DIRECTIONS: Please circle the best response. Submit the completed post-test to the conference staff person at the break. Thank you!

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1 PRE-TEST EVALUATION SPEAKERS: Barbara Speedling, BS TITLE: Creatively Achieving a Meaningful and Satisfying Life: PASRR Evaluation and Recommendations That Matter September 24, 2015 Oklahoma State University, Tulsa, OK PARTICIPANT NAME: DIRECTIONS: Please circle the best response. Submit the completed post-test to the conference staff person at the break. Thank you! 1. A PASRR Level I Screen is required as a component of the admission application to an Article 28 nursing facility. 2. A person must be rescreened for Level II recommendations only following a significant change in mental health. 3. All people with a diagnosis of MI/ID will receive Level II recommendations for special services in a nursing facility. 4. People admitted for short-term rehab or a short-term, respite stay do not require PASRR Level I SCREEN to qualify for admission to a nursing facility. 5. PASRR Level II recommendations for specialized services are obtained through outside resources/providers, not the nursing facility staff. 6. PASRR Level II recommendations for therapeutic group participation are only met if the groups are led by social work, psychiatry or psychology.

2 Creatively Achieving a Meaningful and Satisfying Life PASRR Evaluations and Recommendations That Matter Barbara Speedling Quality of Life Specialist NAPP - September 2015 Conflict of Interests I have no conflict of interest to report. Learning Objectives: Describe the concept of culture change and the expectations of regulators and consumers with regard to applying these principles, particularly as applied to populations with special needs; Define the scope of responsibility to ensure all residents are appropriately screened and accommodated for special needs; 1

3 Learning Objectives: Create person-centered, innovative interventions as alternatives to pharmacologic remedies in response to the behavioral health needs of the populations served. Develop leadership and organizational systems that will support an ongoing path to achieving and sustaining quality of care and quality of life for all those served. What is Quality of Life? Subjective, multidimensional, encompassing positive and negative features of life. A dynamic condition that responds to life events Prevalence of Mental Illness in Long Term Care Number of hospital discharges with psychoses as first-listed diagnosis: 1.5 million (Ref. CDC National Hospital Discharge Survey 2010) Percent of residents with mental disorders: 66.7% (Ref. CDC National Nursing Home Survey 2004) 2

4 Prevalence Of Mental Illness In Long-Term Care According to an article published by the National Institutes of Health in 2010, over the past decade, the proportion of new nursing home admissions with mental illness other than dementia, including major depression & serious mental illness, such as schizophrenia & other psychotic disorders, has overtaken the proportion with dementia only. Grabowski, Aschbrenner, Rome and Bartels, Quality of Mental Health Care for Nursing Home Residents: A Literature Review, National Institutes for Health, 2010, Frequency of Alzheimer s Every 68 seconds someone in America develops Alzheimer s disease By mid-century, someone in America will develop Alzheimer s disease every 33 seconds Mental Health FFS Medicare-Medicaid enrollee population: 41% have one or more mental health diagnoses; One quarter of Medicare-Medicaid enrollees were classified as having depression; and 12% were diagnosed with schizophrenia or another psychotic disorder in Physical and Mental Health Condition Prevalence and Comorbidity among Fee-for-Service Medicare-Medicaid Enrollees Centers for Medicare & Medicaid Services September,

5 Drug Abuse and Mental Health Issues A 2011 study by the Substance Abuse and Mental Health Services Administration found: Baby Boomers who came of age in the 60s and 70s when drug experimentation was pervasive, are far more likely to use illicit drugs; Among adults 50-59, current illicit drug use increased to 6.3 percent in 2011 from 2.7 percent in 2002; The most commonly abused drugs were opiates, cocaine and marijuana. Drug Abuse and Mental Health Issues 2010: An estimated six to eight million older Americans almost 20 % of the elderly population had one or more substance abuse or mental health disorders. 2030: Adults 65 and older is projected to increase to 73 million from 40 million between 2010 and Regulatory Reference F (e) Coordination A facility must coordinate assessments with the pre-admission screening and resident review program under Medicaid in part 483, subpart C to the maximum extent practicable to avoid duplicative testing and effort. 4

6 Compliance and Quality Assurance A Level I SCREEN must be completed for all persons prior to admission to a RHCF (nursing home) for any reason and any length of stay. Quality Concern: Many hospitals and some nursing homes do not adhere to the regulation for Level I SCREENs in the admission screening process. Compliance and Quality Assurance Significant Change Residential health care facility (RHCF) residents who have been previously identified through the PASRR (Preadmission Screen Resident Review) process as having mental illness or intellectual disability and have experienced a significant change in status require a new Level II PASRR evaluation. Compliance and Quality Assurance The PASRR definition for a significant change in status is the same as the MDS 3.0 definition which states, "A significant change is a decline or improvement in a resident's status that: Will not normally resolve itself without intervention by staff or by implementing standard disease-related clinical interventions; is not 'self-limiting' (for declines only); Impacts more than one area of the resident's health status; and Requires interdisciplinary review and/or revision of the health care plan." 5

