PERSON CENTERED CARELORI PRESSER, BSHA, ACC, CDP, CMP, CEAL

WWW.NOAAP.COM

HANDOUTS – UNDER EDUCATION

OBJECTIVES

• PARTICIPANTS WILL BE ABLE TO EXPLAIN THE PELI ASSESSMENT

AND IMPLEMENT WHILE CONNECTING TO REIMBURSEMENT

• PARTICIPANTS WILL BE ABLE TO CREATE PERSON CENTERED CARE

PLANS FOR THOSE THEY SERVE.

HISTORY OF PERSON CENTERED CARE

• THOMAS KITWOOD IN THE LATE 1980S AT THE UNIVERSITY OF BRADFORD IN THE UNITED

KINGDOM.

• IN THE UNITED STATES – ASSISTED LIVING BEGAN PROVIDING PERSON CENTERED CARE

BEFORE SKILLED NURSING COMMUNITIES

• PERSON-CENTERED CARE IS A WAY OF PROVIDING CARE TO PEOPLE IN WHICH THE UNIQUE

PERSON AND THEIR PREFERENCES ARE EMPHASIZED, INSTEAD OF THE DISEASE, ITS EXPECTED

SYMPTOMS AND CHALLENGES, AND THE LOST ABILITIES OF THE PERSON. PERSON-CENTERED

CARE RECOGNIZES THAT DEMENTIA IS ONLY A DIAGNOSIS OF THE PERSON, AND THAT THERE

IS MUCH MORE TO THE PERSON THAN HIS/HER DIAGNOSIS.

ORGANIZATIONS THAT SUPPORT PERSON CENTERED CARE

PRINCIPLES OF PERSON CENTERED CARE

• EVERY PERSON HAS STRENGTHS, GIFTS, AND CONTRIBUTIONS

• EVERY PERSON HAS DREAMS AND DESIRES

• EACH PERSON IS THE PRIMARY AUTHORITY ON HIS OR HER LIFE, ALONG WITH THOSE THAT

CARE FOR THEM

• EVERY PERSON HAS THE ABILITY TO EXPRESS PREFERENCES AND TO MAKE CHOICES

• A PERSON’S CHOICES AND PREFERENCES SHALL ALWAYS BE CONSIDERED

This Photo by Unknown Author is licensed under CC BY-

NC-ND

This Photo by Unknown Author is licensed under CC BY-NC-ND

• FEDERAL AND STATE SNF REGULATIONS INCLUDE VERBIAGE 1ST TIME IN 30 YEARS

• OHIO ASSISTED LIVING REGULATIONS INCLUDE PERSON CENTERED VERBIAGE-1/1/18

PELI ASSESSMENT

• CREATED IN 2005

• PILOTED IN 500 SKILLED NURSING HOMES- TOOL PROVED TO BE RELIABLE AND VALID

MEASURE OF PREFERENCES AND WELL ACCEPTED BY OLDER ADULTS

• ADVANTAGES TO DIRECT CARE STAFF- A CONSISTENT TOOL TO DISCOVER EACH RESIDENT’S

UNIQUE INTERESTS, PASSIONS, AND PRIORITIES

IMPLEMENTED IN OHIO IN 2016

This Photo by Unknown Author is licensed under CC BY-NC

AS PART OF OHIO'S NURSING HOME QUALITY INITIATIVE, EACH LICENSEDNURSING HOME IN THE STATE MUST PARTICIPATE EVERY TWO YEARS IN AT LEAST

ONE QUALITY IMPROVEMENT PROJECT APPROVED BY THE OHIO DEPARTMENT OF AGING.

