

revolve around

activities coordinator

Isolation and

loneliness are

common

Facility is resident

s

home and staff work in

their home

Spontaneous activities

happen around the

clock

Residents and staff

share a feeling of

community and

belonging

Traditional

(14)

Christie Gardens

Apartments and Care

www.christiegardens.org

Accredited November 2006

First in the World

(15)

(16)

Christie Gardens Apartments and

Care Overview

Continuing care retirement community +

person centered care in SNF

Approx. 500 persons served annually

Urban environment

Variety of health & medical services offered

Average age of population in IL = 85, AL =

92, NF = 90

Doing person-centered care for decades

without calling it anything

(17)

Christie Gardens Apartments and

Care Overview

Challenges

Matriarchal legacy

Limited

fi

nancial

resources

Limited space &

long hallways

Conversion of ward

beds

Need to formalize

governance and

leadership policies

Opportunities

Committed staff –

70% over 15 yrs

Career choice to

work there

Knew residents and

support systems –

relationship

formation

Good systems for

measurement in

place

Charitable care

forces organization

to measure value

(18)

St. Ann

’

s Community

www.stannscommunity.org

Accredited March 2007

First in the US

(19)

(20)

St. Ann

’

s Community Overview

Person centered care in NF, CIIRP for

sub-acute, adult day services, assisted living

Dementia specialization

Everything is included under one umbrella

structure = aging services network

Approx 1200 persons served annually

Majority of persons served 86+

(21)

St. Ann

’

s Community Overview

Challenges

Addressing areas

of potential risk in

person-centered

planning

Providing

information

regarding scope of

services

Opportunities

Staff commitment

to

Person-centered care

Strong medical

service team

Quanti

fi

able

performance data

(22)

Research Supports PCLTCC

Residents reported signi

fi

cantly higher satisfaction with

their facility as a place to live than did residents of

traditional nursing homes, better scores on many

dimensions of self-reported quality of life

In terms of care and health outcomes, residents

experienced lower rates of depression, bed rest,

reduced activity, and decline in functional abilities

Residents reported signi

fi

cantly higher scores on

emotional well-being indicators.

Resident Outcomes in Small-House Nursing Homes: A

Longitudinal Evaluation of the Initial Green House Program,

Rosalie A. Kane, PhD, June 2007 Journal of the American

Geriatrics Society

(23)

Program Definition

for

PCLTCC

’

s

Culture supports autonomy, diversity, choice

Leadership supports the cultivation of

relationships

Leaders and the community commit to:

Responsiveness

Spontaneity

Continuous learning and growth

Residents and personnel

Celebrate cycles of life

Connect to local community

Help to continue relationships that nurture

quality of every-day life

(24)

Residents:

Are experts regarding life in their home

Participate in deciding about

— Rhythm of their day

— Services

— Issues that are important to them in their home

Families/support systems

Are welcomed

Partner with residents to ensure personnel

understand

— What services residents want

— How services are to be delivered

— How they can help in their home

Program Definition

for

(25)

A person-centered long-term care

community is a place where

Residents want to live

Personnel want to work

Both choose to stay

Program Definition

for

(26)

PCLTCC Standards Themes

Blending quality of care with quality of life

Relationships

Supporting personal satisfaction & goals

in residents

lives

Creating individualized living spaces

Respect for individual resident life patterns, routines,

preferences, needs

Opportunity for personal growth, learning and

contribution

Connection to greater community

Family/support system active engagement

(27)

Relationships

Leadership role:

Ensure opportunities for s

pontaneous

activities

Development of relationships

Con

fl

ict resolution

Intergenerational relationships

Personnel o

ngoing education and a forum to

discuss concerns regarding persons served.

Consistently assigned personnel

Visitation policies support relationships

Pets are welcomed

(28)

Choice: The Hallmark of PCLTC

Services re

fl

ect residents

choice:

Services

Timing of services

Lifestyle

Organization is prepared to negotiate risk with

resident choices when applicable

Information on available services inside and

external to program

Individual rooms: décor, privacy, security,

accessibility, healthcare needs

(29)

Choice: Rhythm of Life and Food

Freedom to determine the cycle of each day

Waking, sleeping, eating, bathing,

grooming, dressing

Choice of clothing

Participating in customary community routines

Cleaning – cooking – gardening

Recreation – activities – exercise

Religion – intimacy – hobbies

Persons served can select what they would

like to eat, p

lan their meals, prepare their

(30)

Personal Goals: Sharing Talents

Organization has resources to assist person served to

meet their personal goals

Persons served are provided opportunities to s

hare

talents and skills

Organization provides or arranges for formal and

informal educational opportunities and access to

c

omputers, internet and other media, information of

interest

Activities embrace diversity of persons served, help with

functioning and personal growth

Persons served choose their level of participation

Opportunities exist for unstructured, spontaneous,

self-scheduled activities

(31)

Personal Goals: Staff

Competencies

Care team includes person served,

family/supports, other stakeholders.

