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Our Objectives Discuss the implications of the aging population for our hospital Discuss the opportunities and resources offered by the NICHE program

NICHE Nurses Improving Care for Healthsystem Elders NICHE is a program of the Hartford Institute at the New York University College of Nursing NICHE is the only national geriatric nursing program that addresses the needs of hospitalized older adults Currently there are approximately 300 hospitals in more than 40 states as well as Canada with NICHE designation and this number is expanding

Why a program focused on older adults?

Graying of Canada 24% of population is over 55 years of age – Expected to double in next 25 years Average life expectancy is 80.4 years of age Canada ranks #11 in the world in terms of life expectancy – Global: 67.2 years – OECD nations (Organization for Economic Cooperation and Development): 79.8 years – USA: 77.8 years (ranks #38 in the world) References: 1. Canada. (2006). World Health Organization, Statistics Life Expectancy Hits 80.4 years: Statistics Canada. (2008). CBC News.

Aging Demographics in Canada

Majority of Canadian Healthcare is for Older Adults 59% of visits to general physicians 84.7% of home care visits Canada spends 8-10% of total budget on healthcare for older adults Canadian government pays for 74% of healthcare costs for older adults References: 1. Inpatient Hospitalizations in Canada Increase Slightly after Many Years of Decline. (2005). Canadian Institute for Health Information Markle-Reid, et al. (2003). Frail Elderly Homecare Clients. Canadian Health Services Research Foundation Canada’s Demographic Challenge. (2005). Canadian Department of Finance. /budget05/bp/bpa3e.htmhttp:// /budget05/bp/bpa3e.htm

Older Adults Are Hospitals’ CORE Consumers Around 40% of hospital expenditures Older adults stay an average of 2 days longer than younger adults (8 versus 6 days) 25% of hospitalized older adults are readmitted within 30 days References: 1. Inpatient Hospitalizations in Canada Increase Slightly after Many Years of Decline. (2005). Canadian Institute for Health Information.

Older Adults Are Hospitals’ CORE Consumers ___% of_____________ (our hospital) inpatient admissions are 85 years and older

The Quality Imperative: Improve Clinical and Fiscal Outcomes! Older adults have: Longer lengths of stay Higher rates of re-admission within 30 days Higher rates of functional decline and medical errors

Improving Care for Hospitalized Older Adults is Good Business Optimal care requires appropriate skills –Aging demographics –Geriatric skill gap –High cost of inaction Older adult patients are everywhere –Need for flexibility –Ongoing training and coaching roles –Cost effective “train the trainer” virtual services

Improving Care for Hospitalized Older Adults is Good Business Proactive & skilled nursing care avoids costly problems –“Never” events –Complications that increase LOS and costs Patients and families satisfaction –Better functional status at discharge –Smoother transitions Improved nurse satisfaction & efficiency, less turnover Improved MD satisfaction and improved efficiency

NICHE Program Goal –Achieve systematic nursing change that will benefit hospitalized older adults Vision –Provide geriatric sensitive and exemplary care to all hospitalized older adults 65 years and over Mission –Import principles and tools to stimulate change in the culture of healthcare facilities to achieve patient-centered care for older adults

What is the focus of NICHE? NICHE focuses on programs and protocols that are predominantly under the control of nursing practice.

In other words… areas where nursing interventions have a substantive and positive impact on patient care

Hospitals participating in NICHE report… Enhanced staff knowledge and skills Greater patient satisfaction Decreased length of stay for older adult patients Reduction in costs associated with hospital care for the older adult Enhanced Magnet initiatives Improved compliance with regulations and industry standards

What are the objectives of the NICHE program?

1. Improve patient outcomes 2. Improve the patient experience 3. Promote staff effectiveness and satisfaction 4. Establish leadership as a provider of care to older adults 5. Provide fiscally responsible care 6. Increase collegial networks NICHE Program Goals

Geriatric Resource Nurse (GRN) Model Began in Boston –Early 1980’s at Beth Israel Unit based experts using existing resources Expanded at Yale New Haven Hospital Rationale - those who voluntarily chose to participate in the effort would provide better care to older adults Central to the role - geriatric education, competency evaluation, and mentoring

Rewards Related to the GRN Model Clinical ladder Novice expert feeling Respect within role Deeper expertise - content specialists in more circumscribed areas Parsimonious use of resources Outcomes described by NICHE sites improved clinical outcomes increased staff skill increased satisfaction

NICHE in Acute Care of the Elderly (ACE) Units Key Elements Prepared physical environment Use of evidence-based protocols Patient centered care Family involvement Medical care review Education of staff Improved patient outcomes Hospital outcomes Length of stay Case mix Cost per case Readmission within 30 days

What resources does the NICHE Program offer?

NICHE Program This website provides online access to: The NICHE journey, how to get started Online Leadership Training Program information Annual Conference information NICHE Knowledge Center (online tools and resources) Individual NICHE hospital websites Consumer Patient and Family resources

NICHE Program for “Members Only” Start-up Tools NICHE Planning & Implementation Guide Leadership Training Program Measurement Geriatric Institutional Assessment Profile (GIAP) Clinical Outcomes Program Self-Evaluation Clinical Management Tools Organizational Strategies & Clinical Improvement Models Exemplar

NICHE Program for “Members Only” Training and Education Programs Core Curricula: for Nurses, Patient Care Techs & Other Disciplines Webinars and Inservice Materials Contact Hours Educational Resources for Patients and Families Conferences National Community NICHE Listserv and Discussion Boards and more...

Getting Started Gather Stakeholders Identify needs derived from: staff development measures clinical outcomes financial outcomes budget considerations satisfaction surveys other strategic initiatives/plans passion of the “gerontologized”

Attend Leadership Training Program (LTP) Who should attend the LTP? (minimum of 3 people responsible for initial steering of initiative) – Nurse Clinical Leader – Clinical Educator – Quality Manager or Administrator – Recommended additions to steer initiative: direct care staff, and other disciplines (medical, rehab, social work, pharmacy etc.) How to Become a NICHE Designated Hospital

How is the LTP delivered? 6 week online program delivery –Participate in several scheduled live webinars –Engage in online group activities Facilitated by NICHE faculty & experts from experienced NICHE sites Earn 38 contact hours Development of Action Plan upon program completion – Reviewed & discussed with NICHE staff and faculty

© 2011 NICHE All rights reserved. The information contained in this module is provided for informational purposes only. The content has been developed by NICHE participants and the NICHE staff of the Hartford Institute for Geriatric Nursing at New York University’s College of Nursing and is protected by copyright under the laws of the United States and foreign laws. Under no circumstances may these material be reproduced for sale or profit. Any use of content not expressly permitted may violate copyright, trademark, and other laws. Thank you! For more information, please go to