Transcript Person Center Care Goal

• Welcome to the webinar for Long-Term Care
Ombudsman on the Person Centered Care AE
Goal.
• We will begin in a few minutes.
• If you have a question, please type them in
the box on the right side of your screen.
• Beverely Laubert, AE Board Chair and Ohio State Long-Term Care Ombudsman
• Becky Kurtz, Director, Office of the Long-Term Care Ombudsman, AoA
• Lori Smetanka, Director, National Ombudsman Resource Center, Consumer
Voice
• Amy Elliott, PhD Pioneer Network, Chair AE PCC Workgroup
• Scott D. Crespy, Ph.D.
Kimberly VanHaitsma, Ph.D.
and
Polisher Research Institute
Madlyn and Leonard Abramson Center for Jewish Life
• Q&A
Becky A. Kurtz
Director, Office of LTC Ombudsman Programs
Administration on Aging
Administration for Community Living
US Department of Health and Human Services
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ACL encourages State and local-level
ombudsman engagement
AoA/ACL encourages States’ LTC Ombudsman
Programs – at State and local/regional levels -to be engaged in LANEs and other AE work to:
•
promote quality improvement and personcentered practices in nursing homes across
the country;
• develop strategic partnerships to support the
interests of nursing home residents.
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LTCO Program options to support nursing home
quality improvement through AE
In nursing homes that are participating in the
campaign:
• Educate residents or families/friends about
the AE campaign.
• Inform residents or families/friends about
how they as individuals and as a council can
participate in the campaign.
• Prepare residents or families and friends to
discuss how they can help staff achieve the
campaign goals
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LTCO Program options to support nursing home
quality improvement through AE
In nursing homes that are not participating in the
campaign
• Educate residents or families/friends about the AE
campaign.
• Discuss how residents or families/friends might
encourage the nursing home to join the campaign.
• Inform residents or families/friends about how they
can participate in the campaign even if their nursing
home does not.
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ACL/AoA support for person-centered planning:
Part of our Strategic Goals:
Goal 1: Advocate to ensure the interest of people with disabilities, older adults,
and their families are reflected in the design and implementation of public policies
and programs.
Goal 3: Work with older adults and people with disabilities as they full engage and
participate in their communities, make informed decisions, and exercise selfdetermination and control about their independence, well-being, and health
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LTCO Program support for facilities to use personcentered planning
• What Ombudsman programs have been doing for years – really nothing new to
this audience
• The core of LTC Ombudsman philosophy and practice:
• “What does the resident want?”
• AE goal gives facilities tools to:
• make it simpler for facility staff to understand what residents want
• make it simpler for facility staff to know if resident preferences are being
honored
• make it simpler for supervisors, administrators, and corporate officers to
know whether resident preferences are being honored.
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For resident and family/friends – why personcentered care matters . . .
What is person-centered care?
The team creates your care plan based on your strengths, as well as physical and emotional
needs, to support your choices.
Why should person-centered care be important to you and your family?
Being treated with dignity and respect is a basic right.
Why is person-centered care important for nursing home staff?
Nursing homes that use PCC have residents, families, friends and staff that are more
satisfied. Better communication adds to satisfaction and better care!
Source:
http://www.nhqualitycampaign.org/files/AE_PersonCenteredCare_ConsumerFactSheet.pdf
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Lori Smetanka,
Director, National Ombudsman Resource Center, Consumer Voice
Advancing Excellence Campaign:
Person-Centered Care Goal
Informational webinar for
Ombudsmen
Amy Elliot, PhD
Pioneer Network, Chair AE PCC Workgroup
Scott D. Crespy, Ph.D.
Kimberly VanHaitsma, Ph.D.
Polisher Research Institute
Madlyn and Leonard Abramson Center for Jewish Life
What is the Person
Centered Care Goal?
• Person-centered care promotes choice, purpose and
meaning in daily life.
• Person-centered care means that nursing home
residents are supported in achieving the level of
physical, mental and psychosocial well-being that is
individually practicable.
• This goal honors the importance of keeping the
person at the center of the care planning and
decision-making process.
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How does the PCC goal benefit
residents and families?
•
•
•
•
Maintains autonomy and choices in daily living;
Improves engagement and quality of life;
Creates environment of trust and respect;
Encourages close relationships with staff that are
attuned to an individual’s preferences and changes
and can respond appropriately;
• Empowers residents and families to share their
preferences and partner to create a meaningful life in
the nursing home.
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How does the PCC goal
benefit nursing homes?
• Encourages partnerships with residents and their families to
know each person and maintain a meaningful quality of life;
• Fosters knowledge of individual preferences (and awareness
of gaps);
• Provides opportunities to analyze preferences for a group of
residents (e.g. neighborhood, home) and understand
successes and gaps at a systemic level;
• Improves efficiency in person-centered care practices through
integration into existing practices (i.e., care planning and MDS
assessment);
• Creates positive organizational outcomes (e.g., quality, staff,
census).
