Helping Continuing Care Retirement Communities Determine the Best Level of Care for Each Patient

Background: Continuing Care Retirement Communities (CCRCs) consists of various neighborhoods and care spaces for senior adults. The neighborhoods are organized and residents are housed based on “levels of care” (LOC), Independent, Assisted, and Nursing. During scheduled interprofessional meetings, the CCRC leadership has the critical task of understanding the residents’ needs and assigning them to the appropriate LOC. Currently, the process of completing this task lacks the necessary structure, which engenders challenges in making recommendations in a systematic way. This project seeks to offer the CCRC interprofessional team a structured approach to determine which LOC and its resources would best serve each individual resident. Methods: User-centered research began at a CCRC, The Hill at Whitemarsh, in Summer 2019. Interviews with administration, employees, and patients were organized. Meetings with employees were observed. Preliminary LOC checklists and questionnaires were tested at The Hill’s biweekly LOC meetings and a final tool was produced. Results: The administration felt the lack of structure during the biweekly LOC meetings led to inefficient discussion and decision-making. The meetings also did not take into consideration patient individuality. The Interprofessional care team preferred a list of questions that was arranged with the intent to guide discussion, with enough freedom to consider the uniqueness of each elder. Conclusion: This tool provides the CCRC Level of Care team with a format to guide their meetings and carefully consider the needs of each resident. Based on feedback, the administration believes this tool improves the efficiency and structure of their discussions. One limitation of this project is time. To improve the validity, the project can be extended to accurately determine the success of the tool for meeting efficiency and patient satisfaction

Using a Checklist to Guide Discussion in Level of Care Meetings at the Hill at Whitemarsh

Background: The Hill at Whitemarsh is a retirement facility in Lafayette Hill, Pennsylvania which has three bundles of services for residents termed levels of care (LOC). Meeting are held routinely by medical and administrative staff to determine if an individual needs to move to a different LOC to improve her/his quality of life and safety. These meetings require integration of medical, functional, cognitive, social, and subjective factors often requiring input from several staff members. In this project, we seek a checklist for staff members at the Hill to use at the LOC meetings to ensure important points of discussion for a patient are not missed. Methods: We began our research by interviewing the Hill staff including the CEO, director of nursing, social worker, director of recreational therapy, nurses, and nursing assistants. Next, we generated several iterations of the checklist. Then, we implemented the checklist at the Hill in several level of care meetings, and the responses of the staff were recorded. Results: We identified a project at the Hill, interviewed key personnel, iterated, and implemented our design. Although staff admitted that the checklist captured important points of discussion for each patient, it was not thought to improve the decision-making process because decisions were often made without all the information included in the checklist. Conclusions: In this project we found a need to improve the LOC meeting by making a tool to integrate complex impressions from multiple people; however, our solution did not adequately capture the flexibility needed in LOC meetings. A future tool would quantify both the important factors and how important they are in deciding