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Keeping the Promise : Inventing a New Long-Term Care Nancy Fox, VIVAGE

Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

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Page 1: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Keeping the Promise : Inventing a New Long-Term Care

Nancy Fox, VIVAGE

Page 2: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

An Ageist Society

•  Daily, in America we are witness to, or even unwitting participants in, cruel imagery, jokes, language, and attitudes directed at older people

•  Even old people are ageist

Page 3: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Declinist View of Aging

•  Aging is bad

•  Elderly – a bundle of negative stereotypes about older people

•  Black balloons on your 40th birthday, coffins on your 50th.

•  The only GOOD old person is an old person who…

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Page 4: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Acts like a young person!

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Page 5: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Anti-Aging: A Booming Market

•  Americans spent >$30 billion on anti-aging products last year

•  That is expected to rise to $70 billion in the next 30 months

•  All in an effort to not have wrinkles

Page 6: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Aging “Remedies” •  Anti-aging creams don’t work – they

have been proven to reduce wrinkle depth by less than 10%

•  Botox – a diluted form of a deadly toxin – 1 gram could kill 1 million people – temporary and paralyzing

•  Surest method of wrinkle prevention is…

Page 7: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

… Death at an early age

Page 8: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

The Declinist’s View

•  Has led us to create and inhabit a constellation of programs, services, and facilities that attempt to mitigate aging by dealing with decline.

•  “Long-Term Care” - dreadful hopelessness

Page 9: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

A question for you…

•  What are old people for?

Page 10: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

The Declinist’s View

•  Created “God’s Waiting Room” •  Followed an Institutional Model of Care for our

infirm and elderly. •  Last 20 years – tremendous improvements in

quality of care •  Those are becoming harder and harder to

sustain •  The “Perfect Storm” of Long-Term Care •  Even though care of the human body has

improved, the human spirit is till suffering •  A place where no one wants to live and few want

to work

Page 11: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

A question for all of us… •  Why don’t people like us?

Page 12: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Daniel Pink – Drive: The Surprising Truth About What Motivates Us

•  “The course of human freedom has always moved in the direction of more freedom. And there is a reason for that – because it is in our nature to push for it.”

•  “The secret to high performance and satisfaction - at work, at school, and at home – is the deeply human need to direct our own lives.”

•  “We are born to be Players, not Pawns.”

Page 13: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

The reason people don’t like us •  Under the institutional model we remove every

ounce of autonomy and freedom from their lives •  We engage in Surplus Safety at the high cost of

stripping meaning and joy out of their lives •  We tell our staff to leave their hearts and their

brains at the door •  Then a few very courageous and tireless people

rush madly about trying to keep everyone in line

Page 14: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Culture Change - A New View

•  Developmental Aging •  Aging is a continued stage of growth

and development •  Elders are not less or more than

adults •  They are different •  Just as adults are different from

children

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Page 15: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Culture Change Movement •  A Social Movement to change the way we think

about and care for our Elders and those with disabilities.

•  Developmental Aging – that restores relationships, autonomy, meaning, purpose & joy

•  Engages & empowers the residents, staff and families in effort to unleash the creative energy and spark of life of the community

•  Began in nursing homes •  Now spreading to all care settings and around

the world

Page 16: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Person-Directed Care

•  A world in which Residents truly direct their own care and make their own choices about how they spend their time.

•  A world in which Caregivers are highly involved in decisions that are relevant to their jobs and the people they care for.

•  The Residents, their families, and the staff are a part of a thriving, interdependent community

where relationships matter.

Does this speak to your natural drive for autonomy?

Page 17: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Person-Centered Care

•  A world in which the Resident’s natural need for autonomy is recognized and honored in an environment where maximum choice is balanced with the need for support, and risk is recognized and honored as a means to creating dignity.

•  A world in which Caregivers know each resident well and create a supportive, yet empowering environment offering choices and balancing risk with autonomy for each individual resident on each day for each decision.

Page 18: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Dispelling the Myths –  Culture Change costs too much –  I can’t “do” Culture Change because I

have an old building –  Culture Change is only for old people –  The regulations won’t allow it –  Culture change doesn’t work in subacute –  My residents are not able to make

decisions –  My residents are sicker than yours –  We are assisted living, we already do

culture change –  We tried that and it doesn’t work –  We don’t have time for Culture Change

Page 19: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

A little about VIVAGE •  Merger of Pinon Management and QLM in JAN

2012 •  Manage 25 SNFs & 2 ALS serving 2200

residents in 3 states •  Also do temporary management and consulting

nationally •  6 of our managed homes serve younger

populations including people living with chronic mental illness, MS, Huntington’s, TBI

•  Many of our buildings were built in the 1960’s and 70’s

•  Known for turnarounds of troubled homes

Page 20: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Customer Satisfaction Surveys

Scale (1 – 5) VIVAGE National Range Overall Quality 4.3 4.2 4.08 – 4.66 Individual Needs 4.4 4.3 4.10 – 4.68 Dignity 4.6 4.5 4.39 – 4.8

Average scores across all homes were above the national averages in 14 of the 15 categories

Source: Pinnacle Quality Insight 2012

Page 21: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Survey Outcomes & 5-Star Ratings

•  VIVAGE average # of deficiencies = 6.6

•  Statewide average # of deficiencies = 15.7

•  VIVAGE has the largest number of Colorado facilities ranked at 4 or 5 stars by CMS

•  Of the 55 homes in the US attaining 5 stars in 2012, VIVAGE manages 10 of those homes.

