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Tool provides infrastructure for benchmarking
Field-testing is now under way for an assessment tool that will enable performance measurement and help establish benchmarks for adult day services (ADS) centers, a relatively new form of long-term care that is growing in popularity.
Supported by funding from the National Institutes of Health (NIH), Oakland CA-based RTZ Associates is rolling out its ADS Data Set for ultimate use in the approximately 7,000 ADS centers located across the country. ADS centers in Alameda County, CA, began using the data set this past summer; it is now being implemented in centers located in Iowa, Arizona, Washington, and Hawaii.
There is a tremendous need for this type of tool in the ADS industry, according to RTZ Associates senior partner Rick Zawadski. "At present, ADS centers serve many different types of consumers, making record keeping and measuring success across programs difficult — much like comparing apples and oranges."
"By setting up a standardized data system, we will, for the first time be able to compare clients and programs. The resulting information can be used to improve reimbursement of ADS centers, improve their service delivery systems, and institute policy change," Zawadski adds.
The ADS center model
The ADS center is an approach to the treatment of adults whose ability to live independently is threatened or impaired. In practice, this concept is referred to by many names, including adult day support centers, adult day health care, medical day care, day treatment, and Alzheimer’s day care programs. The ADS is a current version of a model of care that Zawadski helped create in California in the early 1970s. These centers can provide a wide range of services (i.e., a continuum of care) stretching from very limited direct services to extensive and intensive medical and rehabilitation therapies, depending upon the needs of the participants being served and the resources available.
According to the California Association for Adult Day Services (CAAD), ADS centers:
• are designed for adults who are frail and/or physically, cognitively, or emotionally impaired with conditions such as heart disease, cerebrovascular disease, Parkinson’s disease, diabetes, arthritis, Alzheimer’s disease or other related dementia;
• emphasize keeping each participant at their highest degree of independence and well-being;
• offer a daytime program with some combination of psychosocial, health, and/or rehabilitative services in a setting that is enjoyable, emotionally supportive, and relatively informal;
• bring participants together in a group to promote socialization, provide peer support, and strengthen participant self-esteem and motivation for self-care, as well as control costs.
Generally speaking, clients usually spend some four to six hours a day at an ADS center, according to Zawadski. "In some instances, the center simply provides people with a brief respite from caring for a elderly, frail family member," he explains. "But for many, the center is a place where the client can receive the therapeutic regimens [such as occupational and/or physical therapy] and support services [such as meals and assistance with personal care] they need to stay out of a nursing home."
From the cost standpoint, ADS centers compare favorably with other care alternatives for the frail and elderly. A day at an ADS center is usually around half the price of a home health care visit, according to Zawadski. Meanwhile, the annual cost of three to five days a week at an ADS Center is also about half that of full-time nursing home care.
Generally, in California, says Zawadski, a day at an ADS center costs $64, which includes all services. A nursing home day is more than $100, which does not include therapies and other specialized services that are typically included at the ADS Center. However, the typical ADS customer uses the center three to five days a week; the typical nursing home patient is a seven-day a week customer.
The relatively low cost of the ADS model of care has led to its increasing popularity nationwide. "The ADS center as a phenomenon has taken hold in many communities," says Zawadski. And, at the same time, the model has taken on many different "flavors" as far as the mix of services it offers in response to community-level needs — which is not an altogether good thing.
"Depending on the location, the services offered by the ADS center can vary widely," says Zawadski. "Some facilities are basically social centers with an activities director, while others may provide some monitoring of people who are cognitively impaired and need to be protected," he notes. "Still others may offer extensive therapeutic services. But they all go under the ADS center name."
The impact of these operational/service disparities is twofold. Funding sources for these centers, which include Medicaid, private-payer, and special-purpose (such as Alzheimer’s care) programs, are confused by the wide disparity of activities and costs associated with ADS centers, leading to the model being "under-recognized," says Zawadski.
"Moreover, people in the field think that there is no real way to measure what ADS centers are doing and that it’s impossible to compare what they do with other services," he says. And at the same time, "We also don’t know how to compare across different programs, which we need to be able to do to improve quality."
RTZ Associates’ ADS Data Set was developed to help remedy these situations. Designed for use in paper-based systems or with RTZ’s proprietary enterprise software program (CADCare), the ADS Data Set will create a repository of information that can be used to compare how these centers assist clients with different types of disabilities. With room for data that cover client characteristics, activities, outcomes, billing, scheduling, coordination of services, contact monitoring, and medical reports, the system "tracks everything that can happen within a center with a client," says Zawadski. (See box, p. 124.)
Data elements within the system have been selected from appropriate elements found in the Health Care Financing Administration’s Long Term Care and OASIS home health care data sets, reports Zawadski, along with those from the Administration on Aging’s National Aging Program Information System. "We took elements from all these tools, and added some we felt were missing that applied to the operation of ADS Centers," he says.
By using elements from these established data sets, "We think we have created a tool that is not only easy to use but also one that can be used to link up with these other sets, and allow ADS providers to demonstrate outcomes using terminology that is familiar to traditional acute and long-term care providers," he says.
And in what should be a boon to benchmarking efforts, ADS providers also will be able to share collected outcome data over the Internet, "creating a living database for ADS managers, researchers, advocates, and policymakers to study and evolve the role of ADS in the long-term health care continuum," says Zawadski. Individual participating centers will receive confidential reports of their outcomes and will be able to compare their performance against other centers. "And at the program level," he notes, "providers will benefit by being able to anonymously compare their center’s performance to state and national averages."
RTZ’s development of the ADS Data Set has been assisted by two phases of funding over four years by the NIH’s Small Business Innovation and Research program. The company also manages an extensive Web site that provides information on long-term care services for individual caregivers and the industry at large.
[For more information, contact:
• Rick Zawadski, Partner, RTZ Associates, 2201 Broadway, Suite 211, Oakland, CA 94612-3023. Telephone: (510) 986-6700. E-mail: rick@infocareu. com. Web site: http://www.GetCare.com.]