Taking the stress out of moving into long-term care

Lean improvements in Saskatchewan

Making the decision to move into a long-term care (LTC) home can be a difficult thing to do for both the individual involved and his or her family. Because of that, moving in should be as smooth and stress-free as possible, and that’s what a group of staff from Saskatoon Health Region is working on achieving during 90 Days of Innovation: Ready Every Day, which has improving the patient experience as one of its goals.

A team of employees from both the Region and affiliate LTC homes were tasked with eliminating defects in information flow in the long-term care resident moving-in process during a recent Rapid Process Improvement Workshop (RPIW). What they ended up doing is designing a process that allows moving day to be more about settling into a new home than filling out forms.

There are 30 long-term care homes in Saskatoon Health Region – 10 of which the Region owns and operates and 20 which are affiliates. Usually, about one admission takes place every day. Those admissions are taking anywhere from four to six hours, and there’s no standard process that facilities are following, reported co-team lead Krystal Sander. Right now, the focus at move-in isn’t showing the new resident around their new home, but instead on filling out paperwork – about three hours’ worth.

As part of their design, the team created some principles for the process, including that it should be resident- and family-centred, as well as fair and transparent. They also set a goal of halving the time spent on move-in.

The team developed a checklist of information (PDF) that’s needed from the resident, their chart, and their care team prior to a transfer, with the idea that the collection of the information begins before the resident moves in.

The checklist was designed to cover standard information; however, each care home will have other home specific information that they will need to share with residents once they arrive at the home. The team did highlight three pieces of that information that definitely need to be done pre-move in order to make the first day a good one. One of those pieces is dietary restrictions, including likes and dislikes, so the care home knows what to serve them for their first meal.

“It just creates a more welcoming environment,” said Lori Hinz, co-team lead, “and tells the resident that we have received their information already.”

Another item on the checklist is the serious illness/sudden collapse form. The team recognized that this is an important document for the staff in the long term care home to have as soon as possible; however, it is not a great item to have to discuss on their first day in the home.

“Because of this, we felt it would be a good thing to be discussed and prepared ahead of time and sent prior to move-in day,” said Sander. The home could then have further discussions once a relationship is established with the resident and family instead of doing this on the day the resident moves in.

The team suggested that the information needed pre-move could be gathered by members of the long-term care navigation team. Each team member would collect different documents during their interaction with the resident, and file everything centrally so that the receiving home would have it all in one place as soon as the resident comes in the door. The care team at the LTC home would then have the opportunity to review this information before the resident arrives, and they would only need to ask questions for clarification rather than the current process of asking for all required information. This file would also include any financial documents, which receiving homes are currently asking families to duplicate on move-in day.

With so many forms filled out ahead of time, move-in day would be dedicated to the resident and their family exploring the LTC home with staff, getting a real sense of what life will be like in their new home.

The team also designed a checklist to assist with a resident choosing their preferred home, to ensure the proper services are in place at their preferred location. They also suggested that transitional beds be designated in some LTC homes, so that people can move out of acute care and into a LTC environment as they wait for a room in their preferred home. A number of LTC homes are essentially functioning in this manner now; however, resident and family become upset because they are told they are moving to a permanent LTC bed, rather than a transitional bed. The home is also not recognized for the number of admissions and transfers they are doing.

Following this newly designed process, which also includes a consistent nurse-to-nurse handover component between sending and receiving locations, not only provides a good first day for the new long-term care resident, it allows staff at the LTC home a chance to get to know the family and resident before they move in, and fosters the development of a trusting relationship

“It makes move in day a happy process, a welcome to their new home instead of just hours filling out documents.” (Lori Hinz, co-team lead)

See the www.saskatoonhealthregion.ca/ReadyEveryDay website for more information about 90 Days of Innovation: Ready Every Day.

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