Program Purpose Program Information Arlington Adult Day Program ADSD/CSCB Michael DiGeronimo x0965 Improve the quality of life for adults with age-related or developmental disabilities and their families. The program changed its name in May 2018 as a result of a rebrand and marketing effort suggested during the PMP 2016 process. Mission is to provide personalized care to adults with healthcare needs and disabilities, giving them the ability to live at home longer while providing relief and guidance for their caregivers. 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 Social 60+ Cafes. The Center is licensed for 40 participants based on physical space; however, the actual maximum daily capacity is 24, 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 (60%), developmental disability (18%), and serious mental illness (12%). Other diagnoses (10%) include Parkinson s disease, traumatic brain injury, cerebral palsy, and stroke. Participant age ranges: 64 years and younger (16%), 65 to 74 (24%), 75 to 84 (37%), and 85 and older (23%). A small portion of participants have dual diagnoses (2), including a mental health diagnosis and a history of substance abuse; however, none of those participants are actively using. Participants are 40% male and 60% female. Participant acuity level is based on a 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 (8%), level 2 (18%), level 3 (32%), level 4 (30%), and level 5 (12%). Program participants and caregivers have participated in evidence-based research studies from Penn State and Marymount University, focusing on caregiver stress, muscle memory, and balance in people with Alzheimer s Disease. 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 Arlington Adult Day Program FY 2018 Page 1
Customers and Service FY 2016 FY 2017 FY 2018 Total Number Served 56 55 58 Average Daily Attendance 19 21 21 Average Monthly Census 34 38 39 PM2: How well did we do it? 2.1 Compliance with Virginia Department of Social Services licensing requirements 2.2 Utilization rate 2.3 Adherence to activity requirements PM3: Is anyone better off? 3.1 Effect of Arlington Adult Day Program on quality of life for family/caregivers and program participants Arlington Adult Day Program FY 2018 Page 2
Measure 2.1 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Arlington Adult Day Program Compliance with Virginia Department of Social Services Licensing Requirements Maximum License Possible and License Received FY 2012 FY 2015 FY 2018 FY 2021 (proj) Max License Possible License Received FY 2016 FY 2017 FY 2018 FY 2019 (proj.) Number violations on annual audit 0 0 0 0 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, 2015 and 2018 Licensure granted for next 3 years (2021). What is the story behind the data? 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 2018 audit yielded no violations. In FY 2019, updated state regulations will require additional staff training. The program already meets these new requirements. Forecast Recommendations 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. FY 2019: Anticipate obtaining a three-year license at next review in 2021. Arlington Adult Day Program FY 2018 Page 3
Measure 2.2 Utilization Rate FY 2017 PERFORMANCE PLAN Arlington Adult Day Program 30 25 20 15 19 Scheduled and Attended Days as Percent of Capacity 21 Utilization Goal: 24 24 24 23 21 21 21 10 5 0 FY 2016 19 (76%) 21 (84%) FY 2017 21 (84%) 23 (92%) FY 2018 21 (88%) 24 (100%) FY 2019 (proj.) 21 (88%) 24 (100%) Average Attendance Actuals (Utilization) Average Scheduled Attendance Summary Average daily attendance was 88% in FY 2018, the same number of participants as FY 2017. The percentage increase is due to the change in daily capacity from 25 to 24. Scheduled attendance increased from to 92% in FY 2017 to 100% in FY 2018 (equivalent to 1 participant). Capacity in FY 2015 and 2016 was 25 clients per day. In FY 2017, capacity was adjusted to 24 based on staffing. In FY 2018, the average daily attendance was 21 and the average scheduled attendance was 24. What is the story behind the data? In FY 2018 the program had fewer admissions (15) and discharges (13) than the previous year. However, actual attendance remained the same, due to currently enrolled participants increasing days of attendance. Retention of participants was higher in FY 2018. Program served an average of 38 people per month, with participants scheduled days varying from 2 days a week to 5 days a week. Discharges occurred due to events such as long-term care placement, declining health, voluntary discharge and death. Program attendance is based on individual participant acuity. The program allows for over-booking to balance the Recommendations Continue to offer education and support to people in the community through inquiry calls and 1:1 requests. Prior attempts for a regular support group yielded only 1 or 2 caregivers, thus 1:1 is meeting more caregiver needs. Continue to collaborate with local support groups and use as referral source for those seeking group support. Plan and implement one caregiver training session for Spring 2019 with focus on dementia training. Anticipate an increase in program Walter Reed Adult Day Health Care Center FY 2017 Page 4
