Art is Ageless And Inclusive | https://www.providermagazine.com/Issues/2014/Pages/1214/Art-is-Ageless-And-Inclusive.aspx | Art is Ageless And Inclusive | <div id="__publishingReusableFragmentIdSection"><a href="/ReusableContent/4_.000">a</a></div><p><img width="283" height="212" src="/Issues/2014/PublishingImages/1214/art1.jpg" class="ms-rtePosition-1" alt="" style="margin:10px 15px;" />It began as a thought that gave rise to a question: Assuming artistic expression stimulates the mind, body, and spirit, how might an art program be designed to meet the needs not only of high-functioning long term care residents, but those with cognitive and physical impairments? <br></p>
<p>And so began a conversation during the care planning process that grew into a pilot project that eventually blossomed into Middlesboro Nursing and Rehabilitation Facility’s Artistic Enrichment Program, winner of the Kentucky Association of Health Care Facilities’ 2013 Innovation in Care Award. <br></p>
<p></p>
<div>Developed by Activities Director Christy Bean and Assistant Director Charmaine Moore in November 2010, the well-designed therapeutic program aims to reach all residents at the facility. </div>
<h2 class="ms-rteElement-H2">Focus On Individuality</h2>
<div>The objective is not only to provide fun activities through art, but to focus on the creative journey individuals, regardless of ability, undergo during the artistic process. Goals aren’t set, they’re individually met. No expectations or boundaries are placed on residents, because the intent of the program is not to create “fine art,” but to create art by fine people. </div>
<div><br>The center’s artistic enrichment program requires its activities staff to invent projects that encourage creativity; stimulate memories, emotions, and imagination; foster self-expression; reduce stress and dementia-related behaviors; and provide the sense of personal achievement and independence that leads to increased communication, confidence, and healing in residents spanning the spectrum of cognitive and physical ability. </div>
<div><br>One way the activities staff achieve this is by encouraging residents to work with a variety of mediums that allow for success, not frustration and failure. Thus, residents with reduced cognitive function who are unable to follow simple directions, or “stay within the lines,” so to speak, are still able to tap into their own creativity by using paint mixed in spray bottles, a process that results in unique and colorful abstract paintings. They might hold blow-dryers, which necessitate less manual dexterity, to melt crayons on canvas to make colorful collages, or use celery stalks as paint stamps to create rose bouquets.</div>
<div><br>Tissue paper can be used to make stained glass and chalk or oil to create pastel drawings. Male residents particularly enjoy using hammers and nails to stamp antique cars on solid sheets of aluminum. Higher-functioning residents pursue ongoing projects that can take four weeks to complete. As in a regular art class, they learn techniques such as line, shading, and depth.</div>
<div><br>Activities directors do not need to be artists to generate unique projects. Pinterest offers a wealth of ideas, as does the work of famous artists easily accessed on websites and Google. Moore, for example, showed residents paintings by Georgia O’Keefe, whose abstracts capture the emotion and power of natural objects (most notably, flowers and barren Southwestern landscapes). Residents then turned their eyes on the landscapes of their own experience to convey their own abstract art. <br><span id="__publishingReusableFragment"></span></div>
<h2 class="ms-rteElement-H2">Activities Enhance Skills</h2>
<div>Soon the center’s occupational therapist recognized that artistic enrichment projects can help residents improve fine motor skills, hand-to-eye coordination, sequencing, dexterity, and powers of attention in a fun and rewarding way. Stroke patients benefit from the opportunity to strengthen their non-dominant sides or hands through adaptive equipment. </div>
<div><span><img width="196" height="262" src="/Issues/2014/PublishingImages/1214/art2.jpg" class="ms-rtePosition-2" alt="" style="margin:15px 5px;" /></span><br>There have been many “ah-ha” moments, reassuring activities staff that their vision for the program has been realized. One involved a 98-year-old resident, whose only family, her son, resides in California. Because he is able to visit only twice a year, she spends much of her time thinking of ways to make his visit all the more special. Enter the Artistic Enrichment Program, which allowed her to spend months in her room painting a beautifully shaded horse to give her son as a gift. When he arrived, she felt not only the joy that comes from time spent with family but the thrill of accomplishment. </div>
