Nursing Home Care Plans

hi i'm jean carls, part of the qualityinnovation network national coordinating center team that supports the centers formedicare and medicaid services national nursing home quality care collaborative.on behalf of our team, very pleased to present this webinar focused on mobilitypromoting physical activity for people living in nursing homes. this webinarwill provide an opportunity to learn about strategies to help maintain orimproved mobility for people living in nursing home in this webinar you'll findexamples of mobility strategies that work strategies that can be implemented inyour nursing home. you will hear how one

organization deal with senior livinghas applied physical activity strategies to create changes in their resident's liveswhich went to improve quality of life and enhanced mobility and you will hearhow the plan do study act quality improvement method was used to plan and documentresident's progress and success with the fitness program. you'll hear the benefits ofexercise for people living in nursing homes and how to overcome challenges for promoting mobility. you may be familiar with the change package developed forand used in the national nursing home care collaborative. the change packagefocuses on the practices of high performing nursing homes across thecountry

capturing evidence-based processes andpractices to improve the quality of life care and outcomes for residents. onesection of the change package contains specific bundle of mobility strategiesthat work to help residents be physically active. each strategy includesspecific action items that can be implemented in your organization. copiesof a change package are available at the website listed on this slide. here you will see a list of sixstrategies for the change package mobility bundle. within each strategy thereis additional details that will help to implement that strategy. please refer tothe change package mobility bundle for

details of each strategy listed on thisslide. you will also note throughout this presentation a lightbulb symbol with numbers was behind thesymbol. this symbol and it's following number corresponds to an example of howspecific action item from the change package is being applied. i'm very pleasedto introduce racey ihde, director of wellness initiatives and a wellnessconsultant with tealwood senior living racey will share information about arecent quaity improvement project that was initially implemented within acollaborative of 11 minnesota nursing homes the program has such positive outcomesfor residents that it was standardized throughout the entire tealwoodorganization of more than 40 nursing

homes, assisted-living and memory carefacilities in communities across 4 states. racey is a leader in the area ofexercise and is passionate about keeping people moving in order to reap thebenefits of physical activity. she is a certified personal trainer with an additional senior specialty certificate. she's been workingwith older adults for about 8 years and in the wellness industry since 2006.she holds a master's degree in human services and a bachelor's degree inpsychology. racey will describe for us tealwood's senior living physicalactivity program andwe'll also hear from residents that have participated intheir program. welcome racey. thanks for

joining us. i'm anxious to hear aboutyour physical activity program and goal. ultimately, we would like you assist ourresidents to maintain or improve their level of independence and by aiming for this, we understand that the key concept in ensuring quality of life as well. we really have a couple different directgoals we focus on improving strength flexibility endurance and balance alongwith incorporating the seven dimensions of wellness in addition we encourageresidents to achieve one hundred and fifty minutes of exercise per week andthis is recommended for older adults to the american college of sports medicineand it actually has additional research

behind it for improving sleep quality. we look at physical wellness as a wholeso we not only support therapy and restorative but also created what wecall our well fit program that includes group exercising, individual cardio in additionour company aims to establish a wellness based culture within all of our communities. so an example would be a piece of cardio equipment is placed out in theopen instead tucked away into a backroom we're also adjusting budgets now toinclude dumbbells and other exercise equipment and wellness rooms are now a staple within our future building projects so we ultimately provide those constant reminders thatremaining physically able is

important for the aging population. wedefinitely share well fit test results with each individual resident as well so bystrongly believing that maintenance is a success, we hope to encourage more of theparticipants to stay active than those that just improve. for the most part, our community life staff run our wellfit programs we offer initial and annual education and basicexercise knowledge as well as hands-on instruction on how to properly teachgroup exercise classes. guidelines of the programs are clear and concise andexercise routines require specific concepts that need to be included. however staffs are taught variations within each routine so they can properly adjust to fit to theability of the population they are

leading. those programs are then monitored on a monthly basis by wellness consultants and suggestions for improvements are given accordingly. in supporting staff we also educate other departments on the importance of keeping a residents independent aspossible so we offer research-based techniques and approaches within our trainingmodule for differing departments. i would like to here more about your physicalactivity program. what successes would you attribute to your program. there has beenvery successful in relation to mobility within our communities. we actually makeit a point to share successes when we get all of our staff together at ourbiannual meetings. some staff have shared an example of one woman who exercised on a regular basis.

