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THM P.O. Box 10 Phone (731) 847-6343

Parsons, TN 38363 Fax # (731) 847-4200 10/31/18

Chelsea Ridley, MPH Director, CMP Reinvestment Program Office of Patient Care Advocacy Tennessee Department of Health Andrew Johnson Tower, 5th Floor 710 James Robertson Parkway Nashville, TN 37243 p. 615-532-8198 Chelsea.Ridley@tn.gov

RE: Activities, Restorative, and Therapy in Sync (ARTS) Project Grant Q2 Report

Dear Ms.Ridley,

Tennessee Health Management, Inc. (THM) – Memphis Region Activities, Restorative, and Therapy in Sync (ARTS) program serves approximately 750 nursing home patients, in ten locations throughout West Tennessee including the counties of Henry, Carroll, Weakley, Obion, Gibson, Dyer, Tipton, and Shelby. The objective of the Activities, Restorative, and Therapy in Sync (ARTS) program is to provide the residents in our care an improved quality of life through the implementation of It’s Never 2 Late (iN2L) - fusing therapy, restorative care, and activities into a truly individualized approach. We are aligning the patients’ personal interests and functional limitations with activities, restorative programs, and therapy treatment in a computer-based format.

If additional information is needed on the individual patient questionnaires or iN2L usage, please request and I will gladly submit.

Sincerely,

Heather Lansaw, Regional Director of Operations – Memphis Tennessee Health Management, Inc. 1971 Tennessee Avenue North, P.O. Box 10 Parsons, TN 38363 hlansaw@thmgt.com Telephone#: (731) 695-8981 Fax #: (731) 885-5042

ennesseeTHManagement, Inc.

ealth

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Quarterly Report:

Legal Name of Organization:

Mailing Address, City, State, and Zip:

Phone: EIN: Edison Vendor ID:

CEO/Executive Director:

Phone: Email:

Project Leader:

Phone: Email:

Program name:

Grant ID Number:

Dates Covered by this Grant:

Grant Amount:

Summary of Grant Purpose:

Tennessee Health Management, Inc.

1971 Tennessee Avenue North

P.O. Box 10

Parsons, TN 38363

731-847-6343

Mike Bailey, CEO

621541543

731-847-6343 mbailey@thmgt.com

Heather Lansaw, Regional Director of Operations

731-695-8981 hlansaw@thmgt.com

Activities, Restorative, and Therapy in Sync (ARTS)

Z18172268, Amendment: Z18176942

April 1, 2018 - March 31, 2021

$493,550.87

212086

The objective of the Activities, Restorative, and Therapy in Sync (ARTS) program is to provide the residents in our care an improved quality of life through the implementation of It’s Never 2 Late (iN2L) – fusing activities, restorative care, and therapy into a truly individualized approach. By aligning the patients’ personal interests and functional limitations with activities, restorative programs, and therapy treatment in a computer-based format, we will improve or maintain the patients’ activities of daily living, increase the number of residents in activities, and increase the number of residents in the restorative program. This movement to synchronize the different programs will have a direct impact on the culture in our communities and improve the quality of life for those we serve.

Q2 July 1 2018 – September 30, 2018

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The goals of the project are to 1) to improve or maintain ADL function, and 2) increase patient participation in person-centered recreational and rehabilitation activities.

Project Tasks / Process Objectives

Timeline Month/Year

Responsible Party

Date Completed

Notes

Grant Awarded—sign contract, workout logistics

Apr-18 Regional Director of Operations

Apr-18

Purchase iN2L equipment, schedule initial Onsite Activity-Specific and Therapy-Specific Trainings, System Installations and Program Rollouts for all 10 Memphis Region facilities

May-18 Regional Director of Operations; THM-Memphis Region Administrators

May-18

Collect and record MDS, Restorative Care Log, and Activity Log baseline data

May-18 THM-Memphis Region Administrators

May-18

Inform stakeholders of the project and explain the benefits through the newsletter, flyers, and meetings

Jun-18 THM-Memphis Region Administrators

Jun-18 Facilities completed staff meetings, spoke at Resident Council meetings to ensure staff was aware of the program and its benefits. Flyers posted for meetings throughout the facilities

Participate in Activities and Therapy-specific On-Site Trainings, System Installations and Program Rollouts

Jul-18 Regional Director of Operations; THM-Memphis Region Administrators

Jun-18 Training staff from April – May 15th. Rollout completed by June 2018 for all facilities.

