FY 2016 PERFORMANCE PLAN

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1 Walter Reed Adult Day Health Care Center ADSD Michael DiGeronimo x0965 Program Purpose Program Information Improve the quality of life for adults with age-related or developmental disabilities and their families A combined health and social model is provided in a purpose-built section of the Walter Reed Community Center; it is co-located with senior programs and congregate meals The Center is licensed for 40 participants based on physical space; the actual maximum daily capacity is 25 based on staffing The daily fee of $99 is subsidized with local funds The program provides respite for families/caregivers Services include medication management, therapeutic activities, adapted exercise, physical transfers, toileting assistance, eating assistance, supervision for safety, and ambulation assistance Most common diagnoses of participants are dementia (62%) and intellectual disability (15%), serious mental illness (10%). Other diagnoses include Parkinson s disease, traumatic brain injury, cerebral palsy, and stroke. Participant age ranges are under 64 years old (13%), 65 to 74 (27%), 75 to 84 (33%), and 85 and older (27%) Participants are 49% male and 51% female Participant acuity level is based on a level 1 to 5 scale (least acute to most acute) that rates need for assistance or monitoring with ambulation, toileting, eating, medication management, exit seeking/wandering, psychological monitoring, therapeutic activities, initiating tasks, and communication skills. Participants are assessed at acuity level 1 (6%), level 2 (41%), level 3 (41%), level 4 (12%), and level 5 (0%) Program participants and caregivers have participated in evidence based research studies from Penn State and Marymount University with focus on caregiver stress and muscle memory and balance in people with Alzheimer s Disease, respectively. PM1: How much did we do? Staff 7.75 FTEs: o 1 FTE Director o 1 FTE Public Health Nurse o Direct Care/Floor Staff 1.75 FTE Recreation Therapists 4.0 FTE Human Service Aides Customers and Service PM2: How well did we do it? FY 2014 FY 2015 FY 2016 Total Number Served Average Daily Attendance Average Monthly Census Compliance with Virginia Department of Social Services licensing requirements 2.2 Utilization rate Walter Reed Adult Day Health Care Center FY 2016 Page 1

2 2.3 Adherence to activity requirements PM3: Is anyone better off? 3.1 Effect of WRADHC on quality of life for family/caregivers and program participants Walter Reed Adult Day Health Care Center FY 2016 Page 2

3 Length of License in Years Measure 2.1 Walter Reed Adult Day Health Care Center Compliance with Virginia Department of Social Services Licensing Requirements 3 Maximum License Possible and Licence Received Target: 3 Year (proj) Max License Possible License Received Summary The Center has attained the highest possible license level for the time it has been in operation: a 2-year license in 2010, and a 3-year license in 2012 and 2015 What is the story behind the curve? State licensing process ensures the program is meeting state requirements in the areas of participant safety, documentation, staffing, medication management, and policies and procedures. Achieving maximum license possible indicates program exceeds state standards. The 2016 audit yielded no violations. In addition to meeting the state licensing standards, the program continues to explore best practices that will enhance services. Forecast Recommendations Anticipate getting a three-year license at next review in Continue to implement quality assurance activities and collaborate with Division s Quality Assurance unit to ensure best practices are followed. Continue to update medication policies if areas of improvement are identified through the quality assurance plan. Continue to collaborate with state licensing inspectors and seek clarification on state policy changes. Maintain an active role during the Department of Social Service s review of Adult Day Regulations. Provide ongoing staff training and support to ensure compliance with licensing regulations Over the next 3 years, pursue certifications from Veteran s Affairs and CARF (Commission on Accreditation for Rehabilitation Facilities) if they are found to benefit clients and program. Participate in LeadingAge Virginia s committee to develop Best Practices in Virginia s Adult Day Health Care Programs. Walter Reed Adult Day Health Care Center FY 2016 Page 3

4 Utilization Measure 2.2 Utilization Rate Walter Reed Adult Day Health Care Center 30.0 Scheduled and Attended Days as Percent of Capacity Utilization Goal: FY (88%) 26.8 (107%) FY (82%) 25(100%) Average Attendance Actuals (Utilization) FY (76%) 21.0 (84%) FY 2017 (proj.) 21.0 (84%) 25.0 (100%) Average Scheduled Attendance Summary Utilization rate was 76% in FY 2016, down from 82% in FY 2015 (equivalent to 1.5 participants) Scheduled attendance decreased to 84% in FY 2016 from 100% in FY 2015 (equivalent to 4 participants) Capacity is 25 clients per day What is the story behind the curve? In FY 2016, the program had 20 admissions and 17 discharges. Discharges occurred due to events such as long term care placement, failing health, death, and moves out of state. The timing and number of discharges yielded a drop in scheduled and actual daily attendance. Program continues to try to overbook Scheduled Days in an effort to increase the utilization rate by offsetting the cancellation rate. Some days could not be overbooked due to low census and participant preference. Program served an average of 34 people per month, but participants scheduled days varied from 2 days a week to 5 days a week. Recommendations Continue to collaborate with other adult day programs in the area to discuss strategies to increase census and exchange resources. Analyze alternative ways to demonstrate the utilization rate. Things to consider and determine: Establish an expected attendance range for the adult day population Develop a procedure that considers the acuity rate for determining daily census Lower the ratios rather than following the minimum 1:6 as mandated by licensing. Licensing Walter Reed Adult Day Health Care Center FY 2015 Page 4

