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Facility Orientation/

Annual Mandatory Education

SENIORLIFE

FACILITY ORIENTATION/ANNUAL MANDATORY EDUCATION

eDUCATION ouTLINE

......

ORGANIZATION STRUCTURE

  • The Mission
  • The PACE Benefit
  • An overview of Adult Day Care Program
  • Independent Living Philosophy and Consumer Control
  • Conflict of Interest
  • Provider Network (site specific)

QUALITY ASSURANCE AND PERFORMANCE IMPROVEMENT

  • QAPI Overview
  • Grievance/Appeal Policy
  • Fraud Waste and Abuse

ENVIRONMENTAL SAFETY

  • Bomb Threat
  • Fire Safety
  • Natural Disaster
  • Equipment/Power/Water Failure
  • Material Safety Data Sheet
  • Oxygen Safety
  • Smoking Policy
  • Medical Emergency/ Emergency Care
  • Body Mechanics and Back Safety Techniques

INFECTION CONTROL

  • Exposure Control Plan for Blood-borne Pathogens
  • Infectious Waste Handling (Blood spills, contaminated sharps, contaminated laundry)
  • Hand Hygiene
  • Tuberculosis

PSYCHOSOCIAL WELL-BEING

  • Health Care Ethics
  • Abuse and Neglect
  • Member Rights
  • Communication Techniques
  • Behavior Management Techniques
  • Restraints
  • HIPAA Compliance

PERSONNEL

  • Workplace harassment policy

THE ABOVE TOPICS HAVE BEEN REVIEWED WITH ME AND I HAVE HAD AN OPPORTUNITY TO ASK QUESTIONS.

EMPLOYEE SIGNATURE: ______DATE: ______

EDUCATION PROVIDED BY: ______DATE: ______

Organization Structure

Mission Statement

The mission of Senior LIFE is to partner with members, family and community to enable members to remain at home while preserving dignity and autonomy. The approach is member centered and accomplished by promoting open communication and advance care planning through a shared decision making process with Senior LIFE’s interdisciplinary team.

An Overview of Adult Day Care Programs

Adult day care centers provide community-based programs to meet the needs of adults who are functionally impaired and/or mentally confused. These structured, comprehensive programs provide a variety of health, social, and related support services for people with Alzheimer’s disease and related dementia, chronic illnesses, traumatic brain injuries, developmental disabilities, and other problems that increase their care needs.

The roles and responsibilities of the Adult Day Care Center staff includes: ADL assistance, health monitoring and health related services, medication management, social services, transportation, health education, and professional therapy services.

The ultimate goal of adult day care is to maximize the quality of life
and promote successful living for the participants.

The PACE Benefit

What is PACE?

Many older persons with chronic illness prefer to spend their last years at home. However research has shown that this is too often not the case. Instead, many frail elderly end up in nursing homes because they are unable to care for themselves or are unable to coordinate the services and payers needed for them to stay at home. Programs of All-Inclusive Care forthe Elderly (PACE) address this issue by providing access and coordination for all needed medical and supportive services.

The centerpiece of PACE is a special type of daycare center, where older adults receive primary health care, rehabilitative therapies, meals, social work, and other services. As needed, PACE also arranges for hospital care, medications, medical specialist care, home care, and nursing home care. The goal, however, is to maintain participants at home.

Who is Eligible to Enroll in PACE?

PACE is exclusively for persons 55 years of age or older who live in a defined catchment area and are certified as eligible for nursing home care. Because of these requirements, PACE enrollees closely resemble typical nursing home patients. The average PACE enrollee is elderly, has 8 separate medical conditions, and is unable to perform three activities of daily living. Additionally, almost half of PACE participants have some degree of dementia.

Financing PACE?

Funds to establish a PACE program are generally provided by a combination of private contributions, grants, and collaborations with local healthcare organizations. Once operational, PACE centers receive monthly capitated payments from Medicare, Medicaid, and, in fewer instances, individuals. Most participants are dually certified by Medicare and Medicaid, and the PACE program receives a single monthly fee for each enrollee. The capitated reimbursement structure of PACE provides an incentive to support activities and programs that keep participants healthy.

Research has shown that PACE Improves Outcomes

▪PACE participants are more likely to maintain their physical function.

▪PACE participants have lower rates of nursing home admission, and spend fewer days in hospitals and nursing homes.

▪PACE enrollees are over three times as likely to have advance directives as the general population.

▪In the first 12 months after enrollment, mortality is decreased by 32%.

▪Overall, PACE participants have lower mortality rates, compared to similar nursing home patients.

▪PACE participants at the end of life are able to die at home more than twice as often as others nationally.

▪

Independent Living Philosophy and Consumer Control

Independent living means having control over your own life and being able to make decisions about life work and play in the same ways that people without disabilities do. This is exactly what "independent living" means.

One of the primary principles of the independent living philosophy is "consumer control." "Consumer control" is at the heart of independent living in every way. The individual with a disability must have control over his or her life and all decision-making.

