The assisted living company rated No. 1 in Provider’s 2012 Top 40 Largest Assisted Living Companies is a major partner in a $7.3 million federal grant project, awarded to test the implementation of Interventions to Reduce Acute Care Transitions (INTERACT) in 27 assisted living, independent living, and dementia care communities in Texas and Florida over the next six months.

A Perpetuating Project

Brookdale Senior Living (BSL) will roll out the program to additional communities over the three-year grant period, with the numbers rising by at least 20 percent every six months, to 40 additional communities, according to BSL’s grant abstract. Kevin O’Neil, MD, chief medical officer for BSL, says he expects the replication to be much faster and involve the entire organization.

“We wanted to be conservative in the grant and what we promised,” he says.

Based in Brentwood, Tenn., Brookdale operates 647 senior living communities, nearly 600 of which provide assisted living, serving more than 62,000 residents in 36 states. BSL is partnered on the project with the University of North Texas Health Science Center, which received the grant funds. The project was one of 81 Health Care Innovation Awards, announced June 15, from the Centers for Medicare & Medicaid Services’ (CMS’) Innovation Center. Prior to applying for the grant, BSL piloted INTERACT tools in 11 of its skilled nursing facilities, located in eight states across the country. The project resulted in more than a 50 percent reduction in 30-day hospital readmissions, according to BSL.

The organization is currently working with Joseph Ouslander, MD, and colleagues at Florida Atlantic University on adapting the INTERACT tools to assisted living and home care settings, O’Neil says.
INTERACT is designed to help facility staff identify, assess, communicate, and document changes in resident status before a decision on hospitalization is made.

In addition to reducing readmissions that take place within 30 days of discharge, O’Neil says the project will also look at 60- and 90-day windows for potentially avoidable transfers.

He stresses that while the focus is on reducing readmissions, the target is avoidable readmissions and emergency room transfers.
“It’s important to understand that some people need to be in the hospital,” he says. INTERACT tools “are not designed to prevent people from going to the hospital, but to prevent avoidable readmissions.”

Program Goals

The project has three core goals, according to BSL’s abstract: demonstrate enhanced quality of care and reduced hospital admissions across multiple community settings and services, build the clinical capacity of caregivers and staff in senior living settings to “improve care coordination and transitions of care,” and demonstrate that the program saves more than it costs to sustain. The project is estimated to save nearly $10 million over three years.

Grant funds will be used to hire or train from within an estimated 97 clinical nurse leaders (CNLs) to act as program managers, according to a summary of the project from CMS. CNLs will also train nursing and clinical staff on the use of the INTERACT tools and health information technology.

CNLs are “masters-level nurses who are trained to do systems work and be involved in clinical education,” O’Neil says. “They know how to interpret, analyze, and act on data.”

Other major expenses for the project will include development of the technology infrastructure, O’Neil says. “A big part of the grant is to capture data and look at it in a meaningful way.”

The university, along with other data and technology partners, will be driving forces behind the effort. BSL has implemented an electronic medical record system in its skilled nursing facilities and is in the process of doing so in its assisted living communities, O’Neil says.

Ready To Share Model

BSL hopes the project will serve as a model and that other post-acute care providers will “run with what we are doing to speed the trajectory” of quality improvements, he says. None of the products from the program will be proprietary; BSL is anxious to share the tools and lessons learned, O’Neil says.

“All post-acute care providers, not just skilled nursing facilities but assisted living and home health care, need to understand the importance of looking at their outcomes, collecting data, collaborating with hospitals, and sharing data,” he says.

“I’m convinced that hospitals are going to focus on how they influence where people are going [along the post-acute care continuum] based on the kind of outcomes” providers are able to demonstrate.

This includes training staff to “recognize subtle changes in condition and opportunities to intervene in a timely way on site” to prevent unnecessary hospital transfers that can lead to such complications as delirium, nosocomial infections, falls, and pressure ulcers, O’Neil says.