A Step in the Right Direction: Improving Activities of Daily Living

Jean A. Morgan is a resident at Ave Maria Home in Memphis, Tenn. At 90 years old, she manages to still do a lot for herself. She takes daily walks from her room in a greenhouse on the Ave Maria campus to the main building, dresses herself and brushes her own teeth.

“I was very unsure of my walking, very unsteady,” said Morgan. “I didn’t want to be dependent any more than I had to be on a cane or whatever it took.

After some additional therapy to improve her activities of daily living, or ADLs, with an occupational therapist, Morgan is a lot more active and independent.

“Yes, I can walk well again,” Morgan said.

Watch the video to hear the residents tell their stories.

Room for Improvement
atom Alliance quality improvement advisors helped administrators and staff at Ave Maria Home understand their quarterly quality measures report. The staff saw an opportunity for improvement in their activities of daily living (ADL) measure in their composite score.

“Julie from atom Alliance did a webinar with us to show us our different measures, what they currently were and how we could improve them,” said Becky Lewis, administrator at Ave Maria Home.

“She showed us what she called the ‘low hanging fruit’ that we could probably improve that score immediately. And then she worked with us line by line just so we could get a better understanding as a team where these numbers come from, how we can make them better and what we should really focus in on,” added Lewis.

Two Tactics, One Goal
The staff began to meet and discuss the different quality measures on their atom Alliance reports to identify opportunities for improvement. They identified residents that could use assistance with ADLs and enrolled them in some additional therapy sessions. They also identified some instances where the nurses could use some training, like accurate charting and coding.

“The CNAs were not documenting properly because maybe they weren’t trained properly on how to document or the resident really did need assistance which is where the therapy came in,” said Lewis.

BETTY TrainingAll of the staff were re-trained on charting and coding ADLs with the BETTY training. BETTY addresses the four areas of ADL coding utilized in the skilled nursing facility setting to accurately assess and reflect the care required for the residents – bed mobility, eating, transfer and toilet use.

“It was just the knowledge. A lot of the CNAs and nurses that may have been charting, weren’t charting something because they really didn’t realize what was the right thing to chart,” said Lewis.

Administrators also worked with the therapists on campus to identify residents who could do more on their own with some physical and occupational therapy.

“We identified people that were here for long-term care that needed more assistance with their activities of daily living, and so that’s where their Medicare Part B comes into play,” said Lewis. “We can screen to see if they need assistance with transferring or going to the bathroom or maybe even feeding themselves. And if they did need a little more assistance then we could offer that therapy through part B and they could get stronger and be able to have a higher functioning level,” she explained.

Moving in the Right Direction
Since beginning their performance improvement project to lower their ADL measure, the team at Ave Maria Home has seen their overall composite score reduced from a 12 to a 10. In addition to seeing residents do more for themselves, they have also seen a reduction in falls with injuries and a decline in weight loss.

“Thanks to atom Alliance we are going to be focusing on this number and keeping it where CMS wants it to be,” said Lewis.

To learn more about how atom Alliance helps nursing homes improve care, visit http://atomalliance.org/initiatives/reducing-healthcare-acquired-conditions/.