5 An average of 5 participants per month were on extended absence due to hospitalization, rehabilitation, or travel during FY Participants on extended absence are not counted in Scheduled Attendance. Program continues to serve clients with high acuities, who more frequently miss days due to illness, hospitalizations, medical appointments, and inclement weather. There were 5 inclement weather days that resulted in closing the program. Three additional days had very low attendance following inclement weather. 15% of the census are DDS clients, for whom it is estimated that they will miss 20% of scheduled day program days. There was a 9-month vacancy in a Human Service Aide position, which balanced out the lower than expected utilization rate. When the Commonwealth Coordinated Care (CCC) Program was implemented in FY 2015, it was anticipated that referrals would increase. Adult Day programs have been proven to reduce hospitalizations and re-admissions due to the skilled care and supervision provided during the day a cost savings to the managed care organizations (MCOs). However, this program has not generated any referrals. Because the program contracted with only one of the CCC MCOs, participants did not have choice in plans if they wanted to continue services. These participants either opted out of participating, or chose the MCO in which we participate. To educate the community about the program, the program collaborates with partners such as the Arlington Steering Committee for Older Persons, Employee Assistance Program, Federal Deposit Insurance Corporation, Long Term Care Commission, and the Volunteer Guardianship Program. Monthly Caregiver Support Groups and free memory screenings to the community are provided to increase awareness of adult day services while offering a benefit to the community. Marketing plan was not implemented due to a shift in budget priority, but funding is being explored for FY Forecast allows programs to establish policies on ratio based on services that are provided and by functional levels of participants Work with current Managed Care Organization to increase knowledge of adult day programs. Increase awareness of benefits to mutual clients and the cost savings to the MCO. Identify funding in FY 2017 and pursue the external marketing plan. Focus on increasing attendance by raising awareness of program in the community and re-branding the program. Continue to offer education and support to people in the community. Anticipate scheduling at 100% of capacity and utilization rate of 84% of capacity in FY Walter Reed Adult Day Health Care Center FY 2016 Page 5

6 Criteria Met Walter Reed Adult Day Health Care Center Measure 2.3 Adherence to activity requirements 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Percent of Activities Meeting or Exceeding Requirements 85% FY /40 Target: 93% 93% FY 2017 Summary The Therapeutic Activity Monitoring Tool was created to assess day program activities based on state regulations and best practice Domains assessed include activity content, facilitation, and communication Supervisors and program leaders assess approximately 7 activities per month This measure reports the percentage of activities that met or exceeded expectation on at least 93% of items assessed 85% (34/40) of activities exceeded the 93% rating goal 75% (30) at 100% and 10% (4) at 96% 15% (6/40) of the activities received 92% or less rating 7.5% (3) at 92% and 7.5% (3) at 76% What is the story behind the data? The new assessment tool was introduced in November 2015 Areas that demonstrated consistent strengths: staff maintaining high energy levels to keep participants involved, being attentive to individuals needs, using creativity in planning and implementing activities, and meeting the goals and objectives outlined in the lesson plans. Common areas that received Below Expectations: Group did not start/end on time, leader did not move around the room during activity, leader did not make enough eye contact or use positive body language, leader did not use proper enunciation or Recommendations Program Manager will evaluate efficiency and procedure of the tool. Streamline the monitoring process and reduce the number of groups that are evaluated. This is will make the process more user friendly and allow for thoughtful feedback and coaching to be provided to activity leaders. Review monitoring results in regularly-scheduled team meetings and supervision sessions. Develop trainings for staff that focus on the common areas that need development. Walter Reed Adult Day Health Care Center FY 2016 Page 6

7 volume, and the leader did not appropriately modify level of group to accommodate the levels of function of participants. It was difficult to review monitoring results with each staff due to program and staff schedules. Forecast 93% of the activities will meet or exceed expectations on the Therapeutic Activity Monitoring Form Walter Reed Adult Day Health Care Center FY 2016 Page 7

8 Percent of Respondents Measure 3.1 Walter Reed Adult Day Health Care Center Effect of program on the quality of life for family/caregivers and program participants 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Reported Quality of Life Improvement 94% 95% 100% 100% 100% Target: 90% 93% 93% 93% FY 2014 FY 2015 FY 2016 FY 2017 Caregivers with Improved Quality of Life Participants with Improved Quality of Life Summary 100% of caregivers (14/14) reported that their quality of life improved since the participant enrolled in ADHC. 93% of caregivers (13/14) reported that the participant s quality of life improved. Survey was mailed in June to caregivers of active clients; 14 of 35 responded for a response rate of 40%. What is the story behind the curve? Recommendations Satisfaction remains high o Caregiver quality of life exceeded goal o Participant quality of life exceeded goal Surveys were sent to those that had been attending the program at least 3 months Continue to explore family members perceptions of program impact on quality of life Response rate was 40%, an increase of 8% from last year In FY 2015, surveys were distributed electronically; to increase response rate in FY 2016, surveys were mailed in hard copy with annual forms and a self-addressed stamped envelope Caregivers report being very busy and may not take the time to complete surveys. With other items that require attention, such as annual physicals, income verification, and participant agreements, caregivers require multiple reminders to complete tasks Consider adding questions that gather information about why participants miss days and what families would do without adult day services Continue to emphasize the value of the survey so that families know the information is useful and a means to show validity to the program Consider alternative strategies to capture satisfaction data, such as focus groups or informal telephone surveys Walter Reed Adult Day Health Care Center FY 2016 Page 8

9 As an alternative to paper surveys, the program piloted calling families during the annual ISP to interview them about satisfaction; however, families had time constraints and seemed burdened with long calls Shortening the survey would limit valuable feedback about activities, food, and other comments Forecast FY 2017: Anticipate at least 93% of caregivers will report improved quality of life for themselves and participants Walter Reed Adult Day Health Care Center FY 2016 Page 9