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Gina Zimmermann, MSExecutive DirectorNursing Care Center Accreditation Program Copyright, The Joint CommissionAchieving Post-Acute CareCertification for Nursing CareCenters

GoToWebinar HousekeepingYour ParticipationJoin audio: Choose “Mic & Speakers” to useVoIP Choose “Telephone” and dial usingthe information providedNote: Today’s presentation is beingrecorded and will be posted on theJoint Commission website. Copyright, The Joint CommissionQuestions/Comments: Submit questions and comments viathe Questions panel.

Today’s Objectives Review the benefits of achieving Post-AcuteCare Certification for your organization Learn the key requirements for Post-Acute CareCertification3 Copyright, The Joint Commission Discuss how Post-Acute Care Certification canposition you to achieve more Stars and betteroutcomes

Nursing Care Center AccreditationOptional Specialty CertificationsProvides a solid foundational platform upon whichoptional specialty distinctions may be builtAccredited organizations may elect optional specialtycertifications to highlight areas of additional competencebased on their unique service offerings and market needsVISION:Accreditation requirements relate to highvalue quality and safety issues affectingall patients and residents inNursing Home Settingsand include contemporary focus onperson-centered care and culturaltransformation.* Post-Acute Care Certification Memory Care Certification4 Copyright, The Joint CommissionFlexible Product Options To MeetYour Unique Quality Objectives

Care and services are – goal-directed– time-limited (short-stay) Care is provided to patients – recently hospitalized (or require higher acuity careand services in lieu of hospitalization)– Requiring medically complex care/rehabilitativeservices The goal – To help effectively transition the patient to a lowerlevel of care setting or to their home5 Copyright, The Joint CommissionPost-Acute Care Certification

Validates the organization’s capabilities to care forhigh-acuity patients Provides an unmatched quality distinction by formallyrecognizing advanced care competencies Helps nursing homes build strategic partnershipswithin the care continuum and is an effective way tomeet increasing demands for quality oversight Focuses on minimizing risk of readmissions fromnursing homes to hospitals and other care providers6 Copyright, The Joint CommissionBenefits of Post-Acute CareCertification

Eligibility for Post-Acute CareCertification A minimum of 5 patients have been servedwithin the program with a minimum of 2active patients at the time of survey7 Copyright, The Joint Commission Currently accredited or simultaneouslyseeking accreditation under the Nursing CareCenter Accreditation Program

Data set from CMS NursingHome Compare website, April2015 Accreditation status wasidentified by matching facilitiesin the Nursing Home Comparedata set and facilities in TheJoint Commission database byCMS Certification Number(CCN) CMS Nursing Home Comparedata set included records for15,637 facilities 711 (5%) of the facilities wereidentified as accredited by TheJoint Commission8 Copyright, The Joint CommissionIncreasing Your 5-Star Rating

Joint Commissionaccredited organizationshad statistically higherratings than nonaccredited nursinghomes on the overall fivestar rating and all 4component subscales(health inspections,quality ratings, staffratings, and RN staffratings)9 Copyright, The Joint CommissionStudy Results: 5-Star Ratings

Study Results: 5-Star RatingsOverall 5-Star Rating:Accredited with Post-Acute Care CertificationAccreditedNon TJC Accredited3.63*3.33*3.13Comparison of Accreditation and Certification Status byStar-Rating Component5432.965 2.848 2.8174.36*4.069*3.469*3.2953.488 3.448*3.205Quality RatingStaff Rating3.88*3.37820Health InspectionAccredited with PAC Certificationn 86Accreditedn 641RN Staff RatingNon TJC Accreditedn 14477* Statistical significance P 0.05Comparison of accredited organizations versus non-TJC accredited organizations after adjusting for facility size and ownership typeAs a general rule, smaller non-profit organizations also tended to do statistically better than larger for-profit or government owned facilities10 Copyright, The Joint Commission1

Joint Commissionaccredited facilitiesperformed consistentlybetter on all five of theshort term stay measures(short term stay defined as 100 days)11 Copyright, The Joint CommissionStudy Results: Quality Measures

Patients in accreditedfacilities: less likely to reportsevere to moderate pain less likely to acquire newor worsened pressureulcers less likely to beprescribed antipsychoticmedications more likely to receivepneumococcal andinfluenza vaccinations12 Copyright, The Joint CommissionStudy Results: Quality Measures

Joint Commission PostAcute Care Certificationwas associated withincreasingly betterperformance on pain,pressure ulcer, andantipsychotic medicationmeasures13 Copyright, The Joint CommissionStudy Results: Quality Measures