Meeting with the Patients to educate on the New Program**

Jun-18 Activities Directors

Jun-18 Completed in Resident Council along with individual meetings for some patients.

Outcomes

All residents in the communities were monitored for system use, iN2L participation, restorative program, and questionnaires for alert/oriented patients using the system. The following data was collected on all residents:

• Total Number of In-House Resident Last Day of Month • Total Number of Long-Term Residents last day of the month (including Private)

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• Total Number of Resident using iN2L (could be restorative, act, or therapy) • Number of Residents with My-Story Complete • Number of Residents in the Restorative Program • Number of Residents in the Restorative Program Using iN2L • Number of Residents added to the Restorative Program this Month using iN2L

The monitoring includes only the activities with the iN2L system. After a meeting with THM Electronic Medical Record system team, the process has begun to include a “button” in the Activities section of the electronic medical record to “click” if the activity was completed using the iN2Lsystem. This will give a more accurate picture of usage in Activities.

Total patients and long-term patients’ categories were added to ensure as many as possible long-term residents were included on the “My Story” biography portion of the system. Short term resident will not be included in the “My Story” biography section as the average length of stay is only 27-30 days and continues to decrease. Some short stay residents did choose to complete the “My Story” biography.

Restorative information contains only patients in restorative care using iN2L.

Weekly Data

A weekly meeting was also initiated with greater detail to include:

This form is completed to ensure Activities, Restorative, and Therapy are in sync and discuss the plan for all residents using iN2L and ensure the plan is focused on “fun” activities that will improve their functional or mental status.

It identifies each patient, goals, treating department, and types of engagement. This is a form that will change weekly as patients are added, discharged, or have changes.

Types of Engagement on iN2L

Date Initiated Mem

ory

Care

Impr

ove

Beha

vior

s

Impr

ove

Sequ

enci

ng

Impr

ove

Psyc

hoSo

cial

Impr

ove

Prob

lem

Sol

ving

\Aw

aren

ess

Impr

ove

Mot

or S

kills

Impr

ove

hand

\eye

coo

rdin

atio

n

Impr

ove

mob

ility

Impr

ove

Gait

Impr

ove

safe

ty a

war

enes

s with

surf

ace

tran

sf

Impr

ove

Rang

e of

Mot

ion

Impr

ove

Bala

nce

Impr

ove

Stre

ngth

Oth

er -

plea

se e

xpla

in

Activ

ties

Reso

rativ

e

Occ

upat

iona

l The

rapy

Phys

ical

The

rapy

Spee

ch T

hera

py

Types of Engagement on iN2L

Goals Participating Department

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Month Ending

Total Number of In-House

Residents Last day of Month

Total Number of Long Term Residents last

day of the month

(Including Private)

Total Number of Residents

using iN2L (could be

restorative, act, or therapy)

Number of Residents with

My-Story Complete

Number of Residents in

the Restorative Program

Number of Residents in

the Restorative Program Using

iN2L

Number of Residents

added to the Resorative

Program this Month using

iN2L07/31/18 59 41 43 0 6 5 008/31/18 57 43 43 10 5 4 109/30/18 59 38 45 59 6 5 107/31/18 65 50 21 50 22 5 808/31/18 67 49 20 49 15 4 409/30/18 68 50 21 50 16 5 107/31/18 76 53 23 23 5 5 008/31/18 74 54 27 27 4 4 009/30/18 66 53 32 32 3 3 007/31/18 123 86 61 0 15 15 508/31/18 120 87 62 0 16 16 709/30/18 109 86 64 40 14 14 507/31/18 90 65 24 0 11 0 308/31/18 92 65 24 0 8 0 009/30/18 89 63 25 0 9 0 107/31/18 50 34 12 0 22 8 108/31/18 49 35 32 0 23 5 009/30/18 46 34 43 49 22 4 007/31/18 89 68 32 12 25 23 208/31/18 93 68 29 11 23 19 409/30/18 89 65 38 17 23 20 307/31/18 109 85 44 0 11 8 108/31/18 110 82 45 35 12 8 109/30/18 102 80 47 45 18 13 607/31/18 72 54 35 0 11 5 808/31/18 73 52 42 2 22 10 909/30/18 70 50 34 59 22 5 807/31/18 55 40 30 0 29 16 008/31/18 57 40 30 40 28 15 109/30/18 56 38 35 40 28 16 107/31/18 788 576 325 85 157 90 2808/31/18 792 575 354 174 156 85 27

