Servant Leadership and

Technology Approaches within Long-Term Care

that Promote Independence

Daphne Glenn, MPT, MBA, MHSA, LNHA Administrator Daniel Drake Center SNF and Bridgeway Pointe Assisted Living

Overview: • Impact of Aging Demographics • Servant Leadership Concepts

and promotion of independence • Technology used in Assisted

Living to promote independence

• Case Studies

Learning Objectives:

• To describe how servant leadership within long-term care settings may foster relationships and promote independence.

• To cite examples of how technology has

been used in the long-term care setting of assisted living to promote independence and aging in place

Aging Demographics and

Long-Term Care

Senior Housing Trends Aging Services and Long-Term Care providers face significant demographic, financial, policy, and image challenges: •Rapidly growing senior population •Rising acuity rates •Higher cost of care •Caregiver shortage •Newer generations have higher expectations of care

Impact of Dementia • Alzheimer’s Disease International est. 44.35 million people with

dementia in 2013, 75.62 million by 2030, 135.46 million by 2050 (worldwide).

• 13.8 million people living with Alzheimer’s disease in US. by 2050. Approx. 1 in 8 adults over age of 65 Approx. 1 in 2 adults over age of 85

• Dementia has become more expensive than cancer and heart disease (US census and Health/Retirement Study,2013)

• Dementia costs: $109 billion or $159 billion if consider costs of unpaid care by friends/family or $215 with care provided in facility Heart disease costs: $102 billion Cancer disease costs: $77 billion

• Alzheimer’s Association (includes early dementia) est. future costs of $1.2 trillion by 2050.

Managed Care Trends Boomers

• The number of Americans over 65 will double from 35 million to 70 million by 2030

Caregiver Shortages

• 1.2 million nurses needed by 2020

• Primary care physician shortage of 52,000 by 2020

Facility Shortages

• 2007-2011 nursing home construction declined by 33%

• Average loss on Medicaid patient is $20/day

Data Sources: 1: U.S. Census 2: U.S. Bureau of Labor Statistics 3: Kaiser Health News, Jan 2012 4: Annals of Family Medicine, Nov 2012 5:The Fiscal Times, Jan 2012

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2

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Reduce Wasteful Spending

5.6 6.2 6.4 7.6 5.8

$10,976.00 $12,152.00 $12,544.00

$14,896.00

$11,386.00

COPD CHF Dehydration Pneumonia UTI

Potentially Avoidable Hospital Admissions (Cost per admission)

ALOS Ave Cost

• 25% of all hospital admissions for duals are avoidable • Five conditions account for 80% of potentially avoidable

hospitalizations • Duals average 3 hospital stays per year

Reduce Wasteful Spending In 2011, $357 billion was spent on Long-Term Care services and supports. Medicare, Medicaid and Private Insurance paid 68% of the total bill, putting substantial burden on tax payers and at-risk managed care providers.

$0

$10,000

$20,000

$30,000

$40,000

$50,000

$60,000

$70,000

$80,000

$90,000

$100,000

Nursing Home Assisted Living Home Health Remote Monitoring

$42,600

$20,800

$1,500

Average Annual Care

Costs by Service Type

$90,000

Servant Leadership and

Role in Aging Services

“Servant leadership begins with the natural feeling that one wants to serve, to serve first. Then conscious choice brings one to aspire to lead…The difference manifests itself in the care taken by the servant-first to make sure that other people’s highest priority needs are being served. The best test…is: do those served grow as persons; do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants? And, what is the effect on the least privileged in society; will they benefit, or, at least, will they not be further deprived?” (Greenleaf, 1970, p.15)

Historical Basis of Servant Leadership

• Robert K. Greenleaf coined term Servant Leadership and founded Greenleaf Center for Servant Leadership

• Many leadership writers support servant leadership: Bennis, Blanchard & Hodges, Covey, DePree, Sennge are a few.

• Many organizations use ideas of servant leadership: Starbucks, AT&T, Southwest Airlines, Vanguard Group, Ritz-Carlton

Six Key Components to Servant Leadership

• Value people • Develop people • Build community • Display authenticity • Provide leadership • Share leadership

• Listening-Listen First • Empathy-“Standing in

the shoes of another” • Healing-Care about the

whole person • Awareness-

understanding oneself and impact on others

• Persuasion-Clear communication creating change

• Conceptualization-being a visionary for the organization

Spears (2002)

• Foresight-ability to know the future

• Stewardship-leader takes responsibility for their role

• Commitment to the growth of people-each person is unique and adds value to organization

• Building a Community-individuals with shared interests and a sense of unity

10 Characteristics of a Servant Leader

The capacity to Influence others by unleashing their power and potential to

impact the greater good (Blanchard, 2010)

(Servant Leadership Questionnaire handout)

How do we achieve this in LTC with Servant Leadership?

• Focus on Staff • Focus on Residents • Focus on Families • Focus on STRENTGHS of each INDIVIDUAL

Situational Leadership used to Increase Independence with each Stakeholder

Outcomes of Servant Leadership in LTC:

• Staff Performance and Growth • Resident Performance and Growth • Family Involvement Increases • Organizational Performance increases by

increasing LOS in Assisted Living and increasing efficiency of staff.

