Improving Quality Through Technology

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Improving Quality of Care Through Technology

ARGENTUM

Disclosure of Commercial Interests

• Speaker works for PointClickCare

• This presentation does not promote any specific EHR

or technology

• The speaker has no commercial interests in PointClickCare

or any other organization referenced in this presentation

Session Objectives

By the end of the session, attendees will:

1. Understand the drivers of change and the evolution

of senior living

2. Understand how technology can be leveraged to identify

and improve quality in Senior Living

Drivers of Change

in Senior Living

Driver: The Aging Population

• Senior Living growth fueled by

baby boomers

• By 2050, surviving baby boomers

will be over the age of 85

• Population aged 65+ will

continue to see steady growth

• In 2050, the population aged 65+

is projected to be 83.7 million

Source: An Aging Nation: The Older Population in the United States - Current Population Reports Issued May 2014 P25-1140 By Jennifer M. Ortman, Victoria A. Velkoff, and Howard Hogan

Seniors are delaying their

transition to senior living

• Leads to older, more frail residents

on move-in

• Requires more assistance with care

and with staying well

• Greater need for skilled staff and

potential increase in risk and liability

Need for dual focus on maintaining

wellness and preventing illness

Driver: Changing Needs of Seniors

52.6%

29.9%

10.4%

7.2%

85 and over 75-84 65-74 Under 65

Source: Long-Term Care Providers and Services Users in the United States: Data From the National Study of Long-Term Care Providers, 2013–2014 – U.S. Department of Health & Human Service – CDC

Senior living communities

are unique

o Variations in evaluation models for

communities, states and even

communities within the same states

Growth in legislation expected in

senior living

o Additional state legislation to

standardize provision of care

o Will require providers to better

manage and document care delivery

Driver: Focus on Quality

The Evolution of Senior Living

Social Model with a

Health Conscience

Health Model with a

Social Conscience

Average move-in age = 72

Average

move-in age = 83

1 or 2 Chronicdiseases

3 to 5 Chronic

diseases

Worry about your campus system

Worry about the

healthcare ecosystem

Paper service plans,

property mgmt. and invoicing

Able to manage and

document care delivery

Using technology to manage

top priorities in Senior Living

Top Priorities of Providers

What do you think the most critical success factor

will be to sustaining your business? Please rank.

0

5

10

15

20

25

30Creating effective staff recruitment and retention strategies

Aligning staff resources & skills to different levels of care

Implementing technology to improve and personalize care

Enhancing marketing outreach efforts

Source: Senior Housing News Provider Insight Survey Results

Staff recruitment / retention

#1 priority of senior livingproviders surveyed

Staff Perceptions

• Spend too much time on paper

charting and documentation

• Not enough valuable time with residents

• Heavy workloads

• Generic task lists

• Multiple manual processes

• Outdated or ineffective technology

• Lack of empowerment

How Technology Empowers Your Staff

• Eliminates duplication of information

capture, paper transcription and

unnecessary paperwork

• Increases focus on vocational

expertise – i.e. care delivery

• Increases staff accountability,

ownership and engagement

• Improves staff morale

• Technology attracts next-generation

care workers

• Improves relationships with residents

and family members

Technology’s Effect on Staff

Result: Improvement in Staff

Engagement and Resident Experience

Technology’s Effect on Staffing Costs

Provides real time data to help:

• Reduce overtime and need for

temporary staffing

• Better predict staffing to service

needs so short-staffing and

over-staffing are limited

• Match staffing expertise to

resident need

• Provide more efficient use of

caregiver time

• Re-deploy to higher value services

Aligning staff to levels

of care#2 Focus Identified By

Providers Surveyed

• Acuity levels within senior living are rising

• Seniors are delaying their transition based

on economy and the desire to age in place

• Rising acuity increases requirements for

staffing and for documentation to ensure

adequate level of care provision.

Rise In Acuity

Common Conditions

0 20 40 60

stoke

Cancer

COPD and allied conditions

Diabetes

Osteoporosis

Arthritis

Depression

Heart disease

Alzheimer's disease and other…

High blood pressure

1

1Chronic obstructive pulmonary disease.

NOTE: Cases with missing data are excluded; see *Data sources and methods* section for details.

Source: CDC/NCHS, National Survey of Residential Care Facilities, 2010

• >25% have 4-10 of the most

common conditions

• 50% have been diagnosed

with 2-3

• Increased need for skilled

staff to treat/monitor

prevent decline

Chronic Illness in Senior Living

50%

of AL residents have

3 or more chronic

illnesses

Senior Living Residents By Diagnosis

39.6%

23.2%

16.9%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Alzheimers Disease &other dementia

Depression Diabetes

Source: Centers for Disease Control & Prevention - Long-Term Care Providers and Services Users in the United States: Data From the National Study of Long-Term Care Providers, 2013–2014

The desire to age in place and delay transition to assisted living results

in a larger percentage of senior living residents with chronic diseases

Activities of Daily Living

62%

47%

39%

29% 30%

20%

0%

10%

20%

30%

40%

50%

60%

70%

Bathing Dressing Toileting Walking orlocomotion

Transferring inand out of bed

Eating


Rise in acuity levels means more senior living residents

who need help with activities of daily living

Adverse Events in Senior Living Residents

8.3%

12.4%

21.1%

0% 5% 10% 15% 20% 25%

Overnight hospital stays

Emergency department visits

Falls

The desire to age in place and delay transition to assisted living

results in more adverse and potentially avoidable events


• Increase in acuity means increase in

number of medications

• Paper processes are time consuming

and error prone

• Increase in resident monitoring means

increase in nurse time

• The more complex the care, the more

complex the medication regimens

• Complexity increases risk to resident,

staff and community

Rise in Need For Medication Management

Up to 83% of Senior Living resident need

help with their medications

• Ordering/Reordering

• Storage and Preparation

• Reminders

• Administering

• Monitoring

Residents take an average of 7.5 routine

and 2.3 PRN medications

Poly-pharmacy increases risk for acute

changes in condition and error in

administration – acuity

Medication Management In Senior Living

Source: http://www.ahcancal.org/ncal/resources/Documents/09%202009%20Overview%20of%20Assisted%20Living%20FINAL.pdf

