Project Key Components

The partners propose an evidence-based approach, that incorporates innovative components, for nursing homes (NH) and assisted living facilities (ALF) to

  • Reduce avoidable Emergency Department visits and hospitalizations,
  • Improve overall quality of care and quality of life,
  • Reduce health care costs for NH and ALF residents.

This approach, entitled Strategic Team Activity Yielding High Outcomes and Minimizing Expenditures (STAY HOME), includes four components with related core service delivery components and focus on acute changes of condition (ACOC) that can be addressed in the facility but that often lead to potentially avoidable Emergency Room transfers.

  • Component 1
  • Component 2
  • Component 3
  • Component 4
  • Component 5

Component 1

Provision of technology and other services enhancing assessment, diagnosis and management of health conditions

  • Telemedicine
    • Virtual visits
    • Point of Care testing
  • Additional Point of Care Testing Equipment

Component 2

Integration of evidence-based decision management

  • Protocols for decision management strategies for 20 avoidable conditions
  • INTERACT and RED protocols

Component 3

Establishment of agreements and protocols for transitions of care Agreement with acute care facility for direct admit and specialized services Develop direct admit protocols ALF to NF (using 3-night rule for simple admissions) ALF & NF to acute care hospital INTERACT and RED (acute care components)

Component 4

Education to complement the components

  • Providers
  • Staff of LTC,ALF and acute care facilities
  • Administration of LTC, ALF and Acute care facilities

Component 5

STAY HOME (Strategic Team Activity Yielding High Outcomes and Minimizing Expenditures) is an innovative quality improvement (QI) program for acute changes