Integration of Nursing and Therapy for an Effective Nursing Rehab Program

1. Integration of Nursing and Therapy for an Effective Nursing Rehab Program Bethany D�Antonio, AD, PT Genesis Rehab Services Susan Davis, MS, RN, CRRN ParenteBeard LLC AHCA/NCAL Annual Convention October 11, 2010

2. Learning Outcomes Learn how to develop programs that focus on wellness and that can have an impact on Medicare Part B utilization Discover how to rejuvenate your restorative nursing program Recognize the role education of staff and residents plays in attaining and maintaining functional independence

3. Client History CCRC located in Delaware 60 Skilled Nursing Beds 44 Assisted Living Units 17 Assisted Living Dementia Units 24 Cottages 90 Apartments

4. Client History DON departing ADON stepping up to acting DON MDS coordinator with multiple roles/titles AL Director hired but not started

5. Client History 1 Restorative Aide pulled in many directions Consistent small rehab team with strong manager Strong Wellness department/program In survey window with history of previous G tag (in process of converting to QIS)

6. Client History Operations assessment conducted in 2009 identified the following opportunities for revenue cycle management improvement Medicare RUGs Payor Mix Medicare Part B Utilization Restorative Nursing Medicare Length of Stay

7. Client History Medicare RUGs Over the state average in utilization of Rehab plus Extensive No utilization of Special Care, Clinically Complex or Other Categories Payor Mix Medicare payor mix was 9.6% vs. National average of 12%

8. Client History Medicare Part B Utilization Utilization was at 11% vs. National benchmark of 15% Medicare Part B utilization Medicare Length of Stay (LOS) - Facility LOS was 23 days vs. Delaware state average of 35 days

9. Client History Restorative Nursing Not available 6 days a week Only 3 programs in place Documentation not in place to take credit for programs that were occurring 21 residents on restorative case load and 20 residents on maintenance case load for 1 restorative aide in an 8 hour day

10. Client History Restorative aide unaware of payor types of residents in order to prioritize and capture appropriate delivery of minutes No competencies in place to demonstrate training had occurred to deliver programs No consistent restorative meeting occurring to discuss caseload and progress

11. Where do we start? Good Foundation included: Fitness and Wellness Program Rehab Restorative Aide Physician Assistant

12. Where do we Start? Good Foundation included: Weekly Continuum Care Meetings SWIF Meetings UR Meetings

13. Opportunities Restorative Program Define/evaluate caseload Implement 6 days a week programming Develop additional appropriate programs

14. Opportunities Restorative Program Document competencies Hold monthly restorative meetings Develop resident caseload form with payor status

15. Opportunities Education of Staff - Decline in function training - How to make appropriate rehab referrals - Coordinating wellness services vs. rehab Therapy Evaluation - AL residents upon admission

16. Opportunities Resident Education Rehab 101 monthly education Rehab department open houses Signs and Symptoms of decline and benefits of rehab

17. Opportunities Screening AL quarterly screening AL/IL new admission screens for home environment safety

18. Focus on Wellness Collaboration with rehab, nursing and wellness staff Integration of wellness programs after completion of therapy

19. Focus on Wellness Monthly education programs to residents and staff Home Safety Joint Protection/Arthritis Awareness Fall Prevention

20. Impact of Wellness Focus on Medicare Part B 11% March 2008-March 2009 15.3% July 2009-July 2010 � after implementation Screen to evaluation ratio 50% Improved referrals from all departments across the continuum Increased rehab staffing due to caseload

21. Rejuvenating Restorative Caseload overload, defining restorative aide role and program over site including meetings Documentation Competency Training

22. Rejuvenating Restorative Developing Programs based on resident need and benefit Ambulation Dining PROM AROM Walk to Dine Splints/Braces

23. Restorative Success Stories Dining Program Socialization Improved staff efficiency Improved nutritional outcomes Improved function

24. Restorative Success Stories AROM small group exercise classes supervised use of wellness equipment increased socialization with other residents (IL/AL)

25. Restorative Success Stories Ambulation Program Patients ambulating to dining room vs. wheel chair line up Less institutionalized dining environment All staff participate in program Splints/Braces Incidence in decline of ROM is 0%

26. Restorative Success Stories Additional Benefits of Rejuvenating Restorative Program Increased length of stay to 26 days Capturing of rehab low Referrals back to rehab

27. Restorative Success Stories Additional Benefits of Rejuvenating Restorative Program Improved communication between departments Improved documentation Improved resident quality of life

28. Education of Staff Decline in Function In-services All departments All shifts Rehab Referral Training All departments All shifts

29. Education of Staff Wellness Staff Training - Coordination of Care - Program transitions Restorative Training - Competencies - Documentation

30. Education to Residents Decline in Function/Benefit of Rehab Implementation of Monthly Education Series

31. Education to Residents Open Houses Wellness OT, PT, and SLP month Rehab Week Wellness News Letter

32. Results of Education and Training Part B utilization increased from 11% to 15.3% 50% screen to evaluation ratio Treated 102 different residents in a 1 year time frame for Part B services vs. prior year of 88

33. Results of Education and Training Restorative Program Available 6 days a week Increased from 3 programs to 6 Now capturing rehab low

34. Results of Education and Training Restorative Program Managing caseload appropriately (active/maintenance) Improved documentation Monthly meetings occurring and improved communication

35. Results of Education and Training Medicare Length of Stay Provided education to staff on skilled nursing documentation and skilled criteria Communication improved Collaboration increased Quality of Life improved Quality of Care improved

36. Results of Education and Training Coordination of care across the continuum improved Improved revenue cycle results No G�s on the survey and below state average for tags cited

37. QM/QI Impact

38. Questions??