Episode Transcript:
Christina Chartrand: Hello and welcome to another episode of LIFE Conversations with Christina Chartrand and David Chandler— Woo hoo! We're excited today, David, aren't we?
David Chandler: Absolutely. We are being joined by Teresa Harbour, who is the Chief Operating Officer at the Community Health Accreditation Partner or CHAP. Teresa, welcome to LIFE Conversations!
Teresa Harbour: Hello, glad to be here!
David Chandler: So Teresa, will you share with us a little bit about CHAP, your mission, the role that CHAP plays in healthcare and especially talking about community-based and home-based care?
Teresa Harbour: Absolutely! Well, CHAP is a nonprofit organization. We started back in 1965 as a joint venture between the American Public Health Association and the National League for Nursing. We were the first to be approved by CMS and given deeming authority for home health and hospice. And of course, since then, we've added additional programs such as Home Care and Age-Friendly Care that we're going to be talking about today.
Our mission is to advance the highest quality of care for home and community-based organizations. Our mission very much aligns with Senior Helpers in wanting to assure that high quality care is being delivered. And we take great pride in that as our role as an accreditor to advance those quality initiatives and to also look at innovation and innovative ways to improve care delivery in the home.
Christina Chartrand: So, Teresa, for some of our listeners who don't really understand what community-based organizations are and the types they do, if you could share just a little more detail around that, that would be awesome.
Teresa Harbour: Okay, so anything in the home. So, you know, if it's a home health agency, hospice, a home care, a non-Medicare certified agency, DME companies, palliative care, pharmacy, anything like I said, anything that's care related, not hospital, not facility based organizations.
Christina Chartrand: Okay, that's great. so you're, I'm sorry, go ahead, David.
David Chandler: So what is the value for somebody who, this is, "I'm looking for care for my mom or dad," what is the difference between somebody who is CHAP certified, CHAP accredited? Why does that matter? Why is this something that I should be researching to say or have that conversation about? "Hey, what additional credentials do you have? What standards are you holding yourself to? Why is that important?"
Teresa Harbour: Well, having CHAP accreditation or certification or both really sets agencies apart from their competitors. Having that CHAP seal of approval is something that the industry recognizes as, "Oh, this agency's providing higher standards of care!" And that's really what that stands for is that higher standard of care is being provided. So when you're at Age-Friendly Care, that's even a higher level of care because you are looking at the unique needs of older adults. So that's even a greater certification to have.
David Chandler: And will you tell us a little bit more about the history of Age-Friendly Care, how we've gotten here, where we are now, and then if you could also talk a little bit about the four M's and why that's so important, why Age-Friendly Care was developed.
Teresa Harbour: Okay. Oh my goodness, I get so excited when I talk about Age-Friendly Care! I mean, because it is just an amazing initiative. So our National Medical Director, Dr. Khai Nguyen, works, he still works in a health system in San Diego that has implemented Age-Friendly Care through the John A. Hartford Foundation and the Institute for Healthcare Improvement, IHI. So when Khai came to our organization, he's like, you know, we've got to look at Age-Friendly Care.
David Chandler: Yeah.
Teresa Harbour: And he started talking about, you know, this 4M framework of what matters, medication, mentation, and mobility. And to be honest, David, when he first started talking about this, I'm like, well, we already do this. No, we already, you know, we take care of this. We already do this. And it took several conversations for it to even click with me thinking, yes, we do this, but they're all in silos. They're not practiced as a set.
And so, you know, when that came to, know, at least to my understanding, it's like, this, this is good. And so we worked with the John A. Hartford Foundation. We got a grant from them and worked with them. Gosh, it's just been like a four year time period. Worked with them, worked with IHI, worked with other national organizations, and I should have my phone off. Worked with national organizations such as NAC, NHPCO.
David Chandler: Yeah.
