Commercial Market Place and Nursing Home Transformation: Following Consumer Demand

1
Commercial Market Place and Nursing Home
Transformation Following Consumer Demand

• Bonnie S. Kantor, Sc.D
• Executive Director, Pioneer Network

2
Opportunities for Nursing Home Transformation
Opportunity for practice, research and policy to
view quality and efficiency as interconnected
outcomes.
Improved quality of care and measurable Financial
success
Resident-centered Adaptations
3

• Who here is aging?
• When did you start aging?
• And where have you always lived?

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Home vs. Homelessness

• Home
• Identity
• Connectedness
• Lived Space
• Privacy
• Power/Autonomy
• Safety Predictability
• Journeying

• Homelessness
• Non-Personhood
• Disconnectedness
• Meaningless Space
• Without boundaries
• Powerless/Dependence
• Insecurity/Uncertainty
• Placelessness

Carboni (1990)
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Culture Change

• Renewal of Personal Transformation
• Re-organizing the work
• Renovating the Physical Environment to Create Home

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Pioneer Network Founding Principles

• Know each person
• Community is the antidote to institutionalization
• Practice self-examination, searching for new
  creativity and opportunities for doing better
• Relationship is the fundamental building block of
  a transformed culture

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Pioneer Network Founding Principles

• Risk Taking is a normal part of life
• Put person before task
• All elders are entitled to self-determination
  wherever they live
• Recognize that culture change and transformation
  are not destinations but a journey, always a work
  in progress

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Our Vision

• A culture of aging that is life-affirming,
  satisfying, humane and meaningful.

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A clear understanding of the elder

• Where are you from?
• What is your personal history?
• What is your preferred typical day?
• Who do you want to be in the future?

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• Quality is not a program it is an outcome that
  evolves from organizational culture focused on
  the customer and organizational excellence
• AAHSA 2005

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Person Directed Practices Overlap with Varying
Degrees of Choice and Autonomy
Staff Directed (agency scheduled
routines/staffing dictate care provision)
Consideration of Individual (Seek persons input
and tailor some aspects)
Individual Choice (Offers choices of food,
waking, bathing etc.)
Individual Control (have right of refusal and
right to take risks)
Person Directed (Individual has primacy --
determines own schedules, activities, meals, and
caregivers)
Degree of Person-Directedness
Developed by the Lewin Group
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Are the values of choice, respect, and
self-determination implemented here?
The Question Consumers WILL Ask is
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What Culture Change Is About

• Honoring individuality of residents and staff
• Creating home
• Person vs. task focus

• Creating a new way of being and thinking related
  to aging.
• Creating responsive systems.

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Paradigm Change

• INSTITUTIONAL
• medical
• treatments
• task focus
• float staff
• staff make decisions
• structured activities

• PERSON-DIRECTED
• social/holistic
• nurture spirit
• care matches needs
• consistent assignments
• residents make decisions
• spontaneous activities

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Paradigm Change (cont.)

• INSTITUTIONAL
• schedule for convenience of staff/administration
• facility belongs to staff
• sense of isolation and loneliness
• departmental focus

• PERSON-DIRECTED
• schedule adjusted for resident and staff needs
• facility is residents home
• sense of belonging and community
• team approach

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Opportunities for Nursing Home Transformation
Opportunity for practice, research and policy to
view quality and efficiency as interconnected
outcomes.
Improved quality of care and measurable Financial
success
Resident-centered Adaptations
17
Research on Outcomes Associated with Network
Participation

• In the first empirical, comprehensive study of
  the Pioneer Network, research examined if early
  adopter participants achieved financial and
  quality outcomes that were significantly
  different from outcomes of non-participant
  homes.
• CMS provided data from 1996 (pre-participation in
  the network timeframe) and 2003 (participating in
  the network for at least one year).
• Source Elliot, et al. (2007)

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Quality of Care Results

• Findings comparing quality of care outcomes of
  homes participating in the network to analogous
  control homes denote that early adopter homes
  achieved statistically significant improvement in
  quality of care over control homes.
• In a multivariate analysis of all homes certified
  by CMS in 2003, coefficient estimates indicate
  that length of time participating with the
  network positively affected quality of care.
• Source Elliot, et al. (2007)

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Efficiency Results

• This research also evaluated the effects of
  Pioneer Network participation on the per bed net
  income and operating margins of early adopter
  homes versus analogous control homes and produced
  the following findings
• Overall, homes participating in the Pioneer
  Network displayed statistically significant
  improvement in per bed net income and operating
  margin from 1996 to 2003 when compared to
  controls.
• Source Elliot, et al. (2007)

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Network Participation and the Quality/ Efficiency
Connection

• Thus, this preliminary research suggests that
• participation with the Pioneer Network
• increases the chance that
• Residents (consumers of this network) will
  receive superior quality of care.
• Homes will experience cost savings (as measured
  by net income and operating margins).

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Impact on Medicaid and Implications for Financing
Reform

• Isolating cost centers (e.g. dining) along with
  quality of care components linked with those cost
  centers (e.g. weight loss) would further
  illuminate the positive impact on quality and
  efficiency.
• Measurable outcomes create potential strategies
  (such as Medicaid waivers) to reward homes that
  actively reduce morbidity and improve cost
  efficiency through innovative practices.
• Source Elliot, et al. (2007)

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Opportunities for Nursing Home Transformation
Opportunity for practice, research and policy to
view quality and efficiency as interconnected
outcomes.
Improved quality of care and measurable Financial
success
Resident-centered Adaptations