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How does the PCC goal
benefit Ombudsman?
• Provides a context to advocate for resident choice and
individualized care;
• Creates further opportunities to educate and inform
residents and families about the importance of choice
and self-determination in nursing homes;
• Offers tools and resources to learn the choices of
residents and families and communicate those
preferences to nursing homes;
• Affords a concrete framework to support root cause
analysis and solutions related to issues of quality of life
and self-determination for residents and families.
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Regulatory support for
Person Centered Care
Quality Indicator Survey
Providers need to demonstrate that their care addresses the needs and
preferences of frail elders.
Meaningful use of Medical Records
“Meaningful Use Requirements” have emerged out of health care reform
encouraging providers to make maximum use of electronic medical
records.
Quality Assurance Performance Improvement
This tool can be utilized by facilities to implement their individual
performance improvement programs (PIP).
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Advancing Excellence Campaign
Person Centered Care Workgroup
Members
Name
E-mail
Organization
Amy Elliot, Chair
Chris Condeelis, Chair
Bev Laubert
Judy Sangl
Donna Adair
Lori Porter
Beth Barba
Carol Scott
Sophia Kosmetatos
Denise Boudreau-Scott
Peter Reed
Susan Letvak
Howard Degenholtz
Kris Mattivi
Adrienne Mihelic
Urvi Shah
Kimberly Van Haitsma
Scott Crespy
Sarah Humes
Susanne Morganstein
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
Pioneer Network
AHCA
Ohio State Long-Term Care Ombudsman
Agency for Healthcare Research and Quality (AHRQ)
NAHCA
NAHCA
UNCG School of Nursing
Advancing Excellence
American Health Quality Association
Catalyst for Change
Pioneer Network
UNCG School of Nursing
University of Pittsburgh
CFMC
CFMC
AHCA
Polisher Research Institute, Abramson Center for Jewish Life
Abramson Center for Jewish Life
Abramson Center for Jewish Life
Abramson Center for Jewish Life
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How is Person Centered
Care Measured?
1. Attendance in Care Conference Meeting
a) Extent to which resident,
family/friends, and staff routinely
attend the care conference
b) 3 measures
2. Delivery of Preference Congruent Care
a) Extent to which care is tailored to
fulfilling important resident
preferences
b) 1 measure
Care Conference Attendance:
Ensuring regular opportunities to
interact with the care team
• Resident Attendance at
Care Conference Meeting
• Family Member and/or
Friend Attendance
• CNA/Direct Care Staff
Member Attendance
Optimized Care Planning
Options
• Care Plan written in
Resident Voice
• Advance Care
Planning
• Root Cause
Analyses Conducted
for Gaps in Care
Delivery
Care Plan Meeting Attendance as
a quality measure for the
community as a whole
Attending Care Conferences as a
quality measure: Barriers to
Resident participation
• Difficulties encountered in getting regular attendance by residents:
• Resident may be too impaired to participate in a group
• If resident has difficulties expressing him/herself or
comprehending the flow of conversation, the resident may
end up being “talked about” while present in the meeting
• Resident may find it overwhelming to share thoughts in a
group setting with so many people present
• Resident does not want to attend
• May feel too ill or fatigued to attend
• May be embarrassed to share personal care issues in a group
• Solution: Have a staff member:
1) Interview the resident prior to the meeting to ensure that resident
issues are presented in the voice of the resident
2) Report back to the resident to review the plan of care
Attending Care Conferences as a
quality measure: Barriers to Family
Member participation
• Difficulties encountered in getting regular attendance by family members:
• Family members may not be available to physically or virtually attend
within the mandated window of time
• Solution:
• Schedule the care conference at a time that is convenient to the family
member to a day/time they are normally visiting their family member
and/or friend.
• Provide an update to the family member following the care conference.
Find out preferred method that family member would like to receive
update either via email, phone and/or next time visiting their family
member.
Attending Care Conferences as a
quality measure: Barriers to Direct
Care Staff participation
• Difficulties encountered in getting regular attendance by direct care staff:
• Work schedule may not coincide with the mandated window dates for
care planning
• Difficulties in providing coverage while DCW is in the meeting
• Solution:
• Extend an invitation to the direct care staff to participate in the care
conference so they feel their voice is important.
• Include direct care staff attendance at conferences as a part of normal
job duties in order to assist with scheduling their participation.
• Seek input from the direct care giver prior to care conference and
provide an update to the direct care giver following the care conference.
How is Person Centered
Care Measured?
1. Attendance in Care Conference Meeting
a) Extent to which resident,
family/friends, and staff routinely
attend the care conference
b) 3 measures
2. Delivery of Preference Congruent Care
a) Extent to which care is tailored to
fulfilling important resident
preferences
b) 1 measure
What is Preference
Congruent Care?