• AHCA/NCAL NATIONAL QUALITY AWARD PROGRAM

• AHRQ NURSING HOME SURVEY ON PATIENT SAFETY CULTURE

• CARE TRANSITIONS INTERVENTION

• CHEERING VOICES

• CMS BREAKTHROUGH COMMUNITY ON DEMENTIA CARE

• CPAN READMISSION REDUCTION 2018-2020

• CREATING A CULTURE OF PERSON-DIRECTED DEMENTIA

CARE

• HSAG CLOSTRIDIUM DIFFICILE INITIATIVE

• HSAG NATIONAL NURSING HOME QUALITY CARE

COLLABORATIVE II

• HSAG REDUCING READMISSIONS PROJECT

• IMPLEMENTING CONSISTENT ASSIGNMENT

• INDEPENDENT MUSIC & MEMORY

• INTERACT 4.0 2017-2019

• OMA: OPENING MINDS THROUGH ART

• PELI PAL CARD PROJECT BY SCRIPPS

GERONTOLOGY CENTER

• PERSON-CENTERED STAFF ENGAGEMENT PROJECT

• REDUCING THE USE OF ANTIPSYCHOTICS IN

SKILLED NURSING FACILITIES

• WCEI WOUND CARE CERTIFICATION

HOW THE PELI ASSESSMENT AFFECTS REIMBURSEMENT

• THE PREFERENCES FOR EVERYDAY LIVING INVENTORY (PELI-NH) HAS BEEN SELECTED BY THE OHIO

DEPARTMENT OF MEDICAID AS ONE OF FIVE QUALITY IMPROVEMENT INDICATORS. THIS MEASURE

WAS SELECTED BECAUSE OF ITS DEMONSTRATED VALIDITY AND FLEXIBILITY IN IDENTIFYING

NURSING HOME RESIDENTS’ MOST STRONGLY HELD EVERYDAY PREFERENCES. ASSESSING

PREFERENCES IS AN IMPORTANT FIRST STEP, BUT BASED UPON OUR EXPERIENCE, PROVIDERS NEED

EDUCATION AND TRAINING ON HOW TO APPROACH THE ASSESSMENT OF PREFERENCES AND USE

THE INFORMATION TO DRIVE IMPROVEMENTS IN CARE AND SUSTAIN THOSE GAINS OVER TIME.

• BEING PART OF THE 5 QUALITY INDICATORS THAT CONTRIBUTE TO THE MEDICAID RATE FOR THE

COMMUNITY

PELI INTERVIEW VIDEO

• DON’T APPROACH THE PREFERENCE INTERVIEW AS IF IT’S A TASK FOR THE INTERVIEWER OR

THE RESIDENT. PREFERENCE INTERVIEWS ARE A MEANINGFUL OPPORTUNITY TO PERSONALIZE

CARE AND FOCUS TIME AND RESOURCES THAT WILL HELP RESIDENTS FEEL HAPPY, CARED FOR

AND COMFORTABLE WITH DAILY LIFE.

PELI INTERVIEWING

• PELI INTERVIEWS PROVIDE AN OPPORTUNITY TO GET TO KNOW YOUR RESIDENTS AND TO BUILD INSIGHT,

RELATIONSHIPS, RESPECT AND TRUST.

WHILE A FULL PELI INTERVIEW TYPICALLY TAKES 30 MINUTES AT ONE SITTING, A SERIES OF THREE 10-MINUTE

INTERVIEW SESSIONS OVER A WEEK CAN ACCOMPLISH THE SAME GOALS

• STRIVE FOR CONVERSATIONAL APPROACH

• COMFORTABLE SEATING ARRANGEMENTS WITH PRIVACY

• ANY ASSISTIVE DEVICES SUCH AS AMPLIFIERS, GLASSES, HEARING AIDES

• IF A RESIDENT SAYS HE OR SHE CAN NO LONGER DO A PARTICULAR PREFERENCE, SAY: “I WANT TO KNOW

ABOUT EVERY ACTIVITY THAT WOULD BE IMPORTANT TO YOU IF YOU COULD DO THEM WITH ASSISTANCE OR

SUPPORT."

• BE CAREFUL NOT TO “PUT WORDS IN THE MOUTH” OF THE INTERVIEWEE. GIVE EACH PERSON TIME TO

COLLECT THEIR THOUGHTS AND EXPLAIN PREFERENCES.

• BE SURE TO THANK THE NURSING HOME RESIDENT, FAMILY MEMBER OR FRIEND AT THE END OF EACH

INTERVIEW SESSION. LET THEM KNOW THAT THE INFORMATION WILL BE USED TO HELP PLAN THEIR CARE AND

DAILY ACTIVITIES.

INTERVIEWING TIPS

• QUESTIONS TO CONSIDER—

WHERE ARE YOU FROM? WHAT MAKES YOU SMILE?

WHAT DID YOU DO FOR A LIVING? WHAT DOES YOUR FAMILY LOOK LIKE?

QUALITY ASSURANCE PERFORMANCE IMPROVEMENT PROGRAM (QAPI)

• EFFECTIVE NOVEMBER 28, 2017- FEDERAL REGULATIONS REQUIRE NURSING HOMES TO

IMPLEMENT QUALITY ASSURANCE PERFORMANCE IMPROVEMENT PROGRAMS THAT TAKE

“A SYSTEMATIC, COMPREHENSIVE, DATA-DRIVEN APPROACH’ TO IMPROVING QUALITY CARE

AND QUALITY OF LIFE FOR RESIDENTS.”

