The Value, Cost, & Sustainability of Deep Culture Change. Welcome & Introductions. Discussion Overview

Transcription

1 The Value, Cost, & Sustainability of Deep Culture Change Welcome & Introductions Robert Jenkens, Director The Green House Project, NCB Capital Impact Inc. John Ponthie, Member Summit Health Resources, LLC 2 Discussion Overview Green House model of deep culture change quick overview: Key principles and practices Summit Health Resources story October 20 th webinar detailed The value of deep culture change GHP research results: Satisfaction Clinical Financial Summit Health Resources experience The sustainability of deep culture change 5 years and 100 Green House homes Discussion 3

2 4 Green House Project Goal We did the best we could with what we knew. And when we knew better, we did better. Maya Angelou Green House Beliefs Nursing homes are a necessary service Very good people live and work in nursing homes Nursing homes can deliver good quality clinical care with current practices Can not deliver good quality of life or jobs We have everything we need today the knowledge, talent, and resources Half measures are not sufficient nor sustainable 5 Green House Transformation Radical transformation within current nursing home regulatory and reimbursement structures Simultaneously changes: Philosophy of care Architecture Organizational structure Weaves changes together into a fabric stronger than the individual threads Simultaneous change allows new efficiencies Full transformation delivers good lives and good jobs essential inspiration for sustaining change GHP creates real homes that provide physical and organizational barriers to institutional creep slip resistant change 6

3 7 Philosophy All people, no matter how disabled, deserve meaningful lives in real homes Meaningful lives require control, being known, and reciprocal relationships Control requires that decisions are placed with the elders and the staff who know them best Supporting choices requires flexible operations that can respond to individual preferences Becoming known requires clear strategies for intentional community Reciprocal relationships require deep relationships Reorganization House: Staffed by Shahbazim a versatile staff position providing direct care, housekeeping, laundry, cooking, and enrichment Shahbazim work in self-managed teams Versatile Shahbaz position allows direct care staff flexibility to reorganize continuously to meet elders preferences and needs delivering control Desegregated staffing model puts time in the house allowing meaningful relationships between staff and elders to develop Relationships allow people to be well known to each other and opportunities for reciprocity 8 Reorganization Traditional hierarchy redesigned to balance life with treatment Clinical and departments support homes in a partnership model much like home health Shahbazim s homemaker work not directed by clinical staff work in partnership on personal care through Guide Shahbazim are coached and held accountable by the Guide Nurses coached and accountable to the DON Guide facilitates collaboration between all care and clinical partners All staff extensively trained in philosophy, principles, practices, coaching and selfmanagement skills 9

4 10 Architecture Green House homes and site designed to be similar to the housing in the community: Single family style in rural and suburban areas Low-rise, garden apartment style in dense suburban and low-rise urban areas High-rise in dense urban areas Each best under 7000 NSF Summit Heath Story Mission Trip to first The Green House Project pilot site Why Summit selected the Green House model Growth plan Partnership with state Experience with the model so far Support from The Green House Project 11 Research - NIC Senior Housing and Care Journal (Sept. 2011) 12

5 13 NIC Article Addresses Main GHP Questions Do elders, staff, and family really like it better? If it is really a home, can the care be as good? If it is really better, doesn t it have to cost more? NIC Article - Outcomes Review Kane: JAGs 2007 Satisfaction and Clinical Compared 4 pilot GH homes to traditional NHs Significant improvements in elders, family, and staff satisfaction Better clinical outcomes Sharkey: JAGS 2011 Staff Time and Clinical Compared 14 GH homes to traditional nursing homes Acuity the same between settings Fewer total direct care, nursing, or departmental hours in GH homes Same or better clinical outcomes ½ hour more direct care time 4 times more engagement between staff and elders Bowers: Gerontologist (Expected 2011/2012) Nursing Care Quality Qualitative research at GH homes Seamless communications and deep relationships Nursing care as good or better than traditional 14 NIC Article - Operational Costs Analyzing new and existing research, found: Over all FTEs and operating costs equal 5% reduction in nursing and non-nursing hours 68% reduction in admin/clinical leadership GHP median operating costs within ¾% of national median (+$1.49/day) GHP average operating costs are between the 50 th -60 th percentile of NH costs nationally Case studies: 1.3% lower to 2% higher overall staffing costs including 5% Green House project wage increase for CNAs 15