14 Copyright, The Joint CommissionPost-Acute Care Certification

Post-Acute Care eandcompetencyProvision ofcare for thehigh acuitypatientTransitionsof care15 Copyright, The Joint CommissionPost-AcuteCareCertification

A registered nurse(s) is on duty 24 hours a day, 7days a week Clinical staffing is planned based on patient acuity,complexity of clinical tasks, staff experience andexpertise, and physical layout of the facility Staff identifies learning needs relevant torehabilitation and advanced care services Staff participate in education and training thataddresses how to identify early warning signs of achange in a patient’s condition and how to respond Staff competence is assessed and documented atleast annually16 Copyright, The Joint CommissionThe Standards

The medical director oversees a process fordetermining whether admission, transfer, ordischarge was justified The nursing home uses clinical practice guidelines toguide the provision of rehabilitation and advancedcare services (http://www.guideline.gov) There is written screening criteria developed by aninterdisciplinary team that guides the process foraccepting patients Assessments and reassessments includeinformation about patients’ abilities to perform selfmanaged tasks17 Copyright, The Joint CommissionThe Standards

The Standards Interdisciplinary teams collaborate and shareinformation during the assessment andreassessment processes Medical history and physical exam within 24 hoursprior to or 48 hours after admission or readmission The patient is assessed within 1 hour of admissionto determine immediate care needs18 Copyright, The Joint Commission– Or if done within 30 days prior to admission, the attendingphysician or licensed independent practitioner reviews themedical history, re-examines the patient and updates anyfindings within 24 hours prior to or 48 hours after admissionor readmission

The Standards The patient is assessed within 8 hours of admissionfor pain, fall risk, skin condition, assistance neededin ADLs and risk for re-hospitalization When assessing for pain, the organizationdocuments: Input from the family/surrogates is solicited if thepatient is unable to convey the presence of pain Measures are taken to prevent or reduce discomfortand patient before a treatment or procedure19 Copyright, The Joint Commission– Location, duration, type (sharp, dull, throbbing, etc.),intensity (pain scale), exacerbating and alleviating factors,previous treatments and response, and barriers that mayprevent effective treatment

The Standards The organization has procedures for managingcritical results of tests and diagnostic procedures: The plan for care identifies any advance directives ofthe patient An interim plan of care is updated in response tochanges in the patient’s condition until thecomprehensive plan of care is developed The patient and/or family/surrogate is involved indeveloping an individualized plan of care20 Copyright, The Joint Commission– Definitions of critical results and procedures, by who and towhom critical results are reported, time for reporting ofcritical results of tests and procedures

An interdisciplinary team regularly reviews the patient’sprogress The interdisciplinary team discusses care with the patientand/or family/surrogate on an ongoing basis, includingcurrent status, outcomes, barriers to achieving goals,alternative interventions to facilitate achieving goals An attending or on-call licensed independent practitioner(LIP) is available 24 hours a day, 7 days a week There is a plan to access a licensed independentpractitioner should the organization be unable tocommunicate with the attending or on-call LIP about apatient’s change in condition21 Copyright, The Joint CommissionThe Standards

Resuscitation equipment and supplies are availablebased on the needs of the population served (forexample, crash cart, oxygen, and AED, etc.) There is a process for recognizing and responding tochanges in a patient’s condition Written criteria describe early warning signs of achange in condition or deterioration and when toseek further assistance The patient and family are informed on how to seekassistance when they are concerns about a patient’scondition22 Copyright, The Joint CommissionThe Standards

A designated, qualified individual coordinates theprovision of rehabilitation and advanced careservices The individual coordinates with the interdisciplinaryteam and the patient and/or family/surrogate Discharge plans are discussed with the patient’sfamily/surrogate and relevant practitioners acrossdifferent care settings The name and contact information of the responsiblehealth care provider(s) are included in the dischargeinstructions23 Copyright, The Joint CommissionThe Standards

The Standards Before discharge, the organization documentspatient or family/surrogate understanding of: Prior to discharge, the nursing home facilities thetransfer of information to other service providers The nursing home collects data about readmissionsto the hospital, emergency department, or otherpost-acute care setting The nursing home collects data on opportunities forimprovement after the patient has been discharged24 Copyright, The Joint Commission– Medications, diet and fluid intake, safety considerations,recommended exercises and other activities, lifestylechanges, access to resources in the community, follow-upappointments, indications of worsening condition and howto respond

Considerations for BudgetPlanning Post-Acute Care Certification– On-site survey is 1 additional survey day priced at 1,000/day in2016 Annual Fees for Certification25 Copyright, The Joint Commission– 500 for the 1st certification option elected and 250 for the 2ndcertification option elected– Total 750 annual fees for both optional certifications (in addition toannual fees for basic accreditation)