WHY FOCUS YOUR QAPI INITIATIVE ON MEETING RESIDENT PREFERENCES?

• STAFF THAT KNOW A RESIDENT’S PREFERENCES BECOME MORE TRUSTED AND RESPONSIVE

CAREGIVERS AND WORK MORE EFFICIENTLY

• COMMUNITIES GAIN REFERRALS

• RECORDING AND SHARING POSITIVE FEEDBACK CAN BE A POWERFUL MARKETING STRATEGY

AND ASSIST YOUR COMMUNITY STAND OUT AS A QUALITY PROVIDER

• STAFF RETENTION, JOB SATISFACTION, AND MORALE MAY IMPROVE

• USING THE PELI TO ASSESS PREFERENCES, AND INTEGRATE THEM INTO

RESIDENT CARE PLANS, ENHANCES COMPLIANCE WITH FEDERAL AND

STATE REGULATORY GUIDELINES AND INCENTIVES FOR

PERSON-CENTERED CARE

SUPPORTING RESIDENTS’ RIGHTS WITH THE PELI

• USING THE PELI TO ASSESS AND HONOR RESIDENT PREFERENCES IS ONE OF THE MANY WAY

YOUR COMMUNITY CAN PROMOTE RESIDENT RIGHTS

OCTOBER IS RESIDENT RIGHT MONTH

IN HONOR OF RESIDENTS' RIGHTS MONTH, WE TOOK A LOOK AT THE CLOSECONNECTION BETWEEN PELI ITEMS AND SPECIFIC RESIDENT RIGHTS. ONE EXAMPLE IS

QUESTION 30, WHICH HELPS YOUR COMMUNITY DISCOVER EXACTLY HOW EACHPERSON LIKES TO BE SHOWN RESPECT.

THE TABLE BELOW SHOWS THE TIE BETWEEN ADDITIONAL PELI ITEMS AND RESIDENT RIGHTS.

COMPARING RESIDENT RIGHTS AND PELI QUESTIONS

Residents have the right to... Related PELI Questions

Be fully informed of advance plans in a change in rooms or roommates 34

Be fully informed of assistance if a sensory impairment exists 61

Participate in own their assessment, care planning, treatment and discharge 26, 28

Have private and unrestricted communication with any person of their choice 31-32, 42

Visits by relative, friends and others of the residents' choosing 24-25

Be treated with consideration, respect and dignity 30

Have security of possessions 13, 33, 56

Make personal decisions, such as what to wear and how to spend free time 7, 22-23, 35-41, 45-47, 50, 53-60,

61-72

Reasonable accommodation of their needs and preferences 2-18, 20

Choose a physician 19

Participate in community activities, both inside and outside the nursing home 45-49, 54, 60

SURVEY TRENDS

• CITED ON PELI PREFERENCES AND RESIDENT RIGHTS

-SHOWER PREFERENCES

-OUTSIDE PREFERENCES

-MUSIC PREFERENCES

This Photo by Unknown Author is licensed under CC BY-ND

WHAT IS A PELI PAL CARD?

• DATE(S) OF PROJECT

• MARCH 1ST, 2018 TO AUGUST 30TH, 2018 – FUNDED AND RESEARCHED BY SCRIPPS

GERONTOLOGY CENTER – OHIO DEPARTMENT OF AGING

LTCQUALITY.OHIO.GOV

• THERE ARE MANY BARRIERS TO COMMUNICATING PREFERENCES SUCH AS NOT ALL CARE TEAM

MEMBERS HAVING ACCESS TO ELECTRONIC MEDICAL RECORDS AND HIGH STAFF TURNOVER

• THE FOCUS OF THE PAL CARD PROJECT IS ON FACILITATING THE COMMUNICATION OF NURSING

HOME RESIDENTS’ IMPORTANT PREFERENCE INFORMATION ACROSS DEPARTMENTS BY

IMPLEMENTING A PERSON-CENTERED QUALITY IMPROVEMENT INITIATIVE CALLED PREFERENCES FOR

ACTIVITY AND LEISURE (PAL) CARDS.