Teresa Harbour: HCAOA and other national leaders of home health hospice and even some home care organizations on how to take this approach, this age friendly health system, the 4M framework from a hospital setting and how to apply it to the home setting. And so we rolled this out, started with home health and hospice back in March of 2023 when we did our first. It went extremely well and we decided at that time, let's look at home care. You the non-Medicare certified is typically the personal care agencies because they play such a huge role in care delivery in the home. And so, you know, that's when we started talking to, you know, Senior Helpers. I was gonna tell you Mari Baxter, and you've heard me say this before, is such a visionary and she connected the dots with what initiatives Senior Helpers already have in place and how they aligned with Age-Friendly Care. So, and then kind of the rest is history.
David Chandler: And this has been so impactful for me, learning about Age-Friendly Care and this movement with the 4Ms focusing on what matters, mobility, mentation, medications, and learning about this approach. And it really resonated with me about how the approach with senior care, a lot of times we have these assumptions. And this is even for the family caregivers that are listening in that we make assumptions about mom or dad and because of their age we think we have these preconceived ideas and notions about this is what mom or dad can do. This is what's important to them and we start to apply our own thoughts into caring for older adults or with the approach when an older adult goes to a doctor and the doctor also has these preconceived thoughts and notions. And it's, it's from a caring perspective. It's from a loving perspective, but having an older adult come in for a visit and saying, well, I treat older adults all the time. And they're, they've kind of put them in a box. They put older adults in a box for this is what I've seen all the time. This is what you need.
This is what you're able to do and this is what I'm going to prescribe to you. And so this age friendly care movement has really backed us up to ask the older adult, what matters most to you? That's really at the foundation of, and I love how we've gone out and kind of changed the approach in our assessments. And now,
I'll even have family members that'll say, well, you know, this is what matter. This is what mom wants to do. And I pause, no, hang on. I'm talking to mom or dad. What matters most to you? What do you want to accomplish? And so I've just been so appreciative for the relationship that we've been building with CHAP and, teaching us about this. It's been amazing.
Teresa Harbour: Absolutely. I just look at, when you focus on what matters and build your plan of care around what matters to the patient, look at the outcome, look at the satisfaction that comes with that. Age -friendly health systems, the last I looked on IEGI's website, there's over like 3 ,900 age-friendly health systems. And they're seeing that improve patient outcomes, improve patient satisfaction, and improve staff satisfaction. And that's, I think, the benefits that we've seen going out on home visits with your staff is that they are so in line with what matters to that client. And the feedback that they receive from the family and from the client is so rewarding to them because they're hearing all these positive things and they're so appreciative of the family is that you're focused on truly what's important to their loved ones.
And so I love it. mean, it's just, it's a win -win for everybody. It's a win for Senior Helpers in the class that you serve and your caregivers.
Christina Chartrand: Yeah, I think I love this as well. And it's been a, you know, I think it's just, it's been a perspective change for a lot of us. For many of our listeners, I think we went through those 4Ms really fast. And I think that helping them, even if I, one of the things I think that I'm beginning to understand this is that even if you walk into a doctor's appointment or a healthcare system, a hospital, rehab,
I feel like those 4Ms can help us and help our primary caregivers that are out there ask better questions with their physicians and the people that are supporting their loved one. So the first one, obviously we addressed what matters most, really turning to your mother or your father and saying, "Hey mom, what matters most to you in this situation?" I think that's very powerful.
But can you go through the other three Ms that for help us to be thinking about as primary caregivers, we have so many of them on these calls, is what are some things that we need to think about when we're approaching any clinician?
Teresa Harbour: All right, so David, I'll take this one to start with and definitely chime in. you know, and I'm going to kind of touch back on what matters. I always like to give kind of an example as I go through this. So, you know, what matters to me as a home care client is going to be different from client to client to client. You know, what maybe matters to me is I want to be able to care for my cat. You know, my cat is my world.
