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 on 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 Palliative Care Rehab (LRH) Respite (LRE) (LSA) (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 Currently being Short Stay Policy Policy was revised & revised again and up Implemented approved by JCC in for September 2016 January 2016 July 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 RCT  Purpose of meetings are to keep residents on track and provide support Resident to RCT Social UM Services Nurse Director

Referrals & Length of Stay Referral Sources of Short Stay Admissions August 2015 - July 2016 Total Average Length of Stay 2 3 1 • 50.05 Days 1 14 Average Length of Stay- Respite (LRE) • 30.21 Days Average Length of Stay- Short Stay (LSS) 17 • 61.63 Days Home ZSFGH (Acute) St. Francis (Acute) St. Mary's (Acute) UC Med (Acute) ZSFGH (SNF)

Admissions & Discharges Short Stay Admissions & Community Discharges August 2015 - July 2016 7 6 5 # of Residents 4 3 2 1 0 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 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) 1 0 2 2 1 2 0 0 2 1 3 0 Admissions LSS(Short Stay) 3 0 6 1 1 2 3 1 4 1 1 1 Admissions Discharged to 1 0 6 2 2 2 3 1 4 2 4 0 Community

Admissions & Discharges Short Stay Admissions & Community Discharges by Unit August 2015 - July 2016 9 8 8 8 7 6 # of Residents 5 4 4 4 4 3 3 3 2 2 2 1 3 1 2 5 5 2 4 2 4 0 N1 - Integrated N2 - Memory N6 - Memory PM - Rehab S2 - Positive S3 - Enhanced S4 - Enhanced S5 - Enhanced S6 - Enhanced Wellness Care Care Care Support & Support Support Support Palliative Units Discharged to # of Short Stay Community 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

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