CARF Accreditation - Covenant Health · Vancouver Coastal Health and Fraser Health Authorities (BC)...

© 2017 CARF International. All rights reserved.© 2017 CARF International. All rights reserved.

CARF Accreditation

A Person-Centred Approach to Quality in Palliative Care Services


Faculty / Presenter Disclosure• Faculty: Jill Allison, B.Sc., MBA

• Relationships with commercial interests:• Grants/Research Support:• Speakers Bureau/Honoraria: • Consulting Fees: • Other: Employee of CARF Canada


Potential for conflict(s) of interest• CARF Canada, a member of the CARF

International group of companies; accreditation is the primary business of CARF. CARF Canada is an independent, non-profit organization.


Mitigating Potential Bias• Information provided will be based on

international consensus standards and feedback from the field collected and analyzed by CARF International.


Overview of Workshop• About CARF

• CARF in Canada

• Programs for palliative care services

• Person-centred approach

• Standards and self-evaluation

• Reviewing full standard set…

• Q&A5


CARF International Group of Companies

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About CARF

• Commission on Accreditation of Rehabilitation FacilitiesCARF

• Non-profit• IndependentStatus

• Health and human servicesPrograms

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CARF Quick Facts

Founded in 1966 First Canadian survey in 1969

>7,200 service providers with

55,000+ accredited programs/sites

* More than 10.2 million persons

served annually by CARF-accredited

orgs* Accredited

programs in 23 countries

Incorporated in 2002

Offices in Edmonton

&Toronto

>500 service providers with close to 4,500

accredited programs/sites

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http://carf.org/anniversary

http://carf.org/anniversary


Mission

The mission of CARF is to promote the quality, value, and optimal outcomes of services through a consultativeaccreditation process and continuous improvement services that centre on enhancing the lives of persons served.

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Recognition of CARF in Canada

Alberta Ministry of Health recognizes CARF as an accepted accrediting organization for Alberta’s health system, including seniors care, mental health, and addictions.

British Columbia's Ministry of Children and Family Development (MCFD) and Community Living British Columbia (CLBC) have approved CARF accreditation for both contracted community living agencies and child, youth, and family services.

Vancouver Coastal Health and Fraser Health Authorities (BC) have confirmed that CARF is an accepted accreditation body for contracted residential care providers.

Ontario Ministry of Health and Long-Term Care recognizes CARF accreditation for long-term care homes and provides a funding premium to accredited homes.

Ontario’s Community Care Access Centres (CCACs) recognized CARF Canada as a choice for accreditation of certain contracted service providers.

Ontario’s Mississauga-Halton and Central West Local Health Integration Networks (LHINS) recognize CARF Canada accreditation for certain LHIN-funded agencies.

Workers’ Compensation Board of Nova Scotia requires CARF accreditation for Tier 2 & Tier 3 service providers

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© 2017 CARF International. All rights reserved.

Development of Standards• Active support of:

• Providers• Consumers• Purchasers of service

• Field-driven

• International consensus standards

• Process emphasizes performance improvement in business and service delivery


Standards Development Market

research

International Committees/

Council

Field review

Consensus

Staff, Board review

Publication in manuals

Field and surveyor education

Continued monitoring

for relevance


CARF Standards

• International consensus• Person-centred• Field-driven• Non-prescriptive• Achievable• Community-based• Universal• Practical• Relevant• Current


Survey Experience Feedback Report, 2016

94% 94.1%93.6%96.2%

0

10

20

30

40

50

60

70

80

90

100

All CARF Aging Services

Standards Relevant

Survey Beneficial

%

(N=1922) (N=1933) (N=102) (N=105)

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CARF Accredits

• Aging Services

• Behavioural Health

• Networks

• Child & Youth Services

• Employment & Community Services

• Medical Rehabilitation

• Vision Rehabilitation15


Aging Services Programs

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Adult Day Services

Specialty Programs: •Dementia Care

•Stroke

Assisted Living

PC Long-Term Care Community (PCLTCC)

Home & Community

Services (HCS)(Home Care)

Case Management

Independent Senior Living

Networks….


