Accreditation in Person- Centered Long-Term Care Nursing

© 2005 CARF International. All rights reserved.

Accreditation in Person-Accreditation in Person-

Centered Long-Term CareCentered Long-Term Care

Nursing Home CommunitiesNursing Home Communities

Susanne MatthiesenManaging Director of Aging Services

CARF International

2 © 2005 CARF International. All rights reserved.

Commission on Accreditation ofCommission on Accreditation of

Rehabilitation FacilitiesRehabilitation FacilitiesAn international accreditation and standard setting organization1966 – 42 years oldPrivate, non-profit, independent organizationCustomer Service Units represented

Aging ServicesBehavioral HealthChild and Youth ServicesDurable Medical Equipment, Prosthetics, Orthotics, and SuppliesEmployment and Community ServicesMedical Rehabilitation

Field driven standards developed with input from providers, payers,consumersMoral owners of CARF-CCAC are the persons served in accreditedorganizations


CARFCARF

Accredits over 39,000 programs, at over 17,000 sites, inover 4,950 organizations in U.S., Canada, Europe,South AmericaOver 6.6 million people served annuallyPeer review processProcess emphasizes person served, performanceimprovement, business of human service delivery, andgood managementAging Services accredits:

Adult Day ServicesAssisted LivingAging Services NetworksContinuing Care Retirement CommunitiesPerson-Centered Long Term Care Nursing HomesDementia Care programs


Why PCLTCC?Why PCLTCC?

Expansion of Aging ServicesDid not want to recreate what alreadyexists (regulation, JCAHO)It is “happening” whatever you want tocall it…culture change, transformingLTC, person centered, Greenhouse,etc.Consumers need information to makeinformed choices


Standards DevelopmentStandards Development

Hosted an International AdvisoryCommittee which developed standardsfor Person Centered LTC

Leading innovators in PCLTCUS, UK and Canada

Conducted a focus group in a nursinghome embarking on PCLTCField Review with nearly 300responses


AccreditationAccreditation

The Person Centered Long-Term CareCommunity standards were published inJanuary, 2006Are applied to nursing homes

FreestandingWithin a continuum

Nursing homes achieving accreditationdifferentiate themselves by demonstratingthey meet an international standard forPerson Centered LTC.


CULTURECULTURE

The uniqueness of an organization oran institutionIts “personality”The way an organization/institutiondoes thingsThe values, the lifestyle, the goalswhich are unique to an organization oran institution


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”


Culture change is a process, its goal is aCulture change is a process, its goal is a

person-centered quality homeperson-centered quality home

Culture change aims at a change in goalsChange from traditional emphasis onquality of care to a new focus on quality oflifeQuality of Care can be attained intraditional institutional culture of a facilityTo attain and sustain Quality of Life weneed a cultural shiftStandards focus on both quality of careand life


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 QIsFew resources are spent on

advancing satisfaction surveys


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.


Traditional Traditional vsvs Person Centered Care Person Centered Care

Treatment based onmedical diagnosisSchedules established forconvenience of staffWork is task-oriented –easily transferred fromperson to personDecision making iscentralized

Care based on individual sneedsSchedules establishedaround resident needWork is relationshipcentered and staff haveconsistent assignmentsDecisions made byresidents and thoseclosest to them


Facility belongs tostaff

Structured activitiesrevolve aroundactivities coordinator

Isolation andloneliness arecommon

Facility is resident shome and staff work intheir homeSpontaneous activitieshappen around theclockResidents and staffshare a feeling ofcommunity andbelonging

Traditional Traditional vsvs Person-Centered Care Person-Centered Care


Christie GardensChristie Gardens

Apartments and CareApartments and Carewww.christiegardens.org

Accredited November 2006First in the World



Christie Gardens Apartments andChristie Gardens Apartments and

Care OverviewCare Overview

Continuing care retirement community +person centered care in SNFApprox. 500 persons served annuallyUrban environmentVariety of health & medical services offeredAverage age of population in IL = 85, AL =92, NF = 90Doing person-centered care for decadeswithout calling it anything


