The nations first frail elderly program to earn Disease-Specific Certification by the Joint Commission, Holy Redeemer Home Cares innovative LifeAssess program has dramatically improved patient safety and quality of life for frail elders.
The LifeAssess program helps prevent premature placement in a nursing or long-term care facility by evaluating all home care patients over age 85 for four common geriatric syndromes depression, dementia, falls risk and incontinence as part of the intake process.
Initiated in January 2003, LifeAssess grew out of a challenge from Senior Vice President Toni Hague, who recognized the need to update home caregiving practices to match patient needs.
Patients are coming out of the hospital sooner, much sicker, and are living with chronic illness longer, says Alicia Campbell RN, BSN, vice president of Holy Redeemer Home Care in Egg Harbor, N.J. We knew that our environment was changing, but we were still giving care from 25 years ago.
Among the performance measures Holy Redeemer must report to the Joint Commission, participant perception of care consistently rates 93 percent among all age groups, with some of the highest ratings coming from the 85-years-and-older population. (Holy Redeemer uses Press Ganey Associates, Inc. to measure patient, resident, family and client satisfaction. Action plans are generated to respond to areas of deficiency and recognize outstanding customer service.)
Four-part screening tool
Home care nurses use the tool during the first home visit to investigate depression, dementia, falls risk and urinary incontinence. Each symptom can affect the others, so examining patients for all four simultaneously is important.Alicia Campbell, RN, BSN
If they fall once, they become afraid of falling, Campbell says. So theyre afraid to get up and move around. So they start to get depressed, maybe they start having incontinence, she says.
To assess for cognitive ability and mental health, patients are asked a series of questions such as, During the past month, have you often had little interest or pleasure in doing things? and What was your mothers maiden name? These questions help evaluate the existence and level of depression and dementia.
Falls risk assessment includes timing a patient as he gets up from a chair, walks 10 feet and returns to sitting. For this test, called Timed get Up and Go (TUG), patients are allowed to use assistive devices.
We are looking at ways to minimize the severity of injury in a fall by making sure patients have the right equipment in the home and teaching them to lower themselves if they slip so they dont fall and injure themselves, Campbell says.
Nurses evaluate urinary incontinence through a combination of subjective questions such as Do you ever dribble or leak urine before you can get to the bathroom? and objective observations such as urine stains on clothes or furniture.
Last March, The National Council on Agings (NCOA) Falls Free Coalition recognized Holy Redeemers efforts to reduce home hazards and falls by naming LifeAssess one of the nations Top 10 Creative Programs for reducing home hazards.
Falls are such a serious public health issue and its exciting to see innovative approaches to helping the public especially older adults understand their risks, says Meri-K Appy, president of the Home Safety Council, the agency that conducted the search for best practices nationwide.
Holy Redeemer was selected from among more than 60 self-nominations. LifeAssess also was featured in a report issued in October spotlighting practices recommended by NCOA Center for Healthy Aging for replication by community-based organizations.
Nurses at forefront of team
The programs success is a result of the dedicated care provided by the nurses and other team members who help patients and families understand medications, disease processes and the needs of frail elders in home care.
I find patients are not getting a lot of teaching and instruction before they leave hospital or nursing facility, says Shari Kaminski, RN, BN, a Holy Redeemer field supervisor. Family members can be frazzled, patients can be upset, and they appreciate all the information we provide.
Medical social workers support family members as caregivers for loved ones. Our medical social worker comes in if a patient answers yes on screening to depression, if a patient has dementia or Alzheimers or if caregivers are struggling because they have to go back to work and dont know what to do with Mom or Dad, Kaminski says. A medical social worker examines the family dynamic and offers advice on adult day care, medical care and community financial resources as needed.
Physical and occupational therapists follow up on nurses assessments of patients by working with patients to make sure they can perform their daily tasks safely. Patients perform tasks like preparing their dinner in the presence of a therapist, who then makes recommendations on how to alter the task or the tools to make it easier for the patient.
Numbers are up
Since the inception of LifeAssess four years ago, patients 85 years of age and older have demonstrated a 6.5 percent increase in improvement of cognition, a 19 percent increase in improvement in depressive feelings and a 10 percent increase in improvement in urinary incontinence. Improvement is determined by comparing patient assessments from start of home care to discharge.
In addition, Holy Redeemers already-low rate of hospitalization due to falls (2.2 percent in 2003), has declined by 0.4 percent.
With the valuable information gathered in the LifeAssess process and the united efforts of its entire medical team, Holy Redeemer is working to ensure constant attention to patient safety and quality of life for its frail elders.
We have been able to prevent falls and assist patients with incontinence, depression and dementia, Kaminski says. We love our patients and they love us.