Assisted Living s Whole Brain Fitness: Can It Prevent Re-hospitalization?

Transcription

1 Assisted Living s Whole Brain Fitness: Can It Prevent Re-hospitalization?

2 Health Care Environment Is Changing, Opening Up New Opportuni:es for Assisted Living Center for Medicaid & Medicare Services (CMS) ACCOUNTABILITY CARE ORGANIZATIONS Partnerships formed among doctors, hospitals & other health care providers to coordinate high quality care for 5,000+ Medicare beneficiaries for 3+ Years Incen:ves to Physicians and hospitals to: Reduce cost of Medicare Improve quality of care Increase sa<sfac<on Promote healthy lifestyle

3 Assisted Living is posi<oned to join Skilled Nursing as a resource to prevent re- hospitaliza<on Independent Living Ac<ve, mobile Lifestyle ac<vi<es Some mild cogni<ve impairment Increasingly more clinical and memory care needs, formerly handled by Assisted Living Whole brain fitness programs Assisted Living Need driven Currently, medium to high acuity Trending to ill and frail Serving the popula<on formerly residing in skilled nursing Collabora<on with Hospice allows for end of life care Rehabilita<on Services available on premises Whole brain fitness programs specializing in mild to moderate demen<a Alzheimer s Disease Cogni<ve impairment Mild, moderate and late stages Specialized care required Specialized programming and environments Specialized training for staff Adapted whole brain fitness Nursing Home Ill and frail Full medical care required New emphasis on post- acute rehabilita<on rather than long term care

4 Advantages of Hospital Partnerships with ALFs ALFs provide a more independent and less costly environment than SNFs ALFs provide more social management than other care coordina<on strategies ALFs ideally are incorpora<ng Whole Brain Fitness into their care- coordina<on strategies

5 Whole Brain Fitness & Wellness Brain health is enhanced by lifestyle Appropriate s<mula<on- - mental, physical, nutri<onal, social can shape the func<on and structure of the brain The brain con<nues to grow and develop in adult and late life

6 Who are the residents? Average Age AL years Average Age CCRC years Average Stay months Female % Medica<ons % At age 85, about half will have some form of demen8a and will benefit from Whole Brain Fitness Sources: ASHA, NIC, ALFA, AAHSA, NCAL

7 The Target popula<on for a whole brain fitness program Adapted target STAGE 1 PRECLINICAL ALZHEIMER S STAGE 2 MILD COGNITIVE IMPAIRMENT STAGE 3 ALZHEIMER S DEMENTIA Biomarkers such as brain scans and spinal fluid tests used to diagnose early signs Amyloid and tau proteins Nerve degenera<on Brain shrinkage Research only, not for general popula<on Standards are needed Defined as a change in cogni<on that does not meet defini<on of demen<a Lower performance in memory, ahen<on, or visual/ spa<al skills Mild diminu<on of daily ac<vity skills Biomarker tests can help confirm if MCI is related to AD Two symptoms of cogni<ve or behavioral impairment Memory (not necessary) Language Recogni<on Reasoning Personality changes Symptoms impede daily living ac<vi<es Not another demen<a such as vascular, fronto- temporal or Lewy body.

8 Belmont Village Case Example: Customer Evolu<on: Belmont Village West University 156 units total 130 units Assisted Living 24 units memory care 2013 Belmont Village Geneva Road (Chicago) 158 units total 85 units Assisted Living 73 units memory care Growth in percent of building dedicated to memory care: 15% 46%

9 Whole Brain Fitness Should Begin Before Symptoms Start

10 WHAT IS WHOLE BRAIN FITNESS? IT IS A COMPREHENSIVE PROGRAM THAT BUILDS COGNITIVE RESERVE IN THE BRAIN

11 COGNITIVE RESERVE: What Is It? It is the capacity of the brain to find another set of neurons to handle thinking when either disease or injury has damaged parts of the brain. This cannot be changed This YOU can change TWO ASPECTS OF COGNITIVE RESERVE Amount of available brain hardware (the number of neurons and synapses) Degree of efficiency and flexibility in the brain to process information

12 What Is Included In a Program of Whole Brain Fitness? Strong Social Network Sense of Purpose and Feeling Useful Heart- Healthy Diet Aerobic & Strength Exercise Mental Workout Lifelong Learning Healthy lifestyle: Reduced Stress

