In the News: Center for Home Care Quality and Research [CHCQR]

Home care leaders from across the nation were invited to Washington, DC for the Center for Home Care Quality and Research’s national conference, titled Promoting Excellence in Geriatric Home Care in July 2008. This conference chose to examine the priority care areas of Medication Management, Physical Function, Cognitive Function, Chronic Pain, Palliative Care and Advanced Illness Management and Care Coordination, Management and Transitions.

The National Advisory Committee of CHCQR was charged with developing a Framework for Geriatric Home Care Excellence. Through this process, principles and strategies emerged. In all there were six cross-cutting principles and seven overarching critical strategies identified for the home health delivery system. These principles and strategies must be embraced in order to achieve positive change in practice and policy.

Crossing-Cutting Principles

The National Advisory Committee included its principles in the background materials provided for the July conference. These principles included the following focus for the older person’s home health care. Care should be:

• Relationship-centered:  Actively involve and encourage older persons and their caregivers in care that promotes centrality of familial, social, helping and caring relationships.
• Team-based, interdisciplinary and collaborative:  A coordinated care team that is composed of caregivers, direct care workers and professionals that actively seek contributions from diverse disciplines for the purpose of collaboration on achievement of shared goals is the core of this principle.
• Evidence-based:  Current best practice evidence should be used in care associated with:
• Risks, conditions and syndromes associated with advancing age – e.g., dementia, depression, osteoporosis, incontinence, falls, neglect, failure to thrive, and
• Home care or geriatric interventions shown to minimize risks and improve or sustain health, function and quality of life.
• Individualized and culturally sensitive:  Care plans should reflect each individual’s and their caregiver’s needs, goals, preferences, conditions, capabilities, risks and cultural norms.
• Communication-focused:  This includes multiple, effective communication modes and feedback among and between all team members. Communication should include the sharing of vital data, observations and information, including the preferences and values of older persons and their caregivers, across the care continuum and time.
• Longitudinally-focused:   This principle includes incorporating assessments, ongoing monitoring and evaluation, revising care plans and team-based problem solving that achieves the avoidance of preventable problems, promotes early recognition and treatment of problems, and addresses anticipated and expected health, functional status or quality of life changes. [CHCQR. P.4]

Overarching Strategies for Positive Change

Strategies, presented by the National Advisory Committee, to be utilized to bring about the change, resulting in which improved older persons’ home health care, were detailed as the need to:

• Shift organizational culture from one that is professionally determined to a culture that actively promotes and reinforces collaboration with older persons and their caregivers.
• Redesign roles and responsibilities that currently exist in home health care in order to foster teamwork and maximize the contributions of all team members.
• Realign workforce education and training to integrate evidence-based geriatric knowledge with teambuilding and quality improvement skills. In addition, promote the explicit conscientious use of best current evidence, and acknowledge and reward staff who attain qualifications/certification in geriatrics and related fields.
• Identify, use and refine tools, resources and effective communication channels to foster learning, provide guidance to clinicians, and support practice improvement.
• Identify, adapt and, where necessary, develop valid, reliable measures to monitor: 1) desired improvements in processes, performance and outcomes of care for older persons, and 2) related resource costs.
• Adopt incentives to motivate, reinforce and recognize quality improvements and the related resource costs associated with achieving geriatric home care excellence.
• Establish stronger collaborations between home health organizations, universities and other research and knowledge-sharing organizations to foster advancements in evidence-based home health care for older persons. [CHCQR. P.5]

Priority Application Areas

In choosing task force topics to explore in more depth, the focus was pointed towards critical care and services with the potential to adversely impact the quality of life for older persons. Background, status, implications and implementation relative to the seven priority focus areas were presented in the background materials available through the Visiting Nurse Service of New York’s Center for Home Care Excellence. The conference chose five of these priority areas [Medication Management, Physical Function, Cognitive Function, Chronic Pain, Palliative Care and Care Coordination] and three other core topics [Patient and Family Involvement, Guidelines Submissions and Making the System Work] for its work group assignments.

Summary and Application

These principles and strategies were applied to the priority areas detailed in anticipation that improved geriatric home care will be achieved. This application involves not only individual participation, but also provider and system participation in order to maximize and reach desired outcomes. This will result in achieving excellent geriatric home care, which manifests the cross-cutting principles and strategies. This is believed to be accomplished through reinventing models of care, retooling the workforce and revising policy. However in the redesign process, leaders are cautioned that it is important to build upon and incorporate the existing home care system’s uniqueness, strengths and qualities in to the new geriatric home care model. For more information on this national initiative, access http://www.vnsny.org/research/about/index.html.

References

Center for Home Care Quality and Research. Cross-Cutting Principles and Overarching Strategies in Promoting Excellence In Geriatric Home Care. July 9 2008.