1. nicheprogram.org

2. Our Objectives Discuss the implications of the aging population for our hospital Discuss the opportunities and resources offered by the NICHE program

3. NICHE Nurses Improving Care for Healthsystem Elders NICHE is the premiere national geriatric nursing program that addresses the needs of hospitalized older adults Currently there are almost 500 hospitals in more than 45 states as well as Canada and Bermuda with NICHE designation. Over 100 hospitals are joining NICHE every year! NICHE collaborates with over 20,000 healthcare providers in the NICHE network on important geriatric issues

4. Why a program focused on older adults?

5. Graying of Canada 24% of population is over 55 years of age – Expected to double in next 25 years Average life expectancy is 80.4 years of age Canada ranks #11 in the world in terms of life expectancy – Global: 67.2 years – OECD nations (Organization for Economic Cooperation and Development): 79.8 years – USA: 77.8 years (ranks #38 in the world) References: 1. Canada. (2006). World Health Organization, Statistics. http://www.who.int/countries/can/en/http://www.who.int/countries/can/en/ 2. Life Expectancy Hits 80.4 years: Statistics Canada. (2008). CBC News.http://www.cbc.ca/canada/story/2008/01/14/death-stats.htmlhttp://www.cbc.ca/canada/story/2008/01/14/death-stats.html

6. Aging Demographics in Canada 1991-2041

7. Majority of Canadian Healthcare is for Older Adults 59% of visits to general physicians 84.7% of home care visits Canada spends 8-10% of total budget on healthcare for older adults Canadian government pays for 74% of healthcare costs for older adults References: 1. Inpatient Hospitalizations in Canada Increase Slightly after Many Years of Decline. (2005). Canadian Institute for Health Information. http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=media_30nov2005_e http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=media_30nov2005_e 2. Markle-Reid, et al. (2003). Frail Elderly Homecare Clients. Canadian Health Services Research Foundation. http://www.chsrf.ca/final_research/ogc/markle_e.php http://www.chsrf.ca/final_research/ogc/markle_e.php 3. Canada’s Demographic Challenge. (2005). Canadian Department of Finance. http://www.fin.gc.ca/budget05/bp/bpa3e.htmhttp://www.fin.gc.ca/budget05/bp/bpa3e.htm

8. Older Adults Are Hospitals’ CORE Consumers By 2050, the older adult population will number nearly 89 million, more than double the current population in 2010. Reason for the increasing population: –People living longer –Baby Boom population becoming 65 and older Every day until 2031; 10,000 Baby Boomers turn 65 By 2030 healthcare expenditure will increase by 25% for older adults Medicare spending will go from $555 billion yearly to $903 billion by 2020. http://www.cdc.gov/aging/help/dph-aging/state-aging-health.html

9. Older Adults Are Hospitals’ CORE Consumers ___% of_____________ (our hospital) inpatient admissions are: 65 years and older 85 years and older

10. The Quality Imperative: Improve Clinical and Fiscal Outcomes! Older adults 13% of the population: But comprise 37% of hospital discharges and 43% of hospital days Have longer lengths of stay (7.8 days vs. 5.4 days) Higher rates of 30 day hospital re-admissions Higher rates of functional decline and medical errors Reference: U.S. Dept. of Health and Human Services, Centers for Disease Control. Trends in Health and Aging. Retrieved October 31, 2008 from http://www.cdc.gov/nchs/hdi.htm Hall, M.J., DeFrances, C.J., Williams, S.N., Golosinskiy, A., & Schwartzman A. (2010). National Hospital Discharge Survey: 2007 summary. National health statistics reports; no 29. Hyattsville, MD: National Center for Health Statistics. 2010

11. Improving Care for Hospitalized Older Adults Is Good Business Optimal care requires appropriate skills –Aging demographics –Geriatric skill gap –High cost of inaction Older adult patients are everywhere –Need for flexibility –Ongoing training and coaching roles –Cost effective “train the trainer” virtual services

12. Improving Care for Hospitalized Older Adults Is Good Business Proactive & skilled nursing care avoids costly problems – “Never” events – Complications that increase LOS and costs Patient and family satisfaction – Better functional status at discharge – Smoother transitions Improved nurse satisfaction & efficiency, less turnover Improved MD satisfaction and improved efficiency

13. NICHE Program –Achieve systemic nursing change that will benefit hospitalized older adults –Provide geriatric sensitive and exemplary care to all hospitalized adults 65 years and over –Import principles and tools to stimulate change in the culture of healthcare facilities and achieve patient-centered care for older adults Goal Vision Mission

14. What Is the Focus of NICHE? focuses on programs and protocols that are predominately within the scope of nursing practice.

