CARF Accreditation. A Person-Centred Approach to Quality in Palliative Care Services

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1 CARF Accreditation A Person-Centred Approach to Quality in Palliative Care Services

2 Faculty / Presenter Disclosure Faculty: Jill Allison, B.Sc., MBA Relationships with commercial interests: Grants/Research Support: Speakers Bureau/Honoraria: Consulting Fees: Other: Employee of CARF Canada

3 Potential for conflict(s) of interest CARF Canada, a member of the CARF International group of companies; accreditation is the primary business of CARF. CARF Canada is an independent, non-profit organization.

4 Mitigating Potential Bias Information provided will be based on international consensus standards and feedback from the field collected and analyzed by CARF International.

5 Overview of Workshop About CARF CARF in Canada Programs for palliative care services Person-centred approach Standards and self-evaluation Reviewing full standard set Q&A 5

6 CARF International Group of Companies 6

7 About CARF CARF Commission on Accreditation of Rehabilitation Facilities Status Non-profit Independent Programs Health and human services 7

8 CARF Quick Facts Founded in 1966 First Canadian survey in 1969 >7,200 service providers with 55,000+ accredited programs/sites * More than 10.2 million persons served annually by CARF-accredited orgs * Accredited programs in 23 countries Incorporated in 2002 Offices in Edmonton & Toronto >500 service providers with close to 4,500 accredited programs/sites 8

9 Mission The mission of CARF is to promote the quality, value, and optimal outcomes of services through a consultative accreditation process and continuous improvement services that centre on enhancing the lives of persons served. 9

10 Recognition of CARF in Canada Alberta Ministry of Health recognizes CARF as an accepted accrediting organization for Alberta s health system, including seniors care, mental health, and addictions. British Columbia's Ministry of Children and Family Development (MCFD) and Community Living British Columbia (CLBC) have approved CARF accreditation for both contracted community living agencies and child, youth, and family services. Vancouver Coastal Health and Fraser Health Authorities (BC) have confirmed that CARF is an accepted accreditation body for contracted residential care providers. Ontario Ministry of Health and Long-Term Care recognizes CARF accreditation for long-term care homes and provides a funding premium to accredited homes. Ontario s Community Care Access Centres (CCACs) recognized CARF Canada as a choice for accreditation of certain contracted service providers. Ontario s Mississauga-Halton and Central West Local Health Integration Networks (LHINS) recognize CARF Canada accreditation for certain LHIN-funded agencies. Workers Compensation Board of Nova Scotia requires CARF accreditation for Tier 2 & Tier 3 service providers 10

11 Development of Standards Active support of: Providers Consumers Purchasers of service Field-driven International consensus standards Process emphasizes performance improvement in business and service delivery

12 Standards Development Market research Continued monitoring for relevance International Committees/ Council Field and surveyor education Field review Publication in manuals Consensus Staff, Board review

13 CARF Standards International consensus Person-centred Field-driven Non-prescriptive Achievable Community-based Universal Practical Relevant Current

14 Survey Experience Feedback Report, % 94.1% 93.6% 96.2% % Standards Relevant Survey Beneficial All CARF Aging Services (N=1922) (N=1933) (N=102) (N=105) 14

15 CARF Accredits Aging Services Behavioural Health Networks Child & Youth Services Employment & Community Services Medical Rehabilitation Vision Rehabilitation 15

16 Aging Services Programs Adult Day Services Case Management Specialty Programs: Dementia Care Stroke PC Long-Term Care Community (PCLTCC) Networks. Independent Senior Living Home & Community Services (HCS) (Home Care) Assisted Living 16

17 Accreditation Standards for Palliative Care Services Residential: PC Long-Term Care Community (PCLTCC) Nursing & other services 24/7 Long-term & short-term services (or both) Home Care: Home & Community Services (HCS) Variety of settings Variety of personnel 17

18 Person/Patient/Client-Centred Approach Patient- and family-centered care is working "with" patients and families, rather than just doing "to" or "for" them. Source: Institute for Patient- and Family-Centered Care, (Adapted from: Johnson, B. H. & Abraham, M. R. (2012). Partnering with Patients, Residents, and Families: A Resource for Leaders of Hospitals, Ambulatory Care Settings, and Long-Term Care Communities. Bethesda, MD: Institute for Patient- and Family-Centered Care.) 18

