By NANCY FRAZIER O'BRIEN

Since Dr. Neal Buddensiek joined Benedictine Health System as its chief medical officer in January 2016, much of his attention has been focused on redesigning the advance care planning process and making sure everyone in Benedictine's long-term care facilities, assisted living and independent living residences has an advance care plan in place.

Buddensiek

He's using data on residents already gathered for the federal Centers for Medicare and Medicaid Services to identify individuals without such plans who are most likely to need them in the foreseeable future.

The Cambridge, Mass.-based PointRight company "crunches a lot of variables" in the data provided to CMS and comes up with a numerical score that summarizes the patient's risk of death, Buddensiek said. Among the information analyzed is "any feeding issues, their activities of daily living, how they are walking, how they are sleeping," he added.

PointRight's RADAR predictive analytics mortality index "is highly accurate in predicting death within six months, " he said. "Anything 7 or higher" demonstrates a need to speed up the advance care planning conversation with specially trained facilitators in each senior community.

"PointRight is one of the leading senior living predictive analytics companies, and they had not heard of anyone using the mortality index to guide and promote advanced care planning in the way we are," Buddensiek added.

Touch points
Buddensiek also plans to use the PointRight analyses to assess the need for advance care planning by short-stay rehab clients, but has found in the first few months that "it hasn't worked out as well as we'd hoped." Because those stays are usually seven to 14 days, and it takes seven days for the CMS statistics to be submitted, "there is a lag in getting information to help us," he said.

With more than 40 Catholic senior care communities in Minnesota, North Dakota, Missouri, Wisconsin and Illinois, Benedictine Health System offers a "basic introductory group seminar to residents and their health care agents on a quarterly basis," Buddensiek said.

"We follow that with an offer by the facilitator to hold a conversation between the senior, the person who holds their health care power of attorney and/or family members," he added. "The point of these meetings is to more deeply understand the individual's values, life goals and preferences for future health care, so that those preferences are followed when an acute health change or crisis occurs."

In the first eight months of the program, there have been 296 private conversations and 67 percent of those who participated in them have completed an advance care plan. Depending on the state, a facilitator — who may be a social worker, chaplain, nurse, volunteer or parish nurse — can witness the document signing or a notary may be provided to complete the process.

For residents with cognitive impairment, Benedictine has been having some success using two card games, Go Wish and Hello (formerly called My Gift of Grace), which "encourage conversations around end-of-life medical care," Buddensiek said.

Symptom management
Benedictine supports staff assisting dementia patients and other senior care community residents by providing "well kits." The kits help staff members comfort and calm residents through the senses of smell, sound and touch.

"The 'well kit' provides a thoroughly researched and intuitively designed startup kit with products, policies and procedures, a literature review guide and simple educational resources to aid in getting aromatherapy, therapy dolls, comfort massage and healing music up and running fairly quickly," Buddensiek said.

Rev. Christine Anttila, right, director of spiritual care for Benedictine Living Community of Duluth, Minn., has an advance care planning conversation with Benedictine Health Center resident Joyce Hegg.

"Some Benedictine Health System communities are already very advanced in integrative health and healing interventions, but there are also numerous ones that have struggled to provide these interventions," he added. "We want to position our Benedictine Health System associates to be successful in providing excellent symptom management."

Several dozen Benedictine communities also have begun using a standardized symptom management emergency-kit formulary — developed with pharmacists — to provide comfort for residents from pain, nausea, shortness of breath, anxiety and terminal delirium.

Still in the testing stage is deployment of a "vigil cart" for when a resident is actively dying. Buddensiek said the cart is "stocked with comforting provisions to aid and support the family members' (and caregiver's) psychological, spiritual and physical needs."

"We are systematically developing prayer and ritual to support the dying resident and family," he added. "The spiritually enriching opportunity to pray over the resident's body, be present with the family and facilitate associates' and residents' goodbyes is part of the sacred work that goes on at many Benedictine communities every day."

The spiritual component was developed in conjunction with the Benedictine Sisters of St. Scholastica Monastery, sponsors of Benedictine Health System.

"Mission Integration Director Sr. Lisa Maurer, OSB, and Senior Spiritual Care Consultant David Allen are working on a system for rapid triage of new patients/residents on admission to identify people in urgent spiritual need and to ensure rapid mobilization of spiritual care," Buddensiek said. "Do they need to talk with a chaplain within a day or two or is a routine visit within 30 days appropriate? It matters.

"The promise that we have made to our patients and residents is to understand their values, life goals and preferences for future health care," he added. "Advance care planning facilitates the development of a care plan deeply aligned with their wishes — this is the definition of person-centered care."

Copyright © 2017 by the Catholic Health Association of the United States
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