7 Compliance and Quality Assurance Quality Concerns: Many hospitals and nursing homes are unaware of the significant change requirements; Many hospitals and nursing homes are unaware that the significant change is defined by the MDS 3.0 language; and Residents often return to the nursing home from the hospital following a significant change without benefit of rescreening. PASRR Non-Compliance: Patient Outcomes Lack of treatment for MI/ID; Exacerbation of symptoms and behavioral health concerns associated with MI/ID; Unnecessary hospitalization for symptom management/stabilization; Unnecessary medication/prn psychoactive medications; Diminished standard of quality of life. Corrective Actions Ensure PASRR education for all involved disciplines; Quality assurance monitoring of admission application and review processes; Coordination of services between community, hospital and long term care providers. 6

8 Corrective Actions Develop interdisciplinary, therapeutic plans to address MI/ID needs per the Level II recommendations; and Develop clinical care plans to include psychiatric intervention, support and social groups, and appropriate pharmacologic treatment. Conflict of Interest I have no actual, potential or perceived conflict of interest. Barbara Speedling, Quality of Life Specialist PHONE: Bspeedling@aol.com Creating Meaningful, Satisfying Lives One Person at a Time 7

9 POST-TEST EVALUATION SPEAKERS: Barbara Speedling, BS TITLE: Creatively Achieving a Meaningful and Satisfying Life: PASRR Evaluation and Recommendations That Matter September 24, 2015 Oklahoma State University, Tulsa, OK PARTICIPANT NAME: DIRECTIONS: Please circle the best response. Submit the completed post-test to the conference staff person at the break. Thank you! 1. A PASRR Level I Screen is required as a component of the admission application to an Article 28 nursing facility. 2. A person must be rescreened for Level II recommendations only following a significant change in mental health. 3. All people with a diagnosis of MI/ID will receive Level II recommendations for special services in a nursing facility. 4. People admitted for short-term rehab or a short-term, respite stay do not require PASRR Level I SCREEN to qualify for admission to a nursing facility. 5. PASRR Level II recommendations for specialized services are obtained through outside resources/providers, not the nursing facility staff. 6. PASRR Level II recommendations for therapeutic group participation are only met if the groups are led by social work, psychiatry or psychology.

10 PARTICIPANT EVALUATION FORM SEPTEMBER 24, 2015 WELLNESS: BUILDING THE CAPACITY OF TOMORROW S OLDER ADULTS SPEAKER: Barbara Speedling, BS TITLE: Creatively Achieving a Meaningful and Satisfying Life: PASRR Evaluations and Recommendations That Matter Your evaluation of the program and faculty is very important. It will help us improve our program & serve you better. We review each evaluation, so please consider each question carefully. Please indicate if you are applying for CE credit. Thank you for your input. Name: Date: CE Credit: Nursing LADC MSW LPC LMFT CFLE OT PT NAB Please indicate how well the speaker met the following objectives: 1 Strongly Disagree 2 Disagree 3 Agree 4 Strongly Agree NA Learning Objective 1: Describe the concept of culture change and the expectations of regulators and consumers with regard to applying these principles, particularly as applied to populations with special needs. Learning Objective 2: Define the scope of responsibility to ensure all residents are appropriately screened and accommodated for special needs. Learning Objective 3: Create personcentered, innovative interventions as alternatives to pharmacologic remedies in response to the behavioral health needs of the populations served. Learning Objective 4: Develop leadership and organizational systems that will support an ongoing path to achieving and sustaining quality of care and quality of life for all those served. Please indicate your answers to the following statements: 1 Not Very Likely 2 Probably Not 3 Very Probabl e 4 Definitely NA Presentation content enhanced my knowledge of Gerontology and Geriatrics. Presentation content will be used to alter my professional practice. Presentation information will be applied to my professional practices.

11 SEPTEMBER 24, (continued) WELLNESS: BUILDING THE CAPACITY OF TOMORROW S OLDER ADULTS SPEAKER: Barbara Speedling, BS Please indicate your answers on presentation delivered 1 Poor 2 Satisfactory 4 Good 5 Excellent Materials were useful. Speaker was prepared. Speaker was knowledgeable. Speaker was organized. Speaker s presentation style was appropriate Speaker provided opportunities to ask questions. What ideas do you have for improving the current session? What ideas have you taken away from the session? Please explain how session ideas will be used to alter your professional practice. Please explain how session ideas be applied your professional practice. List other topics of interests. General Comments:

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