welcome to the webinar for long-term care ombudsman on the person centered care ae goal. we will...

• 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. and Kimberly VanHaitsma, Ph.D.

Polisher Research InstituteMadlyn and Leonard Abramson Center for Jewish Life

• Q&A

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Becky A. KurtzDirector, Office of LTC Ombudsman Programs

Administration on AgingAdministration for Community Living

US Department of Health and Human Services

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ACL encourages State and local-level ombudsman engagementAoA/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 person-centered 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 self-determination and control about their independence, well-being, and health

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LTCO Program support for facilities to use person-centered 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 person-centered 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

Lori Smetanka, Director, National Ombudsman Resource Center, Consumer Voice

Informational webinar for Ombudsmen

Amy Elliot, PhDPioneer Network, Chair AE PCC Workgroup

Scott D. Crespy, Ph.D.Kimberly VanHaitsma, Ph.D.

Polisher Research InstituteMadlyn and Leonard Abramson Center for Jewish Life

Advancing Excellence Campaign:

Person-Centered Care Goal

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.15

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Regulatory support for Person Centered Care

Quality Indicator Survey

Meaningful use of Medical Records

Quality Assurance Performance Improvement

Providers need to demonstrate that their care addresses the needs and preferences of frail elders.

“Meaningful Use Requirements” have emerged out of health care reform encouraging providers to make maximum use of electronic medical records.

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 OrganizationAmy Elliot, Chair amy.elliot@pioneernetwork.net Pioneer NetworkChris Condeelis, Chair ccondeelis@ahca.org AHCABev Laubert blaubert@age.state.oh.us Ohio State Long-Term Care OmbudsmanJudy Sangl Judy.sangl@ahrq.hhs.gov Agency for Healthcare Research and Quality (AHRQ) Donna Adair Dadairmember@nahcacareforce.org NAHCALori Porter Lporter@nahcacareforce.org NAHCABeth Barba bebarba@uncg.edu UNCG School of NursingCarol Scott CScott@leadingage.org Advancing ExcellenceSophia Kosmetatos Skosmetatos@ahqa.org American Health Quality AssociationDenise Boudreau-Scott denise@denisebscott.com Catalyst for ChangePeter Reed Peter.reed@pioneernetwork.net Pioneer NetworkSusan Letvak saletvak@uncg.edu UNCG School of NursingHoward Degenholtz degen@pitt.edu University of PittsburghKris Mattivi kmattivi@cfmc.org CFMCAdrienne Mihelic amihelic@cfmc.org CFMCUrvi Shah ushah@ahca.org AHCAKimberly Van Haitsma kvanhaitsma@abramsoncenter.org Polisher Research Institute, Abramson Center for Jewish LifeScott Crespy screspy@abramsoncenter.org Abramson Center for Jewish LifeSarah Humes shumes@abramsoncenter.org Abramson Center for Jewish LifeSusanne Morganstein smorganstein@abramsoncenter.org Abramson Center for Jewish Life

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 Carea) Extent to which care is tailored to

fulfilling important resident preferences

b) 1 measure

• Resident Attendance at Care Conference Meeting

• Family Member and/or Friend Attendance

• CNA/Direct Care Staff Member Attendance

Care Conference Attendance: Ensuring regular opportunities to

interact with the care team

• Care Plan written in Resident Voice

• Advance Care Planning

• Root Cause Analyses Conducted for Gaps in Care Delivery

Optimized Care Planning Options

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 resident2) 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 Meetinga) Extent to which resident,

family/friends, and staff routinely attend the care conference

b) 3 measures

2. Delivery of Preference Congruent Carea) Extent to which care is tailored to

fulfilling important resident preferences

b) 1 measure

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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

Example of “preference congruence”

Important

everyday

preferences

Satisfaction with

daily care related to

an importan

t preferenc

e

CONGRUENCE IS THE MATCH

BETWEEN

How important is it to you to… choose what time to go to bed?

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

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The Interview

What does a preference interview look like?

Insert video here

F0400

Interview for Daily Preferences 1-Very Important2-Somewhat Important3-Not Very Important4-Not Important at all5-Important, but can’t do

1-Mostly or completely satisfied2-Somewhat Satisfied3-Not satisfied at all

How important is it to you to...Resident Response Importance

Resident Response Satisfaction

Priority

A Choose what clothes to wear? A

B Take care of your personal belongings or things? B

C Choose between tub bath, shower, bed bath or sponge bath?

C

D Have snacks available between meals? D

E Choose your own bedtime? E

1 1 Green

Resident name

Identifier

Resident’s Household, Neighborhood or group name

Date of Interview (mm-dd-yyyy)

Stay type

Indicate primary respondent

Rose

A202

Sunshine

11/12/2013

Long stay

Resident

Interviewing the resident or family member

3

1 3 Red

2 2 Yellow

5 Gray

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• 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”, “Yellow” & “Grey”– these areas are opportunities for improvement that are the focus at the care conference

Individual resident report:

How “Preference Congruent” is the daily care experience for an Individual Resident?

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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

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.

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Difficulty Tips for Interviewers

Hearing

• 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

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

Common Difficulties Encountered when Doing PC

Interviews with residents

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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

Common Difficulties Encountered when Doing PC Interviews with

residents (cont.)

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

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

How “Preference Congruent” is your Care for a Group of

Residents?

Sample report: Neighborhood Report

Using PCC information to “Advance Excellence” in Person-Centered Care for

each Household in the Community

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Household Program Development- Look 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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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

GOOD

NEEDS IMPROVEMENT

Which preferences are not being met in your

community?

Sample report: Results by Type of Preference

Choosing Your Own Clothing One provider was surprised that “choosing your own clothing” was an area of low congruence. They found that the dis-satisfaction 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.

Provider Examples by Preference

Measuring Person Centered Care for the

entire Community

March – June 2013

Preference Congruence

Long Stay Short Stay

Number of Residents Tracked this month

1 49

Percent of Resident Preferences “Very Important” or Somewhat Important AND “Mostly or Completely Satisfied

67% 79% 33%

67%

Short Stay

17% 4

%

79%

Long Stay

Overall Preference Congruence by Stay type

Mostly or Completely SatisfiedSomewhat SatisfiedNot at all Satisfied

Using PCC information to Advance Excellence in

Person-Centered Care

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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

Why Should I Use the PCC Tool?

• Increases the understanding of Person Centered Careo Person Centered Care is an abstract concept, this tool makes it more

concrete.

• Increases awareness and communication of resident preferenceso 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 Relationshipo 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 conferenceso 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.orgOR

www.polisherresearchinstitute.org

How is Person Centered Care Measured?

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Contact Information

Amy Elliott, PhD.INSERT HERE

Kimberly S. Van Haitsma, PhDVice President of Research

Director, Polisher Research InstituteMadlyn & Leonard Abramson Center for Jewish Life

Phone: 215.371.1895kvanhaitsma@abramsoncenter.orgwww.polisherresearchinstitute.org

Scott D. Crespy, Ph.D., CPHQVice President of Quality

Madlyn and Leonard Abramson Center for Jewish LifePhone: 215.371.1810

screspy@abramsoncenter.orgwww.abramsoncenter.org

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Questions?