15. Nursing interventions have a substantive and positive impact on patient care outcomes In Other Words…

16. Hospitals Participating in NICHE Report… Enhanced staff knowledge and skills Greater patient satisfaction Decreased length of stay for older adult patients Reduction in costs associated with hospital care for the older adult Enhanced Magnet initiatives Improved compliance with regulations and industry standards

17. What Are the Objectives of the NICHE Program?

18. 1. Improve patient outcomes 2. Improve the patient experience 3. Promote staff effectiveness and satisfaction 4. Establish leadership as a provider of care to older adults 5. Provide fiscally responsible care 6. Increase collegial networks NICHE Program Goals

19. Geriatric Resource Nurse (GRN) Model Began in Boston – Early 1980’s at Beth Israel Unit based experts using existing resources Expanded at Yale New Haven Hospital Rationale - Those who voluntarily chose to participate in the effort would provide better care to older adults Central to the role - Geriatric education, competency evaluation, and mentoring

20. Rewards Related to the GRN Model Clinical ladder Novice expert growth Respect within the role Deeper geriatric expertise Parsimonious use of resources Outcomes described by NICHE sites Improved clinical outcomes Increased staff skill Increased satisfaction, both staff and patient

21. NICHE in Acute Care of the Elderly (ACE) Units Key Elements Patient-centered care Frequent medical review Early rehabilitation Early discharge planning Prepared environment Geriatric trained nurses (GRNs) Interprofessional teams Nursing evidence-based protocols Hospital outcomes Length of stay Case mix Cost per case Readmission within 30 days Improved patient outcomes Restraint use Pain levels Incontinence Pressure ulcer prevention or rates Functional status, fall rates and falls with injury Urinary catheter use Medication use

22. What Resources Does the NICHE Program Offer?

23. NICHE Program www.nicheprogram.org This website provides online access to: The NICHE journey, how to get started Online Leadership Training Program information Annual Conference information NICHE Knowledge Center (online tools and resources) Individual NICHE hospital websites Patient and Family resources

24. NICHE Program for “ Members Only ” Start-up Tools – NICHE Planning & Implementation Guide – Leadership Training Program Measurement – Geriatric Institutional Assessment Profile (GIAP) – Clinical Outcomes – Program Self-Evaluation Clinical Management Tools – Organizational Strategies & Clinical Improvement Models

25. NICHE Program for “ Members Only ” Training and Education Programs –Core Curricula: for Nurses, Patient Care Techs (CNAs), other disciplines and general staff –Webinars and in-service materials –Contact hours –Educational resources for patients and families –Conferences National Community –NICHE Listserv, discussion boards, resource, topic and special interest based

26. Getting Started Gather Stakeholders Identify needs derived from: –Staff development measures –Clinical outcomes –Financial outcomes –Budget considerations –Satisfaction surveys –Other strategic initiatives/plans –Passion of those who want to improve the care of older adults

27. Attend Leadership Training Program (LTP) Who should attend the LTP? ( minimum of 3 people responsible for initial steering of initiative) –Clinical Nurse Leader –Clinical Educator –Quality Manager or Administrator –Recommended additions to steer initiative: direct care staff, other disciplines (physician, rehab, social work, pharmacy, etc.) and community partners How to Become a NICHE Designated Hospital

28. How is the LTP delivered? 6 week online program delivery –Participate in scheduled live webinars and phone conferences –Engage in online group activities Facilitated by NICHE faculty & experts from experienced NICHE sites Earn contact hours Development of Action Plan upon program completion – Reviewed & discussed with NICHE staff and faculty

29. © 2013 NICHE All rights reserved. The information contained in this module is provided for informational purposes only. The content has been developed by NICHE participants and the NICHE staff at New York University’s College of Nursing and is protected by copyright under the laws of the United States and foreign laws. Under no circumstances may these materials be reproduced for sale or profit. Any use of content not expressly permitted may violate copyright, trademark, and other laws. Thank you! For more information, please go to www.nicheprogram.org