How patient-centered care plays an important role in growing nursing homes and hospital relationships
The continued federal and state movement toward more patient-centered care has had a ripple effect across the continuum of care, in many ways altering the relationships between health care sectors that are normally compartmentalised.
Nursing homes and hospital systems are no exception, with the patient-oriented payment model (PDPM) incentivizing relationship-building efforts on both sides.
According to Marie Cleary-Fishman, vice president of clinical quality at the American Hospital Association (AAH).
“Whether the person is coming from the nursing home or home care services, and they’re going through the emergency department…the communication may not be exactly what we want it to be,” said she told Skilled Nursing News.
Patient-centred care also helps build public trust, a huge element as the post-acute care sector struggles to reimage itself in the public eye after the throes of the Covid-19 pandemic.
“When you start to put in place those elements that really take into account what matters to people over the age of 65, you start to build the trust that these people have in your health care setting,” said Cleary- Fishman. “It just improves expectations, it improves satisfaction scores, doesn’t it? This allows access to all of these things and makes it easier for the workforce to deal with these people. »
Cleary-Fishman hopes peer-to-peer learning and sharing between hospital and nursing home staff — and among nursing home staff who work for different operators — will be a positive byproduct of the initiatives. inter-continuum like the AHA’s Age-Friendly Health Systems.
The idea is to keep a holistic approach in mind when caring for people across the continuum, ensuring that what the resident wants and what the family wants aligns with what does staff in that particular care setting, including medication passes and mobility work. .
Neil Pruitt, CEO of Norcross, Georgia, PruittHealth, has already seen the hospital-nursing home relationship become much more collaborative outside of any sort of initiative, and there’s a lot more respect on both sides versus the pre-pandemic.
Patient-focused collaboration often takes the form of partnerships, he said, as hospitals come to terms with the tight cost structure and highly regulated environment of the nursing home industry. Acute care providers find it better for them to have an operator like Pruitt to run community nursing homes rather than owning and operating them themselves, he said.
“We are able to work with hospital providers to ensure a smooth transition of care and a good patient outcome. Those relationships have only grown stronger as we return to normal,” Pruitt added.
According to Cleary-Fishman, direct caregivers and hospital staff connect more through the patient and through initiatives such as Age Friendly, as a patient’s purpose is passed from one care setting to another.
What matters to the resident becomes the glue that informs that next care team, she said; it notifies clinicians when they form a care plan for that resident upon admission. It’s also a time when the family gets involved too, so they can be part of that patient’s goal of moving forward in care.
Public trust starts here, she said, when the family is involved in care planning.
“This aligned communication makes a huge difference when you move someone from place to place along the continuum of care,” she added.
Pruitt has taken the collaboration a step further with its hospital partnerships – the operator is now developing clinical programs tailored to each hospital.
“This allows [residents] to achieve their clinical goals while ensuring that we are able to play a meaningful role across the healthcare spectrum,” added Pruitt.
After presenting on Age Friendly for several years now, Cleary-Fishman said feedback from nurses across all care settings has been positive — the job seems doable for short-staffed settings, even in nursing homes.
“I really hope this helps employees feel like they have a community, a common practice that they can learn from and share with,” she said.
The “four Ms” of the AHA initiative, which have no end date, focus on mobility, medication, nutrition and what matters for patients 65 and older. Through these focal points, Cleary-Fishman hopes to fundamentally change the way our society and caregivers across the continuum think about aging and aging services.
“The goal is to change the culture, to really change the way we think about caring for people over 65,” she said. “The evidence tells us that if we look at these things together, care is better for the person 65 or older.”
The initiative began as an evidence-based concept developed by the Institute for Healthcare Improvement, the AHA, and the Catholic Health Association — and is funded by the John A. Hartford Foundation.
It took a year for hospital systems and other healthcare organizations, including nursing homes, to get involved in the pilot program. There are currently over 400 nursing homes that are recognized as age-friendly.
Holistic initiatives like Age Friendly also contribute to workforce satisfaction, she said.
Direct caregivers can help a resident achieve a goal that was written down from the start, by working on that goal during their stay.
“It’s so different from just saying, ‘I want to be fired.’ Most people want to be released, most people want to go home. It’s really about digging into what brings joy to someone’s life,” Cleary-Fishman noted.
If a certified practical nurse (CNA) discovers that there is a pet in the house that a resident wants to come back to, she says, it’s a good example to dig a little deeper and connect with that person. in order to help her live a better life – and feel more fulfilled as a clinician in the process.
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