APIE: The Importance of the Assessment Process

Job descriptions for activity directors in senior living usually read as follows: “Provide activities that meet the residents’ preferences and needs.” This generalist approach, sometimes guided by regulation and/or company best practices that lack benchmarks and standards, can lead to difficulty in implementation and measurement of success. It’s understandable then that resident engagement is often viewed as “Nice to have” or “Fun” but not a necessity or influential when it comes to return on investment (ROI).  Do activities, or simply resident engagement, make the company money? Assisted living companies want to see a decrease in falls, longer lengths of stay, and, therefore, an increase in census that produces more revenue. Skilled nursing communities would like to stay in compliance with their regulatory requirements and, more recently, score high on their quality measures to earn a competitive 5-star rating, increase in census, and improve their value-based purchasing, producing more revenue.

What if benchmarks and standards were created within resident engagement? What if quality resident engagement is shown to be correlated with better clinical and quality outcomes that foster a higher ROI? Although there has never been established benchmarks or standards within the resident engagement field, it may initially need to be optimized, but let’s try to move towards this goal in order to prove that activities are more than just “Nice to have” or “Fun” but “Clinically necessary” and essential to the overall resident experience.

Let’s start with a familiar, yet perhaps underutilized, standard process, in the activity/recreational therapy field called APIE: Assessment, Plan, Implement, and Evaluate. Person-centered care is based on individuality, choice, and incorporating the resident’s voice as the driver in their care. The standard of care that incorporates person-centered care looks like this: assessing your residents, planning their treatment, implementing their plan, and then evaluating if that plan is working. Therefore, understanding our residents first takes a thorough evaluation in various areas of care. The assessment process is one of the critical steps in providing care to residents. What’s the value of the assessment process? How do your staff view this? Asking and finding out what the resident’s symptoms and diagnoses are, physical and medical needs, cognition, psycho-social well-being, their preferences and needs, as well as their strengths and challenges within an assessment process can help the interdisciplinary team (IDT) start to formulate that understanding.

Understanding our residents leads to improved clinical, quality and organizational outcomes. When staff have the resources to understand their residents, they feel competent and confident and residents are satisfied with their care. This leads to a lower re-hospitalization rate and a longer length of stay, better clinical and satisfaction outcomes, and increased staff retention, that increases quality measures, reimbursement, and revenue.

“Long-term care as we see it is all about improving the quality of life for our residents, whether that’s improving their physical quality, mental quality, or a psycho-social quality – whatever function they still have, we want to help them attain or maintain the highest level of dignity and ensure they are living their fullest lives in any way possible in our range of care.”– AANAC, “The Value of the MDS” (October 24, 2017)

With each life enrichment or activity assessment that is completed, that data needs to be analyzed and a plan developed specific to that resident in order to deliver this person-centered approach. A consideration of the data points listed above should help the activity professional and IDT understand better what kind of engagement and programming is needed to provide the best quality of care. In other words, the information derived from the assessment process should formulate a plan that would include what and how much engagement is needed for each resident to help them get to their optimal level of functioning or at the very minimum, maintain their level of functioning.

Within your organization, how does that assessment information come alive? How is it used and implemented by all staff? Maybe it’s developing resident profiles, reviewing the care plans of the residents or sharing this information in meetings. Is this enough? Do all staff have access to and understand this assessment information? It’s important to take the information gathered and convert it into an actionable plan. For example, one can take the resident’s cognition level and functional status, at minimum, and determine the resident’s level of functioning. Then, a resident engagement regimen, or social prescription, can be developed based on that information and using empirical evidence that has proven better health outcomes in the aging senior. From there, staff can then use that actionable plan.

“The end goal is to create a system where the ‘social prescription’ is as important as a clinical or medical prescription in which a modality based on the psycho-social preference of the Elder would be considered the first course of action before any type of clinical treatment including the use of medication..”–Charles De Vilmorin, CEO and Co-founder of Linked Senior

Optimizing the assessment process empowers staff. They will be able to see what engagement works for each resident by understanding their unique abilities versus challenges. They will learn what kinds of engagement best meet a resident’s needs and preferences. Then then should be able to determine level of functioning and for how long that engagement is needed to be successful in improving quality of life, based on empirical evidence. They would then develop hands-on engagement and intervention techniques based on preferences and needs. In turn, the resident will feel better connected, safe and secure with the staff because this understanding brings about a familiarity and comfort for the resident with their care partners. Additionally, the resident will feel purposeful, hopeful, and fulfilled. This can also stabilize or improve cognition and physical functioning. This connection can lead to better clinical, quality and organizational outcomes. The value of the assessment process lies in this ‘win, win’ for staff, residents, and the business. Learn more about the APIE process and stay tuned for future posts on the Plan, Implement and Evaluate processes by visiting: https://www.linkedsenior.com/resources/resident-engagement-institute/