I don't have really a lot of family support, but my cat is my family and I want to make sure I can care for my cat. Now, to somebody else, I may think, "That's stupid." Who cares about their cat? They may have something that they think is bigger, but to me, this is truly what matters. So then I'm going to look at the medication component of that. Now, with Senior Helpers and your caregivers, there's not a lot of medication. There is in the profile assessment on whether they have a medication, how do they get their medication, can they take their medication. But this is where the communication form really comes into play to where you can capture what matters to the patient. There's other elements of that form as well, but you capture the medications. So then when I go to my primary care physician, I'll take that list with me and then that person can view my medications through the lens of what matters to me. So in my case, it is to be able to look after my cat.
So, you know, my physician is going to review the medications and if he or she sees something on there that could maybe impact maybe my, if I've bend over to get the food out of the container, I may stand back up and get dizzy. So I need to be aware of that as the caregiver and Senior Helpers, I need to be aware. Okay, I may need to make some adjustments to either where I store my cat food. I maybe need to elevate it out of the container, put it on top of the you know, the cabinet and put their food bowl there as well. I may need to elevate the litter box, whatever I need to do to make sure that when I bend over and raise back up, I don't get dizzy and fall. So these are things that the physician can review or maybe it's a medication change that could be made. Yes, absolutely.
Christina Chartrand: Right, the importance of constantly reviewing medication is really important. That every time you're going in and seeing your primary care, really any physician is to really run that list and everyone to take a look at it. You if it's in MyChart or Epic or whatever it's in is to really review and make sure that is it working for right now, right? Because I feel like you just keep adding versus, you know, maybe we don't need this one anymore. Maybe it's not important or maybe it is affecting me being dizzy to bend down and pick up the food for the cat, right? So yes, I think that's really important.
Teresa Harbour: Right, absolutely, absolutely. And making sure that your clients are aware to ask those type of questions. there medications I'm taking that really older adults should not be taken? Are some changes that I can just simply make? Or do I need this? Like I started on this in the hospital, do I really need this at home? So yes, medications is key. So then looking at mentation.
You know, there's a PHQ2, you that you have the senior GEMS program, is...
Christina Chartrand: And what does that mean? I'm sorry, Teresa, what does that mean?
Teresa Harbour: My goodness, I have no idea what PHQ2 stands for, but is it, Oh, mentation! Okay, I thought you was asking me what's a P and the H and Q. So, you know, it's looking at, you know, depression, it's looking at, you know, just confusion, know, delirium in some cases, but it's really just, you know, the, just the mentation, the cognitive functioning of the client is really what what that's looking at. So you know you making sure that you know the caregivers the patient the family are involved in that that they are picking up on changes in mood or memory. Yes. Yes.
Christina Chartrand: Okay. Because there's brain change, right? As you age, there is brain change. And so with brain change, it could be a number of different things. And there are things that are out there that would be able to help and support them, right? As these brain changes happen.
Teresa Harbour: Yes, absolutely. And then with mobility, looking at changes in gait, looking at unsteadiness, potentials for falls, how you can eliminate some of those. And all of that, when you look at it, like I said, it may be that I'm having some like, mentation issues, maybe I'm forgetting to feed my cats, and maybe I need to have a reminder that I put there.
Maybe with my mobility, you know, I'm having a little trouble getting to the kitchen. Maybe I need to move that closer to me. So when you're looking at truly what matters and building kind of your plan around what matters to the patient, you know, it accomplishes many things, but you know, not only, you know, improved outcomes and satisfaction, it's just the right way to deliver care. Yes. Yes. Yeah.
Christina Chartrand: Happiness and independence. keep just feeling it happiness and independence and that's what we all want
David Chandler: I think of one of our first clients that we took once we started implementing the 4Ms and building our care plan around this. One of our very first clients, we asked him, and this was a client that we had had for a couple of years. And we asked him, what matters most to you? And he answered and said, "Well, what matters most to me is I want to stay in my home.
