Senior living communities help develop age-friendly health systems

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The admitting nurse asks all new independent and assisted living residents what matters to them.
The admitting nurse asks all new independent and assisted living residents what matters to them.

Senior living staff members, residents and families are helping develop an “Age-Friendly Health Systems” model to improve care and safety for older adults and optimize value for all involved in the system.

The goal is to have the model in use in one-fifth of U.S. hospitals and health systems by 2020.

The multiyear project is funded by the John A. Hartford Foundation and led by the Institute for Healthcare Improvement in partnership with the American Hospital Association and the​ Catholic Health Association of the United States.

Several organizations — among them Livonia, MI-based Trinity Health, parent of Trinity Health Senior Communities; St. Louis, MO-based Ascension, parent of Ascension Living; Annapolis, MD-based Anne Arundel Medical Center; and others — are participating.

Anne Arundel's goal, according to the AHA, involves reaching almost 20,000 people aged 65 or more years by scaling up the program in nine acute-care units, the emergency department and 25 assisted living communities. A spokeswoman there told McKnight's Senior Living that the project's assisted-living efforts are still in development, too early to discuss.

Further along, however, is Trinity Health, where Trinity Health Senior Communities' Glacier Hills, a continuing care retirement community in Ann Arbor, MI, as well as St. Mary Mercy Hospital in Livonia, MI, Life St. Mary (a PACE site at St. Mary Medical Center in Langhorne, PA) and Saint Alphonsus Health's Boise, ID, Hospital (along with its physician group, home care and hospice) are participating.

Glacier Hills became involved in early 2017, said Cheryl Huckins, M.D., co-medical director at the CCRC and part of IHA, a multi-specialty group that is a Trinity subsidiary. That was after the John A. Hartford Foundation and IHI worked with experts to reduce a longer list to four cornerstones of care — “that if you get those in place, you really are addressing healthcare in an age-friendly manner,” she told McKnight's Senior Living.

The “4 Ms” of the program are learning what matters to the resident or patient; mentation — identifying and managing depression, dementia and delirium across settings; ensuring safe mobility to maintain function; and using age-friendly medications (when needed) that don't interfere with what matters, mentation or mobility.

Glacier Hills piloted how to address the “what matters” and “mobility” aspects in independent and assisted living and worked on mentation and medications in skilled nursing, Huckins said. As of January, 129 and 117 residents have been involved in the “what matters” and “mobility” efforts, respectively. Elsewhere in the CCRC, 331 residents have been screened for delirium and 53 residents have seen a medication reduction, with the use of 153 medications being discontinued.

The project “turned out to be extremely satisfying for the caregivers, for the staff and for the residents,” she added.

After being educated and receiving resources from program leaders, “we started to implement in small projects, first testing with one or two patients and then finding how the best way to approach it is and then spreading it, growing it and sharing it with the larger group,” Huckins said.

Now in Glacier Hills, based on what they learned, she said, “Anybody admitted into the assisted living or independent living area, on their initial admission, gets a question by the admitting nurse about what matters to them. What's important in their life? Is it to live as long as they can or to stay as independent as they want to be or to live to their grandchild's wedding?”

Looking back, the “what matters” work in the initiative meshed well with the mantra of person-centered care in long-term care, Katie Kurili, executive director of the Care & Rehabilitation Center and resident services at Glacier Hills, told McKnight's Senior Living.

“You hear the person-centered approach everywhere you go,” she said. “It's almost like a standard verbiage in the industry, but what does it truly, truly mean? And this was the focus, to be personalized and meeting the goals and preferences of the residents, and not just for the moment but long-term care goals — what were their wishes and desires, and how can we best support them? When we approached it from that direction, the participation and the interaction of the residents — they were very excited about that. It was so neat for our team to see that.”

New residents also can undergo a mobility assessment, Huckins said. “We do a ‘get-up-and-go' kind of test, which assesses their ability to safely get up and down out of a chair and walk a certain distance,” she said. “And from that, either we identify that we have someone who could use help with mobility … or we refer them to our wellness director to help them stay as mobile as they can and participate in all the different kinds of activities that are available for our seniors who live independently.”

Part of the mobility focus includes educating residents and their families on the importance of mobility, Huckins said. “Many of them don't want to move into a higher level of care. They want to stay independent,” she said. “So helping them realize that to do that you need to stay balanced and not have falls, and making good health choices in terms of exercise, becomes part of the community's basic culture.”

That culture manifests itself in many ways, such as signs in the elevator that detail balance exercises, Huckins said.

The community plans to reassess residents over time to see whether their mobility has worsened and, if so, then try to help them maintain strength and balance.

As the project is designed, Glacier Hills continues to implement what it learned through its participation in the Age-Friendly Health Systems project, and others will benefit from it as well.

Initiative-wide testing and scaling of approaches to the 4Ms are expected to continue throughout this year, according to IHI, with testing and scaling up of the Age-Friendly Health System to 10 to 15 more U.S. health systems coming next year on the way to the development of more than 1,000 care settings that show evidence of improved outcomes for older adults in 2020.


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