4/12/2013 1 Higher Acuity in Assisted Living: Risk or Reward? Risk or Reward? Josh Allen, RN, C-AL Care and Compliance Group American Assisted Living Nurses Association Center for Excellence in Assisted Living CEAL • Nonprofit collaborative of 11 national organizations • Alzheimer’s Association, AALNA, AAHSA, AARP, ASHA, ALFA, CCAL, NCAL, NCB Capital Impact, PVA, Pioneer Network • www.theceal.org
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4/12/2013
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Higher Acuity in Assisted Living:Risk or Reward?Risk or Reward?Josh Allen, RN, C-ALCare and Compliance GroupAmerican Assisted Living Nurses AssociationCenter for Excellence in Assisted Living
CEAL• Nonprofit collaborative of
11 national organizations• Alzheimer’s Association, AALNA,
AAHSA, AARP, ASHA, ALFA, CCAL, NCAL, NCB Capital Impact, PVA, Pioneer Network
• www.theceal.org
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yesterday today tomorrow
Truth or just rumors?We’ve been talking about higher acuity f for years…
Assisted Living State Regulatory Review2012 edition at www.ncal.org
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30%of states made
changes to assisted living regulations g g
last year
Nursing Services94% of communities have a licensed nurse available to residents 24 hours/day
NSRCFFirst time national assisted living data collection effort by ythe CDC/NCHS/ASPE
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ADLs37% of residents receive assistance with 3+ activities of daily livingdaily living
50%of AL residents have three or
more chronic conditions
42%have Alzheimer’s disease or other disease or other dementia
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Osteoporosis
Arthritis
Depression
Heart disease
Alzheimer's/dementia
High blood pressure
0 10 20 30 40 50 60
Stroke
CA
COPD
Diabetes
RISK REWARD
Making higher acuity work:
1. Acceptance is the first step
2. Let the regulations be your guideg b y g
3. Is everyone on the same page?
4. Now comes the hard part…
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Care TransitionsCare Transitions
HospitalSkilled Nursing
Facility
SNF
Fundamental Disconnect…Care Transitions
Hospice
HomeAmbulatory Care Clinic
Rehabilitation Facility
Hospice
**Dr. Eric Coleman’s slide, printed here with permission.
35%of assisted living residents in ER in the last 12 months
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1 in 5Medicare recipients discharged from the hospital are readmitted within 30 days
That translated to 2.6 million seniors and overmillion seniors and over
$26 billion annually
The Patient The Patient Protection and Protection and Affordable Care ActAffordable Care Act
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ACAReadmission penalties
ACAAccountable Care Organizations
Medication ManagementMedication Management
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85%of assisted living residents require assistance with medicationsmedications
NCAL
Older adults take an average of5 prescription medications per month
CEAL
Those with 3+ chronic health conditionsAverage 6-7 prescription medications permedications per month
CEAL
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Assisted Living Residents
• 10 routine medications per day
• 3 PRN medications per day
“assisting with self-administration”
a regulatory play on words
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CEAL/UNC Research:
35%of medication administrations involved an error
71%of errors were again related to dose timing
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< 3%of errors had moderate to significant potential for harmpotential for harm
Med Techsdid NOT have a higher error rate than nurses
Written testresults “predicted” likelihood of errors
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Challenges:
Large volume of routineof routine medications
Challenges:
PRN MedicationsMedications
Challenges:
Injections
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Challenges:
Healthcare providers who do pnot specialize in geriatrics
Focus on hi h i khigh-riskmedications
1/3 of emergency room visits by older adults presenting with ADE are caused by 3 drugs:• Warfarin• Insulin• Insulin• Digoxin
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CEAL/UNC Research Showed majority of errors with potential for harm related to:• Warfarin• Insulin• Insulin• Risperidone
Warfarin• Monitor for s/s of bleeding• Coordinate lab tests• Monitor OTC use
Insulin• Follow delegation procedures
• Monitor residents who self-administer
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Individualized Medication Plans Promote person-centered care in all aspects of resident care
Manage High Risk ConcernsManage High Risk Concerns
Manage high risk:Dementia care wandering and elopement
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Manage risk: Falls account for up to 40% of lawsuits in assisted living
Manage risk: Medications1/3 of emergency departmentvisits by older adults presenting with ADEs are caused by 3 drugs — warfarin,insulin, and Digoxin
Higher acuity is here to stay!
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