stated her excitement for now being able to transfer herself into the salon chair at the beauty shop. so you can just see it in her face at how proud she was the day i can do it myself. so that was a really big success for her improving her quality of life. others that had participated havecome into that after only 3 months participation within the wellfit program.they stated i have been sleeping better at night and i can move my legs, feet and anklesmore than i could in the past three years. it seems too that our wellfit programshave become a gateway that individuals who participate soon begin to joininto other things. it ultimately encourages an active lifestyle. so staff have noticed withinthat active lifestyle improvements in

transfers, residents doing more forthemselves, residents taking the initiative duringadls, initiative assisting with cares and taking more charge of their overallwell-being. racey it's been great to hear about your physical activity initiatives. lets here from residents who participated and tealwood's physicalactivity program. now tell us about their experiences ofincreasing their physical activity yes, it's been helping me. i can stand up you know where you use arms, then you use your knees. i think i and i've lost quite a bit of weight too.

well i suppose it keeps my legs goin. it keeps me goin better. sit around and do nothing pretty soon you can't do much. it takes some kinks out of your muscles first thing in the morning and everything if you get on it. anytime during the day. and it kind of relaxes you. a...e...i...o...u... kinda keeps your strength up. i'm starting to rebuild myself a little bit strength and i'm trying for balance too, whatever i can get... wow it's great to hear from your residents. what a nice video.

racey, you mentioned earlier that each resident's progress is monitored. could you please tell us more about that? in looking at each individual's progress we utilize what we call the wellfit test. itis based off of the senior fit test that was created by rikli and jones. so depending upon care level if you have skilled assisted living or memory care, we have adapted a basicand advanced version. basic focuses more so on balance and more extremitystrength while the advanced allows for more overall functional testing. one of our aha moments came up as aresult of our data collection before mansion of the programming to the entirecompany we collected and analyzed around

700 basic wellfit tests. all residents completed the trapped on a quarterly basis whether they participated in our well fit programor not. we were happy to have the results show a high success rate of improving balanceand more extraordinary strength which was not necessarily a surprise but more of a verification of our hard work if residents did not participate in ourprogram, it's almost seems inevitable that they were getting weaker. so this realization made it essential for us to expand our programming and learn how to motivateolder adults and educate everyone on the importance of making mobility. raceywe really appreciated information you shared about your physical activityprogram. has there been any challenges

that you've encountered? definitelymotivating residents to participate in those programs was difficult at times. imean let's face it you don't have to be 95 to have an excuse for why not exercisebut if seems like driving home that concept if you don't use it you lose itwith older adult can be a bit more difficult. so we strategize and sharebest practices between all of our communities on what works and whatdoesn't some example would be offering activitybucks for participation that can be utilized to purchase small items like ina campus store. other creative ideas would be creating contests like bike across ameria that includes residents as

well as staff to participate and cardioprograms. another challenge would be creating global routines to fit all thedifferent communities. we do offer the variations within the routine but we don'thave a personal trainers at all of our sites so sometimes adjustments may not be made by the staff either challenge the resident more or simplify instruction for the weakerfacing cognitive decline. so to overcome this we continually teach and remind themovement variation and we allow staff freedom to adjust routines while stillmaintaining standards but the biggest thing would bewe have that wellness consultant aspect and they come in and they sit in on theclasses and then offered their expertise

in promoting the most appropriate routine for that particular group toward achieving improvements. can youtell us more about your quality improvement initiatives? have you usedthe plan do study act quality improvement method in your organization?we are very familiar with the quality improvement system of plan do study act allthe tools, systems and programs that we create in relation to mobility have been trialedon a small scale. we get suggestions back from staff who tested them and then you revise and retry some items were tested within only two ofour communities, while others were tested on a little bigger scale ofaround 11 of our skilled buildings. once those items were

