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 Boosting Quality In Nursing & Assisted Living Care

Planetree’s designation program takes person-centered care to a new level with evidenced-based criteria and tested measures.

 

​Planetree, a nonprofit organization founded in 1978 on the principle of “personalizing, humanizing, and demystifying the health care experience for patients and their families,” offers a model of care that could be beneficial to long term care providers.
 
Planetree’s model is a patient-centered, holistic approach to health care aimed at promoting mental, emotional, spiritual, social, and physical healing.
 
The organization’s designation program for providers interested in achieving person-centered care, and possible subsequent designation as a Planetree community, is based on 30 years of experience with patient-centered care in acute care settings.
 
For Diane Judson, director of nursing for Bethel Health & Rehabilitation Center and The Cascades Assisted Living, a long term care campus in Bethel, Conn., the distinction between Planetree designation and other quality measures is resident involvement. “The patients and residents own it,” says Judson. “They’re in the driver’s seat.” 

A Fundamental Shift

The Planetree designation program is structured around how residents, family members, frontline staff, and leadership define person-centered care. A set of 63 experience-based criteria derived from focus group work with various stakeholder groups comprises the framework of the program. Collectively, these criteria raise the bar for what consumers and staff can expect from a person-centered provider, including resident-direction in their care and in the operations of the community as a whole, empowerment of staff who work most closely with residents, and prioritization of relationship-building over tasks.
 
For many long term care communities, actualization of these concepts requires a shift not merely in operations, but fundamentally in their culture. The designation program provides a road map for that work. This is achieved by translating high-level concepts into actionable, attainable, and sustainable practices.
 
This is the key to enduring change, says Bethel Health Care Assistant Administrator Maggie Butler. “It is such a huge undertaking to effect change on all of these levels, so [designation] helps you realize that it’s an evolving process and you don’t have to do it all at once. It helps keep you focused.”
 
For the Bethel community, this year’s priorities are implementing trayless dining, re-engineering its orientation process to incorporate the resident experience, developing a mentoring program, and working with residents on room renovations.  

From Conceptual To Operational

Azura of Lakewood is a short-term rehabilitation center in Colorado also working to achieve designation. For principal and founder Tim Heronimus, the opportunity to connect with others similarly committed to transforming the culture of long term care was a large part of the appeal of the process.
 
“We don’t want to provide care the same way it has been provided in nursing homes for the past 60 years,” he says. “To do that, we need to look at best practices and work with others who are working to transform the culture of care.”
 
Dialogue with providers about their most impactful changes and most pressing challenges has informed the program, most recently through the addition of criteria related to improved transitions of care.
In addition, successful innovations culled from long term care communities across the country have been woven into the criteria.
 
For instance, Bethel Health Care’s resident interview teams were the inspiration for the criterion that residents play a role in the hiring and evaluation of staff. As with all the criteria, the specifics of how the criterion is satisfied are left to the determination of individual sites based on their unique culture and structure.
 
Others need not employ Bethel’s strategy of empaneling a resident interview team; however, the existence of established practices such as this can serve as inspiration for others.  

Evidenced-Based Criteria

The designation program is aligned not only with the experiences of residents, families, and staff, but also with the empirical evidence upholding person-centered care.
 
This past year, with the support of the Commonwealth Fund, a collaborative of organizations, including My InnerView, the IDEAS Institute, the Brown University Center for Gerontology  and Health Care Research, and Planetree, refined the program’s criteria and measurement tools. The experience-based criteria consistently conformed to current literature on person-centered approaches.
 
The review process also led to the identification of gaps, resulting in the addition of criteria related to leadership engagement, the dining experience, and gentleness in the provision of daily care. 

How The Pilot Works

Now, the true test of the designation program begins. Fourteen continuing care communities spanning the continuum of long term care are serving as living laboratories where designation is being field tested. Their feedback will guide the refinement of the program to ensure that the criteria are indeed achievable within the parameters of the environmental, budgetary, and regulatory constraints that are operational realities in long term care.
 
For these communities, selection as designation pilot sites affords the opportunity to benchmark their progress with other like-minded organizations, to be exposed to evidence-based, person-centered practices, and to celebrate their successes as a community.
 
The team at Loch Lomond Villa in New Brunswick, Canada, is confident that participation in the designation pilot will help maintain momentum for their person-centered care initiatives, even in the face of competing priorities.
 
“We have a lot of wonderful programs and systems in place; however, with the changing environment and demands we need support to carry on with this wonderful work,” says Chief Executive Officer Cindy Donovan.  “We recognize we need something more to help us all grow in our future journey.”
 
For the team at Bethel, participation in the pilot is an opportunity for its hard-working staff to channel their passion for their work and for the community’s change vision. “There’s nothing more rewarding than watching people blossom in a collaborative way,” says Judson. 

Assessing The Process

Planetree’s pilot sites are also testing a Multi-method Assessment Protocol (MAP), consisting of qualitative and quantitative measures of person-centeredness.
 
The MAP includes focus group work, satisfaction survey data, and a self-assessment process. The final component of the MAP is a Quality Profile, which includes 36 measures categorized as operational, quality, and financial (see sidebar, for sample measures).
 
For communities on the path to person-centered excellence, the designation criteria are providing guidance for establishing an infrastructure that positions their culture change journeys for long-term sustainability.
 
According to Azura of Lakewood’s Heronimus, this infrastructure is creating a solid foundation for decision making and improvement processes based on what is best for their “guests” and alignment with the community’s change vision. This level of sustainability is indeed the ultimate test of the designation program.
 
“The designation process is something you must commit yourself to doing every day, and not just for one year,” says Heronimus. “It is a commitment to now and to the future.” 
 
Planetree is recruiting additional sites to participate in the pilot.
 
Sara Guastello is director of designation and resource development for Planetree. For more information about the designation program, contact Heidi Gil, senior director of continuing care, at (203) 732-1365 or at hgil@planetree.org.
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