<h2 class="ms-rteElement-H2">Program Expands To Community</h2>
<div>But the Artistic Enrichment Program’s target audience is not confined to residents only. Family members, volunteers, and staff also participate, as do members of the larger community. <br><br></div>
<div>For example, art students from nearby Lincoln Memorial University, in Harrogate, Tenn., have assisted Middlesboro Nursing residents with various projects, an outreach initiative that has proven to be an entertaining social event for residents, and an eye-opening and educational experience for young adults who leave the facility with new-found awareness that art is ageless.</div>
<div><br>The local Girl Scout troop visits the facility to learn about art from the residents and earn special badges for their participation. And in the evenings, employee children come to the center to work on art projects with residents.</div>
<div><br>The program also serves as a unique marketing tool for the facility. When prospective residents and their families arrive for tours, they find resident artwork displayed throughout the building, either in showcases or in photos streaming across the Activity Department’s Smart TV bulletin board.</div>
<div><br>Photographs of artwork and articles about the program also appear in Middlesboro Nursing’s newsletter and on the Activity Connection website. The walls of Administrator Alice Maddox’s office display professionally framed resident artwork as well. The message signaled to visitors is loud and clear: The minds, emotions, spirits, and imaginations of residents can thrive here. <span><span><img src="/Issues/2014/PublishingImages/1214/art4.jpg" class="ms-rtePosition-1" alt="" style="margin:20px 15px;" /></span></span></div>
<h2 class="ms-rteElement-H2">Consumers Take Notice </h2>
<div>Thanks to the innovative program, Middlesboro resident artists have become celebrities in the larger community, too. When a local young woman sought donations for an auction to be held to raise relief money for tornado victims in Missouri and Oklahoma, residents got busy. Their artwork was so well-received that the residents have since established a Community Benefit Fund financed primarily with sales of resident art projects. </div>
<div><br>“Future projects include an art show at the local mall and hosting an art class with an area church that teaches community art classes,” Bean says. </div>
<div><br>Ultimately, Middlesboro’s Artistic Enrichment Program can serve as a source of inspiration for activities staff at other long term care facilities. “Art provides the perfect venue for communication and expression, fun and smiles,” says Bean. “There should be no boundaries restricting residents with cognitive impairments from participating in art programs, or limitations when it comes to the tools they can use for creativity and expression.”</div>
<div><br>A successful art program does not require an actual artist on staff, Bean says. With research and Internet<span><em><img width="104" height="130" src="/Issues/2014/PublishingImages/1214/AliceMaddox.jpg" alt="Alice Maddox" class="ms-rtePosition-2" style="margin:5px;" /></em></span> access, all facilities can access tools and project ideas. “Art enrichment requires no talent, but allows residents to uncover the emotions that help them to tap into their imaginations. The result is improved communication skills, increased confidence, and, ultimately, healing.” <br><br><em>Alice Maddox is administrator of Middlesboro Nursing and Rehabilitation Facility in Middlesboro, Ky. She would like to thank Elizabeth Lamont, PhD, for assistance in editing this article.<br><br></em></div>
<p></p> | Developed by Activities Director Christy Bean and Assistant Director Charmaine Moore in November 2010, the Middlesboro Nursing and Rehabilitation Facility’s Artistic Enrichment Program aims to reach all residents at the facility. | 2014-12-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/1214/art_t.jpg" style="BORDER:0px solid;" /> | By You, For You;Quality | Column | 12 |
A Younger Resident Finds Her Place In A Caring Community | https://www.providermagazine.com/Issues/2014/Pages/1214/A-Younger-Resident.aspx | A Younger Resident Finds Her Place In A Caring Community | <div>Imagine yourself as a person in her early 40s coming to a nursing facility for rehabilitation. When I came through the door I was pleasantly surprised. What I had in my mind as an “old folks home” quickly became a place where real people worked, lived, and seemed like a family. </div>
<div> </div>
