1. Welcome to the webinar for Long-Term Care Ombudsman on the Person Centered Care AE Goal. We will begin in a few minutes. If you have a question, please type them in the box on the right side of your screen.

2. Beverley Laubert, AE Board Chair and Ohio State Long-Term Care Ombudsman Becky Kurtz, Director, Office of the Long-Term Care Ombudsman, AoA Lori Smetanka, Director, National Ombudsman Resource Center, Consumer Voice Amy Elliott, PhD Pioneer Network, Chair AE PCC Workgroup Scott D. Crespy, Ph.D. and Kimberly VanHaitsma, Ph.D. Polisher Research Institute Madlyn and Leonard Abramson Center for Jewish Life Q&A

3. Becky A. Kurtz Director, Office of LTC Ombudsman Programs Administration on Aging Administration for Community Living US Department of Health and Human Services 3

4. ACL encourages State and local-level ombudsman engagement AoA/ACL encourages States’ LTC Ombudsman Programs – at State and local/regional levels -- to be engaged in LANEs and other AE work to: promote quality improvement and person- centered practices in nursing homes across the country; develop strategic partnerships to support the interests of nursing home residents. 4

5. LTCO Program options to support nursing home quality improvement through AE 5 In nursing homes that are participating in the campaign: Educate residents or families/friends about the AE campaign. Inform residents or families/friends about how they as individuals and as a council can participate in the campaign. Prepare residents or families and friends to discuss how they can help staff achieve the campaign goals

6. LTCO Program options to support nursing home quality improvement through AE 6 In nursing homes that are not participating in the campaign Educate residents or families/friends about the AE campaign. Discuss how residents or families/friends might encourage the nursing home to join the campaign. Inform residents or families/friends about how they can participate in the campaign even if their nursing home does not.

7. ACL/AoA support for person-centered planning: Part of our Strategic Goals: Goal 1: Advocate to ensure the interest of people with disabilities, older adults, and their families are reflected in the design and implementation of public policies and programs. Goal 3: Work with older adults and people with disabilities as they full engage and participate in their communities, make informed decisions, and exercise self- determination and control about their independence, well-being, and health 7

8. LTCO Program support for facilities to use person- centered planning What Ombudsman programs have been doing for years – really nothing new to this audience The core of LTC Ombudsman philosophy and practice: “What does the resident want?” AE goal gives facilities tools to: make it simpler for facility staff to understand what residents want make it simpler for facility staff to know if resident preferences are being honored make it simpler for supervisors, administrators, and corporate officers to know whether resident preferences are being honored. 8

9. For resident and family/friends – why person- centered care matters... 9 What is person-centered care? The team creates your care plan based on your strengths, as well as physical and emotional needs, to support your choices. Why should person-centered care be important to you and your family? Being treated with dignity and respect is a basic right. Why is person-centered care important for nursing home staff? Nursing homes that use PCC have residents, families, friends and staff that are more satisfied. Better communication adds to satisfaction and better care! Source: http://www.nhqualitycampaign.org/files/AE_PersonCenteredCare_ConsumerFactSheet.pdf

10. Advancing Excellence PERSON CENTERED CARE GOAL a webinar for LONG-TERM CARE OMBUDSMEN LORI SMETANKA Director, National LTC Ombudsman Resource Center March 18, 2014

11. Person-Centered Care Philosophy and Practice Person-centered care creates a resident-directed approach to all aspects of life in long-term care Person-centered care is included in Ombudsman communication with residents, families, and providers Supporting resident-directed care is important and meaningful at every level including collaboration in coalitions and daily advocacy

12. Promoting Person-Centered Care is a Core Function of LTCOP work Older Americans Act Advocate for quality care and rights of residents at the individual and systemic level Resolve problems by representing the interest of the resident and to the resident’s satisfaction Support community efforts to improve long-term care Act on residents’ behalf in response to action or inaction by others Person Centered Care Promote resident-directed care and culture change during complaint resolution Provide information to residents, families and providers regarding culture-change and resident-directed care Collaborate with others for widespread change and promote culture change as systems advocacy Right to highest practicable physical, mental, psychosocial well-being of each resident Right to be treated with consideration, respect, and dignity Right to self- determination and choice OBRA ‘87

13. Focus on Incorporating Person-Centered Care Principles Into Ombudsman Work Seize daily opportunities to incorporate person centered care principles and encourage resident- directed care in: – LTCO training – Complaint resolution process – Systemic advocacy – Program leadership – Resource allocation Remain sensitive to potential perceptions of conflict of interest in your role or the LTCOP’s integrity as a resident advocate