In 2014, an Argentum report listed medication

administration as the top deficiency in senior

living

Observational Study by Oregon Health and

Sciences Institute, Rutgers, University of

Washington, and Northern Illinois University

Study 2011:

• 28.8% medication error rate in

assisted living

• 70.8% of medication errors related to dose

timing

• 8.2% when the time errors are removed

• No errors were judged highly likely to cause

harm (out of 1373 errors)

Medication Management By The Numbers

Sources: Medication administration errors in assisted living: scope, characteristics, and the importance of staff training. - Zimmerman S1, Love K, Sloane PD, Cohen LW, Reed D, Carder PC; Center for Excellence in Assisted Living-University of North Carolina Collaborative.

Drug Error Rates in Senior Living

Source: CEAL Report - 2012

70.8

12.9

11.1

3.5

1.5 0.2

Timing

Wrong Dose

Omitted Dose

Extra Dose

Unauthorized Drug

Wrong Drug

State Regulations are

all over the place:

• 10 use nurse delegation

• 20 unlicensed assistive personnel

• 20 require assistance with self

administration

Lack of Standards

Documentation

• Better documentation at time of transfer

• Anywhere, anytime documentation makes it easier to

capture changes in acuity

• Earlier identification of change in condition

Staffing to Acuity

• Acuity level of residents more easily identified

• Time spent servicing residents more

efficiently tracked

• Increases the ability to ensure the right services

identified, planned and staffed for

Technology and Acuity Management

Result: Resident Experience, Compliance

Technology to improve

and personalize care

#3 priority of senior living providers surveyed

Work smarter not harder

Provides time efficiencies for staff documentation that

gets them back to the bedside

Better documentation to reduce liability and risk

Data capture to identify and highlight changes in

condition and service provision

Real time access to information improves care

collaboration

Reasons for Technology Implementation

Using Technology To Stand Out

What technology solutions do you believe will enable you to

stand out against your competitors?

63.6%61.8%

56.4% 56.4%

40.0%

35.5%

27.3% 26.4%

0%

10%

20%

30%

40%

50%

60%

70%

ElectronicHealth Record

ResidentMonitoring

Family Portal CustomerRelationshipManagement

Point of Care Wireless NurseCall

PropertyManagement

Remote Care

Response Percent (highest to lowest)

Source: Senior Housing News Provider Insight Survey Results

In a 2010 (United States), Survey of

Residential Care Communities:

• Only 17% of residential care

communities reported using an EHR.

• Larger locations, those with 26 or more

beds, were more likely (25%) to have

had an EHR in use than smaller ones

(14%) of four to 25 beds, while those co-

located with another care setting had

even higher rates (29%) of EHR use.

EHR Usage in Senior Living

Source: CDC/NCHS National Survey of Residential Care Facilities, 2010

70% of communities using an

EHR tracked:

• Medical provider information

• Resident demographics

• Individual service plans

• Lists of residents' medications

• Active medication allergies


Source: CDC/NCHS National Survey of Residential Care Facilities, 2010

17


Source CDC/NCHS National Survey of Residential Care Facilities, 2010

also had support

for electronic

exchange of health

information with

service providers

had support for

electronic exchange

with pharmacies

1740%

25% %

had support for

electronic exchange

with physicians

Of senior living communities using EHR:

EHR and Interoperability

EHR and Personalized Care

Improved documentation

• Eliminates time intensive inefficient

paper processes – faxing, filing

• Single point data entry to reduce

copy errors

• Immediate electronic access to

health records from anywhere in

the facility

• Improved accuracy of

care documented

Improved coordination

• Brings all systems together on

one device

• Improved decision making tools

promote wellness

• Better coordination of care and

sharing of information between

care team members and during

transitions of care

Result: Improved Care

ENHANCING MARKETING

OUTREACH#4 priority of senior livingproviders surveyed

Source of Referrals

of senior living referrals

come from family

members or friends

95.7%

of referrals by a friend

is the reason resident

moved in

63.8%

of your

organization’s worth

40

Source: http://www.forbes.com/2010/02/01/brand-reputation-value-leadership-managing-ethisphere.html

Reputation

Your most valuableasset is your

good name.

Your reputation

represents

%

External Influences on Reputation

Damage to reputation and public image for

such breaches

Reputation

Re

alit

y

Perceived Reality

Day 1 Day 30 Day 60 Day 90 Day 120 Day 180

Expectation Index

Compliance

Regulatory

ChangesConsumer

Influence

Using Technology To Impact Reputation

Exceed expectations of residents and families by showing what you can do, and what you

have done

Enhance the level

of personalized

care and attention

your residents

receive, thereby

increasing referrals

Collect and share

knowledge about

your residents to

gain greater

intelligence across

your organization

Prove it Personalize it Share it

SummaryTechnology is needed to meet today’s top priorities

and address changes for the future

Reputation

Personalized Care

AcuityStaffing

Questions?

To learn more, visit us

in the exhibit hall

Booth #715

Advancing senior care.