<div>After I went home and had to come back again for more rehabilitation, I knew where I wanted to go. I knew I didn’t want to burden my family, and if I couldn’t be home, I wanted to be here at Carillon Nursing and Rehabilitation Center. In the back of my mind, I didn’t want to admit that I would ever need to be in a nursing home. It was a difficult decision, but my health was failing, and I had no choice. More importantly, I wanted to be in the hands of people who I knew and trusted. </div>
<h2 class="ms-rteElement-H2">Freedom To Choose</h2>
<div>When the times come to talk about my care, I am fully involved and make decisions about how I am cared for and what my preferences are. Family and friends can come and go, there’s no restriction on visiting me, I am given the choice to get up when I want and go to bed when I want. <br><br></div>
<div>I felt depressed in the beginning, knowing that I wouldn’t be going home, but the nurses, doctors, and all of the people who work in the departments helped me come through it. <br><br></div>
<div>What I want everyone to know is that a long term nursing home can be a place where a young person can feel alive. I found myself becoming involved in activities and making longlasting friendships. A nursing home has to adjust its regular schedules for someone like me, and Carillon has. We don’t play Bingo every day, we have beautiful parties, Wii Games, socials. Playing Black Jack, trivia games, and cooking programs here are better than a nap any day. Sometimes I get together with a special friend, and we enjoy a meal together. </div>
<h2 class="ms-rteElement-H2">Finding A New Outlet</h2>
<div>The staff listen to me, and when I ask, they always try to accommodate my dialysis schedule so I can be a part of the things I enjoy. They suggested that I become part of the Nursing Home Leadership Group, where we meet at each other’s nursing homes. We talk about our rights and how we can accomplish changes in nursing homes all around. I like having a voice that is heard, and this group has a voice. This makes me feel independent, as I travel to other homes in the community. <br><br></div>
<div>In a place where 315 people live, my privacy is respected, and I can always decide if I want to be with others or find a quiet corner to read a book.<br><br></div>
<div>I have had to learn to deal with other residents that may not be so friendly and just accept them as they are. I found that when I came to this realization, life got better. It’s not so hard to take people as they are, say hello, and go about my day. </div>
<div><br>If you told me 20 years ago I would have ended up in a nursing home, I wouldn’t have believed it, let alone thought I would actually enjoy it. And I do. </div>
<div> </div>
<div><em>Ida Cuomo is a resident at Carillon Nursing and Rehabilitation Center in Huntington, N.Y.</em></div>
| When the times come to talk about my care, I am fully involved and make decisions about how I am cared for and what my preferences are. Family and friends can come and go, there’s no restriction on visiting me, I am given the choice to get up when I want and go to bed when I want. | 2014-12-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/1214/IdaCuomo_t.jpg" style="BORDER:0px solid;" /> | By You, For You;Caregiving;Management;Quality | Column | 12 |
20 Years Really Doesn’t Bring That Much Change—Does It? | https://www.providermagazine.com/Issues/2014/Pages/1214/20-Years-Really-Doesn’t-Bring-That-Much-Change—Does-It.aspx | 20 Years Really Doesn’t Bring That Much Change—Does It? | <div>Flashback! It’s April 1995 and I am writing an article for a large long term care (LTC) publication titled the “Grassroots Training of a Young Administrator.” In this article I would be sharing what I felt were critical attributes to becoming a successful nursing home administrator after completing a year-long administrator-in-training course by a leading company in LTC. Yep. Back then we still called them nursing homes. </div>
<img src="/Issues/2014/PublishingImages/1214/JohnVrba_t.jpg" alt="John Vrba" class="ms-rtePosition-2" style="margin:15px 5px;" /><br><div>Flash to today. Today I sit here typing this letter as an independent owner of a post-acute/skilled nursing facility. </div>
<div> </div>
<div>One thing I can tell ya: Live for today, as tomorrow is promised to no one, whether in your personal or professional lives. So, we all know we are in a new age of health care, but the foundation for operating a quality post-acute/skilled nursing facility (SNF) really hasn’t changed, has it?</div>
<h2 class="ms-rteElement-H2">What Builds A Strong Foundation</h2>
<div>Back in 1995 I wrote that textbooks provide you an education, but solid “hands-on” training is what gets you out of the shallow end of the pool and into the deep end and jumping off the high diving board!<br></div>
