Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Phoebe Ministries

Name of Innovative Program: 
Eldercare Method Community Care Teams: A Vehicle for Enhancing Long Term Care Culture and Patient Care for Older Adults
Sponsoring Organization
Phoebe Ministries
Name of Innovative Program Lead: 
Kelly O’Shea Carney, PhD, CMC
E-mail Address of Innovative Program Lead: 
kcarney@phoebe.org
Project Description: 
Recently, dramatic changes have been noted in populations served within long term care (LTC).  Medical acuity levels are higher, functional levels are more compromised and the majority of residents present with cognitive impairment and/or behavioral health diagnoses.  Addressing the complex needs of residents requires coordinated, integrated care provided by an interdisciplinary team with an awareness of the psychosocial needs of the individual.  However, in most LTC settings, behavioral health expertise is either absent or operates outside the interdisciplinary team. The Eldercare Method offers a creative approach to address the complex needs of residents and further the culture change necessary to ensure that each individual has the opportunity to thrive.  It achieves these goals by fully integrating behavioral health care professionals into LTC settings as clinicians and leaders.  They provide direct care services, consultation and leadership within interdisciplinary teams, which address the behavioral, psychological, social and growth-oriented needs of the individual.   
Creativity and Innovation: 
Traditionally, long term care settings have been dominated by a medical model.  As the “culture change” movement has emerged, LTC settings have sought to become more person-centered, which is important because psychosocial needs in the senior population are too often an after-thought and not widely discussed.  In the Eldercare Method, behavioral health professionals assume leadership for the facilitation of interdisciplinary care planning related to behavioral, psychological, social and growth-oriented needs of the resident.  This model positions the behavioral health professional as a leader, role model and catalyst for change.  In this role, the behavioral health professional offers not only behavioral health expertise in conceptualizing and care planning for the resident, but also serves as a powerful influence on the members of the team, encouraging compassionate conceptualization and person-centered care.  The creativity of this approach lies in infusing the behavioral health mindset and skill set into the LTC setting.
Leadership: 
In the last two years, the Centers for Medicare and Medicaid Services (CMS) have implemented a national initiative directed at reducing the use of psychotropic medications to address the behavioral needs of nursing home residents in favor of person centered care and strategic behavioral interventions.  Through this initiative, CMS has been gathering and disseminating strategies and models for achieving these goals.   The Eldercare Method, which has been in use in Pennsylvania for over 15 years, has been referenced by CMS as a resource (https://nhqualitycampaign.org and www.nursinghometoolkit.com).   In this regard, the Eldercare Method has already been recognized as an innovative and effective approach with demonstrated leadership in improving care for nursing home residents and effecting culture change in LTC settings.  Our goal is to continue developing and sharing this model with other LTC providers, both in support of the CMS initiative and to enhance the person-centered care approach. 
Sustainability: 
Behavioral health care has not traditionally been viewed as a core discipline within LTC.  Rather, it has been viewed as a consultative service to be utilized in response to emergent needs and third party reimbursement has severely limited the range of services behavioral health providers can offer.    However, the Eldercare Method is designed to rely upon a variety of revenue streams to make the services sustainable.  In addition to drawing upon a diversified revenue stream, the Eldercare Method also results in medical cost offset within the LTC setting, making the facility costs more manageable.  Medical cost offsets demonstrated in different settings have included reductions in the use of psychotropic medications, staff injuries, staff turnover and psychiatric hospitalizations.  These cost offsets, in addition to the enhanced marketability of LTC services that fully integrate behavioral health care, help to make the model sustainable in the facilities served. 
Replicability: 
The Eldercare Method has been replicated in over a dozen long term care settings in Northeast Pennsylvania.  The settings served have included personal care, skilled care and memory support settings.  Since its development in 2000, the conceptual model has evolved and policies, procedures and documentation practices have been refined and standardized in a manner that maximizes integration and impact of the services.  At present, the model is being launched at four (4) long term care facilities and is being offered at 3 levels of care, i.e. personal care, skilled care and memory support.  Outcomes associated with this implementation are currently being studied in a formal research project.  While the model has been successfully replicated across a variety of settings in Pennsylvania, it is expected that the study will provide the additional evidence needed to share the model with LTC providers outside of our region.
Results/Outcomes: 
To date, outcomes associated with the Eldercare Method have been measured at each facility served via quality improvement data.  The outcomes documented by various facilities have included reductions in falls, use of psychotropic medications, staff injuries, staff turnover and challenging behavioral expressions.  In addition, facilities have noted increases in staff knowledge and understanding of dementia and behavioral health needs, improved teamwork and higher levels of resident engagement and improvements in resident’s moods.  Our research study, conducted under the guidance of an academic partner from Penn State University, is being implemented across four campuses in eastern Pennsylvania to gather additional outcome data related to the model.  The aims of the study are to determine the impact of the model on resident wellbeing and staff member knowledge, skill and efficacy related to the psychosocial needs of residents. 
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