Servant Leadership and Technology Approaches within Long-Term Care that Promote Independence Daphne Glenn, MPT, MBA, MHSA, LNHA Administrator Daniel Drake Center SNF and Bridgeway Pointe Assisted Living
Overview: Impact of Aging Demographics Servant Leadership Concepts and promotion of independence Technology used in Assisted Living to promote independence Case Studies
Learning Objectives: To describe how servant leadership within long-term care settings may foster relationships and promote independence. To cite examples of how technology has been used in the long-term care setting of assisted living to promote independence and aging in place
Aging Demographics and Long-Term Care
Senior Aging Services Housing and Trends Long-Term Care providers face significant demographic, financial, policy, and image challenges: Rapidly growing senior population Rising acuity rates Higher cost of care Caregiver shortage Newer generations have higher expectations of care
Impact of Dementia Alzheimer s Disease International est. 44.35 million people with dementia in 2013, 75.62 million by 2030, 135.46 million by 2050 (worldwide). 13.8 million people living with Alzheimer s disease in US. by 2050. Approx. 1 in 8 adults over age of 65 Approx. 1 in 2 adults over age of 85 Dementia has become more expensive than cancer and heart disease (US census and Health/Retirement Study,2013) Dementia costs: $109 billion or $159 billion if consider costs of unpaid care by friends/family or $215 with care provided in facility Heart disease costs: $102 billion Cancer disease costs: $77 billion Alzheimer s Association (includes early dementia) est. future costs of $1.2 trillion by 2050.
Managed Care Trends Data Sources: 1: U.S. Census 2: U.S. Bureau of Labor Statistics 3: Kaiser Health News, Jan 2012 4: Annals of Family Medicine, Nov 2012 5:The Fiscal Times, Jan 2012 Boomers The number of Americans over 65 will double from 35 million to 70 million by 2030 Caregiver Shortages 1 1.2 million nurses needed by 2020 Primary care physician shortage of 52,000 by 2020 2 Facility Shortages 2007-2011 nursing home construction declined by 33% Average loss on Medicaid patient is $20/day 4 3 5
Reduce Wasteful Spending Potentially Avoidable Hospital Admissions (Cost per admission) ALOS Ave Cost $14,896.00 $10,976.00 $12,152.00 $12,544.00 $11,386.00 5.6 6.2 6.4 7.6 5.8 COPD CHF Dehydration Pneumonia UTI 25% of all hospital admissions for duals are avoidable Five conditions account for 80% of potentially avoidable hospitalizations Duals average 3 hospital stays per year
In 2011, $357 billion was spent on Long-Term Care services and supports. Reduce Medicare, Wasteful Medicaid and Private Spending Insurance paid 68% of the total bill, putting substantial burden on tax payers and at-risk managed care providers. $100,000 $90,000 $80,000 $70,000 $90,000 $60,000 $50,000 $40,000 $30,000 $42,600 Average Annual Care Costs by Service Type $20,000 $10,000 $20,800 $0 Nursing Home Assisted Living Home Health Remote Monitoring $1,500
Servant Leadership and Role in Aging Services
Servant leadership begins with the natural feeling that one wants to serve, to serve first. Then conscious choice brings one to aspire to lead The difference manifests itself in the care taken by the servant-first to make sure that other people s highest priority needs are being served. The best test is: do those served grow as persons; do they, while being served, become healthier, wiser, freer, more autonomous, more likely themselves to become servants? And, what is the effect on the least privileged in society; will they benefit, or, at least, will they not be further deprived? (Greenleaf, 1970, p.15)
Historical Basis of Servant Leadership Robert K. Greenleaf coined term Servant Leadership and founded Greenleaf Center for Servant Leadership Many leadership writers support servant leadership: Bennis, Blanchard & Hodges, Covey, DePree, Sennge are a few. Many organizations use ideas of servant leadership: Starbucks, AT&T, Southwest Airlines, Vanguard Group, Ritz-Carlton
Six Key Components to Servant Leadership Value people Develop people Build community Display authenticity Provide leadership Share leadership
10 Characteristics of a Servant Leader Listening-Listen First Empathy- Standing in the shoes of another Healing-Care about the whole person Awarenessunderstanding oneself and impact on others Persuasion-Clear communication creating change Conceptualization-being a visionary for the organization Spears (2002) Foresight-ability to know the future Stewardship-leader takes responsibility for their role Commitment to the growth of people-each person is unique and adds value to organization Building a Communityindividuals with shared interests and a sense of unity
The capacity to Influence others by unleashing their power and potential to impact the greater good (Blanchard, 2010) (Servant Leadership Questionnaire handout)
How do we achieve this in LTC with Servant Leadership? Focus on Staff Focus on Residents Focus on Families Focus on STRENTGHS of each INDIVIDUAL
Situational Leadership used to Increase Independence with each Stakeholder
Outcomes of Servant Leadership in LTC: Staff Performance and Growth Resident Performance and Growth Family Involvement Increases Organizational Performance increases by increasing LOS in Assisted Living and increasing efficiency of staff. Community Involvement Increases Societal Impact of successful aging in place occurs. (from Liden, Wayne, Zhao, Henderson, 2008)