• Community Involvement Increases • Societal Impact of successful aging in place

occurs. (from Liden, Wayne, Zhao, Henderson, 2008)

Technology used in Assisted Living to promote independence

• Meets people where they are • Supports abilities • Increases communication • Predicts behaviors

Goal at Bridgeway Pointe Assisted Living/UC Health

• To help residents live safely and without locked environment while experiencing “Great Life Moments.”

• To support and connect staff with knowledge regarding residents

• To assist families with managing the journey of aging parents

Bridgeway Pointe “Safety Net”-Customizable to Help Maintain

Independence Compassionate Nurses 24/7

Emergency Call Pendant

Full Apartment Sensor System

Locator

Wander Sensors

Resident

Biometric Vital Sign & Wellness Monitoring Weight Scale Blood Pressure Pulse Oximeter Glucometer

Activity of Daily Living (ADL) Monitoring Call Pendant Contact Sensors Motion Sensors Bed & Toilet Sensors

Healthsense eNeighbor® System

Intelligently Inform

Caregivers of Senior Needs

Caregivers are alerted through call, text, or email to provide assistance or care to seniors.

3 Continuously Monitor

Daily Living Activities

Healthsense hardware generates wireless signals of activity. Data securely and seamlessly sent to cloud.

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011010101

Encryption

2 Analyze Data to Identify

Risks to Patient Health

Machine learning used to detect and predict unusual activities and generate reports through portal.

Servant Leadership….

Identify Strengths Customize Technology Support

Servant Leadership and Technology Outcomes at Bridgeway Pointe/UC

Health: • Staff Performance and Growth • Resident Performance and Growth • Family Involvement Increases • Organizational Performance increases by

increasing LOS in Assisted Living and increasing efficiency of staff.

• Community Involvement Increases • Societal Impact of successful aging in place

occurs. (from Liden, Wayne, Zhao, Henderson, 2008)

Bridgeway Pointe Assisted Living Case Studies:

Real-World Case: Margaret

Name: Margaret Age: 76 Health: Dementia,

Night Wandering Solution: Door Sensors, Bed Sensor

Customized Solution:

1. Staff have identified Margaret to have increased confusion at night and some wondering periods

2. Family has been informed of concerns and they also note some increased confusion.

3. Decision made to incorporate door sensor and bed sensor into care plan.

4. Emails sent to care team to notify patterns of door opening and bed unloading.

5. Calls made to care team during specific times to notify of door openings and need to check on resident.

6. Resident behavior monitored and resident is still able to live in current apartment with this minimal added support.

Name: Ron Age: 79 Health: Dementia,

loves to walk and not

able to find his way

back when leaving

facility. Solution: Wander Pendant

Customized Solution:

1.Ron loves to walk. He wants to please and does not want to cause anyone trouble. However, he cannot find his way back when leaving the facility but he is able to enjoy courtyards and grounds safely. 2. Decided to use wander pendant. 3.Ron, was willing to use pendant but would forget to put it on in the morning. Used signs by the door and bathroom mirror that reminded him to check and created at “pendant home” with family for consistency of placement. Also used phone calls to remind him to wear pendant, since he wakes at the same time each day. 4.Result-Ron soon learned where he could go in the facility and would wear pendant consistently.

Name: Rosie Age: 85 Health: Active but has

frequent UTIs and she will

become very confused. Solution: Apt sensors with toilet and bed monitor sensor monitors and exception notifications

Customized Solution:

1. Rosie is active but is observed to have frequent UTIs. This can cause her significant confusion. Staff have identified that early intervention and diagnosis can help her maintain her active lifestyle.

2. Used apt sensors that enabled the use of toilet and bed sensors to be used to identify frequency of toilet use.

3. When exceptions are noted outside of her usual patterns, care team is notified and testing can be done to determine if medication is needed.

4. Result-Proactive care provided and confusion avoided if possible.

Name: Sue Age: 83 Health: Significant

Dementia, Wandering

during day/night,

changes in mood and

weight Solution: Wander pendant, Full apartment system

Customized Solution:

1.Staff have identified Sue to progressed dementia. She is wandering but is easily redirected, her mood has changed and her weight has changed. 2. Family has been informed of concerns and they do not want her placed in a locked unit. They want her to stay in her third floor apartment as long as possible. 3.Decision made to use full apartment support system, wander pendant, web portal for behavior monitoring, emails to care team for exception patterns and calls to staff for door openings. 4.Staff provide support by going to resident when calls are received and checking on resident 5.Medications are changed to better support sleep patterns, resulting in resident’s mood improving 6.Calls set up via system to remind resident to go to cabinet/fridge to obtain food. Sensor on doors can determine if resident went. Weight improved. 7. Successful in keeping resident in current apartment for 18 months after initial recommendation to move to locked unit. Collaborative efforts from care team and family.

Servant Leadership and Technology Working to Create

“Great Life Moments” at

Bridgeway Pointe Assisted Living

(short video)