PREFERENCEDBASEDLIVING.COM

• PAL CARDS ARE PERSONALIZED 5X7 LAMINATED CARDS THAT REFLECT A RESIDENT’S

RECREATION AND LEISURE PREFERENCE INFORMATION GATHERED USING EITHER THE 8

ACTIVITY ITEMS FROM THE MDS 3.0 IN SECTION F OR 33 ITEMS FROM THE PREFERENCES FOR

EVERYDAY LIVING INVENTORY (PELI). THE CARDS ARE THEN PLACED ON A RESIDENT

WHEELCHAIR/WALKER/DOOR AS A WAY TO COMMUNICATE IMPORTANT PREFERENCES TO

STAFF, VOLUNTEERS, AND OTHER RESIDENTS THROUGHOUT A PROVIDER COMMUNITY.

QUALITY IMPROVEMENT OUTCOMES

• COMMUNICATE RESIDENTS’ PREFERENCES REGARDING IMPORTANT RECREATION AND LEISURE INTERESTS

• SUCCESSFULLY INITIATE CONVERSATIONS BETWEEN STAFF AND RESIDENTS OR RESIDENTS AND VOLUNTEERS

• ASSIST “FILL-IN” OR “FLOATING” STAFF TO BE ABLE TO QUICKLY LEARN ABOUT THE RESIDENTS THEY

ARE PROVIDING CARE FOR

• PROVIDE OPPORTUNITIES FOR STAFF AND RESIDENTS TO DEVELOP STRONGER RELATIONSHIPS

• INCREASE RESIDENT’S WELL-BEING KNOWING THEIR VOICES ARE HEARD AND PREFERENCES UNDERSTOOD

• BUILD CAPACITY TO BE ABLE TO IMPLEMENT PAL CARDS WITH ALL RESIDENTS IN THE COMMUNITY

RESOURCES

• HTTPS://PREFERENCEBASEDLIVING.COM/

• HTTPS://PREFERENCEBASEDLIVING.COM/?Q=PAL_CARD_RESOURCES

PELI CARD ACTIVITY

• 6 PREFERENCES

• CUSTOMIZE YOUR PELI CARD

• STRIVE FOR CONVERSATIONAL APPROACH

• NO MEDICAL INFORMATION SHOULD BE INCLUDED D/T HIPPA INFO SUCH AS “RISK FOR FALLS”

MAYBE CONSIDERED PHI- PROTECTED HEALTH INFORMATION

This Photo by Unknown Author is licensed under CC

BY-SA

INTEGRATING PREFERENCES INTO CARE PLANS

• CARE PLAN MEETING VIDEO

• USING THE PREFERENCES FOR EVERYDAY LIVING INVENTORY (PELI) TO PERSONALIZE CARE OFFERS IMPORTANT

BENEFITS FOR RESIDENTS, FAMILIES AND COMMUNITIES. UNDERSTANDING AND MEETING PREFERENCES:

• ENHANCES NURSING HOME RESIDENTS’ AUTONOMY, QUALITY OF LIFE AND PHYSICAL AND EMOTIONAL

WELLBEING.

• SUPPORTS MORE EFFECTIVE AND HOLISTIC CARE PLANNING.

• INCREASES SATISFACTION AMONG RESIDENTS AND THEIR FAMILY MEMBERS.

• STRENGTHENS TRUST AND COMMUNICATION AMONG RESIDENTS, FAMILY MEMBERS AND NURSING HOME

STAFF.

• COMPLIES WITH REGULATIONS REQUIRING THAT CARE PLANS REFLECT RESIDENTS’ VOICES AND PREFERENCES

SO THAT EACH PERSON CAN EXPERIENCE A MEANINGFUL AND ENJOYABLE LIFE.

PRIOR TO THE CARE CONFERENCE

• BEFORE THE MEETING, ONE OR MORE CARE TEAM MEMBERS CAN REVIEW THE RESIDENT’S PELI

RESPONSES AND DRAFT SIMPLE STATEMENTS THAT CAPTURE THE INDIVIDUAL’S PREFERENCES FOR

TEAM DISCUSSION. ONE APPROACH FOR THESE SUMMARIES SPEAKS IN THE RESIDENT’S VOICE:

• PERSONAL CARE PREFERENCES: CONSIDER MY MOST IMPORTANT PREFERENCES, SUCH AS

[CHOOSING WHAT CLOTHES TO WEAR] IN ORDER TO HELP ME ENGAGE POSITIVELY IN CARE THAT I

CAN DO MYSELF.

• RECREATION PREFERENCES: CONSIDER MY MOST IMPORTANT PREFERENCES, SUCH AS [DOING MY

FAVORITE ACTIVITIES: READING, PAINTING, GARDENING] IN ORDER TO HELP ME ENJOY MY LEISURE

TIME.

