webinar: using acfi to improve care delivery & increase revenue
TRANSCRIPT
ACFI Through Education
How did I get to this point?
A bit of History
Began nursing in 1986 (first Tertiary qualified group in NSW) with Gerontological studies completed 1992.Rural and Remote primary care.Various middle / senior management roles• Clinical care coordination. • Facility/ Service Management – multiple
organisations, stand alone, non-profit as well as large providers.
• Area clinical development across FNQ to the Torres Strait – Indigenous care.
Funding consultancy in partnership.
2013 Started key2care to address the inequity between funding entitlements and funding actuals and to build capacity and independent sustainable growth enabling excellence in care and quality of life for our elders.
Tiffany WilesRN Gerontology
Presentation Outline
webinar
ACFI Disruptors
Example of our achievements and offerings
Our approach - goals and guarantees and a new way of thinking.
The importance of Diagnosis
Normal Ageing
The impact of Ageing and disease
Aspects of assessment
Accreditation -Impacts on standard 2.
How Key2care can help… some take home suggestions.
ACFI Disruptors
Care Mismatches
Intention
Care Delivery• Funding activities seen as non-essential
• The little red hen mentality- It’s not my job!
• Staff don’t know the residents at all well
• Too many other tasks that are seen as priority – care before paperwork
• Differing priorities
Lack of focus• No shared skill or knowledge
• ACFI training doesn’t teach the tools for success
• Accountability issues – registration at risk!
• ACFI seen as Work flow disruption
• Lack of staff engagement
Documentation Complexity• Onerous burden of documentation
• Lack of clarity around non-mandatory assessments & the use of mandatory tools
• Lack of congruence with too many contributors to the claiming process
• Multiple recording of data
Who is thinking ACFI???
TheFinancial Rewards
OurAchievements 19 beds
Ave daily increase $121.88
Total site increase $845,270
40 beds
Ave daily increase $127.27
Total site increase $1.858 million
20 beds
Ave daily increase $129.67
Total site increase $946,591
NB: All increases validated With zero loss in funding
Our Approach
Goals and a New Way of Thinking.
Key2care’s Overarching Principle……is to achieve the highest possible quality of life for Australians living within our aged care community.
A new way of thinking……consistent engagement of care staff connecting them to why they do what they do rather than just following instructions.
…some new ideas for assessment – the gaps.…a team model? Sure… How novel!
Diagnosis
Why is this important?
It’s a requirement!
Be an artist – paint a picture!
How to colour in to create impact.
Care Pathways and ACFI Intersections.
The Impact of Ageing
The slipperyslope
Getting old is no walk in the park!
Skin – reduced elasticity, lines and wrinkles; less oil production leading to dryness; this and becomes more fragile.
Hair – Thins and loses pigment (becomes grey).
Height reduction – By age 80 it is possible to have lost 5cm in height related to changes in posture, compression of joints, spine and spinal discs.
Hearing – loss speeds up after 55 with higher frequencies harder to hear with the nuances of speech (tone) less clear. 48% of men and 37% of women >75 experience hearing difficulties.
Vision – Presbyopia (lens inflexibility) develops in the 40’s. Night vision and visual sharpness decline. Difficulty locating objects.
Sleep – Less nocturnal sleep, more nocturnal awakenings.
Bones – Gradual loss of mineral content with bones becoming less dense and strong. Higher risk of osteoporosis. Increasing probability of arthritis.
The Impact of Ageing
The slipperyslope continues
Metabolism – generally lower energy requirements; hormone changes result in shifting body fat and loss of muscle mass…which slows metabolism. Increased probability of diabetes.
Brain and nervous system – from 30 the brain’s size, neural network and blood flow decreases (there is some adaptation so don’t despair); Less recall with newly learned information lost more quickly (STML). Greater need for repetition to learn new information. Word finding and spatial ability declines with age. Slower response times.
Heart and circulation – Becomes less efficient; heart muscle enlarges; reduction in energy and endurance. Increased probability of hypertension.
Lungs – become less efficient and so supplies the body with less oxygen.
Kidneys – reduce in size and function. Takes longer to clear waste and medicines from the blood as quickly and less able to manage homeostasis in dehydration.
Clinical Assessment
The Key Aspects?
