1. Bonnie S. Kantor, Sc.D Executive Director, Pioneer Network
Commercial Market Place and Nursing Home Transformation: Following Consumer Demand
Bonnie S. Kantor, Sc.D
Executive Director, Pioneer Network
MC v2

2. Opportunities for Nursing Home Transformation
Opportunity for practice, research and policy to view quality and efficiency as interconnected outcomes.
Improved quality
of care and
measurable
Financial success
Resident-centered
Adaptations

3. Who here is aging?
When did you start aging?
And where have you always lived?

4. Home vs. Homelessness Home Homelessness Identity Non-Personhood
Connectedness
Lived Space
Privacy
Power/Autonomy
Safety Predictability
Journeying
Homelessness
Non-Personhood
Disconnectedness
Meaningless Space
Without boundaries
Powerless/Dependence
Insecurity/Uncertainty
Placelessness
Carboni (1990)

5. Culture Change Renewal of Personal Transformation
Re-organizing the work
Renovating the Physical Environment to Create Home

6. Pioneer Network Founding Principles
Know each person
Community is the antidote to institutionalization
Practice self-examination, searching for new creativity and opportunities for doing better
Relationship is the fundamental building block of a transformed culture

7. Pioneer Network Founding Principles
Risk Taking is a normal part of life
Put person before task
All elders are entitled to self-determination wherever they live
Recognize that culture change and transformation are not destinations but a journey, always a work in progress

8. Our Vision…
A culture of aging that is life-affirming, satisfying, humane and meaningful.

9. A clear understanding of the elder:
Where are you from?
What is your personal history?
What is your preferred typical day?
Who do you want to be in the future?

10. “Quality is not a program; it is an outcome that evolves from organizational culture focused on the customer and organizational excellence”
AAHSA 2005

11. Person Directed Practices
Person Directed Practices Overlap with Varying Degrees of Choice and Autonomy
Person Directed Practices
(Begins somewhere between Consideration of the Person and Person’s Choice)
Staff Directed
(agency scheduled routines/staffing dictate care provision)
Consideration of Individual
(Seek person’s input and tailor some aspects)
Individual Choice
(Offers choices of food, waking, bathing etc.)
Individual Control
(have right of refusal and right to take risks)
Person Directed
(Individual has primacy -- determines own schedules, activities, meals, and caregivers)
Degree of Person-Directedness
Developed by the Lewin Group

12. The Question Consumers WILL Ask is…
Are the values of choice, respect, and self-determination implemented here?

13. What Culture Change Is About:
Honoring individuality of residents and staff
Creating “home”
Person vs. task focus
Creating a new way of being and thinking related to aging.
Creating responsive systems.

14. Paradigm Change INSTITUTIONAL medical “treatments” task focus
“float” staff
staff make decisions
structured activities
PERSON-DIRECTED
social/holistic
nurture spirit
care matches needs
consistent assignments
residents make decisions
spontaneous activities

15. Paradigm Change (cont.)
INSTITUTIONAL
schedule for convenience of staff/administration
facility “belongs” to staff
sense of isolation and loneliness
departmental focus
PERSON-DIRECTED
schedule adjusted for resident and staff needs
facility is residents’ home
sense of belonging and community
team approach

16. Opportunities for Nursing Home Transformation
Opportunity for practice, research and policy to view quality and efficiency as interconnected outcomes.
Improved quality
of care and
measurable
Financial success
Resident-centered
Adaptations

17. Research on Outcomes Associated with Network Participation
In the first empirical, comprehensive study of the Pioneer Network, research examined if “early adopter” participants achieved financial and quality outcomes that were significantly different from outcomes of non-participant homes.*
CMS provided data from 1996 (pre-participation in the network timeframe) and 2003 (participating in the network for at least one year).
*Source: Elliot, et al. (2007)

18. Quality of Care Results
Findings comparing quality of care outcomes of homes participating in the network to analogous control homes denote that early adopter homes achieved statistically significant improvement in quality of care over control homes.
In a multivariate analysis of all homes certified by CMS in 2003, coefficient estimates indicate that length of time participating with the network positively affected quality of care.
*Source: Elliot, et al. (2007)

19. Efficiency Results
This research also evaluated the effects of Pioneer Network participation on the per bed net income and operating margins of early adopter homes versus analogous control homes and produced the following findings:
Overall, homes participating in the Pioneer Network displayed statistically significant improvement in per bed net income and operating margin from 1996 to 2003 when compared to controls.
*Source: Elliot, et al. (2007)

20. Network Participation and the Quality/ Efficiency Connection
Thus, this preliminary research suggests that
participation with the Pioneer Network
increases the chance that:
Residents (consumers of this network) will receive superior quality of care.
Homes will experience cost savings (as measured by net income and operating margins).

21. Impact on Medicaid and Implications for Financing Reform
Isolating cost centers (e.g. dining) along with quality of care components linked with those cost centers (e.g. weight loss) would further illuminate the positive impact on quality and efficiency.
Measurable outcomes create potential strategies (such as Medicaid waivers) to reward homes that actively reduce morbidity and improve cost efficiency through innovative practices.
*Source: Elliot, et al. (2007)

22. Opportunities for Nursing Home Transformation
Opportunity for practice, research and policy to view quality and efficiency as interconnected outcomes.
Improved quality
of care and
measurable
Financial success
Resident-centered
Adaptations