13 Requirements for Mental Fitness It must be something NEW to the brain It must be a MENTAL STRETCH

14 Leisure vs. Therapeu<c LEISURE GOALS: 1. To provide opportuni<es for recrea<onal and leisure outlets 2. To increase social and spiritual connec<ons and rela<onships 3. No measured goal or outcome THERAPEUTIC GOALS: 1. To maintain or improve higher level of func<oning: social- emo<onal, 2. cogni<ve, physical, spiritual and crea<ve 3. To provide learning opportuni<es that are a Just Right Challenge 4. To enhance sense of purpose and meaning 5. To measure goals/outcomes: quan<fy enjoyment, socializa<on, mental and physical maintenance or improvement LEISURE THERAPEUTIC

15 Leisure vs. Therapeu<c: Which One Is It? Wine/cheese + entertainment Reminiscing Bingo Karaoke Lunch ou<ng Listening to a lecture Read together (newspaper, book etc)

16 Snapshot Of The Circle Of Friends 8- hour, 7 day- a- week group ac<vi<es for mental fitness, socializa<on, and self- esteem Groups consist of 8 to 12 residents Full- <me ac<vity leaders Detailed calendar of ac<vi<es, policies, and protocols developed by in- house experts Intensive staff training provided by corporate gerontologist and in- house experts Programs con<nually monitored for effec<veness and revised on- going Physical Mental Social Nutri<on

17 1. Is program being implemented, as intended? Findings: Content and structure of ac<vi<es needed revision or refinement 2. Are staff adequately trained to deliver the program? Findings: Some staff required addi<onal training; Some groups were too large for 1 leader 3. Are staff consistent in delivery? Findings: Program leaders varied both within and between sites 4. What outcomes are being measured? Findings: Cogni<ve func<oning and depression only

18 CHANGES INSPIRED BY THE PROGRAM EVALUATION

19 The 5 R s for Quality Right Staff Right Residents Right Programs Right Training Right Evalua<ons

20 The Right Staff Ap<tude Educa<on Enthusiasm Imagina<on World View

21 The Right Programs The Six Domains of Mental Fitness Cri:cal Thinking Memory- Body Movement Learn Something New Step- by- Step Sequencing Long- Term Memory Math & Problem Solving

22 The Right Residents Assessment Enrollment Par<cipa<on Measurement Folstein Mini- Mental State Examina:on at Belmont Village Score Cogni<on Normal cogni<on Circle of Friends MCI Mild demen<a Alzheimer s Neighborhood Moderate demen<a < 10 Severe demen<a

23 The Right Training Dynamic Video Roleplay Cer<fica<on Mentoring

24 THE RIGHT EVALUATION

25 MMSE Results BELMONT Number of Residents Circle of Friends MBA Club Control Group Atlanta (Alternate Control) MMSE Baseline* MMSE 6 months Later % Who Maintained or Improved % % % * Note about MMSE scores: the majority of our COF residents have mild demen<a, with scores < 22. This score is the lower limit for normal memory func<on. Folstein Mini- Mental State Exam MMSE measures memory Score range is 0 30 (higher score means less impairment) = MCI = Mild demen<a = Moderate Dem. Clinical expecta<on in a mild to moderate demen<a popula<on is for scores to decline Maintaining scores is as important as improving scores in a MCI/demen<a popula<on COF results: majority maintained or improved. These are simple averages for program purposes only, and not subjected to rigorous sta8s8cal analysis

26 The Clock Test Results BELMONT Circle of Friends MBA Club Control Group Atlanta (Alternate Control) Number of Residents CLOCK Baseline CLOCK 6 Months Later % Who Maintained or Improved % % % The Clock- Drawing Test Measures the health of the frontal lobe: decision- making, judgment, and planning Score range is 0 20 (higher score means less impairment) = normal 18 and lower = demen<a COF results: scores maintained or improved. These are simple overview averages to show trends. Data gathered for program purposes only. Data not subjected to rigors of sta8s8cal analysis

27 COF Clock Test Example 1 Pre Circle of Friends Post Circle of Friends

28 CLOCK COF PRE CIRCLE OF FRIENDS POST CIRCLE OF FRIENDS

29 Whole Brain Fitness Can Contribute to Preven:ng Re- hospitaliza:on, if program design includes.. Whole Brain Fitness is a major component of Culture Change Ac<vi<es are Therapeu<c and evidenced- based Therapeu<c ac<vity programs are more than leisure and fun: they are on a par with clinical services Con<nuous training and an educated staff is required Ongoing evalua<on is built- into the program to ensure quality No more One- Size- Fits- All. Assisted Living works with clusters of func<onal levels and interests