<div>I also wrote that the need for cooperation and communication across departments stood out as paramount. These days, as back then, any reference to a “team approach” in the SNF-post-acute sector tends to sound like a cliché, but teamwork is exactly what it was all about in 1995, and the same stands true today almost two decades later.</div>
<div><br>If you know you have that within your facilities walls, good for you. If you are not quite sure or think you have it somewhat, try harder—do not accept less. If you know you don’t have strong teamwork, it may be time to change some players on the field. Everyone needs to be focused on one thing and one thing only—quality care in a compassionate environment. </div>
<div><br>Back in 1995 I wrote that my belief was that more administrators need to get out from behind their desks and interact (boy, that word sure sounds familiar) and listen to their residents, patients, family members, and staff. It’s ironic, but that is our mission statement today: “We will take care of the residents, patients, families, and staff...and the rest will take care of itself.” </div>
<div><br>Back in 1995 I wrote about how much I learned about positive reinforcement and how vital it is to the staff member who often ends up doing the most distasteful and challenging work, yet tends to receive the fewest rewards or appreciation. Teach others to take time to walk in another person’s shoes before taking the easy way out and judging them.</div>
<h2 class="ms-rteElement-H2">Remember To Be Human</h2>
<div>So yes, health care has changed exponentially! But the foundation for the current leaders and future leaders of health care in 2015 and beyond hasn’t changed—and I venture it never may. The individual touch, the lending of an ear, the dropping to a knee to speak with someone in a wheelchair, the handwritten thank you note (okay, or email/text) is better than nothing, the note under the windshield wiper saying, “Thank you—what you did today really made a difference.” The golden rule is: “Treat others as you would like to be treated.” So easy to say but often not so easy to do.</div>
<div><br>I am truly afraid that this ever-changing world of health care is becoming too much about technology and metrics and less about the human touch. All the metrics, all the technology, all the programs—they all contribute to successful outcomes, and they definitely enhance our care delivery system—but the true outcome will always be quality care and compassion. What sets the top echelon apart is the human touch.</div>
<div>Health care is one rewarding calling, and I thank each of you for dedicating your career to serving others! <br><br><em>John Vrba is chief executive officer of Burgess Square Healthcare and Rehab Centre, Westmont, Ill. He is also president of the Illinois Health Care Association.</em><br></div> | Live for today, as tomorrow is promised to no one, whether in your personal or professional lives. | 2014-12-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/1214/JohnVrba_t.jpg" style="BORDER:0px solid;" /> | By You, For You;Management | Column | 12 |
A Lake Is Like A Mirror | https://www.providermagazine.com/Issues/2014/Pages/1214/A-Lake-Is-Like-A-Mirror.aspx | A Lake Is Like A Mirror | A lake is like a mirror;<br>it reflects the mood of the sky.<br>When the clouds are dark and threatening<br>the lake has anger in its eye.<br>But when the sky is clear and blue<br>and the sun is shining bright,<br>the lake’s a thing of beauty,<br>its face with radiance alight!<br><br>And so it is with people;<br>your personality shines through.<br>Your thoughts and deeds are never hidden,<br>because they’re reflected back to you<br>in the thoughts and deeds of others<br>who react in the same way.<br>Thus we have the power to set the mood <br>for every passing day!<br><br><span><em><img width="169" height="150" src="/Issues/2014/PublishingImages/1214/poetry_Peterson.jpg" class="ms-rtePosition-1" alt="" style="margin:5px 10px;" /></em></span><em>It is the reason we do what we do. Be inspired by the gifts, talents, and history of the long term care <br><br>residents and assisted living tenants who live in your organizations. Seek their passions, glean their wisdom, and admire their resiliency. </em><br><br><em>At 100 years old, Dr. Allan Peterson, a tenant of The SUMMIT Assisted Living, is a soft-spoken gentleman whose life experiences quickly captivate the listener. A professor of entomology, Dr. Peterson describes how a well-placed original poem, in a lecture, would be just the secret to keep a college student on his toes. It is no wonder his classes were bulging at the seams with engaged students as Dr. Peterson’s published works are as inspiring and interesting as he. </em><br> | It is the reason we do what we do. Be inspired by the gifts, talents, and history of the long term care residents and assisted living tenants who live in your organizations. Seek their passions, glean their wisdom, and admire their resiliency. | 2014-12-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/1214/poetry_lake_Peterson_t.jpg" style="BORDER:0px solid;" /> | By You, For You | Column | 12 |
