ARGENTUM
Improving Quality of Care Through Technology
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Disclosure of Commercial Interests • Speaker works for PointClickCare • This presentation does not promote any specific EHR or technology • The speaker has no commercial interests in PointClickCare or any other organization referenced in this presentation
Session Objectives By the end of the session, attendees will: 1. Understand the drivers of change and the evolution of senior living 2. Understand how technology can be leveraged to identify and improve quality in Senior Living
Drivers of Change in Senior Living
Driver: The Aging Population
• Senior Living growth fueled by baby boomers • By 2050, surviving baby boomers will be over the age of 85 • Population aged 65+ will continue to see steady growth • In 2050, the population aged 65+ is projected to be 83.7 million
Source: An Aging Nation: The Older Population in the United States - Current Population Reports Issued May 2014 P25-1140 By Jennifer M. Ortman, Victoria A. Velkoff, and Howard Hogan
Driver: Changing Needs of Seniors Seniors are delaying their transition to senior living •
•
Leads to older, more frail residents on move-in
7.2% 10.4%
Requires more assistance with care and with staying well 52.6%
•
Greater need for skilled staff and potential increase in risk and liability
29.9%
Need for dual focus on maintaining wellness and preventing illness 85 and over
Source: Long-Term Care Providers and Services Users in the United States: Data From the National Study of Long-Term Care Providers, 2013–2014 – U.S. Department of Health & Human Service – CDC
75-84
65-74
Under 65
Driver: Focus on Quality Senior living communities are unique o
Variations in evaluation models for communities, states and even communities within the same states
Growth in legislation expected in senior living o
Additional state legislation to standardize provision of care
o
Will require providers to better manage and document care delivery
The Evolution of Senior Living Social Model with a Health Conscience
Health Model with a Social Conscience
Average move-in age = 72
Average move-in age = 83
1 or 2 Chronic diseases
3 to 5 Chronic diseases
Worry about your campus system
Worry about the healthcare ecosystem
Paper service plans, property mgmt. and invoicing
Able to manage and document care delivery
Using technology to manage top priorities in Senior Living
Top Priorities of Providers What do you think the most critical success factor will be to sustaining your business? Please rank. 30
Creating effective staff recruitment and retention strategies
25
20
15
10
5
0
Source: Senior Housing News Provider Insight Survey Results
Aligning staff resources & skills to different levels of care Implementing technology to improve and personalize care Enhancing marketing outreach efforts
Staff recruitment / retention #1 priority of senior living providers surveyed
Staff Perceptions • Spend too much time on paper charting and documentation • Not enough valuable time with residents • Heavy workloads • Generic task lists • Multiple manual processes • Outdated or ineffective technology • Lack of empowerment
How Technology Empowers Your Staff • Eliminates duplication of information capture, paper transcription and unnecessary paperwork • Increases focus on vocational expertise – i.e. care delivery • Increases staff accountability, ownership and engagement
Technology’s Effect on Staff • Improves staff morale • Technology attracts next-generation care workers • Improves relationships with residents and family members
Result: Improvement in Staff Engagement and Resident Experience
Technology’s Effect on Staffing Costs Provides real time data to help: •
Reduce overtime and need for temporary staffing
•
Better predict staffing to service needs so short-staffing and over-staffing are limited
•
Match staffing expertise to resident need
•
Provide more efficient use of caregiver time
•
Re-deploy to higher value services
Aligning staff to levels of care #2 Focus Identified By Providers Surveyed
Rise In Acuity • Acuity levels within senior living are rising • Seniors are delaying their transition based on economy and the desire to age in place • Rising acuity increases requirements for staffing and for documentation to ensure adequate level of care provision.
Common Conditions
High blood pressure Alzheimer's disease and other‌ Heart disease Depression Arthritis Osteoporosis
Diabetes COPD 1and allied conditions
Cancer stoke
0 1Chronic
20
40
60
obstructive pulmonary disease. NOTE: Cases with missing data are excluded; see *Data sources and methods* section for details. Source: CDC/NCHS, National Survey of Residential Care Facilities, 2010
Chronic Illness in Senior Living
50
%
of AL residents have 3 or more chronic illnesses
• >25% have 4-10 of the most common conditions • 50% have been diagnosed with 2-3 • Increased need for skilled staff to treat/monitor prevent decline
Senior Living Residents By Diagnosis The desire to age in place and delay transition to assisted living results in a larger percentage of senior living residents with chronic diseases
45% 40%
39.6%
35% 30%
23.2%
25% 20%
16.9%
15% 10% 5% 0%
Alzheimers Disease & other dementia
Depression
Source: Centers for Disease Control & Prevention - Long-Term Care Providers and Services Users in the United States: Data From the National Study of Long-Term Care Providers, 2013–2014
Diabetes
Activities of Daily Living Rise in acuity levels means more senior living residents who need help with activities of daily living 70% 62% 60% 47%
50%
39%
40%
29%
30%
30% 20%
20% 10% 0% Bathing
Dressing
Toileting
Walking or locomotion
Transferring in and out of bed
Source: Centers for Disease Control & Prevention - Long-Term Care Providers and Services Users in the United States: Data From the National Study of Long-Term Care Providers, 2013–2014
Eating
Adverse Events in Senior Living Residents The desire to age in place and delay transition to assisted living results in more adverse and potentially avoidable events
Falls
21.1%
Emergency department visits
12.4%
Overnight hospital stays
8.3%
0%
5%
10%
15%
Source: Centers for Disease Control & Prevention - Long-Term Care Providers and Services Users in the United States: Data From the National Study of Long-Term Care Providers, 2013–2014
20%
25%
Rise in Need For Medication Management • Increase in acuity means increase in number of medications • Paper processes are time consuming and error prone • Increase in resident monitoring means increase in nurse time • The more complex the care, the more complex the medication regimens • Complexity increases risk to resident, staff and community
Medication Management In Senior Living Up to 83% of Senior Living resident need help with their medications •
Ordering/Reordering
•
Storage and Preparation
•
Reminders
•
Administering
•
Monitoring
Residents take an average of 7.5 routine and 2.3 PRN medications Poly-pharmacy increases risk for acute changes in condition and error in administration – acuity
Source: http://www.ahcancal.org/ncal/resources/Documents/09%202009%20Overview%20of%20Assisted%20Living%20FINAL.pdf
Medication Management By The Numbers In 2014, an Argentum report listed medication administration as the top deficiency in senior living Observational Study by Oregon Health and Sciences Institute, Rutgers, University of Washington, and Northern Illinois University Study 2011: •
28.8% medication error rate in assisted living
•
70.8% of medication errors related to dose timing
•
8.2% when the time errors are removed
•
No errors were judged highly likely to cause harm (out of 1373 errors)
Sources: Medication administration errors in assisted living: scope, characteristics, and the importance of staff training. - Zimmerman S1, Love K, Sloane PD, Cohen LW, Reed D, Carder PC; Center for Excellence in Assisted Living-University of North Carolina Collaborative.
