Certified Nurse Practitioners (in collaboration with physicians) serve as the primary care providers in the adult day center and are the lead member of the interdisciplinary team. The LIFE interdisciplinary teams consist of Nurse Practitioners, Social Workers, RN/LPNs, Physical and Occupational Therapists, Registered Dieticians, Recreational Therapists, Creative Arts Therapists, Chaplains, Nurse’s Aids, Van Drivers, and Physicians. All of the interdisciplinary staff within the plan interact frequently throughout each day to provide cohesive services to plan members. Plan members remain with the same clinical team throughout the length of their enrollment at LIFE.
LIFE employs two full-time physicians and six full-time Nurse Practitioners arranged in four teams to serve 335 members. Along with in-center primary care duties, LIFE physicians focus on out-of-center care, particularly hospital care. This is important because the culture of acute care settings is still not as accepting of NPs as MDs, and MDs are required for most inpatient processes. LIFE, however is leading the way for nursing as it begins to make inroads to more meaningfully integrate its nurse practitioners into acute and sub-acute care settings.
In 2007, LIFE implemented a customized electronic health record (EHR). The EHR includes a pre-enrollment module that captures information gathered during a patient’s eligibility determination process; information in this module includes initial assessments conducted by nursing, social work, and home care. This information can be helpful even for those who do not enroll with LIFE, as many individuals reapply to the program.
In addition, the EHR captures all information from interdisciplinary team assessments and includes the care plan, which is based on the standardized Omaha Nursing Classification system. Each LIFE discipline was given the opportunity to customize their assessment forms for the EHR.
In 2006, LIFE deployed Medisure automated medication dispensing units in homes of participants who were having difficulty complying with their medication regimens. Approximately 10 percent of LIFE members have Medisure technology in their homes at any one point in time. For the most part, the technology is used as a temporary tool to help teach patients to comply with their medication regimes and support caregivers and families in helping patients comply.
The adult day center serves as the locus for the majority of care and socialization services provided by LIFE. LIFE members receive all their primary care in the center, as well as rehab services (physical, occupational and speech therapy), and outpatient specialty care (some physician specialists give appointments in the center). LIFE staffs a full-time psychiatric nurse practitioner at the staff and contracts with psychiatrists who come to the center to see LIFE members. The center also provides recreational therapy, structured exercise, meals, nutrition therapy, and social work/case management support.
In addition, the center provides many opportunities for seniors to interact with each other. One wing was designed to resemble an urban street and includes a salon, library and reading room, chapel, pool hall, sewing room, and fitness center. The center also offers space for arts & crafts, creative arts therapy, cards and token-fed slot machines, and choir practice. The center provides a variety of spirituality services and support, including on-site memorial services for deceased members.
LIFE provides door-through-door transportation to and from the adult day center and to outside medical appointments. LIFE participants also receive homecare, home adaptations and modifications, home-delivered meals, DME and other supports and services to remain safe and comfortable at home. Finally, LIFE is a Medicare Part D provider so all medications are delivered free of cost to participants and prescriptions, medication management and monitoring are fully integrated under on primary care system and team.
As part of the University of Pennsylvania School of Nursing, LIFE makes a serious effort to expose students to their care model and philosophy. In 2007, LIFE worked with 223 students and provided well over 1,500 hours of educational experiences. Of these, 178 were students from academic programs within the University of Pennsylvania with 70 coming from the School of Nursing and the remainder from eight other institutions of higher learning.