Care Has Been Constant, But Data A New factor | https://www.providermagazine.com/Issues/2014/Pages/1214/Care-Has-Been-Constant,-But-Data-A-New-factor.aspx | Care Has Been Constant, But Data A New factor | Caring for the frail and elderly has remained a near constant, but the manner and means of analyzing care is constantly revolving, and is changing everything for everyone, a diverse group of provider executives agree. <br><br>Convening <em>Provider’s</em> Executive Roundtable, Van Dyk Health Care President and Chief Executive Officer (CEO) Bob Van Dyk noted that “data seems to be king.”<br><br>“Can I assume that’s pretty much across the board, all of us are finding ourselves collecting data that perhaps in the past we never really paid much attention to?” he asked his colleagues. <br>Most agreed. <br><br>“I have been in the profession for many years, and I think our care has not changed a lot,” Sterling Healthcare CEO Bob Hagan said.<br><br>What has changed, though, is the demands of regulators for several different streams of information, Hagan said. “We’re a medium-sized company,” he said. “Having that ability to collect the data and put it out in the different ways that each of the different managed care [organizations] and [what] the state <br>wants is, I think, one of the biggest changes I’ve seen in the way we have to make an investment.”<br><br>The executives, gathered at the American Health Care Association/National Center for Assisted Living Annual Convention & Expo in October, largely acknowledged that they were beefing up their information technology departments to meet the demands of the Information Age. But while tech has been a great resource, it has created its own challenges, some of the executives said. <br><br>“I think one of the challenges is just when you engage these various products that they integrate with each other, so that you are not just working with three different systems that don’t talk to each other. And it is very costly,” Vetter Health Services’ Chief Financial Officer (CFO) Joani Schelm said. <br><br>There doesn’t seem to be any consensus about how to build those vital tech elements, though. Welcov Healthcare President and Chief Operating Officer (COO) Thomas Boerboom created his company’s own tech department earlier this year after discovering that outsourcing wasn’t answering Welcov’s needs, “and we really found that in order to get what we wanted, we needed to bring it in-house.”<br><br>Sterling’s Hagan decided simply to hire a different consultant. The key is to be patient, he said.<br>“I had to hire a smarter person than I was,” Hagan said. “We had been with the same software company for about 15 years … but they could not keep up with the demand at all.“<br><br>The transition has been “tough, very tough” on staff, “but it is coming together,” Hagan said. <br>The key to any tech moves, Prestige Care President and COO David Henderson said, is “to have a software company that will listen to the provider and make changes, because they’re not in the business [of operating] a nursing home.”<br><br>Care Initiatives Vice President and CFO Steve Marlow said that his company has decided to take its tech investments beyond regulatory requirements and put a lot of money into going on offense.<br><br>“What we’ve tried to do is really focus our investments now around analytics,” Marlow said. “So we’re doing a lot more in trying to mine our own data in preparation for some of the new payment model issues that are coming, like the bundled payment program.... Now, whether or not we ultimately go that far is still way up in the air, but we want to be in the position to know our data ourselves” before it becomes a government demand or issue.<br><br>Data analysis can also become part of frontline care, Vetter Health COO Patrick Fairbanks said. <br>“We’ve added additional nurse assessment coordinators’ support … to make sure that we are getting the right data going into it,” he said. “We’ve also hired a couple of health information managers at the home office level that … help us in understanding what is the right system that we should be using.”<br>In fact, good data analysis can put providers in a great position to capitalize on the revolutions in health care, Welcov Vice President Sharon Thole said. <br><br>“I think the hospitals don’t necessarily have a good strategic plan right now because their payment systems are all over the place,” Thole said. “So they’re looking at what their provider networks are going to look like, and who they want to line up with, and who is going to have those outcomes to help them.”