19 Patient- and family-centered care is an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families. It redefines the relationships in health care by placing an emphasis on collaborating with people of all ages, at all levels of care, and in all health care settings. In patient- and family-centered care, patients and families define their family and determine how they will participate in care and decision-making. A key goal is to promote the health and well-being of individuals and families and to maintain their control. This perspective is based on the recognition that patients and families are essential allies for quality and safety not only in direct care interactions, but also in quality improvement, safety initiatives, education of health professionals, research, facility design, and policy development. Patient- and family-centered care leads to better health outcomes, improved patient and family experience of care, better clinician and staff satisfaction, and wiser allocation of resources. Source: Institute for Patient- and Family-Centered Care, (Adapted from: Johnson, B. H. & Abraham, M. R. (2012). Partnering with Patients, Residents, and Families: A Resource for Leaders of Hospitals, Ambulatory Care Settings, and Long-Term Care Communities. Bethesda, MD: Institute for Patient- and Family-Centered Care.) 19

20 Collaboration Dignity & Respect Core Concepts Information Sharing Participation Source: Institute for Patient- and Family-Centered Care, (Adapted from: Johnson, B. H. & Abraham, M. R. (2012). Partnering with Patients, Residents, and Families: A Resource for Leaders of Hospitals, Ambulatory Care Settings, and Long-Term Care Communities. Bethesda, MD: Institute for Patient- and Family-Centered Care.) 20

21 How does CARF integrate a personcentred approach into a range of quality themes applicable to palliative care organizations? 21

22 Consumer involved in standards development Persons served involvement in survey Standards that require personcentred philosophy and practice 22

23 Family/Support System Discussions/partnership/information sharing when appropriate/in accordance with the person served 23

24 CARF Program Descriptions Services foster a culture that supports: Autonomy Diversity Individual choice 24

25 PCLTCC foster a holistic culture that focuses on: Relationships among persons served, families/support systems, and personnel. Understanding what services persons served want, how the services should be delivered, and how the persons served can be engaged in the community. Persons served making decisions about the rhythm of their day, the services provided to them, and the issues that are important to them. 25

26 Standards 26

27 27

Standards Manual Organization Section 1 ASPIRE to Excellence

providers Section 2 Care Process for Person Served Entry,

Program-Specific Standards Unique to service type and/or

28 Standards Manual Organization Section 1 ASPIRE to Excellence : Business Practice Standards Practices common to all providers Section 2 Care Process for Person Served Entry, transition, exit and processes for services Section 3 Program-Specific Standards Unique to service type and/or setting Section 4 Specialty Program Standards Optional specialized services 28

29 Sample Standard Leadership (Section 1.A.) Standard 1.A.2. A person-centered philosophy: a. Is demonstrated by: (1) Leadership. (2) Personnel. b. Guides the service delivery. c. Is communicated to stakeholders in an understandable manner. Intent Statement The organization s person-centered philosophy should be evident in the development and delivery of services, systems, approaches, and interventions. Implementation of this philosophy from the unique perspectives of the leadership, personnel, and persons served is addressed during the survey process. See the Glossary for the definition of stakeholders. Examples Exploring the normal pattern of the day of a person served to best meet program scheduling. Recognizing unique aspects of the person served and how these might be incorporated into the programming; for example, active in their community, religious or social agencies; active volunteer, worker, leader of a group. 2.c. The person-centered philosophy could be communicated a number of ways, including: Posting it on the walls or website of the organization. Incorporating it into materials that are distributed to stakeholders, such as orientation handbooks for the persons served and their families, personnel, volunteers, and advisory and governing boards; fact sheets, plans, and performance reports; and marketing brochures and pamphlets. Articulating it during tours of the organization; presentations such as orientation and training for personnel, volunteers, and advisory and governing boards; community education sessions; meetings and forums to seek input from stakeholders; recorded messages such as the voice response system. * Source: 2017 CARF Aging Services Standards Manual 29