• “Preference Congruent” care is care that fulfills
important resident preferences for personal
care and recreational activities.
– Interviews resident to discover:
• Which preferences are “very” or “somewhat”
important
• Which preferences are “important, but can’t do”
• How satisfied s/he is with each of the important
preferences being fulfilled
– Provides visual feedback to staff in 3 areas:
• Which preferences are being fully met and which require further follow up
• Which preference gaps may be affecting many persons residing together in a
household, floor or unit
• Overall measure of quality that can be benchmarked and tracked over time
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Example of “preference
congruence”
Important
everyday
preferences
How important is it to you to…
choose what time to go to bed?
CONGRUENCE
IS THE MATCH
BETWEEN
Satisfaction with
daily care related
to an important
preference
How satisfied are you in being able to…
choose what time to go to bed?
What Information Does
the Quality Measure
Provide?
Provides critical visual feedback to in 3 areas:
1. Individual Report: Which preferences are being fully
met and those that are not being fully met and
require more discussion by the care planning team
2. Household Report: Which preference gaps may be
affecting many persons residing together in a
household, floor or neighborhood
3. Community Report: Overall measure of quality for the
community that can be benchmarked and tracked
over time
The Interview
What does a preference
interview look like?
Insert video here
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Interviewing the resident
or family member
Resident name
Rose
Identifier
A202
Resident’s Household, Neighborhood or group name
Sunshine
Date of Interview (mm-dd-yyyy)
11/12/2013
Stay type
Long stay
Indicate primary respondent
Resident
F0400
Interview for Daily Preferences
How important is it to you to...
1-Very Important
2-Somewhat Important
3-Not Very Important
4-Not Important at all
5-Important, but can’t do
1-Mostly or completely
satisfied
2-Somewhat Satisfied
3-Not satisfied at all
Resident
Response
Resident
Response
Importance
Satisfaction
Priority
A
Choose what clothes to wear?
1
A
1
B
Take care of your personal belongings or things?
3
B
9
C
Choose between tub bath, shower, bed bath or
sponge bath?
1
C
3
Red
D
Have snacks available between meals?
2
D
2
Yellow
E
Choose your own bedtime?
5
E
9
Gray
Green
How “Preference Congruent”
is the daily care experience
for an Individual Resident?
Individual resident report:
•Resident interview occurs PRIOR to
care conference
•Report provides feedback on how
well care team is meeting a
resident’s individual daily care
preferences
–
–
“Green”- opportunities for
celebration!
“Red”, “
” & “Grey”– these
areas are opportunities for
improvement that are the focus at
the care conference
Case examples of
individual resident reports
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Renee’s Interview
Responses
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Renee’s Daily Care
Experience
Renee is an 85-year-old female who uses a walker and a
wheelchair and has mild cognitive impairment. She enjoys
reading books and listening to music she likes. She also likes to
keep up with the news and participate in religious activities.
When interviewed, Renee also commented about the
importance of “doing things with groups of people”. She stated
that she liked cooking. However, the cooking classes offered
only include watching the activity therapist do the cooking.
Renee talked openly about the importance of having snacks
available between meals. However, she shared that the facility
did not offer the choice of snacks. “We do not have any snacks
available between meals. I would like a little something between
meals. There isn't any.”
Furthermore, Renee responded that it was very important to
have a choice between a tub bath, shower, bed bath or sponge
bath, but was not satisfied with how often she showers. She
stated that she was used to showering every day. She
understands the facility policy that she only receives a shower
two times a week, but she talked about enjoying her showers
and wanting them more frequently.
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Sadie’s Interview
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Sadie
Sadie had history of being combative when
care was being delivered to her. Staff were
receiving physical altercations when
attempting to approach her for care. The
direct care worker inquired of staff on her
prior unit what interventions worked well for
providing her daily care. It was discovered
through this investigation that Sadie was
sister of an actor on a popular TV show.
Singing the theme song of that popular show
helped to calm Sadie so that she was more
approachable during personal care activities.
Common Difficulties
Encountered when Doing PC
Interviews with residents
Difficulty
Tips for Interviewers
Hearing
•
•
•
•
•
Vision
• Remind resident of response scale after each question
Issues with using
response set
• Direct resident back to response sheet by pointing to response options
• Establish if a preference is important or not important, then ask if it is
very or somewhat important or not very or not important at all
Cognitive
impairment
• Allow time for resident to process the question and give an answer
• Repeat questions and response set as needed
Identify and position yourself to talk into the better ear
Speak slowly and clearly
Make sure hearing aids are in and being used properly
Provide a copy of questions for resident to read along
Use amplifier
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Common Difficulties
Encountered when Doing PC
Interviews with residents (cont.)
