Celebrating Aging in Arkansas

Transcription

1 Celebrating Aging in Arkansas Carmen Bowman, MHS Regulator turned Educator EDU-CATERING Catering Education for Compliance and Culture Change in LTC

2 13 years of culture change More really The Eden Alternative

3 Celebrating Arkansas

4 We have a lot to celebrate!

5 CMS=Culture Change Partner CMS has become a partner in the culture change movement and wishes to encourage innovations Culture Change now has a place on the CMS Administrator s Action Plan (Creating Home Symposium brochure) And the list goes on

6 2002 CMS satellite broadcast Innovations in Quality of Life the Pioneer Network QIO 8 th SOW 2006 Artifacts of Culture Change tool codeveloped by CMS and Edu-Catering 2007 CMS From Institutional to Individual Care Case Studies in Culture Change 4 part series Training to CMS Regional Offices on CC Dissemination of Culture Change Now magazine to SAs Culture Change Committee at CMS CO! Not to mention

7 Creating Home Symposium II

8 New Proposed Dining Standards stay tuned!

9 Regulators have supported CC all along the way New York state Eden s beginning Statute only one four legged animal per nh! *CMS Captains Beechinor and Chikering and Dr. Bill Thomas, founder of Eden Motorcycle Culture Change Tour in CA!

10 I felt surprised and wondered why did that statute pass in the first place? I felt frustrated and angry and resoluted in the sense that even though something has been put in my way, I was going to overcome it somehow. When I took the job, I vowed to visit every facility. In 10 years I had gotten to about 90%, and it was very frustrating, what I was seeing. So then I was told by a staff person about Chase and sought to visit it. That experience was just amazing. I knew I was seeing something I had never seen before. Amazing, unique, we ve got to bottle it. I told Dr. Thomas that if there was ever anything I could do, to let me know. It had the potential to revolutionize the system, and here I was presented with a law that no one even knew about, and I was supposed to stop them? I got so ticked off I decided this isn t going to stop me. I could lose my job, but so what? Not on this one, I m on the side of the angels with this one. I thought, what the heck, let s go! (Creating Home background paper, Bowman, 2008). Former NY Regulator Norm Andrewjeski:

11 State Success Stories California - CMS Western Consortium highly involved in Coalition, survey agency too, Dining Pilot Arkansas new legislation to allow for Green Houses, Eden, permit universal workers, rewriting state regulations to encourage culture change practices, survey agency leading culture change, grant project Oregon surveyor serves on a CC team! Rhode Island Individualized Care Pilot, Survey Director President of CC Coalition Kansas Secretary of Aging highly involved with CC now Secretary of Aging for DHHS

12 Mass/MN/MO/OH/TN survey agency highly involved OK survey agency led coalition activities, new law passed allows Green House architectural model WY LTC Choices Act 2007, 10 or less to a home NC survey staff person is coalition secretary, agency absorbs cost of qtr newsletter FL Beds against the wall legislation, Artifacts of CC study, 40 nh s, Retirement Research Foundation, coaches Colorado CMP Grants: Artifacts Collaborative and Surveyor Dialogue State Success Stories

13 Florida annual, five locations Texas annual three locations, in statute Kansas twice a year Missouri, Oregon, New York Many have started via coalitions, a new trend One tip: Relationship is the fundamental building block of a changed culture PN Joint Provider/Surveyor Training

14 Regulations do not stand in the way Pioneers around now over 13 years Person-directed care embodies what OBRA 87 intended What about the regs?

15 Keep Deficiencies & CC Separate There are two problems that invoke blame of the regs: 1) that providers sometimes haven't read them or use them as an excuse for not doing anything new, and 2) just because you are trying to do culture change doesn't mean that you might not be doing something badly - good intentions don't substitute for good performance. Mary Jane Koren, former New York State Survey Agency Director

16 You risk deficiencies every time survey takes place in your building. You can continue to provide care in the old way and risk deficiencies or move toward the new way and risk deficiencies. C. Bowman Risk

17 CMS supports CC CMS sees improved quality of life w/ CC. New Interpretive Guidance reflects CC. What about CMS?

18 AHFSA supports culture change more and more 2008 commitment to identifying Culture Change Contact in each state agency New culture change committee Individualized Care Committee. What about AHFSA?

