Senior Living Business: Accreditation: A Stringent But Valuable Process--
ACTS Finds CARF-CCAC Accreditation Benefits All Stakeholders
Accreditation is a system developed by an independent body that provides consistent standards to help measure and assess quality and continued performance improvements.
“Accreditation is important,” explained Marvin Mashner, President and CEO of ACTS Retirement-Life Communities, Inc., “because it helps an organization focus on the effort to continually improve services for the benefit of its stakeholders, which for senior care providers include the residents and their families.”
ACTS owns and manages 19 CCRCs, 17 of which have been awarded CARF-CCAC accreditation. Four of the 17 were re-accredited in 2008. Park Pointe Village in Rock Hill, South Carolina, is in the midst of the accreditation process, while Magnolia Trace in Huntsville, Alabama, a new acquisition (May 2008), is concentrating on acclimating itself to its new parent’s policies and protocols before putting itself through an accreditation process. “A great deal of work and commitment goes into the process,” noted Elsie Norton, Senior Vice President of Quality Care and also a CARF-CCAC peer surveyor.
What is CARF-CCAC?
CARF International is a not-for-profit accreditation organization that has been in place since 1966. It offers standards and accreditation for providers throughout the human services arena. Through an accreditation process, CARF helps communities identify areas of excellence and best practices, as well as areas that might be improved.
CCAC was formed by AAHSA in 1985, a time when CCRCs were gaining prominence and consumers were concerned about paying sizable upfront entrance fees and monthly fees that often could be sizable, as well. “Consumers were looking for added assurance that the CCRCs were stable organizations,” said Sue Matthiesen, Managing Director of CARF International.
In the late 1990s, CARF collaborated with CCAC on assisted living accreditation and developed standards for adult day care; in 2003, CARF acquired CCAC from AAHSA. Today, CARF-CCAC offers standards for assisted living, adult day care, CCRCs, long-term care homes and aging services networks. Standards for home- and community-based services are being developed. CARF-CCAC is the only third-party system that accredits the entire CCRC, according to Matthiesen.
Moving into any senior care or long-term care setting is a major life change and often a significant financial investment. Many consumers don’t quite know how to navigate the system, which is hardly easy, and decisions often tend to be emotionally charged. “Simply being licensed or certified isn’t enough,” said Matthiesen. “Knowing that a CCRC has voluntarily chosen to have an independent accrediting organization review its operations is both informative and reassuring to the consumer. It demonstrates the organization’s commitment to quality.”
Meeting rigorous standards
While accreditation may be mandated for some types of providers, it is generally voluntary for CCRCs. About 320 CCRCs are currently accredited—just under 18% of the estimated 1,800 CCRCs in the United States.
The CARF-CCAC accreditation process is a self-monitoring exercise in which the organization seeking accreditation applies a set of standards developed by the field for the field. The standards are designed to provide flexibility in terms of how they’re applied, based on each organization’s unique structure and the people it serves.
“Organizations seeking accreditation must first evaluate whether they can apply the rigorous CCAC standards,” said Matthiesen, “which require an organization to identify where it is excelling but also to identify areas for improvement. The standards are updated in a major way approximately every five years, with minor changes on an annual basis. So we’re always raising the bar.”
A peer review is conducted by trained surveyors who are from already accredited CCRCs in good standing and have been through the process. “The surveyors look at every aspect of an organization’s business practices, financials, care delivery, transition, person-center planning, assessments, leadership, HR, health and safety practices, risk management, accessibility…you name it,” said Matthiesen. “They look at how the organization is conducting strategic planning, its investment policies, how its tracks actual expenditures vs. the budget, how it is transparent to the population it serves, how it protects the rights of individuals, and how it not only gathers the input of residents but also uses it when planning.”
A year-long process—at least
Preparations for the self-directed accreditation process can take a year or more before the site survey occurs. “With our communities, we begin about 12-15 months before the survey or re-survey,” explained Norton. “We present the expectations to the community leadership and introduce the standards—particularly any that have been refined or revised since the last accreditation.”
After receiving a copy of the CARF-CCAC standards manual, which includes the actual standards, examples, and guidance on how to apply them, a community seeking accreditation must implement and use the standards in its programs for at least six months prior to the site survey and also evaluate its conformance to the standards.
ACTS encourages its communities to form what it calls a PIT crew—a performance improvement team, which focuses on improvements that can be made by going through the process. The team divides the standards into areas of responsibility and decides what to measure and what to improve at all levels of the continuum in terms of efficiency, effectiveness, access, and feedback. “We encourage our communities to set their own goals and objectives,” Norton explained. “We have corporate goals for turnover rates and things of that nature; but during the CARF-CCAC process, our community leaders identify where they want to improve to make it more meaningful.”
Then, the community must submit an Intent to Survey —an application—to CARF with a nonrefundable $700 fee. When the application is accepted and processed, CARF puts together a three-person team of peer surveyors —administrative, financial, and program experts—to assess conformity to the standards. The surveyors are selected based on specific expertise matching the applicant’s unique requirements.
The site visit—which is also required for re-accreditation every three or five years—takes 2-1/2 days. It involves a campus tour, meetings and interviews with all stakeholders (management, staff, governance, residents, and families), and a review of documentation. At the end of each day, the surveyors meet with key individuals in the community to share findings; on the last day, they prepare individual reports and conduct an exit conference.
The surveyors submit their findings and recommendations to CARF, which performs a review to ensure that standards were applied accurately and consistently and interpreted appropriately, and that any recommendations given to the organization for areas of improvement were helpful and instructive.
Six to eight weeks after the site survey, the organization receives its accreditation outcome, along with a detailed report with all the findings. Accredited organizations are then awarded a certificate of accreditation, which lists the programs and services included in the accreditation.
But that’s not all…within 90 days after notification of accreditation, the organization must submit a Quality Improvement Plan that outlines the actions that have been or will be taken in response to the recommendations in the survey report. Then, to continue to be accredited in good standing, the organization must submit an Annual Conformance to Quality Report that covers any major changes, as well as progress on recommendations, and reaffirms the ongoing conformance to the CARF standards.
Benefits of accreditation
“Accreditation reflects an interaction between staff, management, and those whom we serve,” according to Mashner. “It allows joint input and a joint review. The fact that we get residents involved and that they understand all the issues that management must consider is one of the benefits that we’ve experienced going through the accreditation process over the years. Likewise, we better understand the important concerns that residents have.”
So if a person is comparing one community that is accredited and one that is not, all else being equal, that could be the tipping point. “When people are going to put up a sum of money for an organization to provide not only housing but also support services, they want to know that it has a track record of providing quality services, that it’s financially secure, and that it will strive to meet their needs appropriately,” Mashner added.
ACTS also finds accreditation to be a very effective tool from a sales and marketing perspective. “It’s important in our industry to earn the public trust,” noted Michael Smith, Corporate Director of Public Relations, “and recognition of the fact that we provide quality care and services has much more credibility coming from a third party such as CARF. It’s a tremendous competitive advantage and certainly something that we point out as much as we can.” ACTS highlights community accreditations on its website, in its marketing and sales materials and in resident newsletters. Each community’s framed certificate of accreditation is prominently displayed. Some communities host internal celebrations when they become accredited or re-accredited.
“Historically, ACTS has consistently averaged more than 95% occupancy in our communities,” Smith added. “We believe accreditation is one of the reasons.”