The IMPACT Act is a 2014 law called The Improving Medicare Post-Acute Care Transformation Act (H.R. 4994). The purpose of the IMPACT Act is to protect clients’ choice and streamline service provision.

CMS (Centers for Medicare & Medicaid Services) is implementing the IMPACT Act. Here’s how Dementia Capable Care training and resources can help you meet the challenges of the act.
 

IMPACT Act summary


The goal of the IMPACT Act is to connect post-acute care across the care continuum. This is a lofty goal and one in which persons with dementia will figure prominently, since the use of Medicare and Medicaid benefits for this population is extremely high. Medicare is expected to cover $117 billion, or 50%, of total healthcare and long-term care payments for people with Alzheimer’s disease and related dementias (ADRD) in 2016.


So why implement the IMPACT Act now?


One reason is that outcomes for persons with Alzheimer’s/dementia have been poor and communication of care has resulted in avoidable problems such as re-hospitalizations and long, costly stays in post-acute settings such as skilled nursing facilities.

Another reason is that costs are extremely high and only getting higher as the rate of baby boomers applying for Medicare is 10,000/day. Yes, 10,000! Couple that with the fact that 5.2 million people in our country aged 65 and older have Alzheimer’s disease and you can see that we have a crisis and a huge need to deliver quality dementia care that’s affordable.


CMS’s goals for implementing the IMPACT Act are:

  • Making care safer by reducing harm caused in the delivery of care.
  • Ensuring that each person and family is engaged as partners in their care.
  • Promoting effective communication and coordination of care.
  • Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.
  • Working with communities to promote wide use of best practices to enable healthy living.
  • Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new healthcare delivery models.

The future will see payment linked to quality outcomes. In order to do that, IMPACT strives to standardize systems and information exchanges.
 

Measure Domains to be standardized:

  • Skin integrity and changes in skin integrity
  • Functional status, cognitive function, and changes in function and cognitive function
  • Medication reconciliation
  • Incidence of major falls
  • Transfer of health information and care preferences when an individual transitions
  • Resource use measures, including total estimated Medicare spending per beneficiary
  • Discharge to community
  • All-condition risk-adjusted potentially preventable hospital readmissions rates


IMPACT Act timeline


Beginning in October 2018, long-term care hospitals, independent rehab facilities, and skilled nursing facilities will be required to report data on:
  • Functional status
  • Cognitive function and mental status
  • Special services, treatments, and interventions
  • Medical conditions and co-morbidities
  • Impairments
  • Other categories


The positive influence of a dementia-trained staff on quality outcomes


Clearly the goals of Dementia Capable Care—which are to enable those with dementia to perform at the highest level of function possible, in activities of value, as supported by care partners and the environment—lend themselves to the facilitation of the quality care outcomes named above.

The Allen Cognitive Levels/dementia stages are a road map for care. They tell us what is possible for the person at a stage or level, and they also alert us to the areas of highest risk. The dementia stage provides a plethora of information to facilitate maximum performance in ADLs and mobility, and they help us proactively identify areas of high risk in order to reduce the incidence of hospitalizations.
 

ADL function and mobility


Through our comprehensive assessments and treatment (in which the Allen level is prioritized), we identify the functional potential that exists and eliminate barriers to achieving potential, followed by training and collaboration with a Dementia Capable Care partner. As a result, we can:
  • Minimize ADL decline/loss (create the “just-right challenge” using stage-appropriate approaches)
  • Improve current ADL levels (often related to excess disability due to the complex nature of the client)
  • Minimize mobility decline/loss
  • Improve current mobility status and safety
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Hospitalizations/rehospitalizations


Hospitalizations cost Medicare a lot of money. As a result, much attention is being paid to providing care that reduces problems that lead to hospitalization.

Through our comprehensive assessments and treatment (in which the Allen level is prioritized), we can identify the areas of highest risk for a person at a dementia stage, as we clearly understand how cognitive deficits of a certain degree may create a risk situation.

Through our unique skills, we can develop a preventative plan of action that we share with our Dementia Capable Care partners to reduce the chance of a risk becoming a reality. A proactive approach can prevent many common occurrences such as falls, which often lead to hospitalization.
 

Discharge to community


Is the resident with ADRD ready and able to live in the community? Dementia Capable Caregivers and Therapists are the most qualified individuals to assess the person’s function, safety, and community supports in making that determination. We can use standardized assessments and our knowledge of task equivalence to quite accurately predict if a person with dementia can live successfully within the community. We can also help the family and the person with ADRD access community services, which may also decrease the risk of future illness and re-hospitalization.
 

Staff turnover

  When residents are enabled to perform at their best ability, leading to higher function and a positive emotional state, staff burden can decrease. Staff burden is one of the reasons that turnover occurs. The amount of staff turnover is yet another quality area being measured by Medicare that may eventually influence reimbursement.
 

Conclusion


There are not too many tomorrows before the light bulb will go off to illuminate for leaders of geriatric care environments the fact that they cannot conduct quality care without a Dementia Capable Care staff and dementia therapists.

The skilled assessment and treatment of those with Alzheimer’s disease and related dementias (ADRD) provided by a dementia therapist is the service needed to facilitate quality outcomes such as those named above that will be measured and tracked.

The future points to a reimbursement system in which those who provide the best quality care will be rewarded and those who don’t may be challenged to stay in business.

We applaud Medicare for the focus on quality, and we encourage you to advocate for your Dementia Capable Care skills being a solution to this need. And in the end, we make life better for those LIVING with dementia.