19 All on a learning curve - share information. The Eden Alternative educates surveyors for FREE! AR 21 surveyors trained 4/08 SA is a public entity, providers should call with questions. Is it a reg or is it a surveyor s opinion? Culture change surveyor training? Role models of good language? What about the surveyors?

20 Often it is the interpretation of the regs by some surveyors that might make things difficult for innovators. That requires a different solution than eliminating the OBRA regs. Mary Jane Koren, former New York State Survey Agency Director Keep Survey/Surveyors & Regs Separate

21 Short stay rehab? Nice & choices Hospitals? Planetree Assisted living? Home or little NH? Home health? Eden at Home Hospice? ICFMR s? What about:

22 Creating Home symposium lead to: Pioneer Network Life Safety Task Force Submitted proposals to NFPA! Background paper to symposium NFPA presentations, papers Transcripts of entire symposium What about the LSC?

23 NFPA Proposals Residential Cooking - kitchen hood with grease removal capability and air flow, protected per UL 300A, a residential suppression system, 24 or less residents (Type I commercial hood not required). Open Kitchen - residential scale kitchens, 24 or fewer residents, to be open to the common areas and corridors, deactivation switch for cooking equipment, locked, only accessible to staff and a fire extinguisher in each kitchen area.

24 Corridors - Where the corridor is 8 feet, permits areas along the corridor to contain secured chair, bench or grouping of chairs that are specifically placed at strategic intervals to allow residents to sit and rest during Decorations - Increases percentage of wall and door areas for decorations (photographs, paintings) from 20% to 50% inside resident sleeping rooms, with sprinkler system, same requirement of day care centers and schools.

25 Fireplaces Currently fireplace is defined as an item having a fire box, a hearth and a chimney which includes gas log fireplaces that are actually heaters with gas fired logs but not real fireplaces. Clarifies that a gas heating device designed to look like a fireplace is not a solid fuel fireplace so it can be permitted inside the sleeping room areas.

26 Life Safety Task Force Food and Dining Clinical Standards Task Force Promising Practices in Dining Design on a Dollar Early Adopter Outcome study Consumer Awareness project What about our national movement? Pioneer Network

27 Annual Pioneer Network Conference Join us! August 1-3, 2011 St. Charles Missouri St. Louis Area THE conference to be at!

28 Medicare P4P Quality Based Purchasing Abt study for Medicare, studied use of Artifacts of CC Medicaid P4P Colorado incorporates CC Michigan additional $5.00/person for private room (nh)in capital cost formula! State-owned Medicaid rules go make some worthwhile changes! What about reimbursement?

29 An institutional culture can be changed with no/little money, otherwise a wise investment b/c CC Outcomes Increased census Decreased turnover Higher satisfaction More efficient Money to be saved No More Excuses What about money?

30 Good Customer Service = $ Crestview: $20,000 saved in not wasting food, $90,000 in inc. products

31 Engagement vs. Disengagement Activity programming or Living Life? The Chateau Assisted Living Residence Englewood, CO

32 Living Life Real Life

33 Sewing and Ironing That s s living life!

34 Can be used for bad or for good Administrators are world makers. Eden In 11 years, you are the first surveyor to ever introduced yourself to me Surveyors, a compliment goes a long way! What if you required your surveyors to give compliments? What if? Power

35 People have to have a willingness to analyze the regulatory outcomes. We just do surveys over and over and over again and rarely have time to step back and actually look at what did we find? What did we tell the provider? What did we accept as a plan of correction? Ray Rusin, RI SSA Dir. Former AHFSA Pres, RI CC Coalition Dir.

36 What if surveyors started to investigate and cite: that residents were not given choice? that residents find bibs undignified? that lighting is not bright enough for residents? that closet rods are out of reach for residents? that inconsistent staff leads to inconsistent care? that residents know they are called feeders or other labels by staff and they find that disrespectful? that a new order was not pursued from the physician when another is refused? alarms were causing more harm than good? that residents are not being asked their ideas concerning proposed policy and operational decisions of the facility?(tags 243/244) Surveyors, you have great opportunity to find out what is meaningful to residents and help change institutional cultures!

