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 The Center that Could: Person-Centered Care in a Kansas Nursing Center

A pay-for-performance program boosts motivation and improves outcomes.

 

When long-time certified nurse assistant (CNA) Luanne Foust heard that her center was planning to adopt person-centered care (PCC), she knew that she had only two choices—learn all she could about it and embrace it, or find someplace else to work. She chose the former and is happy that she did.

Here’s what she had to say about the experience: “I could go on and on about the things we had done here at Medicalodges of Columbus to provide residents a happier life, but the one thing I will say is a happy resident will always make your job of taking care of him so much easier, and you have more time to enjoy personal, quality, family time with all of them.”

While Foust had always enjoyed working at the center, she did so even more after adopting PCC. It’s like having a big extended family, she says, as all of the friends and families of these residents have also become just like family to staff.

“All of our residents get to experience the neighborhood concept, but they also have choices of what they want to do, when they want to do it, and where they do it,” says Foust. “I just hope that someday everyone working in nursing centers can experience life as we know it now at Medicalodges Columbus.”

PEAK Makes it Possible

More and more, CNAs and residents in Kansas are experiencing the benefits of PCC, thanks to the Promoting Excellence Alternatives in Kansas nursing centers (PEAK) 2.0 program sponsored by the Kansas Department for Aging and Disabilities Services (KDADS) and administered by the Kansas State University Center on Aging.

This pay-for-performance program gives incentive to centers with accelerated Medicaid per diem rates based on level of adoption of PCC: Centers at the highest ranking can earn tens of thousands of dollars yearly, but the nonmonetary rewards experienced by the centers are much greater than the monetary ones.

Motivation gets a Prod

In 2002, the PEAK program started as a recognition process. Centers could self-nominate for having achieved a level of culture change. These centers were evaluated and given a small award and designation as a “PEAK Home.” At the time, changing the culture to person-centered care was intrinsically motivated, meaning that administrators would direct the process because they believed in their hearts it was the right thing to do.

After several years it became obvious that not many people were being intrinsically motivated, and a relatively small number of centers were being recognized. It was at this point that the secretary for KDADS determined that extrinsic motivation might be helpful.

Evolution to Pay for Performance

In 2012, the program became a pay-for-performance program with increased Medicaid rates being tied to PCC performance. The Center on Aging was asked to play a role in developing the processes and the education that were necessary to bring centers along on this journey. Center personnel soon discovered that it was going to be very important to evaluate and educate centers consistently using the criteria KDADS developed, which provided common definitions and guidelines for the centers to follow. The result is that the shared definition of PCC has created a common language and a dialogue that helps keep the centers on the same page.

Perhaps one of the most exciting aspects is that this structure has allowed researchers to be able to measure, more definitively than ever before, the outcomes of person-centered care.

Reaching the Highest PEAK

Medicalodges Columbus, under the corporate management of Medicalodges, was one of the centers that enrolled in the program. With support and guidance from its central organization, the Columbus center has evolved in PCC and was recently awarded the highest level of achievement for PEAK. Columbus is considered a mentor center and earns $4.00 per day per Medicaid resident.

The satisfaction rankings of residents and families exceed the best in class average, they received a zero deficiency survey this year, their census average is well above occupancy in the surrounding area, and the use of antipsychotic medications has fallen from 15 percent to 0 percent.

It is common to believe that changing the culture of a nursing center requires lots of money to renovate the building. Medicalodges, Columbus, has proved this is not necessary. The center has created opportunities and choice for residents in a very traditional nursing center model with very little expense.

Introducing Change Statewide

As thrilling as it is for this one center to discover the intrinsic value of changing its culture, PEAK is even more exciting at the state level. When comparing outcomes for 220 nursing centers across the state, major depressive symptoms declined by 42 percent from the non-PEAK participants to the highest levels of achievement.

The same groups had a 38 percent decline in low-risk residents with pressure ulcers. Residents with in-dwelling catheters and urinary tract infections also significantly decreased.

An interesting outcome from the research on resident satisfaction was that it did not rise significantly until the center had done a comprehensive adoption of PCC, proving that satisfaction won’t improve just by changing a dining menu (or other isolated incremental program changes).

Breaking Down a Holistic Approach

The four major core domains for the program are resident choice, staff empowerment, center environment, and meaningful life. Within each of these domains are secondary criteria to be addressed. For example, under resident choice, food, sleep, bathing, and daily routines are considered. Each of these areas is further broken down for a holistic approach to the care environment. It is important to note that the needs of staff are also primary considerations.

Researchers at Kansas State University are just beginning to document the benefits of PEAK for person-centered care, but initial reports reveal that extrinsic motivation for change can be a good way to initiate intrinsic motivation. Once staff, families, and residents begin to experience the improvements in life that come with PCC, they recognize that it’s the right thing to do. And that feels good.
 
Gayle Doll, PhD, is director, Kansas State University Center on Aging, and can be reached at gdoll@ksu.edu or 785-532-5945. Laci Cornelison is PEAK project director, Kansas State University Center on Aging, and can be reached at lljh8484@ksu.edu or 785-532-5945. Amy Higgins, RN, is a Medicalodges Columbus administrator; she can be reached at akhiggins@medicalodges.com.
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