Nursing Home Transformation Following Consumer Demand

1. Nursing Home Transformation Following Consumer Demand Bonnie S. Kantor, Sc.D Executive Director, Pioneer Network October 19, 2007

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

3. 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)

4. 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

5. THE PIONEER NETWORK • Diversity of Stakeholders including: • Providers • State trade associations • QIO community • Consumers • Medical community • Aging network • Regulators • Universities and….

6. STATE COALITIONS • 36 Active, independent statewide coalitions; • Diverse stakeholder involvement and structure; • Always aligned with other statewide efforts; • Enormous opportunities ahead.

7. Key Questions • What is Resident-Centered Care and why do we want it? • Where are we now? • What will it take to make it the norm?

8. Resident-Centered Care: The Play • Place: Medical Director’s Home • Time: Middle of the night • Date: August 2007 • Action: and the phone rings…..

9. Resident-Centered Care is the Integrated Practice of Health Care and Resident Support based on: • A core set of values and beliefs; • Each individual’s needs and desires; • Creating home and community. (BINGO!)

10. In Practical Terms, Culture Change and Resident-Centered Care Result In… • Smaller living environments; • Permanent work assignments and decision making closest to the residents; • Flattened hierarchy; • Dismantling daily routines and systems to allow freedom and choice.

11. What We Know Is… • It is possible to provide quality medical services and good personal care while allowing for resident choice. In fact…. • Better clinical outcomes can be achieved; • The range of clinical outcomes is broadened; • Clinical concerns are uncovered earlier if not prevented all together.

12. And the Next Step… What Will It Take To Make Resident-Centered Care The Norm?

13. Where Are We Now? • From debate to conversation; • Critical mass of early adopters; • Credible results confirming that it works; • But the barriers remain persistent.

14. Five Key Action Steps: • Reframe the question and get rid of “the elephant;” • Address leadership needs and engage new partners; • Develop and disseminate core competencies and measurable markers; • Ensure education and training in Resident-Center Care for all providers at all levels of training; • And…

15. Promote the “Business Case” 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

16. Elliot (2007)

17. Elliot (2007)

19. How can you help? • CMS/ Pioneer Network symposium: Creating Home in the Nursing Home: a national symposium on culture change and the environment requirements; • Medicare and graduate medical education and training; • Medicaid reimbursement opportunities.