<br><br>The opportunities may be an unintended consequence of the creeping spread of managed care, Avamere CEO John Morgan said. <br><br>“So you can call it whatever you want—ACO, NCO, CCO, ABCDO—they all have a similar flavor. And so they’re all very much about managing that total episode of care, trying to do it most efficiently.<br><br>“And I think what we are trying to do is to come to them and find out where their bottlenecks really are,” he said. “And it’s been very interesting how that tide has shifted. Our relevance, in their minds, has gone up pretty dramatically, and so it’s not like you have to struggle to get an appointment these days.” | Caring for the frail and elderly has remained a near constant, but the manner and means of analyzing care is constantly revolving, and is changing everything for everyone, a diverse group of provider executives agree. | 2014-12-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/1214/roundtable_t.jpg" style="BORDER:0px solid;" /> | Caregiving;Quality | Column | 12 |
Eating With Dementia | https://www.providermagazine.com/Issues/2014/Pages/1214/Eating-With-Dementia.aspx | Eating With Dementia | <div>The importance of our food to our bodies in our lives has been around since the dawn of man, as indicated on cave drawings of hunts and feasts. Charles Pierre Monselet (1825-1888) once said, “Ponder well on this point: The pleasant hours of our life are all connected by a more or less tangible link, with some memory of the table.” </div>
<h2 class="ms-rteElement-H2">Understand The Challenges</h2>
<div>A person with dementia or Alzheimer’s disease presents a complex situation when it comes to maintaining nutritional status. The ability to tie memories to food diminishes. When the brain is involved, all functions that are needed to eat, such as seeing, smelling, thinking, responding, and moving, are impacted. These individuals are experiencing the common factors that affect all of us as we age, but they are magnified. Not only is there a decrease of smell, taste, chewing ability, and digestion and absorption, but the following challenges emerge:</div>
<div>■ Forgetting how long food has been around or out of the refrigerator, causing an increased risk of food-borne illness;</div>
<div>■ Increased distraction;</div>
<div>■ Not sitting long enough to eat;</div>
<div>■ Forgetting to eat;</div>
<div>■ Forgetting she has eaten;</div>
<div>■ Rejecting food;</div>
<div>■ Difficulty planning the movement of scooping with a utensil;</div>
<div>■ Inability to express needs and desires; and</div>
<div>■ Compromised quality of life and fear.</div>
<h2 class="ms-rteElement-H2">It’s Personal</h2>
<div>The key to addressing the needs of the individual with dementia was summed up nicely by Lacy and Burrows in 2004: “You need to know where I am so you can come to me.” If you are going to be effective, no matter what you do, you must get to know the individual and understand where they are at the moment and where they are in the disease process. <br></div>
<div><br>You need to know: </div>
<div>■ What time they used to eat;</div>
<div>■ What they used to like to eat or their favorite foods; and</div>
<div>■ Did they participate in cooking, setting the table at home, or did they eat out most of the time?</div>
<div>Depending on the type and stage of dementia or Alzheimer’s, you can get this information directly from the individual or a close family member. Then you’ll need to incorporate as many of those items into their daily routine as possible. </div>
<h2 class="ms-rteElement-H2">Be Aware Of Weight-Loss Danger</h2>
<div>A research study from the <em>Journal of Clinical Nursing</em> (2007) demonstrated that weight gain was achieved in individuals with dementia by “adjusting the meal environment to the individual’s needs” and “ensuring good meal situations were given high priority.”<br><br></div>
<div>Weight loss and nutrient deficiencies, which increase the rate of mortality in the individual with dementia, are a challenge. We may not be able to stop it in the last stage of the disease. But with the use of these <a href="/Issues/2014/Pages/1214/What-We-Can-Do.aspx" title="What We Can Do" target="_blank">interventions</a>, we can have a positive impact on nutritional status and quality of life for however long the moments last.</div>