Drug Error Rates in Senior Living 1.5
0.2
3.5
Timing
11.1
Wrong Dose Omitted Dose
12.9
Extra Dose 70.8 Unauthorized Drug Wrong Drug
Source: CEAL Report - 2012
Lack of Standards State Regulations are all over the place: • 10 use nurse delegation • 20 unlicensed assistive personnel • 20 require assistance with self administration
Technology and Acuity Management Documentation •
Better documentation at time of transfer
•
Anywhere, anytime documentation makes it easier to capture changes in acuity
•
Earlier identification of change in condition
Staffing to Acuity •
Acuity level of residents more easily identified
•
Time spent servicing residents more efficiently tracked
•
Increases the ability to ensure the right services identified, planned and staffed for
Result: Resident Experience, Compliance
Technology to improve and personalize care #3 priority of senior living providers surveyed
Reasons for Technology Implementation Work smarter not harder Provides time efficiencies for staff documentation that gets them back to the bedside Better documentation to reduce liability and risk Data capture to identify and highlight changes in condition and service provision Real time access to information improves care collaboration
Using Technology To Stand Out What technology solutions do you believe will enable you to stand out against your competitors? Response Percent (highest to lowest) 70%
63.6%
61.8%
60%
56.4%
56.4%
50% 40.0%
40%
35.5% 27.3%
30%
26.4%
20% 10% 0% Electronic Health Record
Source: Senior Housing News Provider Insight Survey Results
Resident Monitoring
Family Portal
Customer Relationship Management
Point of Care Wireless Nurse Property Call Management
Remote Care
EHR Usage in Senior Living In a 2010 (United States), Survey of Residential Care Communities:
Source: CDC/NCHS National Survey of Residential Care Facilities, 2010
•
Only 17% of residential care communities reported using an EHR.
•
Larger locations, those with 26 or more beds, were more likely (25%) to have had an EHR in use than smaller ones (14%) of four to 25 beds, while those colocated with another care setting had even higher rates (29%) of EHR use.
EHR Usage in Senior Living 70% of communities using an EHR tracked:
Source: CDC/NCHS National Survey of Residential Care Facilities, 2010
•
Medical provider information
•
Resident demographics
•
Individual service plans
•
Lists of residents' medications
•
Active medication allergies
EHR Usage in Senior Living Of senior living communities using EHR:
40 1725 %
also had support for electronic exchange of health information with service providers
Source CDC/NCHS National Survey of Residential Care Facilities, 2010
%
had support for electronic exchange with pharmacies
17
%
had support for electronic exchange with physicians
EHR and Interoperability
EHR and Personalized Care Improved documentation
Improved coordination
• Eliminates time intensive inefficient paper processes – faxing, filing • Single point data entry to reduce copy errors • Immediate electronic access to health records from anywhere in the facility • Improved accuracy of care documented
• Brings all systems together on one device • Improved decision making tools promote wellness • Better coordination of care and sharing of information between care team members and during transitions of care
Result: Improved Care
ENHANCING MARKETING OUTREACH #4 priority of senior living providers surveyed
Source of Referrals
95.7 63.8
%
%
of senior living referrals come from family members or friends
of referrals by a friend is the reason resident moved in
Reputation
Your most valuable asset is your
good name.
Source: http://www.forbes.com/2010/02/01/brand-reputation-value-leadership-managing-ethisphere.html
Your reputation represents
40
%
of your organization’s worth
External Influences on Reputation
Regulatory Changes
Consumer Influence
Reality
Reputation Damage to reputation Expectation and public image for such breaches Index Compliance
Day 1
Day 30
Day 60
Day 90
Day 120
Perceived Reality
Day 180
Using Technology To Impact Reputation
Exceed expectations of residents and families by showing what you can do, and what you have done
Prove it
Enhance the level of personalized care and attention your residents receive, thereby increasing referrals
Personalize it
Collect and share knowledge about your residents to gain greater intelligence across your organization
Share it
Summary Technology is needed to meet today’s top priorities and address changes for the future
Reputation Staffing
Acuity
Personalized Care
Questions?
Advancing senior care. To learn more, visit us in the exhibit hall
Booth #715