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 LongTerm Care Ombudsman Becky Kurtz ID: 633375
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Slide1
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.Slide2
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 Institute
Madlyn
and Leonard Abramson Center for Jewish Life
Q&A
Slide3
Becky A. Kurtz
Director, Office of LTC Ombudsman Programs
Administration on Aging
Administration for Community Living
US Department of Health and Human Services
3Slide4
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 person-centered practices in nursing homes across the country;
d
evelop strategic partnerships to support the interests of nursing home residents.
4Slide5
LTCO Program options to support
n
ursing
h
ome quality improvement through AE5
In
nursing homes that are participating in the
campaign:
E
ducate
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 goalsSlide6
LTCO Program options to support
n
ursing
h
ome quality improvement through AE6
In nursing homes that are
not
participating in the campaign
E
ducate
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. Slide7
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
7Slide8
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
w
ant?”
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.
8Slide9
F
or resident and family/friends – why person-centered care matters . . .
9
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 Slide10
Lori Smetanka
,
Director, National Ombudsman Resource Center, Consumer VoiceSlide11
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
Advancing Excellence Campaign:
Person-Centered Care Goal Slide12
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.
12Slide13
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.
13Slide14
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).
14Slide15
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.
15Slide16
Regulatory support for Person Centered Care
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).
16Slide17
17
Advancing Excellence Campaign Person Centered Care Workgroup MembersSlide18
How is Person Centered Care Measured?
1.
Attendance in Care Conference Meeting
Extent
to which resident, family/friends, and staff routinely attend the care conference 3 measures 2. Delivery of Preference Congruent Care
a) Extent to which care is tailored to fulfilling important resident preferences
b) 1 measureSlide19
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 teamSlide20
Care Plan written in Resident Voice
Advance Care Planning
Root Cause Analyses Conducted for Gaps in Care Delivery
Optimized Care Planning OptionsSlide21
Care Plan Meeting Attendance as a quality measure for the community as a wholeSlide22
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 groupIf 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:
I
nterview the resident prior to the meeting
to ensure that resident issues are presented in the voice of the residentReport back to the resident to review the plan of care Slide23
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 timeSolution:
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. Slide24
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 planningDifficulties 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.Slide25
How is Person Centered Care Measured?
1.
Attendance in Care Conference Meeting
Extent
to which resident, family/friends, and staff routinely attend the care conference 3 measures 2. Delivery of Preference Congruent Care
a) Extent to which care is tailored to fulfilling important resident preferences
b) 1 measureSlide26
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” importantWhich preferences are “important, but can’t do”
H
ow satisfied s/he is with each of the important preferences being fulfilled
Provides
visual
feedback to staff in 3 areas:
W
hich 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
26Slide27
Example of “preference congruence”
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?Slide28
What Information Does the Quality Measure Provide?
Provides critical
visual
feedback to in 3 areas:
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 Household Report: Which preference gaps may be affecting many persons residing together in a household, floor or neighborhoodCommunity Report
: Overall measure of quality for the community that can be benchmarked and tracked over timeSlide29
The Interview
What does a preference interview look like?
Insert video here
29Slide30
F0400
Interview for Daily
Preferences
1-Very Important
2-Somewhat Important3-Not Very Important4-Not Important at all
5-Important, but can’t do
1-Mostly or completely satisfied
2-Somewhat
Satisfied
3-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
9
9Slide31
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?Slide32
Case examples of individual resident reports
32Slide33
33
Renee’s Interview ResponsesSlide34
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.
34Slide35
35
Sadie’s InterviewSlide36
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. Slide37
37
Difficulty
Tips for Interviewers
Hearing
Identify and position yourself to talk into the better earSpeak 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 optionsEstablish 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 residentsSlide38
38
Difficulty
Tips for Interviewers
Distracted or off
topicRedirect resident back to question and response sheetVerbal
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.)Slide39
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 processesSlide40
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?Slide41
Sample report: Neighborhood ReportSlide42
Using PCC information to “Advance Excellence” in Person-Centered Care for each Household in the Community
42
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
staffSlide43
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?
43Slide44
Sample report: Results by Type of PreferenceSlide45
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
resident
s 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 PreferenceSlide46
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%
Overall Preference Congruence by Stay type
Mostly or Completely Satisfied
Somewhat Satisfied
Not at all SatisfiedSlide47
Using PCC information to Advance Excellence in
Person-Centered Care
47
Incorporate
results into ongoing QAPI efforts in your communitySet goals to strive for
Celebrate
your success! Slide48
48
Why should
a provider
consider
using the PCC Tool?
Feedback from Pilot CommunitiesSlide49
Why Should I Use the PCC Tool?
Increases the understanding of Person Centered Care
Person Centered Care is an abstract concept, this tool makes it more concrete.
Increases awareness and communication of resident preferences
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
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
This critical meeting can be “super-charged” by following optimized guidelines outlined in the tool.Slide50
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.Slide51
Available PCC Goal Resources
Excel Spreadsheet
Implementation Guide
Fact Sheets- Resident, Family, Staff
Educational workshops60 or 90 minute versionsSlide52
The PCC Toolkit Resources
For a copy of the toolkit go to:
www.NHQualityCampaign.org
OR
www.polisherresearchinstitute.orgSlide53
How is Person Centered Care Measured?
53Slide54
Contact Information
Amy Elliott, PhD.
INSERT HERE
Kimberly S. Van Haitsma, PhDVice President of ResearchDirector, Polisher Research Institute
Madlyn & Leonard Abramson Center for Jewish LifePhone: 215.371.1895kvanhaitsma@abramsoncenter.orgwww.polisherresearchinstitute.orgScott D. Crespy, Ph.D., CPHQ
Vice President of Quality
Madlyn
and Leonard
Abramson
Center for Jewish LifePhone:
215.371.1810
screspy@abramsoncenter.org
www.abramsoncenter.orgSlide55
Questions?
55