Technology used in Assisted Living to promote independence Meets people where they are Supports abilities Increases communication Predicts behaviors
Goal at Bridgeway Pointe Assisted Living/UC Health To help residents live safely and without locked environment while experiencing Great Life Moments. To support and connect staff with knowledge regarding residents To assist families with managing the journey of aging parents
Bridgeway Pointe Safety Net - Customizable to Help Maintain Independence Emergency Call Pendant Locator Compassionate Nurses 24/7 Resident Full Apartment Sensor System Wander Sensors
Healthsense eneighbor System Activity of Daily Living (ADL) Monitoring Call Pendant Contact Sensors Motion Sensors Bed & Toilet Sensors Biometric Vital Sign & Wellness Monitoring Weight Scale Blood Pressure Pulse Oximeter Glucometer 1 Continuously Monitor Daily Living Activities Healthsense hardware generates wireless signals of activity. Data securely and seamlessly sent to cloud. 2 Analyze Data to Identify Risks to Patient Health Machine learning used to detect and predict unusual activities and generate reports through portal. 3 Intelligently Inform Caregivers of Senior Needs Caregivers are alerted through call, text, or email to provide assistance or care to seniors. 011010101 Encryption
Servant Leadership. Identify Strengths Customize Technology Support
Servant Leadership and Technology Outcomes at Bridgeway Pointe/UC Health: Staff Performance and Growth Resident Performance and Growth Family Involvement Increases Organizational Performance increases by increasing LOS in Assisted Living and increasing efficiency of staff. Community Involvement Increases Societal Impact of successful aging in place occurs. (from Liden, Wayne, Zhao, Henderson, 2008)
Bridgeway Pointe Assisted Living Case Studies:
Real-World Case: Margaret Name: Margaret Age: 76 Health: Dementia, Night Wandering Solution: Door Sensors, Bed Sensor Customized Solution: 1. Staff have identified Margaret to have increased confusion at night and some wondering periods 2. Family has been informed of concerns and they also note some increased confusion. 3. Decision made to incorporate door sensor and bed sensor into care plan. 4. Emails sent to care team to notify patterns of door opening and bed unloading. 5. Calls made to care team during specific times to notify of door openings and need to check on resident. 6. Resident behavior monitored and resident is still able to live in current apartment with this minimal added support.
Name: Ron Age: 79 Health: Dementia, loves to walk and not able to find his way back when leaving facility. Solution: Wander Pendant Customized Solution: 1.Ron loves to walk. He wants to please and does not want to cause anyone trouble. However, he cannot find his way back when leaving the facility but he is able to enjoy courtyards and grounds safely. 2. Decided to use wander pendant. 3.Ron, was willing to use pendant but would forget to put it on in the morning. Used signs by the door and bathroom mirror that reminded him to check and created at pendant home with family for consistency of placement. Also used phone calls to remind him to wear pendant, since he wakes at the same time each day. 4.Result-Ron soon learned where he could go in the facility and would wear pendant consistently.
Name: Rosie Age: 85 Health: Active but has frequent UTIs and she will become very confused. Solution: Apt sensors with toilet and bed monitor sensor monitors and exception notifications Customized Solution: 1. Rosie is active but is observed to have frequent UTIs. This can cause her significant confusion. Staff have identified that early intervention and diagnosis can help her maintain her active lifestyle. 2. Used apt sensors that enabled the use of toilet and bed sensors to be used to identify frequency of toilet use. 3. When exceptions are noted outside of her usual patterns, care team is notified and testing can be done to determine if medication is needed. 4. Result-Proactive care provided and confusion avoided if possible.
Name: Sue Age: 83 Health: Significant Dementia, Wandering during day/night, changes in mood and weight Solution: Wander pendant, Full apartment system Customized Solution: 1.Staff have identified Sue to progressed dementia. She is wandering but is easily redirected, her mood has changed and her weight has changed. 2. Family has been informed of concerns and they do not want her placed in a locked unit. They want her to stay in her third floor apartment as long as possible. 3.Decision made to use full apartment support system, wander pendant, web portal for behavior monitoring, emails to care team for exception patterns and calls to staff for door openings. 4.Staff provide support by going to resident when calls are received and checking on resident 5.Medications are changed to better support sleep patterns, resulting in resident s mood improving 6.Calls set up via system to remind resident to go to cabinet/fridge to obtain food. Sensor on doors can determine if resident went. Weight improved. 7. Successful in keeping resident in current apartment for 18 months after initial recommendation to move to locked unit. Collaborative efforts from care team and family.
Servant Leadership and Technology Working to Create Great Life Moments at Bridgeway Pointe Assisted Living (short video)