Totals 09/30/18 754 557 384 391 161 85 26

McKenzie

Paris

Union City

Van Ayer

Applingwood

Bright Glade

Covington Care

Dyersburg

Harbor View

Humboldt

280

300

320

340

360

380

400

07/01/18 08/01/18 09/01/18

Number of Residents using iN2l

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0

100

200

300

400

500

07/01/18 08/01/18 09/01/18

Number of Residents with My-Story Complete

iN2L Restorative All Restorative

0

20

40

60

80

100

120

140

160

180

07/01/18 08/01/18 09/01/18

Restorative

Series1 Series2

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iN2L System Usage in Hours

Early on three facilities identified connectivity issues, which was quickly resolved by contacting the iN2L Customer Success Manager. Staff has been in-serviced on ensuring that the systems are online to access 100% of the content. Also, some areas of facilities were “dropping” the connection even after the staff verified the computer was online. IT has been notified of internet “drops” when moving the computer or in certain areas in the facility. Each incident reported has been investigated by IT and corrective actions have been initiated. Some “internet drops” are still being investigated by IT. The results so far have been different in different facilities. Some have needed an increase in band width, change in access, mounting router in a different area, and installing wireless range extenders.

QOL Survey It was determined by the ARTS Committee that the questionnaire should focus on the residents’ emotional status. We are using the iN2L QOL Outcome Survey to track quality of life measures.

Each data point is assigned a value:

• Very negative = 1 • Negative = 2 • Neutral = 3

Jul Aug Sep AverageApplingwood 276.56 238.44 193.63 236.21 Bright Glade 656.65 649.42 432.52 579.53Covington Care 178.13 329.07 173.86 227.02Dyersburg 482.15 497.28 338.69 439.37Harbor View 352.41 108.69 121.28 194.13Humboldt 646.84 1019.82 961.61 876.09McKenzie 328.46 517.68 734.27 526.80Paris 364.62 617.06 589.06 523.58Union City 499.44 570.45 333.37 467.75VanAyer 166.38 503.92 278.51 316.27Team Average 395.16 505.18 415.68

Hours of In2L Usage per Facility Per Month

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• Positive = 4 • Very positive = 5

The higher the average, the better the outcome.

Facility Name Num

ber o

f Sur

veys

Com

plet

ed

1. H

ow m

uch

of th

e tim

e du

ring

the

past

wo

wee

ks

have

you

felt

full

of p

ep?

2.Ho

w o

ften

have

you

bee

n ab

le to

find

joy

in li

fe o

ver

the

past

two

wee

ks?

3.Ho

w m

uch

of th

e tim

e du

ring

the

past

two

wee

ks

have

you

felt

calm

?4.

How

muc

h of

the

time

durin

g th

e pa

st tw

o w

eeks

ha

ve y

ou h

ad lo

ts o

f ene

rgy?

5.Ho

w m

uch

of th

e tim

e du

ring

the

past

two

wee

ks

have

you

bee

n ha

ppy?

6. H

ow o

ften

have

you

felt

peac

eful

ove

r the

pas

t tw

o w

eeks

?7.

How

muc

h tim

e ha

ve y

ou fe

lt re

sted

and

rela

xed

over

the

past

two

wee

ks?

8.Du

ring

the

past

two

wee

ks, h

ow m

uch

of th

e tim

e ha

s you

r phy

sical

hea

lth o

r em

otio

nal p

robl

ems

inte

rfer

ed w

ith y

our s

ocia

l act

iviti

es?

9.Ho

w o

ften

have

you

had

littl

e in

tere

st o

r ple

asur

e in

do

ing

thin

gs o

ver t

he p

ast t

wo

wee

ks?

10.H

ow o

ften

have

you

had

trou

ble

falli

ng a

sleep

or

stay

ing

asle

ep o

ver t

he p

ast t

wo

wee

ks?

11.H

ow o

ften

have

you

had

trou

ble

conc

entr

atin

g ov

er

the

past

two

wee

ks?

12. H

ow m

uch

of th

e tim

e du

ring

the

past

two

wee

ks

have

you

felt

so d

own

in th

e du

mps

that

not

hing

cou

ld

13. H

ow o

ften

have

you

felt

fidge

ty o

r res

tless

ove

r th

e pa

st tw

o w

eeks

?14

. How

muc

h of

the

time

durin

g th

e pa

st tw

o w

eeks

ha

ve y

ou fe

lt tir

ed?