"Consumer control" is defined as: significant representation, power, authority, and influence of individuals with varying disabilities in all aspects of an organization that provides services to enhance independence and that seeks to change the political, social, and economic environment and quality of life possible for all disabled persons.

The concept of consumer control is based on the premise that people who use our services know best what they should be, how they should be structured and delivered.

Conflict of Interest

Conflict of interest can be defined as any situation in which an individual or corporation is in a position to exploit a professional or official capacity in some way for their personal or corporate benefit.

Examples of the most common forms of conflicts of interest:

▪Outside employment, in which the interests of one job contradict another (Rob moonlighting with AAA as an assessor while continuing his role at SL.)

▪Self –dealing, in which public and private interests collide (Natalie’s husband owns and operates a DME company. Natalie goes to the members of SL and persuades them to request their new wheelchairs from her husband’s company.)

Remember, the best way to handle a conflict of interest is to avoid them entirely. If this is not possible, the next step is disclosure and recusal.

Disclosure is when you disclose information that is an actual or a potential conflict of interest.

Recusalis when those with a conflict of interest are expected to recuse themselves from decisions where such a conflict exists.

Quality Assurance
and

Performance Improvement

Quality Assurance and Performance
Improvement Plan Overview

Purpose:

The Quality Assurance Performance Improvement (QAPI) program at SeniorLIFE is designed and organized to support the mission, values, and goals ofSeniorLIFE and the Program of All Inclusive Care for the Elderly (PACE). To this end, all employees are expected to consistently make improvements, minimize errors, and strive to do the following:

▪Develop and support a therapeutic clinical environment in which every member’s capability is maximized;

▪Develop an environment in which each discipline of the Interdisciplinary Team plays an integral part in the improvement process;

▪Promote an environment of open communication;

▪Progressively improve all services;

▪Create an atmosphere that promotes and encourages innovation and creativity; and

▪Seek and utilize input from members, caregivers, staff, and interested members of the community to enhance services.

The QAPI Program is based on the following principles:

▪Effective operation of SeniorLIFE depends upon the performance of program staff, the operation of internal and external systems, the performance of contractors working for the program, and cooperative teamwork among the members, caregivers, families, interested members of the community and SeniorLIFE staff.

▪Central to the effectiveness of the PACE program is the Interdisciplinary Team, which assesses each member individually, develops and implements individualized plans of care, monitors member progress, and modifies the plan of care as necessary.

▪The program maintains a customer-first orientation with the needs, preferences, and values of internal and external customers driving quality goals. As part of this principle, member and caregiver involvement in the QAPI process is sought.

▪The program implements and maintains a strategic planning process, which includes support for continuing QAPI.

▪SeniorLIFE leaders show full support in the total QAPI process and communicate the importance of this process to every associate.

▪QAPI education and training are integral parts of staff development activities.

▪All disciplines and contract providers are interdependent and share responsibility for evaluating and improving the quality of member care and services.

▪All SeniorLIFE providers maintain the confidentiality of medical information, written and otherwise, and show respect for members’ beliefs, values, expectations, and attitudes about health,illness,

health care, and quality of life.

▪To the greatest extent possible, QAPI activities will utilize objective, quantifiable measures, statistically valid analysis techniques, and meaningful comparison data.

▪All domains of service, including structure, process, and outcomes are addressed by the QAPI Program.

Goal:

The goal of the QAPI program is to improve future performance through effective improvement activities driven by identifying key, objective performance measures, tracking them and reliably reporting them to decision-making and care-giving staff.

Objectives:

Specific objectives of the QAPI Plan are to:

▪Assure effective, timely and safe delivery of care

▪Identify core and critical processes that most affect member outcomes as a focus of process standardization and performance improvement.

▪Ensure all team members, staff and contract providers, are involved in the development of and implementation of the quality assessment and performance improvement activities and are aware
of the results of these activities.

Responsibilities:

The QAPI plan applies to all services provided by medical staff, employees, volunteers, contractors and others affiliated with SeniorLIFE.

Responsibility for quality assessment and performance improvement ultimately rests with the organization’s governing body, the Pennsylvania PACE, Inc. This governing body has the final authority to ensure that adequate resources are committed and a culture is created that allows QAPI efforts to flourish. The governing body, directly or through delegation to the SeniorLIFE Board of Directors, will:

▪Lead the organization toward continually improving the quality of member care and services through the oversight of the organization’s mission and operation;

▪Incorporate findings from quality assessment and improvement activities in strategic, program, and resource planning;

▪Provide guidance toward continuing education concerning the approach, methods, tools, and application of continuous quality improvement;

▪Establish broad guidelines for quality improvement activities in conjunction with the Director and Medical Staff leaders;

▪Guide process analysis and improvement;

▪Provide for and review an annual evaluation of the performance of the QAPI Plan.

The SeniorLIFE Management Team provides oversight of all QAPI activities at SeniorLIFE. The SeniorLIFE QI Coordinator is responsible for ensuring that quality data is collected from all appropriate sources, that the data is examined and that results are shared with all appropriate staff and/or committee members for follow-up action.