37 The Worth of a Worthwhile Deficiency Breakfast Cooked-to to-order

38 Fairacres Greeley, CO Weller s s Bistro

39 Facility must listen to views/ act upon grievances and recommendations concerning proposed policy and operational decisions affecting resident care and life in the facility Wow is that happening in your home? Are you surveying for that? *Community Meeting that discusses budget *Why should I pick the paint? Tags F243/F244 Participation in resident and family groups

40 Surveyors hold providers accountable Do providers hold surveyors accountable? Speak from experience: Come with me. Show me it s not deficient. Highest compliment for a surveyor to be known as fair Fairness

41 I can t tell you how to do it/consult CMS already humanized this/gave an out INFORMATION TRANSFER You can refer to other homes You can share what you ve seen You can be helpful (just not consult/tell how) Humanizing Survey

42 Gotcha attitude We eat them up and spit them out. Nancy Fox We write people up and fire them. Changing that institutional culture is about growing people. Eden Humanizing LTC

43 Proposed New Dining Practice Standards Pioneer Network Food and Dining Clinical Standards Task Force Sponsored by: February, 2011

44 Proposed New Food and Dining Clinical Standards Diet Liberalization: Diabetic, Low Sodium, Cardiac Altered Consistency Diet Tube Feeding Real Food First Honoring Choice Shifting Traditional Professional Control to Support Self Directed Living New Negative Outcome

45 AMDA ADA CMS Research Trends Current Thinking Recommended Course of Practice Each Section includes:

46 American Medical Directors Association (AMDA), National Association Directors of Nursing Administration in Long Term Care (NADONA), Coalition of Geriatric Nursing Organizations, (9 orgs), American Dietetic Association (ADA), American Society of Consultant Pharmacists, American Occupational Therapy Association, American Speech-Language-Hearing Assoc. National Association of Healthcare Assistants, Dietary Managers Association Food & Dining Clinical Standards Task Force Standard Setting Organizations

47 Recommended Course of Practice Diet determined with the person not exclusively by diagnosis. Assess the condition of the person. Include quality of life i.e. satisfaction with food, meal time service, control, independence. Unless a medical condition warrants a restricted diet, consider beginning with a regular diet and monitoring Empower and honor the person first, whole interdisciplinary team second, to look at concerns and create effective solutions. Support self-direction and individualize the plan of care. Ensure that the physician and consultant pharmacist are aware of resident food and dining preferences so that medication issues can be addressed and coordinated i.e. medication timing and impact on appetite.

48 Monitor person and condition related to their goals regarding nutritional status, physical, mental and psychosocial well-being. Although a person may have not been able to make decisions about certain aspects of their life, that does not mean they cannot make choices in dining. When one makes risky decisions, plan of care will be adjusted to honor informed choice, provide support to mitigate risks. Most professional codes of ethics require professional to support the person in making their own decisions.

49 When caring for frail elders there is often no clear right answer. Possible interventions often have the potential to both help and harm the elder. This is why the physician must explain the risks and benefits to both the resident and interdisciplinary team. The information should be discussed amongst the team and resident/family. The resident then has the right to make his/her informed choice even if it is not to follow recommended medical advice and the team supports the person and his/her decision, mitigating risks by offering support, i.e. offering foods of natural pureed consistency when one refuses recommended tube feeding. It is when the team makes decisions for the person without acknowledgement by all that problems arise. The agreed upon plan of care should then be monitored to make sure the community is best meeting the resident's needs.

50 All decisions default to the person. Endorsement by organizations Used by nursing home profession Standards get referred to by CMS A Bright Future

51 A national commitment Each state s commitment A society s commitment LaVrene Norton of Action Pact teaches: An organizational commitment A physical commitment, and A personal commitment Changing institutional culture takes:

52 What is your call to action?

53 Regulatory Support for Culture Change Quality of Life: Differences between Deficient, Common and CC Practice Living Life to the Fullest: A Match Made in OBRA 87 Meaningful Activity Assessment SOFTEN the Assessment Process & DVD Building Coalitions Changing the Culture of Care Planning Resources (C Bowman, Action Pact)

54 Every 3 rd Friday 1 jam-packed hour Culture change training directly into your home and to your team Sponsored by Action Pact culturechangenow.com June 17 The Role of the Pharmacist in Person- Directed Care Denise Hyde, PharmD July 15 Dining Compliance and Culture Change Linda Handy, RD, Retired CA Surveyor

55 So, who will be the first no bib state? No get up state? Go for it Arkansas! Edu-Catering Catering Education for Compliance and Culture Change educatering.com