30 Sample Standard PCLTCC (Section 1.I.) Standard 1.I.5. The organization provides documented personnel training: a. At: (1) Orientation. (2) Regular intervals. b. That addresses, at a minimum: (1) The identified competencies needed by personnel. (2) Confidentiality requirements. (3) Customer service. (4) Diversity. (5) Ethical codes of conduct. (6) Promoting wellness of the persons served. (7) Person-centered practice. (8) Reporting of: (a) Suspected abuse. (b) Suspected neglect. (9) Rights of the persons served. (10) Rights of personnel. (11) Unique needs of the persons served. Intent Statement. Examples. * Source: 2017 CARF Aging Services Standards Manual 30

31 Sample Standard Input (Section 1.D.) Standard 1.D.1. The organization demonstrates that it obtains input: a. On an ongoing basis. b. From: (1)Persons served. (2)Personnel. (3)Other stakeholders. c. Using a variety of mechanisms. Intent Statement Examples Input is requested and collected to help determine the expectations and preferences of the organization s stakeholders and to better understand how the organization is performing from the perspective of its stakeholders. The input obtained relates to the persons served and the organization s service delivery and business practices. The organization identifies the relevant stakeholders, in addition to the persons served and personnel, from whom it solicits input. There are a variety of mechanisms to solicit and collect information. They range from the informal to the formal. * Source: 2017 CARF Aging Services Standards Manual 31

32 Your Practice - Examples Person Served Personnel Other Stakeholders

33 Input Mechanisms Examples Performance improvement activities Written or telephone surveys Suggestion boxes Councils or committees composed of persons served Formal & Informal Complaint or incident summaries Input forums (e.g. advisory groups or consumer forums) Program/ service development Strategic planning * Source: 2017 CARF Aging Services Standards Manual, 1.D.1. Examples. 33

34 Related Standards Standards 1.C.2. A strategic plan: a. Is developed with input from: (1) Persons served. (2) Personnel. (3) Other stakeholders 1.N.1. A written analysis is completed: a. At least annually. b. That analyzes performance indicators in relation to performance targets, including: (d) Satisfaction and other feedback from: (i) The persons served. c. That: (1) Identifies areas needing performance improvement. (2) Results in an action plan to address the improvements needed to reach established or revised performance targets. (3) Outlines actions taken or changes made to improve performance. 1.N.3. The organization communicates performance information: a. To: (1) Persons served. 34 * Source: 2017 CARF Aging Services Standards Manual

35 Sample Standard Care Process - Section 2.A. Standard 2.A.13. Based on the scope of services of the program, initial and ongoing written screenings/assessments: a. Address the following areas: (1) Behavior. (2) Cognition. (3) Communication. (4) Dental. (5) Function. (6) Health. (7) Legal involvement. (8) Medications. (9) Nutritional. (10) Pain management. (11) Physical. (12) Psychological. (13) Relationships. (14) Recreation and leisure. (15) Social. (16) Spiritual. (17) Others, as appropriate to the needs of the person served. b. Identify: (1) Prior daily routines. (2) The preferences of the persons served. (3) The choices of the persons served. (4) The personal goals of the persons served. c. Are used to develop person-centered plans for the persons served. Intent Statement * Source: 2017 CARF Aging Services Standards Manual Examples 35

36 Sample Standard Section 2.A. and 4. Standard 2.A.51. As appropriate, the program incorporates into the personcentered plan: a. A palliative approach to care. b. End-of-life care. Intent Statement Persons served, families/support systems, and personnel have opportunities to discuss end-of-life issues and participate in planning remembrance or memorial activities and creating end-of-life protocols. Examples. See also 4.A.6. in Dementia Care Specialty Program Standards * Source: 2017 CARF Aging Services Standards Manual 36

37 Your Practice - Examples 37

38 Examples Resources Families/support systems should be involved in the development of advance directives and in identifying the extent to which medical intervention is to be administered. Whenever possible, no one dies alone. Support and presence is planned for each person served so that he or she does not die alone. The person served and his or her family/support system are interviewed about preferences for the dying process (e.g., five wishes, music, individuals present, preparation and notification, comfort items, and spiritual needs); care planning includes these preferences. Memorial gardens may be developed outside on organization property in remembrance of those lost. Memorials that reflect the person may be evident throughout the organization. Do not resuscitate (DNR) orders are known and strictly adhered to. Efforts are made to clarify issues related to a person s end-of-life wishes to avoid any misunderstanding on the part of personnel and/or the family/support system. Some organizations do not choose to have a memorial service, but they may provide opportunities for personnel to express their grief by supporting them so they may attend the funeral of a person served. [Canada] The Way Forward: Integrated Palliative Care Approach Framework at 38 * Source: 2017 CARF Aging Services Standards Manual

