The Hospital Elder Life Program ABC Hospital Annual Report 1/1/2014 – 12/31/2014

The Hospital Elder Life Program (HELP) Comprehensive, evidence-based model of care that improves outcomes for older adults Targeted interventions completed by interdisciplinary staff and trained volunteers Primary goals: Maintain cognitive and physical functioning Maximize independence at discharge Assist with transition from hospital to home Prevent unplanned hospital readmissions

2014 Goals of HELP at ABC Hospital Outcome Increase ELNS position from 0.6 FTE to 1.0 FTE by 9/30/14 Accomplished 11/15/14 Expand HELP to Rehab Unit 1 by 12/1/14 Will complete by 6/30/15 Recruit at least 10 new volunteers with summer availability by 4/30/14 11 volunteers recruited between Feb and Apr, 10 staying past the summer Enroll 1500 patients in HELP during this reporting period 1507 patients enrolled 85% of patients will report satisfaction with their care during this reporting period 92% of patients reported satisfaction with their care Achieve adherence rate (complete and partial) of 85% during this reporting period Achieved adherence rate of 90%

HELP at ABC Hospital HELP Staff 1.0 FTE Elder Life Specialist (John Doe, BSW) 0.9 FTE Elder Life Nurse Specialist (Jane Jones, MSN, RN) 0.1 FTE Geriatrician (Sally Smith, MD) 0.1 FTE Program Director (Jane Jones, MSN, RN) HELP Units: Medical Unit 1, Medical Unit 2, Surgical Unit 1, Surgical Unit 2 Patients Enrolled: 1507 Volunteers: 55 volunteers, 5500 volunteer hours

HELP Patients at ABC Hospital (Total enrolled = 1507) Characteristic Age, mean (range) 78 (70-88) Female, N (%) 995 (66) Non-White, N (%) 256 (17) Hispanic, N (%) 90 (6) Length of stay in days, mean 9.2

Adherence Rates of Interventions by Admission (N=1716 admissions of 1507 patients) Adherence rate1 patient-days, N(%) Complete Partial Non-Adherence Intervention assigned (# patient-days) Orientation 8272 (83) 1288 (13) 389 (4) 9949 Therapeutic Activities 6760 (68) 2246 (23) 948 (10) 9954 Sleep Enhancement 136 (10) 826 (61) 390 (29) 1352 Early Mobilization 4469 (46) 4168 (42) 1171 (12) 9808 Vision Protocol 879 (90) 31 (3) 65 (7) 975 Hearing Protocol 824 (80) 139 (13) 71 (7) 1034 Fluid Repletion 120 (46) 78 (30) 65 (25) 263 Feeding Assistance 1692 (45) 1260 (33) 844 (22) 3796 Overall 22152 (60) 10036 (30) 3943 (11) 37131 1. Adherence rates calculated as adherence recorded for each patient-day/total number of patients-days intervention was assigned

Reasons for Non-Adherence (N = 3943 non-adherent patient-days for all interventions) Lack of availability of staff/volunteers 1262 (32) Patient refusal of intervention 1025 (26) Medical contraindication 867 (22) Patient unavailable (e.g., off floor for procedure) 513 (13) Other 276 (7)

HELP Outcomes by Admission (N = 1716 admissions in 1507 patients) Admissions (N=1716) Change in SPMSQ score from admission to discharge Same or improved, N (%) Decline, N (%) 1028 (92) 86 (8) Change in ADL score from admission to discharge 969 (86) 153 (14) LOS, days Mean ± SD Median (range) 9.2 ± 8.7 7 (1-163) Discharge destination, N (%) Home, no services Home, with services Skilled nursing facility Short-term Long-term Not specified Deceased Other2 489 (29) 470 (27) 248 (15) 147 (9) 115 (7) 50 (3) 157 (9) Fall rate (falls per 1,000 patient days) 3.2 Delirium rate, N (%) 189 (11) 30 day unplanned readmission rate, N (%) 137 (8) 1. SPMSQ = Short Portable Mental Status Questionnaire, ADL = Activities of Daily Living, LOS = Length of hospital stay, SD = standard deviation 2. “Other” category includes: hospice, transfer to acute rehabilitation unit, assisted living, rest home, and unknown

Comparisons over time of patient outcomes Patients enrolled in HELP vs. Eligible patients not enrolled in HELP

Patient/Caregiver Satisfaction (1280 surveys completed, 85% completion rate) Question “Agree” or “Strongly Agree” N(%) Volunteers were helpful during my hospitalization 1216 (95) HELP staff explained the program in a way I could understand 1165 (91) Overall, I was satisfied with the care I received in the HELP program 1178 (92) 1. Answer choices: strongly disagree, disagree, neutral, agree, strongly agree

Patient/Caregiver Quotations “Brought me magazines, took me for walks, and also we did exercises while in bed. So yes, I do believe this Hospital Elder Life Program is very, very helpful to the patient and gives them something to look forward to.” “Thank goodness for HELP! With the volunteers my husband was much improved from his last hospital stay, where he went into acute delirium.”

Staff Satisfaction (200 surveys completed, 87% completion rate) Question “Agree” or “Strongly Agree” N(%) The HELP staff are supportive HELP is a useful resource at ABC Hospital to support elder care My job has been more satisfying due to having assistance from the HELP volunteers and staff in caring for older patients 1. Answer choices: strongly disagree, disagree, neutral, agree, strongly agree

Staff Quotations “The positive feedback from patients and staff is so powerful – that convinces our administrators and anyone else who might have doubted it. In fact, nurses on other floors are asking, ‘Why can’t we get HELP on OUR floor?’” “The patients said that the HELP Program was the best part about their stay.”