Christie Gardens Apartments andChristie Gardens Apartments and

Care OverviewCare Overview

ChallengesMatriarchal legacyLimited financialresourcesLimited space &long hallwaysConversion of wardbedsNeed to formalizegovernance andleadership policies

OpportunitiesCommitted staff –70% over 15 yrsCareer choice towork thereKnew residents andsupport systems –relationshipformationGood systems formeasurement inplaceCharitable careforces organizationto measure value


St. AnnSt. Ann’’s Communitys Communitywww.stannscommunity.orgwww.stannscommunity.org

Accredited March 2007First in the US



St. AnnSt. Ann’’s Community Overviews Community Overview

Person centered care in NF, CIIRP for sub-acute, adult day services, assisted livingDementia specializationEverything is included under one umbrellastructure = aging services networkApprox 1200 persons served annuallyMajority of persons served 86+Multiple health conditions


St. AnnSt. Ann’’s Community Overviews Community Overview

ChallengesAddressing areasof potential risk inperson-centeredplanningProvidinginformationregarding scope ofservices

OpportunitiesStaff commitmentto Person-centered careStrong medicalservice team

Quantifiableperformance data


Research Supports PCLTCCResearch Supports PCLTCC

Residents reported significantly higher satisfaction withtheir facility as a place to live than did residents oftraditional nursing homes, better scores on manydimensions of self-reported quality of lifeIn terms of care and health outcomes, residentsexperienced lower rates of depression, bed rest,reduced activity, and decline in functional abilitiesResidents reported significantly higher scores onemotional well-being indicators.

Resident Outcomes in Small-House Nursing Homes: ALongitudinal Evaluation of the Initial Green House Program,Rosalie A. Kane, PhD, June 2007 Journal of the AmericanGeriatrics Society


Program DefinitionProgram Definition

for for PCLTCCPCLTCC’’ss

Culture supports autonomy, diversity, choiceLeadership supports the cultivation ofrelationshipsLeaders and the community commit to:

ResponsivenessSpontaneityContinuous learning and growth

Residents and personnelCelebrate cycles of lifeConnect to local communityHelp to continue relationships that nurturequality of every-day life


Residents:Are experts regarding life in their homeParticipate in deciding about

— Rhythm of their day— Services— Issues that are important to them in their home

Families/support systemsAre welcomedPartner with residents to ensure personnelunderstand

— What services residents want— How services are to be delivered— How they can help in their home




A person-centered long-term carecommunity is a place where

Residents want to livePersonnel want to workBoth choose to stay




PCLTCC Standards ThemesPCLTCC Standards Themes

Blending quality of care with quality of lifeRelationshipsSupporting personal satisfaction & goalsin residents livesCreating individualized living spacesRespect for individual resident life patterns, routines,preferences, needsOpportunity for personal growth, learning andcontributionConnection to greater communityFamily/support system active engagementLeadership support


RelationshipsRelationships

Leadership role:Ensure opportunities for spontaneousactivitiesDevelopment of relationshipsConflict resolutionIntergenerational relationships

Personnel ongoing education and a forum todiscuss concerns regarding persons served.Consistently assigned personnelVisitation policies support relationshipsPets are welcomed


Choice: The Hallmark of PCLTCChoice: The Hallmark of PCLTC

Services reflect residents choice:ServicesTiming of servicesLifestyle

Organization is prepared to negotiate risk withresident choices when applicableInformation on available services inside andexternal to programIndividual rooms: décor, privacy, security,accessibility, healthcare needsPerson served may choose living arrangements


Choice: Rhythm of Life and FoodChoice: Rhythm of Life and Food

Freedom to determine the cycle of each dayWaking, sleeping, eating, bathing,grooming, dressing

Choice of clothingParticipating in customary community routines

Cleaning – cooking – gardeningRecreation – activities – exerciseReligion – intimacy – hobbies