Difficulty
Tips for Interviewers
Distracted or off
topic
• Redirect resident back to question and response sheet
Verbal
communication
• Allow resident to point to the answer on the response sheet
• Have them type answers on computer
Fatigue
• Reschedule interview for another day
Not feeling well
• Reschedule interview for another day
Visitor
• Reschedule interview for another day or if resident is comfortable,
continue interview but ask the visitor not to participate in answering
questions for the resident
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Using PCC information to focus
content of care conference for an
Individual Resident
•
Bring Individual Resident
Preference Congruence report
to care conference meeting
•
Use as an aid to help focus the
content of care conference on
resident daily care experience
•
Implementation guide
provides tips on how to use
this information to enhance
quality of care planning
processes
How “Preference Congruent”
is your Care for a Group of
Residents?
Household/Group
information:
–
Select which household you would like
to view from drop down menu
–
See “at a glance” particular
preferences that are not being met for
several persons who live in a common
location
–
Assists with program and service
planning and evaluation
Sample report: Neighborhood
Report
Using PCC information to “Advance
Excellence” in Person-Centered Care
for each Household in the Community
Household Program DevelopmentLook for Patterns!
• Use “Household Reports” to
problem solve areas for
improvement that may affect the
care experiences of many residents
in a given household
• Set goals for care conference
attendance by residents, family
members and direct care staff
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Which preferences are not
being met in your
community?
Information about your
community:
–
See at a glance which types of
preferences are not being met
overall within entire community
–
Assists in identifying which
preferences need attention first
–
Guides program and service
planning and evaluation
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Sample report: Results by Type of
Preference
Provider Examples by Preference
Choosing Your Own Clothing
One provider was surprised that “choosing
your own clothing” was an area of low
congruence. They found that the dissatisfaction was an issue for residents with
mild cognitive impairment. Cognitively
capable residents were choosing their own
clothes, but staff was doing all the choosing
for the more impaired residents. They are
working on strategies with staff to provide
more choice to residents.
Going out side to get fresh air when the
weather is good
One provider learned that their residents
would appreciate more opportunities to go
outside. They are having discussions with
Activities to brainstorm how to provide more
opportunities.
Measuring
Person Centered Care for the
entire Community
March – June 2013
Preference
Congruence
Long Stay
Number of
Residents Tracked
this month
1
Percent of
Resident
Preferences “Very
Important” or
Somewhat
Important AND
“Mostly or
Completely
Satisfied
67%
Overall Preference Congruence by Stay type
Short
Stay
Short Stay
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Long Stay
17%
79%
4%
33%
67%
79%
Mostly or Completely Satisfied
Somewhat Satisfied
Not at all Satisfied
Using PCC information to Advance
Excellence in
Person-Centered Care
Incorporate results into
ongoing QAPI efforts in
your community
•
•
Set goals to strive for
Celebrate your
success!
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Why should a provider consider
using the PCC Tool?
Feedback from Pilot Communities
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Why Should I Use the PCC Tool?
• Increases the understanding of Person Centered Care
o Person Centered Care is an abstract concept, this tool makes it more
concrete.
• Increases awareness and communication of resident preferences
o Resident preferences are often known to some, but not all staff. This
tool makes it easier to share these preferences all staff.
• Enhances quality of Resident & Staff Relationship
o Tool can serve as a “conversation starter” and a vehicle for getting to
know more about what is important to each resident.
• Enhances quality of care conferences
o This critical meeting can be “super-charged” by following optimized
guidelines outlined in the tool.
Why Should I Use the PCC Tool?
• Provides a way to “connect the dots” to see at a glance how well each
household is providing care.
• The Tool facilitates a nursing home’s compliance with QAPI guidelines
and serves as a specific Performance Improvement Program (PIP).
• Provides direct feedback on what the community is doing well and what
can be an opportunity for improvement.
• Provides a way to track a nursing home’s Person Centered Care levels
over time so that early declines can be identified, analyzed and specific
issues can be addressed.
Available PCC Goal
Resources
• Excel Spreadsheet
• Implementation Guide
• Fact Sheets- Resident, Family, Staff
• Educational workshops
• 60 or 90 minute versions
The PCC Toolkit Resources
For a copy of the toolkit go to:
www.NHQualityCampaign.org
OR
www.polisherresearchinstitute.org
How is Person Centered
Care Measured?
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Contact Information
Amy Elliott, PhD.
INSERT HERE
Kimberly S. Van Haitsma, PhD
Vice President of Research
Director, Polisher Research Institute
Madlyn & Leonard Abramson Center for Jewish Life
Phone: 215.371.1895
[email protected]
www.polisherresearchinstitute.org
Scott D. Crespy, Ph.D., CPHQ
Vice President of Quality
Madlyn and Leonard Abramson Center for Jewish Life
Phone: 215.371.1810
[email protected]
www.abramsoncenter.org
Questions?
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