SGS Event

that grew out of a need to effectively and efficiently treat patients with multiple chronic conditions outside of the hospital setting. The PACE Model incorporates an Interdisciplinary Team (IDT) approach to care for older adults with these chronic conditions, helping them remain in their home. The PACE IDT is comprised of a team of providers, homecare coordinators, transportation drivers, nurses, social workers, physical and occupational therapists, dietitians, recreational therapists, and others, who evaluate PACE participants and develop an individualized plan of care. This IDT is similar to other team-based programs in healthcare, but is unique in that it includes both professionals and paraprofessionals who take a comprehensive approach to care management. The IDT ensures that services are provided throughout the full continuum of care: preventive, primary, acute, rehabilitative, long-term, palliative and end of life. The care team partners with participants and caregivers to coordinate and provide all medical services necessary for their improved health and well-beingThe IDT ensures that services are provided throughout the full continuum of care: preventive, primary, acute, rehabilitative, long-term, palliative and end of life. The care team partners with participants and caregivers to coordinate and provide all medical services necessary for their improved health and well-being. The IDT's unique ability to influence health outcomes by working together towards a common goal, is what makes the PACE model of care so successful. They have greater depth, creativity, proactivity, and flexibility in their problem solving, resulting in better interactions and cohesiveness within the IDT, and influence in the overall care management of participants. This leads to better care plans, coordination of services, compassionate and comprehensive care, and ultimately better outcomes for participants and their families.

due to rising acuity, multiple chronic conditions and increasing prevalence of dementia. Because of this complexity, nursing centers often find it challenging to move from an institutional model to a person-centered model of care. Nursing home leadership and staff are called upon to change organizational culture, embedded practices and revolutionize care practices across the organization. While this is laudable, it is also very challenging and depends greatly on a highly trained and empowered staff. Further, residents and families need to be engaged to develop creative and person-centered strategies to reduce resident loneliness, helplessness and boredom in order to improve both quality of care and quality of life. This symposium addresses this issue from multiple perspectives. This presentation overviews a statewide project aimed at resourcing nursing homes with a variety of educational events and onsite training to support the development and empowerment of staff and describes the preliminary results of a statewide representative survey of nursing homes that identifies the barriers and facilitators to culture change. Implications for developing partnerships or coalition-based research projects in nursing homes will be discussed.