Sensory
Physical
Neurological
Mental / Psychological
Emotional
Chemical
Cultural
Accreditation
Effects on Standard 2 -
Health & Personal Care
The Principle: Residents’ physical and mental health will be promoted and achieved at the optimum level in partnership between each resident (or his or her representative) and the health care team.
2.1 Continuous improvement:2.3 Education & staff development2.4 Clinical care2.5 Specialised nursing care needs (ACFI 12)2.6 Other health and related services (ACFI 12)2.7 Medication management (ACFI 11)2.8 Pain management (ACFI 12, relates to ACFI 1,ACFI 2, ACFI 3, ACFI 4, ACFI 5 )2.9 Palliative care (ACFI 12 specifically but additionally D1 and D2)2.10 Nutrition and hydration (ACFI 1, relates to ACFI 2 ACFI 12)2.11 Skin care (ACFI 12, relates to ACFI 2, ACFI 4, ACFI 5)2.12 Continence management (ACFI 5)2.13 Behavioural management (ACFI 7 - 9)2.14 Mobility, dexterity & rehabilitation (ACFI 2, ACFI 3, ACFI 4,
relates to ACFI 5, ACFI 10, ACFI 12)2.15 Oral and Dental care (ACFI 3, related to ACFI 1)2.16 Sensory loss (All ACFI Domains)2.17 Sleep (All ACFI domains)
The Human
Rewards
Why WE Do What We Do
ACFI
Outcomes for Residents
Fewer falls
Better skin care
Mood elevation
Improved pain management
Better Nutrition
ComplianceIncreased Funding
Health
Increased financial and Service sustainability.
Ability to attract and maintain quality staff.
More resources per resident.Documentation
Improved standard of documentation.
Clear and concise care planning.
Defined ACFI process with clear allocation of
responsibility
Workforce Satisfaction
Staff understand why they do what they do.
They are able to focus on caring for their residents.
Increase in job satisfaction, engagement and a sense of contribution to the bigger
picture.
OurSolutions
What we Offer
Our goal is to ensure that every resident is fully funded given their unique and specific care needs….no exceptions!
We charge nothing until your increased income is realised plus we do not charge expenses as additional but absorb them to increase affordability.
We come to your site and reassess EVERY resident and train your staff in ACFI… care staff, RN’s, AHP’s even your GP’s on ACFI and the specific requirements. Your residents learn about it too.
We charge 20% of increases for 12 months from the date of the ACFI claim. 20% is half, yes HALF, the percentage charged by other companies. PLUS we guarantee to refund our fee if there is any loss at validation…but so far we have had no loss.
We take on only 3 age care groups per year related to the time commitment for each, perhaps only one for larger groups. Your success is our success…and that takes time.
SomeTakeaways
Suggestions
The language used by staff is very impotent and is an area validators use to claw back funds. Nurses tend to use non-specific terms like ‘occasionally’. Remove it, and others like it, from your vocabulary now.
Be specific and confident in descriptive terms. If you lack confidence the validators will ‘sense your fear’. NO Fear!
Case conference all ACFI claims. Interview staff from all shifts. Behaviours don’t only happen on the pm shift. Get a broad picture covering all shifts. This will give credence to any single observation. Behaviours, especially, happen in clusters…and often at peak care intervention times.
Identify your care and funding targets based on your case conference data…then cement the anecdotal information into clinical assessments.
Carers are an integral team component. Use their skills…they are the eyes and ears of the facility.
Cross check all information for congruence across all ACFI questions. Any errors will give raise doubt in the mind of your validator. Firm confident evidence will raise no questions.
Remember that residents respond to questions with answers they think you want to hear or because they are concerned that you will ‘do’ something to them. Use or create relationships of trust for the best outcomes.
Always, always, always use the area for comments in assessments.
More Takeaways
Clinical
The World Health Organisation defines a chronic wound is one that has failed to progress through the phases of healing in an orderly and timely fashion.
Continence is like death or pregnancy… …Either you are or your aren’t!! It’s not possible to be a little bit dead or slightly pregnant.
Incontinence is defined as any involuntary loss of urine. Volume is of no consequence. It’s euphemistically called LBL or light bladder leakage on TV advertisements.
Its only the lucky ones who don’t experience pain. The elderly wear pain like a cloak. They put it on like they put their clothes on and habituate to its presence even though it really does hurt.
The Cornell Scale for Depression IS NOT a happiness scale…why do so many comments paint a rainbows and unicorns type of picture? The presence of depression does not reflect the quality of care.
