Laguna Honda Short Stay Program Jennifer Carton-Wade, Assistant - - PowerPoint PPT Presentation

Laguna Honda Short Stay Program

Jennifer Carton-Wade, Assistant Hospital Administrator for Clinical Services Janet Gillen, Director of Social Services

Joint Conference Committee

Sept 13, 2016

Background

• Healthcare Reform
• Shifting of Payment Model to Capitated and Managed Care
• Focus on appropriate level of care
• Focus on Patient Flow - Increased Demand for Skilled Nursing

Services:

• Discharge to post-acute care is common for adults 65+ (41%)
• ~7,000 discharges to skilled nursing facilities/year for San Francisco residents
• Hospital SNF closures have resulted in an increase in discharges to community

SNFs

• Patients Unable to Transition to SNFs - 67 patients waiting in acute care hospitals
• n a given day
• Controller’s Office City Service Auditor City Performance Unit – 2015

LHH Discharge Planning Improvement Project Recommendations

Systems Developed

• Short Stay Code Defined:
• A short stay code designates residents expected to discharge from

general SNF care to the community with 100 days of admission.

• Short Stay hospital service codes:
• Since 2005 LHH have Hospital Codes for residents who are anticipated

to be discharged to community

Positive Care (LSA) Rehab (LRH) Respite (LRE) Palliative Care (LHP)

Systems Developed

• New short stay Hospital Code for general SNF who are

short stay residents effective January 2015

• Hospitalwide Policy and Procedure on Short Stay Developed

Short Stay Policy Implemented January 2016 Policy was revised & approved by JCC in July 2016 Currently being revised again and up for September 2016 JCC approval

Systems Developed

• Periodic monitoring of short stay residents by Patient Flow

Coordinator and Social Services Director

• Weekly Discharge Huddles in the Neighborhoods
• Purpose of meetings are to keep

residents on track and provide support to RCT

Resident

RCT Social Services Director UM Nurse

Referrals & Length of Stay

14 17 1 1 3 2

Referral Sources of Short Stay Admissions August 2015 - July 2016

Home ZSFGH (Acute)

• St. Francis (Acute)
• St. Mary's (Acute)

UC Med (Acute) ZSFGH (SNF)

Total Average Length of Stay

• 50.05 Days

Average Length of Stay- Respite (LRE)

• 30.21 Days

Average Length of Stay- Short Stay (LSS)

• 61.63 Days

Admissions & Discharges

1 2 3 4 5 6 7 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16

# of Residents

Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 LRE(Respite) Admissions 1 2 2 1 2 2 1 3 LSS(Short Stay) Admissions 3 6 1 1 2 3 1 4 1 1 1 Discharged to Community 1 6 2 2 2 3 1 4 2 4

Short Stay Admissions & Community Discharges August 2015 - July 2016

Admissions & Discharges

3 1 2 5 5 2 4 2 4 4 2 3 8 8 3 4 2 4 1 2 3 4 5 6 7 8 9 N1 - Integrated Wellness N2 - Memory Care N6 - Memory Care PM - Rehab S2 - Positive Care S3 - Enhanced Support & Palliative S4 - Enhanced Support S5 - Enhanced Support S6 - Enhanced Support

# of Residents Units

Short Stay Admissions & Community Discharges by Unit August 2015 - July 2016

Discharged to Community # of Short Stay Admissions

Next Steps

• Revised Short Stay Policy and Procedure for JCC Approval September

2016

• Implementation of Short Stay Dashboard by October 2016
• Implementation of bi-monthly meetings with Patient Flow Coordinator and

Director of Social Services with RCT to evaluate the status of residents who have reached the 45 and/or 75 day benchmark by September 2016

• Incorporating Short Stay Discharge to Quality Measures - Centers for

Medicare and Medicaid Services added 6 quality measures to Nursing Home Compare. One of which is - Percentage of short-stay residents who were successfully discharged to the community (claims-based) since July 2016

• Ongoing Collaborative Efforts to Improve Discharge to community:
• Participate in citywide post acute care collaborative projects
• Advocate for flexibility and expansion of community programs and

affordable housing to care for post-acute care patients

QUESTIONS..