Hospital admissions among assisted living residents in 46 Brookdale Senior Living communities decreased 17% in a three-year pilot program funded by a $7.3 million Centers for Medicare & Medicaid Services Health Innovations Challenge grant. The findings provide hope for improving quality of life for residents and saving costs in the healthcare system.

The project introduced into the communities a quality improvement program known as Interventions to Reduce Acute Care Transfers (INTERACT). The program, originally developed for use in skilled nursing facilities by a Florida Atlantic University team led by Joseph Ouslander, M.D., provides checklist and communication tools to help care teams better determine when an older adult truly needs to go to the hospital. To modify the program for assisted living, project organizers chose the INTERACT components most relevant for those residents. Key elements were the STOP and WATCH and SBAR (Situation, Background, Assessment, Recommendations) communication tools, as well as advance care planning resources.

“The program worked because it combines the observation and timely reporting of health changes with the STOP and WATCH tool,” said Kevin O’Neil, M.D., Brookdale’s chief medical officer and pilot project co-director. The SBAR tool is a way to communicate with physicians, and the advance care planning tools help identify residents’ wishes and goals of care before a crisis arises, he added.

The team also had to develop and implement a comprehensive care transition management technology platform. “Capturing data is now an even more important aspect of healthcare,” O’Neil said. “Measurement is necessary … to determine if a project results in improvement in care quality.”

Entire community teams needed to be trained to use INTERACT. “We educated every associate, from bus drivers to wait staff to caregivers, because they all work with our residents every day,” O’Neil said. “Our associates often know when something is not right with a resident, so their observations are important.”

Staff members were asked to report their observations so that a nurse or physician could perform a clinical evaluation. “Timely onsite assessment and intervention can often reduce the need for transfer to the hospital,” O’Neil said, adding that these behaviors also help meet the goals of the project: to improve health outcomes, reduce avoidable hospitalizations and decrease the overall cost of care.

Learning the new program is not necessarily easy for staff members, and that fact makes the quality and consistency of the training vital to the program’s success, said Thomas J. Fairchild, Ph.D., the University of North Texas Health Science Center professor who co-directed the project.

The results of the demonstration project, however, reveal the important role that assisted living can serve in containing healthcare costs while helping older adults have a greater quality of life, O’Neil said. “With the availability of onsite home health and therapy services and appropriately trained staff, assisted living can be a lower-cost care option than skilled nursing,” he added. “With the number of residents with more health challenges rising, we can accommodate them in this wonderful setting and keep them from making unnecessary hospital visits by providing comprehensive associate training and the right resources.”

As Brookdale contemplates implementing the program at more of its assisted living communities, other providers can access the INTERACT tools online.