15. H

ow o

ften

have

you

felt

sad

over

the

past

two

wee

ks?

Applingwood 21 3.0 3.6 3.5 2.9 3.9 3.7 3.9 3.8 4.0 4.5 3.0 3.7 3.4 3.1 3.6Bright Glade 26 3.1 3.5 3.3 3.0 3.7 3.3 3.3 4.0 4.0 3.1 3.3 4.4 3.3 3.1 3.5Covington Care 22 3.6 4.1 4.1 3.5 4.0 4.2 4.5 4.1 3.9 4.2 4.7 4.4 3.9 3.8 4.3Dyersburg 21 3.6 3.6 4.0 3.0 4.1 3.7 3.6 3.6 3.1 3.6 3.9 4.1 3.8 3.2 3.7Harbor View 20 3.4 4.0 4.0 3.5 3.8 4.1 4.2 3.7 3.3 3.6 3.8 4.2 3.6 3.5 4.2Humboldt 33 3.0 3.6 3.8 2.6 3.7 3.6 3.4 3.6 3.5 3.4 3.5 3.9 3.6 2.7 3.7McKenzie 22 3.6 3.7 3.9 3.2 4.1 4.0 3.6 3.9 3.8 3.9 3.3 3.8 3.7 3.0 3.6Paris 24 2.8 3.8 4.0 2.5 4.0 4.0 3.7 3.3 3.6 3.8 3.8 4.2 3.8 2.8 3.8Union City 28 3.1 3.3 3.3 3.1 3.4 3.3 3.0 3.3 3.1 3.2 3.4 3.5 3.3 3.1 3.2VanAyer 14 3.7 4.5 4.1 3.7 4.2 4.0 4.0 3.9 4.1 3.7 4.0 4.4 4.3 3.6 4.4Average 3.3 3.8 3.8 3.1 3.9 3.8 3.7 3.7 3.6 3.7 3.7 4.1 3.7 3.2 3.8Total Surveys Completed 231

Resident Questionnaire - Average Score for Each Question Per FacilityScoring of the questions:

1 - All the time. 2 - Most of the time. 3 - Sometimes4 - Rarely5 - Never

Answers are completed by alert and oriented residents, tabulated by iN2L and reported to facilities quarterly.

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As this is baseline data due to changing the survey, comparative data will be provided going forward.

Groups making significant contributions

Partnerships have developed in all facilities with the family members of the residents. Through the process of creating My Page buttons and discussing the digital biographies, the long-term residents and families are more engaged with the staff and volunteers.

An unexpected partner in one of the facilities is the local high school softball team. The coach inquired about a special project to promote community service and reached out to a facility when they read the article in the local paper. Upon resident\family approval, they have volunteered to work with our residents to complete the digital biographies. This intergenerational volunteer program was piloted in the Union City facility and continues every Wednesday afternoon.

The students meet with the residents and discuss their life story while creating digital biographies on the “My Story” section of iN2L.

Evidence of Effectiveness Of the 190 residents in the baseline study:

93.2% of the residents maintained or improved their bed mobility 93.2% of the patients maintained or improved their current ability to transfer 92.6% of patients maintained or improved their ability to dress 89.5% maintained or improved in eating 93.2% maintained or improved their toileting use 94.2% maintain or improved their bathing ability. 93.7% maintained or improved their Mood (frequency

All Residents:

Number of residents using the ARTS program is increasing every month. Over half of all residents have completed “My Story” biographies.

Qualitative Impact of ARTS Program The American Health Care Association Convention in October of 2018 hosted a seminar on the use of technology systems in long-term care and the Team Leader for the ARTS project spoke about the program and the impact on patients. Her father, a current resident at Union City Nursing and Rehabilitation with a diagnosis of Parkinson’s and Alzheimer’s disease, was featured as a patient that benefited from the program.

Results of the Memphis region ARTS program were shared with the THM Leadership team along with all other THM facilities in management staff meetings.

Problems/Delays

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A lack of understanding from activities staff resulted in a misidentification of connectivity issues. In addition, during the first few months, several facilities experienced issues with the internet connections being slow to download. The IT department addressed all issues and reports from June 2018 were improved. Streaming is successful with few, if any, interruptions.

Staff turnover in Activities and Restorative has also caused some challenges. One Activity Coordinator and several Restorative positions have been replaced and the hiring and training process for some was longer than expected. However, we resolved our staffing issues before they impacted the program.