In November we will be celebrating the 6th Annual Green House Meeting and Celebration in Boston, MA. THE GREEN HOUSE® Annual Meeting & Celebration is an event exclusively available to Green House adopters for sharing, learning, and celebrating the growth of The Green House model! The Annual Meeting honors organizations for their commitment to create real home, empowered staff, and meaningful lives for elders. Sessions provide peers with an opportunity to reflect on lessons learned, revisit skills for coaching leaders, and build relationships to support sustainable change. One of the thought leaders presenting at the meeting this year is Dr. Kimberly Van Haitsma and we are pleased to share the below information on her latest project.
Kimberly Van Haitsma, Ph.D. is Vice President of Research at the Madlyn and Leonard Abramson Center for Jewish Life, North Wales, PA. After working as a nursing assistant in a nursing home, Dr. Van Haitsma decided to focus her career as a clinical psychologist on developing ways to improve quality of life for older people. For the past 20 years, she has directed research on understanding the needs and preferences of older adults living in their own homes and in long-term care communities. Most recently, she collaborated with the Advancing Excellence in America’s Nursing Homes campaign to design and test the new Person-Centered Care Toolkit described here.
The New Toolkit
In May 2013, Advancing Excellence in America’s Nursing Homes, a national long-term care collaborative aiming to improve quality of care, launched a toolkit to help communities provide more personalized care for their residents (www.nhqualitycampaign.org). The toolkit makes it easier for staff to learn about resident preferences, see how well care aligns with resident wishes, and problem solve when there are gaps.
The toolkit has two major parts. The first is an interview protocol that staff, including direct care workers, can use to ask residents about their preferences for personal care and recreational activities, as well as to gauge how satisfied residents are with the way their important preferences are addressed. The interview builds on information already collected as part of MDS 3.0 – Section F (Preferences for Customary Routine and Activities), by adding new questions that ask residents how satisfied they are with fulfillment of “very” or “somewhat” important preferences.
In the second part, staff record this information in a user-friendly, pre-programmed Excel workbook. This tool produces color-coded graphic displays showing when a resident’s preferences are being fully met (in green) and when preferences require further follow up (in yellow or red). Staff can use the results as the basis for discussion and problem solving during individual care planning conferences.
Also, the Excel workbook can show preference gaps affecting many persons residing together in a household. The tool allows staff to see “at a glance” particular preferences that are not being met for several individuals who live in a common location. Staff then can collaborate on strategies for improvement.
A final feature of the workbook is that it automatically calculates four person-centered care quality indicators. One measure shows the percentage of “preference congruence” (the extent to which a resident is satisfied with the way important preferences are met) for an individual, household or facility during a given month. Three other measures show the percentage of care conferences attended by residents, family or friends, and direct care workers in a one-month period.
The Advancing Excellence Person-Centered Care toolkit is available for free download at www.nhqualitycampaign.org.
Pilot Testing the Toolkit
Before Advancing Excellence rolled out the new toolkit nationally, Dr. Van Haitsma and her team led a pilot study in which 12 nursing homes tested the interview protocol and software and reported on their experience. The study offered a first look into rates of preference congruence, which averaged 67% for short-stay and 75% for long-stay residents across the nursing homes.
What Do Providers Say About the New Toolkit?
Overall, pilot sites gave the toolkit strong positive ratings. In a follow up survey and interview, site coordinators said that the components were easy to use, and they would recommend the toolkit to others. Providers found many benefits:
Acceptability for residents, family and staff
- Nursing home residents valued the opportunity to give input about their preferences and satisfaction levels.
- Families were impressed with communities’ commitment to quality of care, as demonstrated by taking the time to ask about a loved one’s preferences.
- Social workers, recreation staff and direct care workers all found the tool easy to use.
- CNAs enjoyed the experience of interviewing residents, and learning about their preferences before providing care.
Enhances individual care planning and delivery
- The toolkit increased understanding of person-centered care – interview protocols and data displays make this abstract concept more concrete.
- The interview provided a conversation starter and a systematic way to get to know more about what is important to each resident. Ultimately, this can enhance relationships between residents and staff.
- The software made it easier to share resident preferences with the whole care team, and the colors and graphics showed clearly what needed to be done for individual residents.
- Quarterly interviews help providers stay up to date with changes in resident preferences or satisfaction levels.
Assessing care at the individual and household level
- The toolkit’s graphic displays provided a useful visual resource to help communities know “what we are doing well and what we need to keep working on”.
- With new information in hand, staff identified previously unknown areas of preference incongruence at the resident level (e.g., desire for a bath versus shower) and household level (e.g., in one household, residents were dissatisfied with their access to the outdoors in good weather).
Already over 500 long-term care communities have downloaded the new tool. Dr. Van Haitsma and the Advancing Excellence team will study user experiences, and promote sharing of best practices across communities to strengthen person-centered care for residents nationwide.
For more information, contact Dr. Kimberly Van Haitsma, firstname.lastname@example.org, http://www.polisherresearchinstitute.org/ or visit the Advancing Excellence website at www.nhqualitycampaign.org.