Care Plan for the Older Adult: Training

1. Care Plan for the Older Adult: Training Faculty Scholars Program November 1, 2013 Kathleen T. Foley, PhD, OTR/L Associate Professor, Occupational Therapy College of Health Sciences Brenau University—North Atlanta Campus

2. Learning Objectives • Discuss the importance of care planning for the older adult. • Identify differences between multi-, trans-, & interdisciplinary teams in health care. • Describe the rationale for interprofessional care and interprofessional training given current healthcare trends. • Describe a comprehensive education approach for teaching interprofessional care planning.

3. Older Adult Health Care • Characteristics of their health care?

4. Vignette-Guiding Questions • What is the overarching goal? • What are the older adult’s issues & impact on health & quality of life? • What are strengths & resources? Additional information needed? • What is the plan of care? • What needs to be done; • Who will do it; • When will it happen? • What is the priority of each issue? • What outcome(s) should be expected for each issue?

5. Concerns in Health Care • Optimal use of health workforce • Cost effectiveness • Efficient transition of care • Safety of patients (IOM, 2007) • JCAHO reports nearly 70% of patient adverse events cite the lack of collaboration and communication between providers as a main cause of error. Sentinel event statistics. http://www.jointcommission.org/NR/rdonlyres?FA465646-5F5F-4543-AC8F-E8AF6571E372/0/root_cause_se_jpg

6. Care Plan for the Older Adult • Is developed from a complete assessment that evaluates the current and future medical, social, emotional, environmental, and financial needs of the older adult • Includes issues/problems, interventions, and expected outcomes • “Road map” for care; it should all aspects of care • Traditional to nursing

7. Care Plan for the Older Adult • Caring for the complex older adult is important • Multiple diagnoses combined with normal aging processes • Results a complex care requiring multiple services • Care plan coordination should be: • Client-centered; • Supportive of family and informal caregivers • Focus on chronic care and health care transitions; • Bridge medical and social services; • Employ a comprehensive assessment; and • Implement and monitor a flexible care plan.

8. Benefits of Teams • The integration of healthcare teams has lead to: • Stronger continuity of care, • Improved health outcomes, and • Lower costs. (Jencks et al, 2009; Hirth et al, 2009)

9. Issues in Health Care Teams • Differing approaches and expectations toward client treatment • Lack of knowledge of roles within team • Negative attitudes and stereotyping • Conflicts concerning accountability and responsibility (Freeman et al, 2000; Garmen et al, 2006; Mickan & Rodger, 2000)

10. Type of Health Care Teams-Review • Multidisciplinary • Transdisciplinary • Interdisciplinary

11. Type of Team Review Multidisciplinary • Discipline oriented goals • Each member responsible for work within their discipline’s boundaries • Outcome is sum of each member’s efforts Client OT Psych RN PT

12. Type of Team Review Transdisciplinary • Based on patient needs, one member is team leader • Leader delivers care • Other members contributing information & recommendations MD Respiratory RN Client OT PT Dietary SLP

13. Type of Team Review Interdisciplinary • Members involved in problem-solving beyond their discipline • Team identified goals • Works toward goals with respect to their discipline • Collaboration replaces communication SW OT Client MD PT RN Psych

14. Types of Teams • Multidisciplinary teams • Transdisciplinary teams • Interdisciplinary teams • Interprofessional teams?

15. The Interprofessional Team • Similar to interdisciplinary; latest term • “When multiple health workers from different professional backgrounds work with patients, families, caregivers, and communities to deliver the highest quality care”. (WHO, 2010) • “Care delivered by intentionally created…small work groups in health care…having a collective identity and shared responsibility for a patient…” (IPEC, 2011, pg. 2)

16. Why Interprofessional Teams • Benefits of the Interprofessional team (IPT): • Client-centered care • Safer • Timelier • Improved efficiency • Improved effectiveness (Coleman, 2009) • Equitable (IOM, 2001) • Future of health care

17. Effective IPT Characteristics • Team members who: • Bring respective specialized knowledge and skills; • Recognize and appreciate contribution of each member; • Take part in decision-making; • Assume responsibility for their own decisions and team decisions; • Have good communication skills; and, • Seamless team cooperation and coordination (Xyrichis & Lowton, 2008; Priegel & Kupperschmidt, 2009)

18. Educating Professionals • Interprofessional education (IPE) is recommended; defined as: • “When students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes.” (WHO, 2010) • Goals: • Improve communication • Increase cooperation

19. The Future Professional • Core Competencies for Interprofessional Collaborative Practice (Interprofessional Education Collaborative, 2011) • Four Core Competencies: • Values/ethics for interprofessional practice • Roles/responsibilities • Interprofessional communication • Teams and teamwork http://www.aota.org/Business/Partner/41738.aspx

20. Interdisciplinary Team Training (IDT) • Goal is to experience what it is like to: • Participate on an interdisciplinary team • Develop a care plan in collaboration with other health care professionals • Sponsored by the UAB Center for Aging and Geriatric Education Center • 9 disciplines totaling 300 trainees observe an interdisciplinary interview of an older adult • Develop a care plan in smaller trainee groups

21. Interprofessional Clinical Experience (ICE) • Goal is to experience what it is like to: • Communicate with OAs to address problems from medical, emotional, social, environmental and economic perspective • Work effectively in an IDT appreciating differences and values of various disciplines • Sponsored by the UAB Comprehensive Center for Healthy Aging & Geriatric Education Center • Student trainees rotate weekly • Interview a resident as a group • Meet as a team to develop a care plan; facilitated by a geriatrician

22. Reference for ICE • Ford, CR, Foley, KT, Ritchie, CS, Sheppard, K, Sawyer, P, Swanson, M, Harada, CN, & Brown, CJ. (2013). Creation of an interprofessional clinical experience for healthcare professions trainees in a nursing home setting. Medical Teacher,35(7), 544-8. doi: 10.3109/0142159X.2013.787138. Epub2013April30.

23. Integrating the IPT (Reeves et al, 2009) • Interprofessional Collaboration Framework

24. What can you do? • Education/training level: • Incorporate IPT training into orientation and/or annual training; include didactic and practical components • Disseminate information on the various professions—OT , Nursing, PT, SW, Month • Practice level: • Model behavior • Distribute reminders on the characteristics of a “good team” • Organizational level: • Policies and procedures for the IPT • Recognize “good” teamwork

25. Interprofessional Team “Build for your team a feeling of oneness, of dependence on one another, and of strength to be derived by unity.” –Vince Lombardi

26. Notes… • The University of Alabama School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The University of Alabama School of Medicine designates this educational activity for a maximum of 1 AMA PRA Category 1 credit(s). Physicians should only claim credit commensurate with the extent of their participation in the activity. The University of Alabama School of Medicine is an equal opportunity/affirmative action institution. • The University of Alabama School of Medicine (UAB) is committed to the provision o f CME that is balanced, objective, and evidence-based. The University of Alabama School of Medicine adheres to Accreditation Council for Continuing Medical Education (ACCME) Essentials and Standards. Accordingly, all parties involved in content development have disclosed any real or apparent conflicts of interest relating to the topics of this educational activity and the disclosure summary follows. The University of Alabama School of Medicine Division of CME has established mechanisms to resolve conflicts of interest should they arise. Participants in UAB CME programs are afforded the opportunity to provide feedback on the quality of individual programs at the conclusion of the activity. Comments can also be sent directly to the Division of CME at cme@uab.edu.