Accreditation Standards for Palliative Care Services

• Residential:

• Home Care:

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PC Long-Term Care Community (PCLTCC)

• Nursing & other services 24/7• Long-term & short-term services (or

both)

Home & Community Services (HCS)

• Variety of settings• Variety of personnel


Person/Patient/Client-Centred Approach

“Patient- and family-centered care is working "with" patients and families, rather than just doing "to" or "for" them.”

Source: Institute for Patient- and Family-Centered Care, (Adapted from: Johnson, B. H. & Abraham, M. R. (2012). Partnering with Patients, Residents, and Families: A Resource for Leaders of Hospitals, Ambulatory Care Settings, and Long-Term Care Communities. Bethesda, MD: Institute for Patient- and Family-Centered Care.) http://www.ipfcc.org/about/pfcc.html

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http://www.ipfcc.org/about/pfcc.html


“Patient- and family-centered care is an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care providers, patients, and families. It redefines the relationships in health care by placing an emphasis on collaborating with people of all ages, at all levels of care, and in all health care settings. In patient- and family-centered care, patients and families define their “family” and determine how they will participate in care and decision-making. A key goal is to promote the health and well-being of individuals and families and to maintain their control.

This perspective is based on the recognition that patients and families are essential allies for quality and safety—not only in direct care interactions, but also in quality improvement, safety initiatives, education of health professionals, research, facility design, and policy development.

Patient- and family-centered care leads to better health outcomes, improved patient and family experience of care, better clinician and staff satisfaction, and wiser allocation of resources.”


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Core Concepts

Collaboration

Information Sharing

Participation

Dignity & Respect


http://www.ipfcc.org/about/pfcc.html


• How does CARF integrate a person-centred approach into a range of quality themes applicable to palliative care organizations?

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• Consumer involved in standards development

• Persons served involvement in survey

• Standards that require person-centred philosophy and practice

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Family/Support System

• Discussions/partnership/information sharing when appropriate/in accordance with the person served

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CARF Program Descriptions

• Services foster a culture that supports:– Autonomy– Diversity– Individual choice

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• PCLTCC foster a holistic culture that focuses on:– Relationships among persons served,

families/support systems, and personnel.– Understanding what services persons served want,

how the services should be delivered, and how the persons served can be engaged in the community.

– Persons served making decisions about the rhythm of their day, the services provided to them, and the issues that are important to them.

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Standards

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Standards Manual Organization

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Section 1ASPIRE to

Excellence®: Business Practice

Standards

Practices common to all providers

Section 2 Care Process for Person Served

Entry, transition, exit and

processes for services

Section 3 Program-Specific Standards

Unique to service type and/or setting

Section 4 Specialty ProgramStandards

Optional specialized

services


Sample Standard – Leadership (Section 1.A.)

1.A.2. A person-centered philosophy:a. Is demonstrated by:

(1) Leadership.(2) Personnel.

b. Guides the service delivery.c. Is communicated to stakeholders in an understandable manner.

The organization’s person-centered philosophy should be evident in the development and delivery of services, systems, approaches, and interventions. Implementation of this philosophy from the unique perspectives of the leadership, personnel, and persons served is addressed during the survey process.

See the Glossary for the definition of stakeholders.

Exploring the normal pattern of the day of a person served to best meet program scheduling.

Recognizing unique aspects of the person served and how these might be incorporated into the programming; for example, active in their community, religious or social agencies; active volunteer, worker, leader of a group.

2.c. The person-centered philosophy could be communicated a number of ways, including:— Posting it on the walls or website of the organization.— Incorporating it into materials that are distributed to stakeholders, such as orientation

handbooks for the persons served and their families, personnel, volunteers, and advisory and governing boards; fact sheets, plans, and performance reports; and marketing brochures and pamphlets.

— Articulating it during tours of the organization; presentations such as orientation and training for personnel, volunteers, and advisory and governing boards; community education sessions; meetings and forums to seek input from stakeholders; recorded messages such as the voice response system.

* Source: 2017 CARF Aging Services Standards Manual

Standard

Intent Statement

Examples

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Sample Standard – PCLTCC (Section 1.I.)