I don't want to go, I want to stay here. I want to stay independent." As much as we love our senior living partners, he was not at that point of needing that level of care and his goal was to stay at home. And so then we started looking at those other 4Ms, looking at his medications. Are there any medications that are impacting whether he would be able to stay at home? His mobility, what are some ways that we can improve his mobility? he having any depression that is keeping him from losing motivation or getting up out of bed that day? And so we built it into our care plan to then say, your number one goal, what matters most to you is staying at home. And if you're laying in bed all day, you're not going to be able to do that. We got to get you up. We got to get you out. We got to get started doing some exercises. We got to keep you clean. Make sure you have clean laundry. Make sure that you're eating the right foods and staying hydrated. And it just completely changed our approach to supporting this client with achieving what mattered most to him. It really is a completely different way of approaching care for hospitals, home health, hospice, home care, to incorporate this into what you're providing in the conversations.
Christina Chartrand: Yeah, no, it's great. And I think it's really nice for, know, I represent a lot of times Teresa here on these calls is that primary caregiver for us as primary caregivers to rethink when, you know, caring for our loved ones and supporting, you know, our mom or our dad, it changes the perspective to really think about, you know, what am I doing here?
And what can I do better to be able to keep my mom or my dad safe and comfortable and happy and independent as I keep saying in their space?
David Chandler: Yeah. And it's interesting also to think about a lot of times when we're applying what we think matters most, then with the loved one that we're caring for, maybe taking that, maybe thinking, well, my daughter, this is what matters most to her for me. And so I'm taking that on for my daughter and instead, family caregivers that are listening, pausing, and actually saying to your loved one, really mattered? Forget about what I've said in the past. What matters most to you? What matters most to you at this stage in your life? And then how can I help you to accomplish that? It's really exciting and takes us to another level of understanding and supporting our loved ones.
Christina Chartrand: Love it. I love it. I think everybody needs to jump on this bandwagon, right?
David Chandler: Absolutely. Yep. Yeah.
Christina Chartrand: I mean, it's definitely, you can see more and more people are, you know, people are talking about it a bit more, but honestly, you know, every physician, every healthcare system really should be thinking in this direction.
Teresa Harbour: Well, and yet. Well, I was going to say, and another great thing with this is that it doesn't add additional work. You know, it's not like you've got to implement this new program because it's not a program. It's an initiative. You know, it is is part of your workflow. And that's what the feedback we get back from from agencies that have gone through this is that, you know, it's just like I've said before, it's just the right thing to do and that the right way to deliver care and to receive care.
David Chandler: And so, Teresa, I'm going to get my, my, we're going to get our plug in for Senior Helpers here being the first home care in the, in the country, in the world actually, to achieve Age Friendly Care Certification, which we're super excited about, really adding home care into this healthcare continuum. started with hospitals, then it went to home health and hospice, and now we have home care entering the playing field of providing this Age-Friendly Care and joining this movement. And so from your perspective, what does this mean? How is it changing the approach and the impact of home care on older adults?
Teresa Harbour: So as I said earlier, we started off when we pulled this big work group together, we pulled in some home care organizations and quickly saw that we had to put that on pause and really focus on home health and hospice, knowing that we would come back to home care. so, they was like what we talked about, home care organizations, they play such a key role in keeping our older adults at home. And when you look at our age and population, 10 ,000 Americans every single day, — goodness, there's a telemarketer is calling— every single day, and they have to deal with that as well, because I've got to get to that age, and they call me all the time. But our turn at age 65 every single day, one in six of our population are age 65 and older in it, they want to stay at home. And that is where, you know, Age-Friendly Care meets them where they're at, focusing on, you know, what's important and the unique needs that they have. And so, you know, seeing how Senior Helpers have been able to do that and seeing how it was really an easy lift for Senior Helpers because of all the things that you already had in place. I mean, you're really getting recognized for all the work that you've been doing.
And that is where, you know, I think that, that, you know, with, you all is being, it's been, it's easy. It's been easy because you're doing it. You're doing the work. Yes. Yes.
Christina Chartrand: We've already been doing it. Yeah. We've already been believing it. We just didn't know what it was. And now, now we have a definition around it.