Personnel in accordance

with the choice of the

resident, help with achievement of personal

goals

of the following types:

— Functional

— Psychological

— Health

— Social

— Spiritual

— Vocational

(32)

Involvement With External

Community

Each person served has access to information

on p

olitical and civic issues as desired.

Active engagement in national and local issues

affecting their interests may be voting in

elections or preservation of natural resources

Organization makes information regarding local

or regional resources for s

upport and

advocacy

available

(33)

Life Cycle Events

Identi

fi

cation and celebration of meaningful

lifecycle events

Organization honors rituals around:

Events in human life.

Community events.

(34)

Information Sharing

Organization provides information to persons served

e

ither prior to move in or at time of move in

about persons served and satisfaction levels

Information is shared with person served at

initiation of services or at a transition regarding

needs identification, securing possessions and

various choices available

Written procedures for transfer within continuum,

receiving counseling for, and/or appealing:

Involuntary internal transfers.

Involuntary discharge.

(35)

Initial/Ongoing Assessments

Initial and ongoing written screenings/assessments:

Prior daily routines.

Relevant to the needs of the persons served.

Preferences and choices of the persons served.

Personal goals of the persons served.

Develop a person-centered plan.

Necessary interventions and supports.

Resource utilization.

Integration of available resources.

Intensity and frequency of services.

Discharge/move-out/transition/contract termination

plans.

Changing needs of the person served, including

(36)

Person-Centered Plan

A written person-centered plan is developed that is based on:

— Initial and ongoing screenings/assessments and

observations.

— Preferences and choices of persons served.

— Personal goals of persons served.

That includes:

— Identi

fi

ed needs in each service area.

— Types and scope of services.

— Need for negotiated risk agreements.

— Risk/bene

fi

t analysis of any negotiated risk agreements.

— Speci

fi

cs of any negotiated risk agreements.

— Move out/transition/discharge/contract termination plans,

as appropriate.

— Identi

fi

cation of preference of person served for

involvement of family members/signi

fi

cant others.

Addresses changing lifespan issues of person served.

(37)

Managing Behavioral Events

To determine appropriate approach, treatment, and/or

supports necessary for challenging behaviors on an

ongoing basis personnel:

Observe

person served.

Describe

behavioral event

Understand

behavioral event:

— From the perspective of the person served.

— From the perspective of personnel.

— As communication on the part of the person served.

Analyze

potential causes.

Implement

appropriate approach, treatment, supports.

Assess

the results.

Share information

learned with:

— Person served.

— Other personnel.

(38)

Personnel have Input

Personnel have opportunities to give

input into decisions that impact their

daily lives and the lives of persons

served, including:

Shift times.

Shared duties and responsibilities.

Break times.

Schedules.

Flex time to:

—

Pilot new services.

—

Implement new services.

(39)

The Environment

Physical plant of nursing home

Is safe and designed to promote effective

service delivery, dignity and self-worth of

persons served

Provides dining space that is accessible to

those with mobility impairment

Suitable outdoor space

Comfortable and supportive

Lighting

Minimize noise and odors

Smoking policy

Safety and Security

(40)

Why Accreditation?

Roadmap for

leaders to use in

implementing

PCLTC

Helps to measure

ROI of any changes

Business strategy

Communication

system

Management tool

Quality strategy

Establishes

baseline of quality

for an industry

Housecleaner

Refocuses

business on person

served/resident

Establishes and

re-establishes

relationships with

stakeholders

(41)

We did the best we could,

with what we knew,

And when we knew better, we did better.

Maya Angelou

(42)

Thank You. Contact Us.

866-888-1122,

www.carf.org/aging

Amanda Birch,

abirch@carf.org

Elizabeth Nelson,

enelson@carf.org

Sue Matthiesen,

smatthiesen@carf.org