1.I.5. The organization provides documented personnel training:a. At:

(1) Orientation.(2) Regular intervals.

b. That addresses, at a minimum:(1) The identified competencies needed by personnel.(2) Confidentiality requirements.(3) Customer service.(4) Diversity.(5) Ethical codes of conduct.(6) Promoting wellness of the persons served.(7) Person-centered practice.(8) Reporting of:

(a) Suspected abuse.(b) Suspected neglect.

(9) Rights of the persons served.(10) Rights of personnel.(11) Unique needs of the persons served.

…. ….


Standard

Intent Statement

Examples

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Sample Standard – Input (Section 1.D.)

1.D.1. The organization demonstrates that it obtains input:a. On an ongoing basis.b. From:

(1)Persons served.(2)Personnel.(3)Other stakeholders.

c. Using a variety of mechanisms.

Input is requested and collected to help determine the expectations and preferences of the organization’s stakeholders and to better understand how the organization is performing from the perspective of its stakeholders. The input obtained relates to the persons served and the organization’s service delivery and business practices. The organization identifies the relevant stakeholders, in addition to the persons served and personnel, from whom it solicits input.

There are a variety of mechanisms to solicit and collect information. They range from the informal to the formal.


Standard

Intent Statement

Examples

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Your Practice - Examples

••

Person Served

••Personnel

••

Other Stakeholders


Input Mechanisms – Examples

Formal &

Informal

Written or telephone surveys

Suggestion boxes

Complaint or incident

summaries

Strategic planning

Program/ service

development

Input forums (e.g. advisory

groups or consumer forums)

Councils or committees

composed of persons served

Performance improvement

activities

* Source: 2017 CARF Aging Services Standards Manual, 1.D.1. Examples.

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Related Standards1.C.2. A strategic plan:a. Is developed with input from:

(1) Persons served.(2) Personnel.(3) Other stakeholders…

1.N.1. A written analysis is completed:a. At least annually.b. That analyzes performance indicators in relation to performance targets, including:…(d) Satisfaction and other feedback from:

(i) The persons served….c. That:

(1) Identifies areas needing performance improvement.(2) Results in an action plan to address the improvements

needed to reach established or revised performance targets.(3) Outlines actions taken or changes made to improve

performance.

1.N.3. The organization communicates performance information:a. To:

(1) Persons served….


Standards

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Sample Standard – Care Process - Section 2.A.2.A.13. Based on the scope of services of the program, initial and ongoing written screenings/assessments:a. Address the following areas:(1) Behavior.(2) Cognition.(3) Communication.(4) Dental.(5) Function.(6) Health.(7) Legal involvement.(8) Medications.(9) Nutritional.(10) Pain management.(11) Physical.(12) Psychological.(13) Relationships.(14) Recreation and leisure.(15) Social.(16) Spiritual.(17) Others, as appropriate to the needs of the person served.b. Identify: (1) Prior daily routines.(2) The preferences of the persons served.(3) The choices of the persons served.(4) The personal goals of the persons served.c. Are used to develop person-centered plans for the persons served.

… …


Standard

Intent Statement

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Examples


Sample Standard – Section 2.A. and 4.2.A.51. As appropriate, the program incorporates into the person-centered plan:a. A palliative approach to care.b. End-of-life care.

Persons served, families/support systems, and personnel have opportunities to discuss end-of-life issues and participate in planning remembrance or memorial activities and creating end-of-life protocols.

….

See also 4.A.6. in Dementia Care Specialty Program Standards


Standard

Intent Statement

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Examples



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• Families/support systems should be involved in the development of advance directives and in identifying the extent to which medical intervention is to be administered.

• Whenever possible, no one dies alone. Support and presence is planned for each person served so that he or she does not die alone.

• The person served and his or her family/support system are interviewed about preferences for the dying process (e.g., five wishes, music, individuals present, preparation and notification, comfort items, and spiritual needs); care planning includes these preferences.

• Memorial gardens may be developed outside on organization property in remembrance of those lost.

• Memorials that reflect the person may be evident throughout the organization.