14. Tips for Long-Term Care Ombudsmen Stay informed about culture change and person- centered care Identify and support provider best practices in the facilities in your area or state Weave person-centered care into all LTCO training Join or create a dialogue or a focus on person- centered care Share information on person-centered care with consumer and facility staff

15. The National Long-Term Care Ombudsman Resource Center (NORC) www.ltcombudsman.org The National Consumer Voice for Quality Long- Term Care (formerly NCCNHR) www.theconsumervoice.org

16. Informational webinar for Ombudsmen Amy Elliot, PhD Pioneer Network, Chair AE PCC Workgroup Scott D. Crespy, Ph.D. Kimberly VanHaitsma, Ph.D. Polisher Research Institute Madlyn and Leonard Abramson Center for Jewish Life Advancing Excellence Campaign: Person-Centered Care Goal

17. What is the Person Centered Care Goal? Person-centered care promotes choice, purpose and meaning in daily life. Person-centered care means that nursing home residents are supported in achieving the level of physical, mental and psychosocial well-being that is individually practicable. This goal honors the importance of keeping the person at the center of the care planning and decision-making process. 17

18. How does the PCC goal benefit residents and families? Maintains autonomy and choices in daily living; Improves engagement and quality of life; Creates environment of trust and respect; Encourages close relationships with staff that are attuned to an individual’s preferences and changes and can respond appropriately; Empowers residents and families to share their preferences and partner to create a meaningful life in the nursing home. 18

19. How does the PCC goal benefit nursing homes? Encourages partnerships with residents and their families to know each person and maintain a meaningful quality of life; Fosters knowledge of individual preferences (and awareness of gaps); Provides opportunities to analyze preferences for a group of residents (e.g. neighborhood, home) and understand successes and gaps at a systemic level; Improves efficiency in person-centered care practices through integration into existing practices (i.e., care planning and MDS assessment); Creates positive organizational outcomes (e.g., quality, staff, census). 19

20. How does the PCC goal benefit Ombudsman? Provides a context to advocate for resident choice and individualized care; Creates further opportunities to educate and inform residents and families about the importance of choice and self-determination in nursing homes; Offers tools and resources to learn the choices of residents and families and communicate those preferences to nursing homes; Affords a concrete framework to support root cause analysis and solutions related to issues of quality of life and self-determination for residents and families. 20

21. Regulatory support for Person Centered Care Quality Indicator SurveyMeaningful use of Medical RecordsQuality Assurance Performance Improvement Providers need to demonstrate that their care addresses the needs and preferences of frail elders. “ Meaningful Use Requirements” have emerged out of health care reform encouraging providers to make maximum use of electronic medical records. This tool can be utilized by facilities to implement their individual performance improvement programs (PIP). 21

22. 22 Advancing Excellence Campaign Person Centered Care Workgroup Members

23. How is Person Centered Care Measured? 1. Attendance in Care Conference Meeting a)Extent to which resident, family/friends, and staff routinely attend the care conference b) 3 measures 2. Delivery of Preference Congruent Care a) Extent to which care is tailored to fulfilling important resident preferences b)1 measure

24. Resident Attendance at Care Conference Meeting Family Member and/or Friend Attendance CNA/Direct Care Staff Member Attendance Care Conference Attendance: Ensuring regular opportunities to interact with the care team

25. Care Plan written in Resident Voice Advance Care Planning Root Cause Analyses Conducted for Gaps in Care Delivery Optimized Care Planning Options

26. Care Plan Meeting Attendance as a quality measure for the community as a whole

27. Attending Care Conferences as a quality measure: Barriers to Resident participation Difficulties encountered in getting regular attendance by residents: Resident may be too impaired to participate in a group If resident has difficulties expressing him/herself or comprehending the flow of conversation, the resident may end up being “talked about” while present in the meeting Resident may find it overwhelming to share thoughts in a group setting with so many people present Resident does not want to attend May feel too ill or fatigued to attend May be embarrassed to share personal care issues in a group Solution: Have a staff member: 1)Interview the resident prior to the meeting to ensure that resident issues are presented in the voice of the resident 2)Report back to the resident to review the plan of care

28. Attending Care Conferences as a quality measure: Barriers to Family Member participation Difficulties encountered in getting regular attendance by family members: Family members may not be available to physically or virtually attend within the mandated window of time Solution: Schedule the care conference at a time that is convenient to the family member to a day/time they are normally visiting their family member and/or friend. Provide an update to the family member following the care conference. Find out preferred method that family member would like to receive update either via email, phone and/or next time visiting their family member.