39 Sample Standard Section 2.B. Standard 2.B.5. The program: a. Provides education, if needed, regarding end-of-life choices. b. Honours the person s choices concerning end of life. c. Initiates related services when appropriate. d. Gives opportunities for expression of final choices concerning end of life to: (1) The persons served. (2) Families/support systems. e. Provides opportunities to express grief and loss. Examples Persons served may be interviewed about preferences regarding end-of-life (i.e., music, people, preparation and notification, comfort items, spiritual needs); person-centered planning includes these preferences. Information regarding advance directives may be kept in an accessible location in a residential unit of the program. Annually during the month of their birthday, persons served might have a physical exam from their primary care physician and meet with clinic staff to perform a medication review and update contact information and advance directives. 39 * Source: 2017 CARF Aging Services Standards Manual

40 Sample Standard PCLTCC - Section 3.C. Standard Intent Statement 3.C.14. The rhythm of daily life is directed by each person served, as demonstrated by: a. Freedom to make choices regarding the cycle of each day, including: (1) Bathing. (2) Dressing. (3) Eating. (4) Hygiene. (5) Oral care. (6) Sleeping. (7) Waking. b. Choice of clothing. c. Choice of grooming style. d. Each person s choice to participate in personally meaningful customary routines, including, but not limited to: (1) Cleaning. (2) Community activities. (3) Contact with pets. (4) Cooking. (5) Exercise/mobility activities. (6) Gardening. (7) Hobbies. (8) Intimacy. (9) Recreation. (10) Social interaction. (11) Spiritual/religious activities. * Source: 2017 CARF Aging Services Standards Manual 40

41 Your Practice - Examples 41

42 Sample Standard Section 3.C.14. Examples Persons served can be afforded opportunities to continue activities they enjoy in their community as well as to pursue activities that will support their growth and development. Some examples of these include: Choosing when to wake up, nap, and retire. Choosing the schedule for completing their ADLs. Participating in meal preparation. Creating a garden of flowers or vegetables for use in the community. Caring for or simply enjoying the companionship of pets. Continuing to participate in activities such as the Rotary, League of Women Voters, or church groups. Tutoring students in English as a second language. Assisting personnel with tax preparation. Engaging in intimacy with a spouse or significant other. Enjoying familiar recreational activities. Learning a new hobby or skill. Opportunities to engage in meaningful work, if desired. Engaging in meaningful interactions with other residents, personnel, and members of the local community. Persons served who wish to do so can be encouraged to participate in the daily routine of their community by continuing to do the things they did at home (e.g., setting the table, dusting, doing laundry, gardening, woodworking.) * Source: 2017 CARF Aging Services Standards Manual 42

43 Sample Standard Section 3.D. Standard 3.D.7. Service delivery is scheduled at an agreed-upon time that supports the person-centered plan. Intent Statement There is a system in place to determine the most appropriate schedule for service delivery based on the lifestyle and preferences of the persons served and the scope of the home and community services. Examples Person served rises late morning or prefers late in the day appointment. * Source: 2017 CARF Aging Services Standards Manual 43

44 Many more standards To review the full range of applicable standards in more detail, request a standards manual. 44

Quality Improvement Plan Steps to Accreditation Submit the Survey Application CARF invoices for the survey

45 CARF maintains contact with the organization Contact CARF Canada staff CARF International Resource Specialist assigned Conduct a self-evaluation Submit the Annual Conformance to Quality Report Submit a Quality Improvement Plan Steps to Accreditation Submit the Survey Application CARF invoices for the survey fees CARF renders the accreditation decision The survey team conducts on-site survey CARF selects the survey team 45

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47 Contact Jill Allison Accreditation Advisor ext

CARF s Consultative Approach to Long-term Care Accreditation. May 15, 2018

CARF s Consultative Approach to Long-term Care Accreditation May 15, 2018 Presenter Jill Allison, B.Sc., MBA Accreditation Advisor Overview of Workshop About CARF CARF in Canada, MB Value, benefits, outcomes