<div><br>In the United States, we have not been a society that “eats to live” for quite some time. Let’s face it, we “live to eat,” so with these devastating diseases, it becomes our responsibility to tie living to eating in preventing poor nutritional status. <br><br><em><img width="119" height="148" class="ms-rtePosition-1" src="/Issues/2014/PublishingImages/1214/AngelaSader.jpg" alt="" style="margin:5px;" />Angela Sader, MBA, RD, LD, serves as senior director of nutrition services for Kindred Healthcare’s Nursing Center Division. Prior to joining Kindred, Sader became a leader in the profession through her experience in all levels of care and hospitality service, including working for such organizations as Golden Living. She is a graduate of Kansas State University specializing in dietetics. Sader is a contributing author in college textbooks and industry management tools. She is a member of the Academy of Nutrition and Dietetics, the Food and Culinary Professionals practice group. She serves on the Executive Committee for Dietitians in Healthcare Communities and is a member of the national RD Executive Council. </em></div>
| A person with dementia or Alzheimer’s disease presents a complex situation when it comes to maintaining nutritional status. The ability to tie memories to food diminishes. When the brain is involved, all functions that are needed to eat, such as seeing, smelling, thinking, responding, and moving, are impacted. These individuals are experiencing the common factors that affect all of us as we age, but they are magnified. | 2014-12-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/1214/dementia_eating_t.jpg" style="BORDER:0px solid;" /> | By You, For You;Management | Column | 12 |
Falls-Prevention Program Targets Residents At Risk | https://www.providermagazine.com/Issues/2014/Pages/1214/Falls-Prevention-Program-Targets-Residents-At-Risk.aspx | Falls-Prevention Program Targets Residents At Risk | <div><br>Falls are always a concern in long term care facilities. In light of this, Jefferson County Nursing Home in Dandridge, Tenn., identified through its Quality Assurance/Performance Improvement (QAPI) process that improvement was needed in the area of falls management. As a result, we began considering a performance improvement project (PIP) by looking for an innovative way to reduce or eliminate the occurrence of falls. </div>
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<div style="text-align:center;"><img width="387" height="257" src="/Issues/2014/PublishingImages/1214/RogerMynatt_BalanceTeam.jpg" class="ms-rtePosition-4" alt="" style="margin:5px;" /></div>
<div> </div>
<div>As a result of a learning circle from among our interdisciplinary team, The Balancing Act was proposed. The intention was to strengthen some of the deficits our elders have that may contribute to falls. After the first time of doing the program, the team was in agreement that The Balancing Act was the appropriate PIP. </div></div>
<h2 class="ms-rteElement-H2">The Balancing Act Is Born</h2>
<div>The goals of Jefferson County’s Balancing Act are to actively engage elders who are at risk for falls, promote endurance and balance for gait stability, and enhance socialization and quality of life. The interdisciplinary team includes the activities department; therapy, including occupational, physical, and speech; housekeeping; and restorative certified nurse assistants. </div>
<div><br>In addition to the team, the group is also joined by students from the local high school who are a part of a program known as the Service Learning Project. Additionally, family members of the elders take part. </div>
<div>The group of elders includes those who have been identified as a fall risk or who have had a recent fall; however, any elder who wishes is invited to participate. The location of The Balancing Act may vary, but the program is usually held in the home’s main dining room due to its size. The length of the program is typically one hour. </div>
<div><br>“Elders who participate in The Balancing Act have more minutes in therapy than elders who do not,” says Lori Toney, physical therapy assistant for Functional Pathways, the facility’s therapy provider.</div>
<h2 class="ms-rteElement-H2">Therapy The Fun Way</h2>
<div>The program usually begins with the traditional activity of gathering around a colorful parachute and using it to develop arm strength and range of motion as the elders get “warmed up.” Once the elders have warmed up, the sky is the limit on the types of nontraditional games used as exercises. </div>
<div><br>“The Balancing Act has turned into both a fun and functional program,” says Debbie Thacker, clinical manager for Functional Pathways.</div>
<div><br>Baseball is one popular game, with the elders hitting the ball and team members running the bases for them. They also play games that include balancing plates on their heads; throwing water balloons outside during the summer heat; volleyball, bowling, kickball, soccer; reminiscing with questions; passing a ball; and taking a turn with a stick while standing and swinging at a piñata. </div>
