What It Means and Why It's Important
When buying a car, many people look to Consumer Reports as the last word on quality, cost and consumer satisfaction. Or, when seeking a new physician, they carefully examine the doctor's credentials, board certification, hospital affiliation, experience and specializations. Yet when considering a home- and community-based rehabilitation program, do you even know how to evaluate it or to whom to turn for answers?

Most people, including many referring health care professionals, don't. That's why there's CARF -the Commission on Accreditation of Rehabilitation Facilities. CARF is considered the gold standard, the premiere accrediting body for rehabilitation programs: facilities that are CARF-accredited must meet stringent international standards. The most interesting thing about CARF, however, is that it is a voluntary accreditation. This means that organizations seeking CARF accreditation spend their own time, money and efforts to undergo the in-depth assessment and review that the organization demands. Why do all this when home and community rehabilitation programs are not required by law to be accredited?

"That's simple," says Alison Gyorke, director of clinical management Bay Area Gentiva Rehab Without Walls. It's the best way to ensure that you're providing the highest quality of care for your customers. Basically, CARF assures our clients that this is a specialty that values them so much that it has voluntarily agreed to adhere to vigorous standards and open the specialty up to intense scrutiny.

At Gentiva Rehab Without Walls, CARF accreditation has always been a priority. All established Gentiva Rehab Without Walls locations across the country are fully accredited for home and community rehabilitation, and its newer ones are on track for full accreditation. Within the home and community category, Gentiva Rehab Without Walls is also eligible to seek accreditation for the specific services a location offers, such as pediatrics.

Of note is that the CARF philosophy and Gentiva Rehab Without Walls' approach to care are remarkably similar. Gyorke explains. At its core, CARF is an advocacy program to ensure that the client remains at the center of the rehabilitation program's focus. It mandates that the persons served are key members of the treatment team and that they take an active role in their recovery. The same is true with Gentiva Rehab Without Walls.

A Consumer-Driven Mission
An independent, not-for-profit accrediting body, CARF provides accreditation not just for rehabilitation but for other human services as well, including employment, child and family, and aging. All share the same approachthat of being in partnership. This means that the survey process is not centered on inspection but rather on consultation, where the CARF survey team works with the provider to improve service resources and outcomes.

CARF sees itself as a catalyst for enhancing the quality of life of the persons served by CARF-accredited organizations. In fact, consumers play an active and vital role in the entire accreditation process, from helping to develop and apply the national performance standards to giving input on the quality of services received by individual rehabilitation programs. In doing so, CARF casts a wide net, placing particular emphasis on diversity and cultural competence in all CARF activities and associations. This contributes to what CARF sees as its core values: ensuring that all people have the right to be treated with dignity and respect; that all people have access to needed services that achieve optimum outcomes; and that all people be empowered to exercise informed choice.

CARF standards are continually developed and revised through a series of leadership panels, national advisory committees, focus groups and field reviewsrelying heavily on active involvement at all levels by persons served.

A Rigorous Accreditation Process
During the survey process itself, what does CARF look at? Everything, states Gyorke. Surveyors scrutinize our clinical practices, business practices, policies and procedures, market and strategic planning, retention and recruitment efforts, quality assurance, safety standards, committee meeting minutes, advocacy initiatives in the community, employee credentialing, and information management. CARF pays particular attention to the latter. They are interested in how we collect data and how we use it to improve services and provide durable outcomes for our clients.

Gyorke explains that Gentiva Rehab Without Walls uses four different tools to collect data: an annual performance evaluation; customer satisfaction surveys sent at discharge to every person who received services, as well as to every payer representative and physician; a professional advisory committeemade up of the executive director of each office, the marketing representative, payers and clientsthat meets several times a year to review practices; and a safety and quality assurance committee that confidentially reviews client records, personnel files and administration records to ensure Gentiva Rehab Without Walls is meeting its standards. At this time, the committee also sets news goals and standards for each office.

In addition, when the surveyors are on-site at each location, they spend time speaking with everyone involved in the rehabilitation process. For example, explains Gyorke, They will interview one or more of the field staff and talk with the executive director, the director of clinical management, the marketing director and the area vice president. They will also talk with external sources, including physicians, a payer case manager, a referrer and several clients and their families. They will observe a treatment session and may sit in on a team conference. All in all, they are very thorough, says Gyorke. There is only one way to prepare for a CARF survey: to build the CARF standards into everything you do. That, in a nutshell, is why Gentiva Rehab Without Walls continues to receive the highest CARF accreditations.

A Hallmark of Quality
CARF offers several levels of accreditation, the highest being the Three-Year Accreditation. This indicates that the provider is meeting or exceeding CARF standards and will not need to be reviewed again for another three years. This is what all established Gentiva Rehab Without Walls locations have. The second level is the One -Year Accreditation, which indicates that while there are still some existing deficiencies in conforming to CARF standards, the program shows capability and commitment toward correcting the deficiencies and making progress. The third level is known as Provisional Accreditation, which means the provider is still functioning at the One -Year level the following year, and has one year to correct the deficiencies and meet CARF standards or it will receive an outcome of non-accreditation.

Getting the three-year CARF accreditation lets us know that not only are we doing a good job with our clinical practices and services, but that we have met the most important criteria of allputting the client first, says Gyorke. It also creates a common language for referral sources. Before referring a patient into any home and community rehabilitation program, I suggest they ask questions about CARF accreditation. At Gentiva Rehab Without Walls we make that information readily available. Each office keeps a copy of the survey report and anyone who askspatient, payer, referrercan read through it. It's like saying the quality of our program is an open book.

Gentiva Rehab Without Walls is committed to maintaining a high level of ethical standards regarding business practice. We are likewise committed to the provision of high quality services to our persons served as a cost consistent with the type and amount of service provided. We have long maintained a compliance program as evidence of this commitment and consistently strive to set the industry standard as a rehabilitation provider of high quality and as a good corporate citizen.