6 Core Labor Hours Traditional Nursing Home Green House Home Traditional Green House 16 Total Time Per Resident Day Traditional Nursing Home Green House Home 60 fewer minutes per day 6 Hours 58 Minutes 5 Hours 58 Minutes 17 Comparative Operating Costs Department Average Operating Expense Per Resident Day National Median Green House Homes Nursing Dietary Laundry & Linen Housekeeping Plant Operations Ancillary Services Administration Other Expenses (excluding capital) Total Expenses (excluding capital) $ $

7 Operating Expense Per Resident Day 28 % 32 % 8% 8% 4% 4% 8% 4% 19 NIC Article - Capital Costs Analyzing new research, found: Capital costs are at the low end of deep culture change models including all private rooms and baths Green House homes preferred: SF/ resident, average 659 SF/resident Household and neighborhood models of culture change average between SF/resident Small house, non GHP: 794 SF/resident Compared to traditional models of NHs with all private rooms (350SF/resident), GH homes (650 SF/resident) capital costs likely add $8.69/day 20 NIC Article - Financial Benefits Analyzing new research, found: Occupancy increases: GH homes average 96% in 2009 and climbing National average 89% and falling Private pay occupancy increases: GH homes increased private pay days by 24% between Nationally, NHs lost 5% private pay days in same period Private pay rates increase with private rooms Nationally, private rooms command 11% more than semi-private Some markets, private rooms + 86% GH homes offer all private rooms Green House homes at top end of deep culture change models shown to reap greatest satisfaction, quality, & financial rewards 21

8 Revenue Enhancements Higher Occupancy Rates More Private Pay Residents Higher Private Pay Rate 96% Average new resident days per 100 units: 2, Revenue Enhancements per 100 Units Revenue from Enhanced Occupancy $529,980 Additional Revenue from Existing Private Pay Residents $132,822 Total Additional Revenue $662,802 Marginal Cost of Providing Additional Care $262,800 Net Revenue Enhancement (available for debt service) $400, System Costs Recent Additional Analysis: Pressure Ulcers: In-house acquired pressure ulcers - GH homes 0%, traditional units 4.2% Hospitalizations: 30% to 75% fewer hospitalizations than national average Potential savings: $1K per elder per year 24

9 25 Summit GH Home Performance To Date Market response Occupancy Private pay and Medicaid rates Operational costs vs. traditional Capital costs Margins Return on investment Market Response - The Media Rising Challenger Takes on Elder-Care System Culture Change Goes Mainstream - Green House Homes, Considered the Pinnacle of the Movement, Spread to 26 States Green House Homes: A Model for Aging That Promotes Growth Where We Live As We Age Reformers Seek To Reinvent Nursing Homes Rethinking Old Age Home Sweet (Rest) Home A Healthier Take on a Nursing Home A Nursing Home You Can Call Home 26 The Green House Project Comprehensive Culture Change Model Strong consumer response Product differentiation in crowded markets Proven Model: Known performance satisfaction, clinical, financial Proven efficiencies Revenue enhancement opportunities Evidence-based implementation approach and tools Sustainable Model On-going and customized education & support Peer Network On-going research Slip-resistant Agile Model: Flexible to meet fast changing LTC environment: Small house allow flexibility and incremental growth Self-sufficient homes allow specialization 27

10 28 Sustainability (7/29/11) Operating 113 homes On 27 campuses In 18 states (AK, AL, AR, AZ, GA, KS, MA, MI, MS, MT, NE, NJ, NY, PA, TN, TX, WA, WI) In Development 161+ homes On 29 campuses In 11 additional states (CA, CO, FL, KY, IL, MD, ME, NC, OH, VA, WY) Totals 278 homes On 56 campuses In 29 states Discussion Questions? Comments? More information: