Lean Green: Breaking the Residential Service Delivery Routine

1. Lean & Green: Breaking the Residential Service Delivery Routine May 13, 2010 Hanni Ruehrdanz & Sterling Wind CAHSA 2010 Annual Convention & Exhibition

2. What is Imagine! Established in 1963 in Boulder County, Colorado, United States Community Centered Board (CCB) Variety of Supportive Services 85% Funding from Medicaid Provides support services to more than 2,500 people

3. About Imagine! The Mission of Imagine! is to create and offer innovative support services to people of all ages with cognitive, developmental, physical, and health related needs so they may live fulfilling lives of independence and quality in their homes and communities.

4. Sustainability? 16.2% of US GDP is spent on Health care Surpassed 2.2 trillion dollars in 2007 50% more than any other country In 2008 - 41% of the US budget was spent on Medicaid, Medicare and Social Security $56,400,000,000,000 in unfunded obligation Estimated 74% by 2030

5. Sustainability? Waiting Lists are Growing 4 to 6 percent annually Direct Support Professional Shortage Home Health/50%increase by 2016 Wages are stagnant

6. Supportive Services in the US are Changing Care is becoming increasingly complex Caregivers need more information People are living longer Wellness Promotion Reimbursement Policies Consumer/Family Involvement Health Professional Shortage

7. Our Approach� Leveraging Opportunity � Product Development/Customer Base Research and Development/Stable Organization Across Service Realms/Similar Service Needs Families/Demand Management Internal - D.I.G�s/Staff Tenure and Development

9. Change to Survive Improve Consumer Services/Supports Assess Service/Support Needs Facilitate Communication/Involvement Families Improve Organizational Efficiency / IT IQ Coordinate Information Assess/Evaluate DSP (Direct Service Professional) Research and Development Design/Develop New Products Demonstrate Success/Failure Create New Service Models Address Waiting Lists Establish/Develop New Partnerships Social Ventures

10. Participatory Process Consumer/Family Involvement Design Selection Process Outline Expectations House Guidelines Consumer/Family Satisfaction Technology Assessment/Evaluation

11. Areas of Technology Consumer Specific Supportive Services Family Communication and Access Operational � Management and Line Staff (DSP) Support and Information Environmental � Home Management and Monitoring Systems

14. Review bullet points. If possible, relate to situations previously described by the audience. This is a good place to refer to previously posted items on the flip chart or white board. Review bullet points. If possible, relate to situations previously described by the audience. This is a good place to refer to previously posted items on the flip chart or white board.

15. Review bullet points. If possible, relate to situations previously described by the audience. This is a good place to refer to previously posted items on the flip chart or white board. Review bullet points. If possible, relate to situations previously described by the audience. This is a good place to refer to previously posted items on the flip chart or white board.

16. Review bullet points. If possible, relate to situations previously described by the audience. This is a good place to refer to previously posted items on the flip chart or white board. Review bullet points. If possible, relate to situations previously described by the audience. This is a good place to refer to previously posted items on the flip chart or white board.

17. Consumer/Family Specific Universal Interface - UMPC Environmental Control System Communication � VOIP RFID, IR and GPS Capable Teaching and Prompting Systems Family Information Systems

18. Operational Software as a Support (SaaS Model) Management Interface -Browser Based Employee Time Tracking DSP Interface - Browser Based Automate Documentation Incident Trending Care Plans Billing/Utilization Multiple Platform Integration LMS Family Access/Portal

19. Variety of Remote Monitoring Systems

20. SaaS Models Create a Support Network Advanced Process Solutions creates a data rich environment by installing and making use of existing sensor technology in a residence. The CARE system then collects, and translates data that delivers timely and relevant information to interested parties, creating a connected community of care. Advanced Process Solutions creates a data rich environment by installing and making use of existing sensor technology in a residence. The CARE system then collects, and translates data that delivers timely and relevant information to interested parties, creating a connected community of care.

21. Transforming Data into Information The CARE System collects information from disparate sources, to creates views of information relevant to each role within the support network. From staff members collect information from sensors (such as location and alert response), just in time log in of services provided, and their use of the web-based information portal. From clients we collect information about their movement throughout the environment, and also from alerts they generate Managers provide the system with definition by completing profiles of Clients, and setting appropriate alert and notification preferences. The CARE Station translates this data into information relevant to each role: actionable cues for staff members: Alerts and notifications social and health information for client contacts (the support network) Global perspective for managers The CARE System collects information from disparate sources, to creates views of information relevant to each role within the support network. From staff members collect information from sensors (such as location and alert response), just in time log in of services provided, and their use of the web-based information portal. From clients we collect information about their movement throughout the environment, and also from alerts they generate Managers provide the system with definition by completing profiles of Clients, and setting appropriate alert and notification preferences. The CARE Station translates this data into information relevant to each role: actionable cues for staff members: Alerts and notifications social and health information for client contacts (the support network) Global perspective for managers

22. Integrated Alert System This is the CARE systems live view of a smart house. Because staff and clients carry location badges, users check online to see where people are at the moment. This slide also demonstrates how the location information is integrated into our alert system. When marilyn calls for help, we know the location from where she called for help. This is the CARE systems live view of a smart house. Because staff and clients carry location badges, users check online to see where people are at the moment. This slide also demonstrates how the location information is integrated into our alert system. When marilyn calls for help, we know the location from where she called for help.

23. Making Alerts Meaningful Who, What, Where, When Customizable Insightful Managers and members of the support network can review the history of information collected by the system. Alerts history is now meaningful. I can view the history for an individual, time of day, group of clients, or the response of a particular staff member. The alert detail allows me to review the types of alert generated, when, who provided assistance, response time, and the type of assistance provided. Managers and members of the support network can review the history of information collected by the system. Alerts history is now meaningful. I can view the history for an individual, time of day, group of clients, or the response of a particular staff member. The alert detail allows me to review the types of alert generated, when, who provided assistance, response time, and the type of assistance provided.

24. Consumer Summary Information Summary and Documentation Hub * Metrics * Communication * Quick Documentation * The Client Summary brings system information together and makes it meaningful for staff members. This view brings staff members up to date on what happened since they were last on shift. They can review the last 24 hours of information collected by the system such as movement, total alerts, and time spent in bed. This is also a place to quickly read and document observations. Because the information system is web based, managers and on-call nursing staff can access the CARE portal online, and allowing the team members to consult one another with an established and accessible point of reference. The Client Summary brings system information together and makes it meaningful for staff members. This view brings staff members up to date on what happened since they were last on shift. They can review the last 24 hours of information collected by the system such as movement, total alerts, and time spent in bed. This is also a place to quickly read and document observations. Because the information system is web based, managers and on-call nursing staff can access the CARE portal online, and allowing the team members to consult one another with an established and accessible point of reference.

25. Engaging the Family and Support Network Sense of Connection alleviates concerns Transparency engages families as members of the support network. Opportunities to contribute provide a sense of belonging and purpose. Client-approved contacts can also be granted a modified view of the client�s information. Client-approved contacts can also be granted a modified view of the client�s information.

27. Web-based � manage records from a central location Intuitive User Interface Improved compliance with Medication Administration 75% reduction of medication administration errors Reduces staff training by 18 hours per residence Pharmacy Interface

28. Alerts and Notifications Color Alert System Notification of upcoming, early or past due medications Alerts received via a cell phone or PDA Notification e-mail notice with detailed information Customizable

29. Case Study 190 consumers 16 Staffed Sites/3 Group Homes/90 Foster Care Residences This organization has experienced 12% growth in their residential program for the last 6 years. During that time the nursing headcount has remained flat increasing the nursing/consumer ratio from 1:27 to 1:56 Quality Assurance audits showed a 48% decrease in Medication errors Cost of Ownership: for 1$ spend on MedSupport� saved $ 15.5

30. Energy Management Energy Efficiency Intelligent Monitoring �Data Mining to Create Usage Profiles Create and Optimize Load Profiles Integrate Adaptive Technology with GridAgents Technology

31. Changing Static to Dynamic Consumer Actions Direct Care Interactions Billing for Reimbursement Notification and Prompting Health/Wellness Family Involvement

32. Current and Potential Research Working with Colorado WIN Partners Identified 31 areas of research Quality of Life Effectiveness of services Provide Cost and Energy Savings Improved Health and Safety Funded through Grants

33. Long Term Goal

34. Areas of Development Consumer Assessment Integrating Multiple IT Platforms DSP Training Product Development and Assessment Adaptive Equipment Behavioral Supports Behavioral Patterns Recognition through Energy Usage Social Networking Capturing Life History

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