An annual Quality Management Summary (QMS) is composed by the QIC and reviewed with Management Team, passed up to the SeniorLIFE Board of Directors via the Program Director and the Medical Director. A copy of the QA annual report will be provided to DPW during their annual review. As applicable, contracted staff will also be sent a summarization of the annual QA report.

Grievance Procedure

Policy:

It is the policy of SeniorLIFE (SL) to assure that all members understand and have access to the established grievance system should a concern/complaint about their care arise. All grievances are reviewed on a routine basis by the Executive Director. The QAPI Coordinator maintains a log of this information in order to foster an environment of continuous improvement. In addition, grievance information is made available for review by CMS and/or the PA DPW upon request. There shall be no discrimination against a member on the grounds that he/she has filed a grievance.

Purpose:

To provide members/family/representatives a process for expressing dissatisfaction with the services provided by SL. All SL members/family/representatives will have the opportunity to express their concerns or dissatisfactions with the services of SL or any of its providers without the fear of reprisal.

The grievance process also provides SL with opportunities to improve on their service delivery system. SL recognizes that grievances may be the first indication that a problem exists. The grievance policy is outlined in the Member Handbook and is reviewed with the member/representative at the time of enrollment and annually via the newsletter at the minimum. In addition, the grievance policy and procedure will be made available to the member/family upon their request and when a grievance is filed.

Definition:

A grievance is defined as a complaint, either written or oral, expressing dissatisfaction with service delivery or the quality of care furnished.

Filing a Grievance:

  1. A grievance may be expressed to any staff member at any time. Any incoming grievances via telephone or in person given to a SL staff member will be documented on a Grievance Formby the staff receiving the complaint. This is then forwarded to the immediate supervisor of the person receiving the grievance.
  2. If during non-center operational hours the member/family/representative wishes to file a grievance, the nurse on-call will be responsible for receiving the complaint and completing the form. The form will be forwarded to the appropriate personnel the next business day.
  3. A written acknowledgement of receipt of the grievance will be provided to the person filing the grievance.

Documentation of a Grievance:

  1. An investigation of the grievance is completed and documented on the Grievance Investigation Formby the staff that was assigned.
  2. It is also written on the Grievance Log and maintained at the facility. Trends and patterns are identified by the QA Coordinator and reported to the QI Committee. The QI Committee is responsible for determining the need for and initiating an improvement plan.Identified trends and action plans are reported back to the Interdisciplinary Team on at least a quarterly basis.

Resolution:

  1. Staff will report the grievance at the next IDT meeting or within a period of five working days (whichever is sooner).
  2. If a solution is found and agreed to by the member within five working days of when the grievance if filed, the grievance is resolved.
  3. All efforts are made by the team to pursue a resolution to its utmost ability so that problems with service delivery do not go unresolved.

Dissatisfaction:

  1. If a solution is not found by the staff within five working days or agreed to by the member, the staff shall develop a written report regarding the nature of the grievance.
  2. The written report shall be sent to the Executive Director, or if the grievance involves medical care, to the Medical Director for final action.
  3. The Executive Director or Medical Director will immediately review and approve or disapprove the staff’s written report, and forward a copy of the approved report to the member within five working days. The report is considered final disposition to the grievance. The report is accompanied by a notice that contains a statement that if the member is not satisfied with this action, he/she has 30 days to request a review by the Plan Advisory Committee.
  4. If the member is not satisfied with the action taken as a result of their grievance, he/she may ask for a review by the Plan Advisory Committee within 30 days of the receipt of the final disposition of their grievance.
  5. The Plan Advisory Committee will send written acknowledgement of the receipt of the grievance within five working days to the member. The Plan Advisory Committee will then investigate and find a solution, and take appropriate actions subject to approval of the Board of Directors.
  6. The committee will send to the member a copy of a report containing a description of the grievance,

the actions taken to resolve the grievance, and the basis for such action. The committee has 30 working days from the day the grievance is filed with the committee to complete its report and send it to the member.

  1. If the decision is wholly or partially adverse to the member, a copy of the report shall be forwarded immediately to DPW and the ombudsman
  1. The member will continue to receive all required services during the grievance process.
  2. The QA Coordinator is responsible for maintaining, aggregating, and analyzing information on grievance proceedings. By analyzing the number and types of grievances, SL can develop activities that will monitor and improve the grievance resolution process, as well as identify and make improvements or modifications in areas of care. This information will, in turn, be reported to the Management Team, and ultimately, the governing board.

Appeal Process

Policy:

It is the policy of SL to assure that all members understand the appeal process and have access to the established appeal system if needed.

Definition:

An appeal is defined as action taken on behalf of a member with respect to the provider’s non-coverage of or non-payment for a service; denial of a request for services; reduction, termination or suspension for a service; untimely provision of services; denial of enrollment; or involuntary disenrollment of the member from the program.

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