Bonnie S. Kantor, Sc.D Executive Director, Pioneer Network Commercial Market Place and Nursing Home Transformation: Following Consumer Demand Bonnie S. Kantor, Sc.D Executive Director, Pioneer Network Track4.02--Kantor--6.15@12.15pm MC v2

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

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

Home vs. Homelessness Home Homelessness Identity Non-Personhood Connectedness Lived Space Privacy Power/Autonomy Safety Predictability Journeying Homelessness Non-Personhood Disconnectedness Meaningless Space Without boundaries Powerless/Dependence Insecurity/Uncertainty Placelessness Carboni (1990)

Culture Change Renewal of Personal Transformation Re-organizing the work Renovating the Physical Environment to Create Home

Pioneer Network Founding Principles Know each person Community is the antidote to institutionalization Practice self-examination, searching for new creativity and opportunities for doing better Relationship is the fundamental building block of a transformed culture

Pioneer Network Founding Principles Risk Taking is a normal part of life Put person before task All elders are entitled to self-determination wherever they live Recognize that culture change and transformation are not destinations but a journey, always a work in progress

Our Vision… A culture of aging that is life-affirming, satisfying, humane and meaningful.

A clear understanding of the elder: Where are you from? What is your personal history? What is your preferred typical day? Who do you want to be in the future?

“Quality is not a program; it is an outcome that evolves from organizational culture focused on the customer and organizational excellence” AAHSA 2005

Person Directed Practices Person Directed Practices Overlap with Varying Degrees of Choice and Autonomy Person Directed Practices (Begins somewhere between Consideration of the Person and Person’s Choice) Staff Directed (agency scheduled routines/staffing dictate care provision) Consideration of Individual (Seek person’s input and tailor some aspects) Individual Choice (Offers choices of food, waking, bathing etc.) Individual Control (have right of refusal and right to take risks) Person Directed (Individual has primacy -- determines own schedules, activities, meals, and caregivers) Degree of Person-Directedness Developed by the Lewin Group

The Question Consumers WILL Ask is… Are the values of choice, respect, and self-determination implemented here?

What Culture Change Is About: Honoring individuality of residents and staff Creating “home” Person vs. task focus Creating a new way of being and thinking related to aging. Creating responsive systems.

Paradigm Change INSTITUTIONAL medical “treatments” task focus “float” staff staff make decisions structured activities PERSON-DIRECTED social/holistic nurture spirit care matches needs consistent assignments residents make decisions spontaneous activities

Paradigm Change (cont.) INSTITUTIONAL schedule for convenience of staff/administration facility “belongs” to staff sense of isolation and loneliness departmental focus PERSON-DIRECTED schedule adjusted for resident and staff needs facility is residents’ home sense of belonging and community team approach

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

Research on Outcomes Associated with Network Participation In the first empirical, comprehensive study of the Pioneer Network, research examined if “early adopter” participants achieved financial and quality outcomes that were significantly different from outcomes of non-participant homes.* CMS provided data from 1996 (pre-participation in the network timeframe) and 2003 (participating in the network for at least one year). *Source: Elliot, et al. (2007)

Quality of Care Results Findings comparing quality of care outcomes of homes participating in the network to analogous control homes denote that early adopter homes achieved statistically significant improvement in quality of care over control homes. In a multivariate analysis of all homes certified by CMS in 2003, coefficient estimates indicate that length of time participating with the network positively affected quality of care. *Source: Elliot, et al. (2007)

Efficiency Results This research also evaluated the effects of Pioneer Network participation on the per bed net income and operating margins of early adopter homes versus analogous control homes and produced the following findings: Overall, homes participating in the Pioneer Network displayed statistically significant improvement in per bed net income and operating margin from 1996 to 2003 when compared to controls. *Source: Elliot, et al. (2007)

Network Participation and the Quality/ Efficiency Connection Thus, this preliminary research suggests that participation with the Pioneer Network increases the chance that: Residents (consumers of this network) will receive superior quality of care. Homes will experience cost savings (as measured by net income and operating margins).

Impact on Medicaid and Implications for Financing Reform Isolating cost centers (e.g. dining) along with quality of care components linked with those cost centers (e.g. weight loss) would further illuminate the positive impact on quality and efficiency. Measurable outcomes create potential strategies (such as Medicaid waivers) to reward homes that actively reduce morbidity and improve cost efficiency through innovative practices. *Source: Elliot, et al. (2007)

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