Page 22: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Financial Outcomes

Net Operating Income Net Income

December 2008 ($27,955) ($240,879)

December 2009 $309,998 ($31,353)

December 2010 $503,509 $407,178

As  an  example  of  financial  impact  of  culture  change,  year-­‐to-­‐date  figures  from  one  home  are  given.    These  numbers  reflect  the  financial  changes  that  occurred  a>er  Piñon  took  over  management    of  this  home  and  brought  in  a  knowledgeable  administrator  in  March  2009  who  implemented  culture  change  pracGces.

Page 23: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Staff Retention

VIVAGE   Colorado*   United  States*  

Nursing - RN 64% 37% 49.5%

Nursing - LPN 63% 50.5% 56%

Nursing - CNA 70% 43.6% 49%

Overall Staff Retention

68%

48.2%

55.1%

*Source: American health Care Association 2010 AHCA Survey Facility Staffing

Page 24: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Clinical Outcomes

VIVAGE Average National Average Colorado Average

Falls w/ Injury .6% .5% .8%

Residents with a UTI

6.1% 7.8% 7.2%

Residents Who Lose Weight

5.2% 5.7% 6.6%

Residents Who Were Physically Restrained

.4% 1.9% 1.8%

Source: Point Right Quality Insights 1/13

Page 25: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Colorado’s Pay for Performance

•  In 2012, all but 2 Vivage homes attained enough points to receive the additional $4/day to their Medicaid rates. The other two scored $3/day.

•  This equated to an additional $1.6 million for our communities

•  50% of Colorado’s P4P is based on person-centered care practices.

Page 26: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Occupancy Rates Comparison

Page 27: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Denver Occupancy Rates

Based on cost report data 2010

Page 28: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Culture Change: A Way of Life

•  NOT a Program 3 initiatives of deep, sustainable culture

change…

•  Physical transformation •  Organizational transformation •  Personal transformation

Page 29: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Physical transformation •  Removes the institutional trappings •  Reflects those who live and work there •  Creates a sense of identity and meaning and

belonging – “lived space” •  Creates levels of privacy •  Encourages socialization •  Creates opportunity for normalcy •  Creates opportunity for relationship with the

larger, living world •  Creates ease of access to companionship, a

balancing of care, and opportunities for variety and spontaneity in the rhythm of daily life

•  Feels like home, not homelike

Page 30: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The
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Old Nurses Station

Christopher House

Page 45: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

New Nurses Station

Christopher House

Page 46: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The
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Old Dining Room

North Star

Page 50: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Remodeled Dining Room

North Star

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Organizational transformation •  Pushes decision-making and resources closer

to the Elder •  Consistent assignment of staff into

Neighborhood or Household •  Team instead of department and shift/

management and staff •  Cross training-blending of roles •  Shifting accountability •  Division of labor based on skills and likes not

job descriptions •  Creates a sense of belonging

Page 61: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

The Residents deciding on Dining Room Décor

Page 62: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Flattening the Hierarchy

Page 63: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The
Page 64: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Daily Community Meeting

Page 65: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

A Neighborhood Team in Learning Circle

Page 66: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Personal transformation

•  Awakening to a new way of seeing the world – Eden Eyes

•  Growing self and others – new skills •  New language •  Creating a new ethos •  New way of communicating •  Higher accountability •  Redefining CARE •  Caring for the whole person •  Leadership is the Key!

Page 67: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Administrators!

•  You are the key! •  Eden Alternative Principle 10: •  “Wise Leadership is the lifeblood of any struggle

against the plagues of the human spirit.” •  Leadership is the single determining factor of

whether an organization can make the leap to deep, sustainable culture change or falls short.

What you do Matters!!!

Page 68: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

You Grow First! – 10 Steps 1.  Become Self-Aware 2.  Know Each Person 3.  Grow a Strong Definition of Self 4.  Use Only Conditioned Power 5.  Create a Just Culture 6.  Expect the Best 7.  Model & Teach Accountability 8.  Ask Questions. Don’t Give Answers 9.  Use Learning Circles & Huddles 10. Join the Colorado Culture Change

Coalition

Page 69: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Colorado Accord

•  June 25th & 26 •  at Mile Hi Church in Lakewood

•  SAVE THE DATE!!!!!

Page 70: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Stop Saying “If Only”

And start asking “What if?”

Page 71: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Downhill Skiing

Page 72: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Join the local swim club

Page 73: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Put childcare in your home

Page 74: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Adult Enrichment Programs at Local College

Page 75: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

Have a Resident Sales Team!

Page 76: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

They come here to live

Page 77: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

And continue to enjoy their simple pleasures..

Page 78: Keeping the Promise : Inventing a New Long-Term Care · • Last 20 years – tremendous improvements in quality of care • Those are becoming harder and harder to sustain • The

We have a promise to keep… •  For our grandmothers and grandfathers, our

mothers and fathers, our children and grandchildren, and for ourselves…

•  We must restore Elders and the disabled to their proper place of honor and respect in our society.

•  That begins with inventing a new long-term care. •  And that begins with each of you.


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