DEVELOPING CARE PLANS THAT BUILD DIGNITY, PRIDE AND SUCCESS

• EACH CARE PLAN SHOULD REFLECT AND HONOR THE INDIVIDUAL’S UNIQUE STRENGTHS AND WISHES. THE AIM

OF THE CARE PLANNING TEAM IS TO DEVELOP REALISTIC, ACHIEVABLE GOALS THAT SUPPORT THE RESIDENT’S

PRIORITIES AND ACCOUNT FOR THEIR UNIQUE NEEDS, CHALLENGES AND STRENGTHS. USE LANGUAGE THAT

BUILDS DIGNITY AND PRIDE – FOR THE RESIDENT TO REVIEW AND APPROVE. KEY ELEMENTS INCLUDE:

• TAILOR ACTIVITIES AND SERVICES TO EACH RESIDENT’S INTERESTS AND FUNCTIONAL ABILITIES. WELL-CRAFTED

CARE PLANS CAN REDUCE STRESS, AGITATION, DEPRESSION AND OTHER SIGNS OF DISCOMFORT.

• LOOK FOR WAYS TO SOLVE OBSTACLES IN MEETING PREFERENCES. THINK CREATIVELY AND “OUT OF THE BOX”

TO SUPPORT THE RESIDENT’S TOP PREFERENCES AND PRIORITIES.

• REASSESS THE CARE PLAN AT REGULAR INTERVALS OR WHEN FUNCTIONAL LEVELS CHANGE.

• DOCUMENT THE PLAN CLEARLY AND CONCISELY SO THAT TEAM MEMBERS ACROSS SHIFTS CAN WORK

TOWARD GOALS CONSISTENTLY.

• KEEP CARE PLANS OPEN AND FLEXIBLE. SMALL CHANGES CAN OCCUR WITHOUT FORMAL CARE PLANNING

MEETINGS.

EXAMPLE OF CARE PLANSMRS. SMITH HAS MILD COGNITIVE DEFICITS AND ARTHRITIS THAT HAVE LED HER TO FEEL LESS

SATISFIED WITH HER FAVORITE ACTIVITY, KNITTING. IN A DISCUSSION WITH HER DAUGHTER, SHE SHARED THAT SHE DOES NOT LIKE TO KNIT IN LARGE GROUPS.

RESIDENT’S PRIORITIES AND

STRENGTHS

GOAL SUPPORTS FOR GOALS

Mrs. Smith: I will feel more satisfied

with my favorite activity, knitting,

when I feel more supported.

I will participate in a smaller

knitting group that meets two or

three times per week (with more

supports).

Organize a knitting group with a

small number of participants.

• Offer Mrs. Smith the opportunity

to make choices regarding color of

yarn or current knitting project.

• Adapt the project: use step-by-

step tasks, such as winding a ball of

yarn for others.

• Provide cues in times of confusion.

MR. JONES HAS MODERATE DEMENTIA. WHILE HE OFTEN EXHIBITS PLEASANT BEHAVIOR, HE ALSO HAS EPISODES OF AGGRESSION, AGITATION AND DISROBING. HE IS 6’4” TALL. THE CARE TEAM HAS BECOME CONCERNED FOR THEIR OWN AS WELL AS OTHER RESIDENTS’ SAFETY DURING

THESE PERIODS OF DIFFICULTY. A CONVERSATION WITH HIS FAMILY ABOUT MR. JONES’ PREFERENCES REVEALED THAT HE WAS AN AVID WINE COLLECTOR WHO ENJOYED READING ABOUT WINE AND SHARING IT WITH OTHERS. AS ONE OF MANY INTERVENTIONS, THE TEAM

DEVELOPED THIS PLAN

RESIDENT’S PRIORITIES AND

STRENGTHS

GOAL SUPPORTS FOR GOALS

Mr. Jones: I will feel less agitated

and am less likely to experience the

urge to disrobe when my hands and

mind are occupied with my genuine

interests.

I

I will look at magazines and

documentaries on wine to decrease

my feelings of agitation.

• Ensure access to wine magazines.

• When agitated, provide with

conversation about wine, wine

magazines or documentaries about

wine.

RESOURCES

• PREFERENCE BASED LIVING.COM

• AGINGOHIO.GOV

• OHIO LONG TERM CARE INITIATIVE

QUESTIONS OR INPUT?

THANK YOU!

• NOAAP-FULL PRESENTATION

• WWW.NOAAP.COM

-EDUCATION –

-2018 RAP CONFERENCE