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The move to a better home will be easier and faster for nursing home residents who have to relocate

IN BRIEF: A nursing home can close voluntarily, or it can be forced to close if it fails code or falls short of regulatory requirements. A closing makes it necessary for residents to relocate, and the process can be difficult because it imposes so much change on people. So the Ohio Department of Aging chartered a Kaizen team to build a better approach. The new relocation process puts residents first while ensuring communication and coordination among all agency staff.

WISE USE OF RESOURCES: Once all the improvements are implemented, the Department of Aging will spend the equivalent of 5 workdays on average. That's a 58% reduction compared to the cumulative average of 12 days previously.

GREATER EFFICIENCY: The transformed process has no delays (compared to 23 delays with the previous approach) and just 1 loopback (compared to 4 instances of backtracking before).

IMPROVED QUALITY OF LIFE: A thorough assessment process, along with thoughtful planning and communication with residents and their families, will ensure that residents move on to new home locations that improve their quality of life.

The search is on. Team members study the current-state process map to uncover all occurrences of inefficiency.

When a nursing home is unexpectedly closed or terminated, residents and their families are put in a difficult position. They have to find a new place to live -- a place that will best serve each person. 

With so many factors weighing in on the decision, and a requirement that the move take place within 30 days, the process can be overwhelming. That's why the State Ombudsman's Office at the Ohio Department of Aging used Kaizen to study the current approach -- and to develop an efficient, standardized, well-documented, and people-centered process to help nursing home residents move to the right homes the first time.

The agency chartered a team involving the departments of Health, Mental Health and Addiction Services, Medicaid, Area Agencies on Aging, and various local entities. The team worked nonstop for five intense days, creating a process that reduces the administrative burden and leads to better outcomes for residents.

The need for this project was underscored during several recent nursing home closures. The team gathered data from these, finding that each closure required more than 150 hours of staff time. Even the smallest facility, with 16 residents, needed more than eight staff working a total of 150+ hours in order to process the relocations. All three closings generated complaints -- a clear indication of process-related improvement needs, and a call to action for the team.

There has never been a shortage of staff people stepping up and doing whatever needed to be done. In fact, that had become part of the problem. An announced closing or termination would prompt action by people from many different agencies, but the good intentions were not always matched by good communication and coordination. Some people would end up duplicating work -- while other tasks went undone because one person assumed that the other person was taking action.

Team leader Erin Pettegrew presents the action plans relating to development of the relocation manual. This mainstay document will serve as a comprehensive resource for staff -- containing everything from summary lists of key process steps to copies of standardized forms and templates.

But thanks to the Kaizen team, these problems will be a thing of the past. The team's newly created process spells out who does what, ensuring that each job is in the right hands. Key steps are thoughtfully sequenced to do what's best for the people who matter most: the residents.

For example, one major improvement is that assessments of each resident will be done very early in the process, to allow more time and better coordination. These assessments gather important information to match the individual with available programs, services, residences, and facilities. In some cases, the relocation can be a golden opportunity that brings a resident closer to the community or family. With an earlier start to the assessment phase, and more time to research the possibilities, the process gives residents their best chance for relocating to a perfect-fit situation.

Going forward, these assessments will be led by people who are especially skilled -- including regional ombudsmen who are well-acquainted with the state in general, their region in particular, and all the service options that currently exist. So residents and their families will have great advocates to guide the relocation process.

The new process also builds in a face-to-face family meeting. This gives everyone a chance to talk through the various relocation-related options. Of course, the previous process involved communication with the family. But the new approach makes the meeting a prominent and essential component.

Another team-led improvement relates to information-sharing. Previously, all the different parties in this complex equation had to use email, print-outs, or phone calls to circulate information. The new process will use SharePoint as a shared database, guaranteeing that people from different agencies have real-time access to all a full set of information.
As a follow-up to the Kaizen event, the relocation manual used by agency staff will be fully updated to reflect all of the improvements. It will include a summary of activities to be conducted in advance of residence terminations, information about SharePoint access and contents, clear language on roles and responsibilities and relocation activities, a high-level process map, newly standardized forms and templates (including templates of letters to families), frequently used contact information, and more.

These major improvements translate into impressive numbers. According to team estimates, the State Ombudsman office was spending the equivalent of 12 full days of work getting ready for a relocation. When the new process is fully in place, it will take an estimated total of 5 days, cutting the time in half and then some.

The process itself is a model of efficiency, with zero delays (compared to 23 delays with the previous approach) and just 1 loopback (compared to 4 instances of backtracking before).

Most important, the process will lead people to new places of residence -- places where they will receive the services, support, community, and family connections that are key to a person's quality of life.


Download a 1-page fact sheet
Download a 2-page article
Download the team report-out
All downloads are in PDF format

This report was published November 15, 2013. Projected and actual results may have changed since then. For the latest info, contact the Ohio Department of Aging or LeanOhio.

    Department of Aging contact:
    Bev Laubert (Team Sponsor)
    State Long-Term Care Ombudsman

Ohio Department of Aging
Nursing Home Quick Response Process
October-November 2013

Team members
Team members: 
Front row, left to right: Jane Black, ODM; Erin Pettegrew, SLTCO (Team Leader); Bev Laubert, SLTCO (Team Sponsor). Back row, left to right: Jacki Dickinson, DAS; George Pelletier, Ohio MHAS; Adam Anderson, Ohio MHAS; Julie Evers, ODM; Mike Schroeder, Ohio MHAS; Tamara Malkoff, ODH; Melissa Gilligan, ODH; and Jeff Ryan, Ohio MHAS. Not pictured: Felicia Sherman, ODA; and Rob Feldmann, ODA.