Teresa Harbour: Exactly. Absolutely. mean, I look at and I talk about this all the time. And, you know, have people calling David, you need to talk to David to find out what Senior Health Helpers is doing because I mean, you are so innovative. And, you know, I look at the LIFE Profiles and, you know, and I tell, you know, our site visitors when we did our training on Age-Friendly Care for home care, you know, what they're going to be seeing with these LIFE Profiles and how you are able to identify the risk of hospitalization. So I mean, when you look at what you're doing with that, and then when you look at, you know, the really the primary drivers for, you know, patients to have an acute care encounter, you know, the 4 M's touches every single one of those.
I mean, it touches, you know, you know, they go back to the hospital because they're not following the plan of care, you know, so they're not involved in their care. They have, you know, a fall, whether it be from you know, unsteadyness or cognitive changes. They have medication errors, there's untimely follow up. You know, this is, know, the hits on every single one of those the 4M framework does. And, you know, having Senior Helpers, you know, really, you know, being the, well, being the first, yes, in the world to achieve this speaks volumes to what, you know, not only what you already have in place, but how innovative you are into looking at new initiatives that's going to meet the needs of our older population.
Christina Chartrand: That's awesome. And just for our listeners, LIFE Profile is the tool that Senior Helpers uses— It's an assessment tool. And what we do is we go in and evaluate the level of independence with our seniors. And so that's what we use to develop our care plan. So just as a reference for people go, what's LIFE Profile?
Teresa Harbour: And I'll also speak to the Senior Gems program as well, because that is, you know, it is when you have this, and I know this was Teepa Snow's Senior Gems and you're classified based on your level of dementia, and then there's, you know, appropriate interventions that's put into play with that. You know, that is all about, you know, mentation right there. You're capturing that, you're utilizing the PHQ -2.
You're also talking to your caregivers and family and clients to help them recognize these changes as well so that you're being proactive and not reactive when it comes to changes that could potentially impact their care.
David Chandler: And Teresa, as we're, as we're wrapping up, could you give us a sneak peek? And now, now it's my, that's all of our listeners that are, that are dialing in wanting to learn more about Age-Friendly Care and get a LIFE Profile assessment. Gosh, we are popular today, aren't we? But can you give us a sneak peek into.
Teresa Harbour: Yes!
Christina Chartrand: I'm next. I should be next. Hahaha
David Chandler: What's on the horizon for CHAP? What do you see in the near future for as we are continuing to evolve and as CHAP is continuing to evolve and provide better care for seniors? What do you see coming up? What's in your big picture?
Teresa Harbour: Well, so we are absolutely going to continue to promote Age-Friendly Care. That's something that we've been doing and we will continue to do because we truly believe in the results and the impact that it's having on older adults. But one of our newer initiatives is hospital at home. And we're seeing the value of keeping, once again, individuals at home and then improved outcomes around that.
I mentioned very early in our podcast about, know, our focus of CHAP is on home and community-based organizations, what we can do to look at ways to improve care that's being delivered in the home setting. And, you know, we are considered the experts in home and community-based care. And, you know, we're, you know, hospital at home, yes, they are, you know, acute care, you know, hospital patients, but they're being cared for in the home is that that's the value that we see that we are going to be able to bring to the hospital at home model is how to ensure that that high quality care is being delivered in the home setting. So that's kind of the sneak peek.
David Chandler: Awesome. That's very interesting. I'm glad you shared that with us. I didn't realize that you guys were having that coming down the pipeline. So we'll have to stay in touch on, on. Yeah.
Christina Chartrand: Yeah, that's really cool.
Teresa Harbour: Yes, yes, we will.
Christina Chartrand: Sure I'd like to learn more about that.
David Chandler: Very good. All right, well, Teresa, I think that's all the time that we have for today, but thank you so much for coming on and sharing about CHAP and Age-Friendly Care with us. This is such an amazing movement and Senior Helpers is so excited to be along for the ride as we continue to implement this and develop. So thank you so much.
Teresa Harbour: Well, thanks for having me. Senior Helpers has been a great partner and we look forward to bringing more and more locations on.
David Chandler: Absolutely. All right. Well, thank you everyone for joining us today on LIFE Conversations. And we look forward to sharing our next episode with you.