Persons served can select what they wouldlike to eat, plan their meals, prepare theirfood, dine with family and friends


Personal Goals: Sharing TalentsPersonal Goals: Sharing Talents

Organization has resources to assist person served tomeet their personal goalsPersons served are provided opportunities to sharetalents and skillsOrganization provides or arranges for formal andinformal educational opportunities and access tocomputers, internet and other media, information ofinterestActivities embrace diversity of persons served, help withfunctioning and personal growthPersons served choose their level of participationOpportunities exist for unstructured, spontaneous, self-scheduled activitiesActivities information is available


Personal Goals: StaffPersonal Goals: Staff

CompetenciesCompetencies

Care team includes person served,family/supports, other stakeholders.Personnel in accordance with the choice of theresident, help with achievement of personalgoals of the following types:

— Functional— Psychological— Health— Social— Spiritual— Vocational

Address impairments of the person served.


Involvement With External

Community

Each person served has access to informationon political and civic issues as desired.

Active engagement in national and local issuesaffecting their interests may be voting inelections or preservation of natural resourcesOrganization makes information regarding localor regional resources for support andadvocacy available

Lodging information


Life Cycle EventsLife Cycle Events

Identification and celebration of meaningfullifecycle eventsOrganization honors rituals around:

Events in human life.Community events.Cultural events.


Information SharingInformation Sharing

Organization provides information to persons servedeither prior to move in or at time of move inabout persons served and satisfaction levelsInformation is shared with person served atinitiation of services or at a transition regardingneeds identification, securing possessions andvarious choices availableWritten procedures for transfer within continuum,receiving counseling for, and/or appealing:

Involuntary internal transfers.Involuntary discharge.Involuntary contract termination.


Initial/Ongoing AssessmentsInitial/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 terminationplans.Changing needs of the person served, includinginput from the primary caregiver.


Person-Centered PlanPerson-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:— Identified needs in each service area.— Types and scope of services.— Need for negotiated risk agreements.— Risk/benefit analysis of any negotiated risk agreements.— Specifics of any negotiated risk agreements.— Move out/transition/discharge/contract termination plans,

as appropriate.— Identification of preference of person served for

involvement of family members/significant others.Addresses changing lifespan issues of person served.

How the PC Plan is implemented


Managing Behavioral EventsManaging Behavioral Events

To determine appropriate approach, treatment, and/orsupports necessary for challenging behaviors on anongoing basis personnel:

Observe person served.Describe behavioral eventUnderstand 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.— Families/support systems.


Personnel have InputPersonnel have Input

Personnel have opportunities to giveinput into decisions that impact theirdaily lives and the lives of personsserved, including:

Shift times.Shared duties and responsibilities.Break times.Schedules.Flex time to:— Pilot new services.— Implement new services.— Participate in learning opportunities.


The EnvironmentThe Environment

Physical plant of nursing homeIs safe and designed to promote effectiveservice delivery, dignity and self-worth ofpersons servedProvides dining space that is accessible tothose with mobility impairment

Suitable outdoor spaceComfortable and supportiveLightingMinimize noise and odorsSmoking policySafety and SecurityEmergency and evacuation plans


Why Accreditation?Why Accreditation?

Roadmap forleaders to use inimplementingPCLTCHelps to measureROI of any changesBusiness strategyCommunicationsystemManagement toolQuality strategy

Establishesbaseline of qualityfor an industryHousecleanerRefocusesbusiness on personserved/residentEstablishes and re-establishesrelationships withstakeholders


We did the best we could,with what we knew,And when we knew better, we did better.

Maya Angelou


Thank You. Contact Us.Thank You. Contact Us.

866-888-1122, www.carf.org/agingAmanda Birch, [email protected] Nelson, [email protected] Matthiesen, [email protected] Ganson, [email protected]

Documents

Accreditation in Person- Centered Long-Term Care Nursing