Cathy GrayCathy Gray has what you would call a full plate in front of her as president and chief executive officer of the Cedarcrest Center for Children with Disabilities in Keene, N.H.
As most top execs in the long term and post-acute care business do, she sets the vision for her organization, which is an intermediate care facility provider charged with caring for children as young as a few weeks old straight out of postnatal care in a hospital, to those who have turned 21 years of age.

Gray, who has a background as a physical therapist and has been at Cedarcrest for more than 23 years, takes a leading role in advocating for policy changes in New Hampshire that will benefit her residents, their families, and staff.

She also must be cognizant of the special status her 26-bed facility and special education center has since Cedarcrest is the only pediatric post-acute care facility in New Hampshire and, on a more limited basis, serves patients from neighboring Vermont and Maine. “They don’t have inpatient services for children supported by ventilators, other than at a hospital,” Gray says.

Given the challenges of caring for such young residents, and supporting their families at the same time, she makes clear that her job, her facility, and her profession focus on the positive of being able to make such a significant difference for some of the most vulnerable individuals in society.

“Cedarcrest is a very happy place,” Gray says. “The children bring joy to the staff, and our goal is to help them to grow and develop and, hopefully, be less dependent on technology, like a ventilator, or wean them from oxygen or removal of trach tube. They are children who happen to have disabilities. That is our focus, child first.”

Shifts in Care Are Clear

And, this focus has not changed over her many years in the profession. But, that is about all that has not changed, given the shifts in resident acuity over time. “Our facility started serving children with medical complexities early on, but the nature of those complexities has really changed,” she says. “In 2011, we started serving children supported by ventilators, so that has been the most dramatic change. Our state, and as it turns out neighboring states, were without a resource for children who required that support and could not be at home.”

As a relatively small facility, the staff really had to gear up to a different level of care than had been provided previously as these new residents came to the door.

“The majority of the children we care for are here for extended stays. For some that means a year or two, particularly for the babies, and for them we are a step down from the hospital. We help them become more medically stable and facilitate transition to the community, hopefully home,” Gray says.

For other children, Cedarcrest is truly long term care. “For a variety of reasons, these children cannot remain at home with family and come to us potentially for years,” she says. Some residents are stable enough on a medical basis to go out to school, and others attend our onsite special education program, which is open to day education students.

What bring these children to Gray and her staff include many medical conditions, such as disabilities related to respiratory compromise, often because of prematurity.

“We also have children with cerebral palsy, also as a result of prematurity,” she says. “That being said, children that we care for also may have developmental delays, or cognitive impairment. The little ones often come directly from the neonatal ICU [intensive care unit].”

Seeking More Medicaid Funds

The challenges of caring for the children who come to Cedar­crest are not only based on medical reasons. As all health providers know, adequate reimbursement is a vital issue, and one that Gray takes an active role in trying to solve.

On Medicaid rates, there could be some good news coming, she says. Medicaid is the primary funding source for the children at Cedarcrest, and there is currently state legislation proposed that if passed would increase rates for all Medicaid providers by 5 percent in year one and 7 percent in year two.

“I am optimistic. As we tell our story to legislators and the general public, they start to understand what it takes to provide quality care and understand our employees should not be some of the lowest paid in the state,” Gray says.

Striving for Better Answers

Gray has also taken a leading role in changing the way the entire community and a varied slate of stakeholders think about the workforce problem.

Like in many locales, Keene, N.H., is not an easy place to find younger people to fill staff in such roles as nurses and certified nurse assistants. “We recognized that we are not going to solve the basic issues of our state having very low unemployment,” she says.

Instead, in forming a task force of sorts—a gathering of providers all along the care continuum, legislators, schools, and chambers of commerce—shifted its focus to eliminating the barriers that stand in the way of enlarging the labor pool.

This effort has resulted in legislation that makes it easier for nurses and allied health professionals to get temporary licenses, as well as separate legislation for nurse assistants to begin work sooner, also with temporary licenses.

The hope of these new policies and increased community outreach is to make the health care profession a desirable option, such as the career Gray has built at Cedarcrest.

“As a region we have an open house and other activities planned, like a health career camp for middle school students. We want to grow the workforce and answer questions on how do we keep college students from going out of state and how to make health care an attractive career,” Gray says.

At Cedarcrest, there is an advantage in finding workers who may be looking at other health care facilities, and that, she says, is the children. Pediatrics is why she got started in the profession, and Gray knows many on her staff would not be in their jobs if not for the special care they want to provide the children.

“We have an advantage in that way,” she says.