29. Attending Care Conferences as a quality measure: Barriers to Direct Care Staff participation Difficulties encountered in getting regular attendance by direct care staff: Work schedule may not coincide with the mandated window dates for care planning Difficulties in providing coverage while DCW is in the meeting Solution: Extend an invitation to the direct care staff to participate in the care conference so they feel their voice is important. Include direct care staff attendance at conferences as a part of normal job duties in order to assist with scheduling their participation. Seek input from the direct care giver prior to care conference and provide an update to the direct care giver following the care conference.

30. How is Person Centered Care Measured? 1. Attendance in Care Conference Meeting a)Extent to which resident, family/friends, and staff routinely attend the care conference b) 3 measures 2. Delivery of Preference Congruent Care a) Extent to which care is tailored to fulfilling important resident preferences b)1 measure

31. What is Preference Congruent Care? “Preference Congruent” care is care that fulfills important resident preferences for personal care and recreational activities. – Interviews resident to discover: Which preferences are “very” or “somewhat” important Which preferences are “important, but can’t do” How satisfied s/he is with each of the important preferences being fulfilled – Provides visual feedback to staff in 3 areas: Which preferences are being fully met and which require further follow up Which preference gaps may be affecting many persons residing together in a household, floor or unit Overall measure of quality that can be benchmarked and tracked over time 31

32. Example of “preference congruence” Important everyday preferences Satisfaction with daily care related to an important preference CONGRUENCE IS THE MATCH BETWEEN How important is it to you to… choose what time to go to bed? How satisfied are you in being able to… choose what time to go to bed?

33. What Information Does the Quality Measure Provide? Provides critical visual feedback to in 3 areas: 1.Individual Report: Which preferences are being fully met and those that are not being fully met and require more discussion by the care planning team 2.Household Report: Which preference gaps may be affecting many persons residing together in a household, floor or neighborhood 3.Community Report: Overall measure of quality for the community that can be benchmarked and tracked over time

34. The Interview What does a preference interview look like? Insert video here 34

35. F0400 Interview for Daily Preferences 1-Very Important 2-Somewhat Important 3-Not Very Important 4-Not Important at all 5-Important, but can’t do 1-Mostly or completely satisfied 2-Somewhat Satisfied 3-Not satisfied at all How important is it to you to... Resident Response Importance Resident Response Satisfaction Priority AChoose what clothes to wear? A BTake care of your personal belongings or things? B C Choose between tub bath, shower, bed bath or sponge bath? C D Have snacks available between meals? D E Choose your own bedtime? E 11 Green Resident name Identifier Resident’s Household, Neighborhood or group name Date of Interview (mm-dd-yyyy) Stay type Indicate primary respondent Rose A202 Sunshine 11/12/2013 Long stay Resident Interviewing the resident or family member 3 13 Red 2 2 Yellow 5Gray 9 9

36. Individual resident report: How “Preference Congruent” is the daily care experience for an Individual Resident?

37. Case examples of individual resident reports 37

38. 38 Renee’s Interview Responses

39. Renee’s Daily Care Experience Renee is an 85-year-old female who uses a walker and a wheelchair and has mild cognitive impairment. She enjoys reading books and listening to music she likes. She also likes to keep up with the news and participate in religious activities. When interviewed, Renee also commented about the importance of “doing things with groups of people”. She stated that she liked cooking. However, the cooking classes offered only include watching the activity therapist do the cooking. Renee talked openly about the importance of having snacks available between meals. However, she shared that the facility did not offer the choice of snacks. “We do not have any snacks available between meals. I would like a little something between meals. There isn't any.” Furthermore, Renee responded that it was very important to have a choice between a tub bath, shower, bed bath or sponge bath, but was not satisfied with how often she showers. She stated that she was used to showering every day. She understands the facility policy that she only receives a shower two times a week, but she talked about enjoying her showers and wanting them more frequently. 39

40. 40 Sadie’s Interview

41. Sadie Sadie had history of being combative when care was being delivered to her. Staff were receiving physical altercations when attempting to approach her for care. The direct care worker inquired of staff on her prior unit what interventions worked well for providing her daily care. It was discovered through this investigation that Sadie was sister of an actor on a popular TV show. Singing the theme song of that popular show helped to calm Sadie so that she was more approachable during personal care activities.