• Do not resuscitate (DNR) orders are known and strictly adhered to. Efforts are made to clarify issues related to a person’s end-of-life wishes to avoid any misunderstanding on the part of personnel and/or the family/support system.

• Some organizations do not choose to have a memorial service, but they may provide opportunities for personnel to express their grief by supporting them so they may attend the funeral of a person served.

[Canada]The Way Forward: Integrated Palliative Care Approach Framework at www.hpcintegration.ca/about-us.aspx* Source: 2017 CARF Aging Services Standards Manual

Examples

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Resources


Sample Standard – Section 2.B.

2.B.5. The program:a. Provides education, if needed, regarding end-of-life choices.b. Honours the person’s choices concerning end of life.c. Initiates related services when appropriate.d. Gives opportunities for expression of final choices concerning end of life to:

(1) The persons served.(2) Families/support systems.

e. Provides opportunities to express grief and loss.

Persons served may be interviewed about preferences regarding end-of-life (i.e., music, people, preparation and notification, comfort items, spiritual needs); person-centered planning includes these preferences.

Information regarding advance directives may be kept in an accessible location in a residential unit of the program.

Annually during the month of their birthday, persons served might have a physical exam from their primary care physician and meet with clinic staff to perform a medication review and update contact information and advance directives.


Standard

Examples

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Sample Standard – PCLTCC - Section 3.C.3.C.14. The rhythm of daily life is directed by each person served, as demonstrated by:a. Freedom to make choices regarding the cycle of each day, including:

(1) Bathing.(2) Dressing.(3) Eating.(4) Hygiene.(5) Oral care.(6) Sleeping.(7) Waking.

b. Choice of clothing.c. Choice of grooming style.d. Each person’s choice to participate in personally meaningful customary routines, including, but not limited to:

(1) Cleaning.(2) Community activities.(3) Contact with pets.(4) Cooking.(5) Exercise/mobility activities.(6) Gardening.(7) Hobbies.(8) Intimacy.(9) Recreation.(10) Social interaction.(11) Spiritual/religious activities.

…


Standard

Intent Statement40



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Sample Standard – Section 3.C.14.Persons served can be afforded opportunities to continue activities they enjoy in their community as well as to pursue activities that will support their growth and development. Some examples of these include:— Choosing when to wake up, nap, and retire.— Choosing the schedule for completing their ADLs.— Participating in meal preparation.— Creating a garden of flowers or vegetables for use in the community.— Caring for or simply enjoying the companionship of pets.— Continuing to participate in activities such as the Rotary, League of Women Voters, or church groups.— Tutoring students in English as a second language.— Assisting personnel with tax preparation.— Engaging in intimacy with a spouse or significant other.— Enjoying familiar recreational activities.— Learning a new hobby or skill.— Opportunities to engage in meaningful work, if desired.— Engaging in meaningful interactions with other residents, personnel, and members of the local community.

Persons served who wish to do so can be encouraged to participate in the daily routine of their community by continuing to do the things they did at home (e.g., setting the table, dusting, doing laundry, gardening, woodworking.)


Examples

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Sample Standard – Section 3.D.3.D.7. Service delivery is scheduled at an agreed-upon time that supports the person-centered plan.

There is a system in place to determine the most appropriate schedule for service delivery based on the lifestyle and preferences of the persons served and the scope of the home and community services.

Person served rises late morning or prefers late in the day appointment.


Standard

Intent Statement

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Examples


Many more standards…

• To review the full range of applicable standards in more detail, request a standards manual.

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Steps to

Accreditation

CARF maintains contact with the

organization

Contact CARF Canada staff–CARF

International Resource Specialist

assigned

Conduct a self-evaluation

Submit the Survey Application

CARF invoices for the survey fees

CARF selects the survey team

The surveyteam conducts on-site survey

CARF renders the accreditation

decision

Submit a Quality Improvement Plan

Submit the Annual Conformance

to Quality Report

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Jill AllisonAccreditation Advisor

1-888-281-6531 ext. [email protected]

Contact

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mailto:[email protected]

CARF Accreditation - Covenant Health · Vancouver Coastal Health and Fraser Health Authorities (BC)...

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