cancellation rate. Two additional spots were allowed Mondays, Tuesdays, Thursdays, and Fridays. Wednesday census was limited to 24, as we tend to be fully staffed mid-week. Scheduled Attendance does not reflect participants that were on extended leave in FY 2018 due to hospitalization, rehabilitation, or travel. It was identified that an alternative tracking method needed to be developed to track these participants however, we were unable maintain a reliable manual data collection system. There was an average of 2.5 unduplicated people on the waiting list for 6 months of FY 2018. It was comprised mostly of current participants that needed additional days and a few new participants. Program continues to serve clients with high acuities, who more frequently miss days due to illness, hospitalizations, medical appointments, and inclement weather (e.g., 6 inclement weather days resulting in closing in FY 2018). 18% of the census are DDS clients, for whom it is estimated that they will miss 20% of scheduled day program days. interest because of external marketing tools that were designed. Forecast Anticipate scheduling at 100% of capacity and utilization rate range of 88% to 91% of capacity in FY 2019. Arlington Adult Day Program FY 2018 Page 5
Criteria Met Arlington Adult Day Program Measure 2.3 Adherence to activity requirements 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Adherence to Activity Requirements 95% 95% 93% FY 2017 23/24 FY 2018 23/24 Target: 93% FY 2019 (proj) 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. Supervisor assess approximately 2 activities per month. This measure reports the percentage of activities that met or exceeded expectation on at least 93% of items assessed. 95% (23/24) of activities exceeded the 93% rating goal 83% (19) at 100%, 4% (1) at 96%, and 13% (3) at 93%. One activity was below target, at 85%. What is the story behind the data? Areas that demonstrated consistent strengths: using creativity in planning and implementing activities, increased collaboration of staff planning special themes and special events, staff maintaining high energy levels to keep participants involved, being attentive to individuals needs, and following the lesson plans. Regular Field Trips resumed after a two-year hiatus, following updated policy and procedure guidelines. Areas identified for needing improvement were ending groups on time and activity leaders moving around the room more. Forecast Recommendations FY 2019: 93% of the activities will meet or exceed expectations. Program Manager will continue to evaluate efficiency and procedure of the tool and incorporate feedback of new hires to ensure it provides userfriendly feedback. Continue to review monitoring results immediately with staff or in regularly-scheduled supervision sessions. Develop trainings for staff that focus on the common areas that need development. Arlington Adult Day Program FY 2018 Page 6
Precent of Respondents Measure 3.1 Arlington Adult Day Program 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 100% 93% 100% 100% 100% 92% Target: 90% 93% 93% FY 2016 FY 2017 FY 2018 FY 2019 (proj) Caregivers with Improved Quality of Life Participants with Improved Quality of Life Summary In FY 2018, 92% of caregivers (16/17) reported that their quality of life improved since the participant enrolled in ADHC. 100% of caregivers (17/17) reported that the participant s quality of life improved. Survey was mailed in June 2018 to caregivers of active clients who have been in the program at least 3 months; 17 of 36 responded for a response rate of 47%. What is the story behind the data? Satisfaction remains high - participant and caregiver quality of life exceeded goal. Comments on the survey included: o Participant s self-esteem has been boosted. Staff is very encouraging. o My loved one really likes the Pet Therapy, so much so, we adopted 2 dogs! o Due to the shock of participant s diagnosis, I don t know what we would have done without AADP. o All of the activities help her sleep at night. They have helped her tremendously. o Staff members are caring. o The current staff are exceptional. o The staff is excellent- caring, loving, smart, thoughtful, and professional. o Thank you for the vital service that has changed our family s life for the better. You all are a blessing to all of us. Recommendations Continue to explore family members perceptions of program impact on quality of life. Continue to emphasize the value of the survey so that families comprehend the information s utility, and how it highlights the program s validity. Arlington Adult Day Program FY 2018 Page 7
o o Every day, I count you among my many blessings. Thank you very much for everything you do to help my mother. I am dealing with my own age-related health issues. The Arlington Adult Day Program enables me to get to my own Dr. appts and chores. I wish to care for my mom at home as long as possible. AADP makes this achievable for us. THANK YOU!! Surveys were mailed with a self-addressed envelope to participants caregivers. Surveys were sent to those who had been attending the program at least 3 months. Response rate was 47%, an increase from 33% in FY 2017. 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. Forecast FY 2019: Anticipate at least 93% of caregivers will report improved quality of life for themselves and participants. Arlington Adult Day Program FY 2018 Page 8