42. 42 DifficultyTips for Interviewers Hearing Identify and position yourself to talk into the better ear Speak slowly and clearly Make sure hearing aids are in and being used properly Provide a copy of questions for resident to read along Use amplifier Vision Remind resident of response scale after each question Issues with using response set Direct resident back to response sheet by pointing to response options Establish if a preference is important or not important, then ask if it is very or somewhat important or not very or not important at all Cognitive impairment Allow time for resident to process the question and give an answer Repeat questions and response set as needed Common Difficulties Encountered when Doing PC Interviews with residents

43. 43 DifficultyTips for Interviewers Distracted or off topic Redirect resident back to question and response sheet Verbal communication Allow resident to point to the answer on the response sheet Have them type answers on computer Fatigue Reschedule interview for another day Not feeling well Reschedule interview for another day Visitor Reschedule interview for another day or if resident is comfortable, continue interview but ask the visitor not to participate in answering questions for the resident Common Difficulties Encountered when Doing PC Interviews with residents (cont.)

44. Using PCC information to focus content of care conference for an Individual Resident Bring Individual Resident Preference Congruence report to care conference meeting Use as an aid to help focus the content of care conference on resident daily care experience Implementation guide provides tips on how to use this information to enhance quality of care planning processes

45. Household/Group information: – Select which household you would like to view from drop down menu – See “at a glance” particular preferences that are not being met for several persons who live in a common location – Assists with program and service planning and evaluation How “Preference Congruent” is your Care for a Group of Residents?

46. Sample report: Neighborhood Report

47. Using PCC information to “Advance Excellence” in Person-Centered Care for each Household in the Community 47 Household Program Development- Look for Patterns! Use “Household Reports” to problem solve areas for improvement that may affect the care experiences of many residents in a given household Set goals for care conference attendance by residents, family members and direct care staff

48. Information about your community: – See at a glance which types of preferences are not being met overall within entire community – Assists in identifying which preferences need attention first – Guides program and service planning and evaluation Which preferences are not being met in your community? 48

49. Sample report: Results by Type of Preference

50. Choosing Your Own Clothing One provider was surprised that “choosing your own clothing” was an area of low congruence. They found that the dis- satisfaction was an issue for residents with mild cognitive impairment. Cognitively capable residents were choosing their own clothes, but staff was doing all the choosing for the more impaired residents. They are working on strategies with staff to provide more choice to residents. Going out side to get fresh air when the weather is good One provider learned that their residents would appreciate more opportunities to go outside. They are having discussions with Activities to brainstorm how to provide more opportunities. Provider Examples by Preference

51. Measuring Person Centered Care for the entire Community March – June 2013 Preference Congruence Long StayShort Stay Number of Residents Tracked this month 149 Percent of Resident Preferences “Very Important” or Somewhat Important AND “Mostly or Completely Satisfied 67%79% Overall Preference Congruence by Stay type Mostly or Completely Satisfied Somewhat Satisfied Not at all Satisfied

52. Using PCC information to Advance Excellence in Person-Centered Care 52 Incorporate results into ongoing QAPI efforts in your community Set goals to strive for Celebrate your success!

53. 53 Why should a provider consider using the PCC Tool? Feedback from Pilot Communities

54. Why Should I Use the PCC Tool? Increases the understanding of Person Centered Care o Person Centered Care is an abstract concept, this tool makes it more concrete. Increases awareness and communication of resident preferences o Resident preferences are often known to some, but not all staff. This tool makes it easier to share these preferences all staff. Enhances quality of Resident & Staff Relationship o Tool can serve as a “conversation starter” and a vehicle for getting to know more about what is important to each resident. Enhances quality of care conferences o This critical meeting can be “super-charged” by following optimized guidelines outlined in the tool.

55. Why Should I Use the PCC Tool? Provides a way to “connect the dots” to see at a glance how well each household is providing care. The Tool facilitates a nursing home’s compliance with QAPI guidelines and serves as a specific Performance Improvement Program (PIP). Provides direct feedback on what the community is doing well and what can be an opportunity for improvement. Provides a way to track a nursing home’s Person Centered Care levels over time so that early declines can be identified, analyzed and specific issues can be addressed.

56. Available PCC Goal Resources Excel Spreadsheet Implementation Guide Fact Sheets- Resident, Family, Staff Educational workshops 60 or 90 minute versions

57. The PCC Toolkit Resources For a copy of the toolkit go to: www.NHQualityCampaign.org OR www.polisherresearchinstitute.org

58. How is Person Centered Care Measured? 58

59. Contact Information Amy Elliott, PhD. Kimberly S. Van Haitsma, PhD Vice President of Research Director, Polisher Research Institute Madlyn & Leonard Abramson Center for Jewish Life Phone: 215.371.1895 kvanhaitsma@abramsoncenter.org www.polisherresearchinstitute.org Scott D. Crespy, Ph.D., CPHQ Vice President of Quality Madlyn and Leonard Abramson Center for Jewish Life Phone: 215.371.1810 screspy@abramsoncenter.org www.abramsoncenter.org

60. Questions? 60