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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
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
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 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
• 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
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
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
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
• 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
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
EHR Usage in Senior Living
Source: CDC/NCHS National Survey of Residential Care Facilities, 2010
17
EHR Usage in Senior Living
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 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
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