efficient than they were expanded to theentire company. though because then the expansion calls for implementation in assisted living and memory care units we definitely then started the psdacycle over and adjusted things where appropriate within the care level but wedefinitely value the quality improvement process overall and ensured that programsare the programs that are being implemented are utilizing our time andresources successfully. racey, you've really put a lot of effort into your wellnessprogram. has it been worth it? what do you see is your greatest outcome? that our entirewell if calendar structure by far the physical wellness programs are the mostextensive. it took and it takes a lot to

properly educate staff, implement new charting and assessments, and then continuously monitor what is being done that will maintain or improve residents’ mobility. however, all the hard work, time and effort is definitely worth the gain. as a result, we are not only seeing improvements in residents’ mobility, but those unintended consequences of improved sociability, cognition and quality of life are coming forth as well. so, ultimately, you get what you work for and much more. i’m glad to hear that your work has provided such positive outcomes! we have one more opportunity to see and hear tealwood senior living residents in action i don’t get enough of it! i like exercising. easy, limber. well, i’ve learned to sit up straight.

yes, i’ve gotta do it to keep myself going. well i think if i didn’t do it i’d get so stiff i wouldn’t be able to wheel myself or anything. i don’t know it makes me feel good, that’s about all i can… and you know it gets me.. it keeps me going! my legs hurt real bad and that’s good for them... and feet and hips, from the hips down to the toes, hurt bad and when i exercise i feel better. i just like being with the people and i like to do the exercises. it helps me to breathe better. friendly group, which i appreciate and we get to know eachother a little better. mmhmm, it’s where we can work, have fun…?

stimulate the mind! yeah, i look forward to it. exercise class is the best and then the bike ride is the second best. that’s what i like doing here everyday. well i look forward to the exercise class because it has something to do, for one thing. it makes your body move! you know, you sit in a chair all day then you get stiff! at least i do. well it’s very good for me because i can transfer now from my wheelchair to the car with very little help and i go to my beauty shop and i can get into the chair with a little bit of help but i can do it pretty much myself… what do you think about the exercise classes? what does it do for you? muscles!

it gives you muscles? what’s your favorite part? a little bit of weight. well this is great! just get out and do it! just get out and do it. it’s great! thanks, racey! you have really done a lot in your program to improve mobility, and the people seem to enjoy and benefit from your physical activity program! now that you have heard and seen stories from tealwood’s residents – take a moment to think about and discuss how you might implement strategies you have seen in your nursing home or organization. what excites you about what you have heard in this presentation? what ideas can you apply in your work?

what action steps are needed for you to apply these ideas? you have heard elders describing individual benefits of exercise in this webinar. you also heard that enhancing and maintaining mobility as a part of daily care helps to maintain a person’s function as well as physical and psychological well-being. we would like to provide you with resources and links that may help you establish a physical activity program in your organization. first, racey mentioned the 7 dimensions of wellness, a philosophy that individuals can live as fully as possible within seven dimensions of wellness. these dimensions move the definition of health and well-being away from a mindset that is based in the management of disease

and into the areas of prevention and proactive strategies. each aspect of wellness acts and interacts in a way that contributes to an individual’s quality of life. also to help you establish your own physical activity program this slide contains the links and references to information presented in the webinar on the change package , plan. do. study. act. (pdsa) quality improvement method the research for the american college of sports medicine recommendation of 150-minutes of physical activity per week, and the rikli & jones research. a variety of resources were used to design tealwood’s senior living’s physical activity program. the three websites listed on this slide are sources of information for designing a physical activity program:

he advancing excellence in america’s nursing homes campaign, the international council on active aging, and the american college of sports medicine. research studies document the benefits of exercise – and - physical activity has been linked to improvements in stability, walking, functional capacity, cognitive functioning, well-being, and pain perception. the three studies listed on this slide continue to build the case for helping residents to maintain or improve mobility, to reduce the severity of obstructive sleep apnea, and to optimize mobility and function for residents with dementia. this slide lists resources that might be helpful in developing programs for ambulatory residents in long-term care facilities.

thank you for listening today! we hope that you are inspired to implement or enhance your mobility program. please contact your local quality innovation network - quality improvement organization (qin-qio) for additional support with your improvement efforts.quality improvement is a journey, where you are always looking for additional ways to improve.