<div><br>The goal is to maximize elders’ standing time by utilizing staff members or volunteers while the games are taking place. The games and activities are all approached by thinking with a “culture change” mindset.</div>
<div>How It’s Working</div>
<div><br>Over the past quarter, falls have been reduced up to 15 percent. The Balancing Act is used as a possible intervention when an elder falls and the program has potential to strengthen them. The program is growing not only in terms of elders who are participating, but with the number of volunteers and family members. The activity continues to generate a great deal of staff and visitor interest.</div>
<div><br>One specific example of a resident who has benefited is Myrtle Reidell. She had a fall but no serious injuries soon after coming into the nursing home. </div>
<div><br>Reidell also completed a round of therapy at the nursing home and was somewhat active within the building. </div>
<div><br>After starting The Balancing Act, Reidell has been attending more outings with the use of her walker. She recently attended a 90-and-over potluck luncheon at her church and was reunited with all of her friends from church, which meant so much to her.</div>
<div><br><img width="137" height="172" src="/Issues/2014/PublishingImages/1214/RogerMynatt.jpg" class="ms-rtePosition-1" alt="" style="margin:5px 15px;" /><br>“The Balancing Act has proven to be a fun and social activity that the elders truly enjoy,” says Rich Henderson, occupational therapist with Functional Pathways. “It has been wonderful to see the elders improve their safety awareness and functional progression toward their therapy goals as a result of this program.” <br><br><em>Roger Mynatt has been administrator of Jefferson County Nursing Home, Dandridge, Tenn., for 22 years. He is married and the father of three daughters, two cats, and one dog.</em><br></div> | The goals of Jefferson County’s Balancing Act are to actively engage elders who are at risk for falls, promote endurance and balance for gait stability, and enhance socialization and quality of life. | 2014-12-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/1214/rogermynatt_l.jpg" style="BORDER:0px solid;" /> | Caregiving;By You, For You | Column | 12 |
Gardenview Finds New Avenues For Life Enrichment | https://www.providermagazine.com/Issues/2014/Pages/1214/Gardenview-Finds-New-Avenues-For-Life-Enrichment.aspx | Gardenview Finds New Avenues For Life Enrichment | <div> </div>
<div>The Converse Home is an assisted living community located in the heart of Burlington, Vt. Established in 1886 as a private, nonprofit organization, the center has 50 traditional assisted living apartments, as well as a memory care community called Gardenview.</div>
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<div>The 16 residents of Gardenview enjoy an environment specially designed for folks with memory impairment. Trained staff provide consistent care and programming that support each individual resident’s strengths.</div>
<h2 class="ms-rteElement-H2">Poetry Lovers Welcome</h2>
<div>Recently, we implemented a new Life Enrichment Program that has greatly enhanced the quality of life for our residents.</div>
<div><br>The first program is called the Poetry Circle. The group was initiated as a result of a resident who had a passion for poetry, and also taught poetry at the college level.</div>
<div><br>The Poetry Circle meets once a week to read a selected poet (Henry Wadsworth Longfellow, Robert Frost, Walt Whitman) or theme-based poems (spring, friendship, love). You will often observe the residents <br>reciting the words right along with the director of life enrichment if it is a poem familiar to them. </div>
<div><br>Following the reading, a poem is created by the group based on the poetry we read. The residents love having the final product read out loud, as evidenced by smiles, positive comments, and clapping. </div>
<div>A collection of poems has been framed and hung as part of a Poetry Gallery in the community. There is also a framed poem in our lobby that changes weekly for families, friends, and all residents to enjoy.</div>
<h2 class="ms-rteElement-H2">Gardenview Newsletter</h2>
<div>Another Life Enrichment Program is called Dear Gardenview. This program was designed as an advice column. Residents, staff, and family members are encouraged to put their “issue” on a piece of paper and deposit it in a box in the front lobby. The issues are collected and presented to Gardenview residents, who meet weekly to provide their input and advice.<br><img src="/Issues/2014/PublishingImages/1214/gardenview.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;" /><br>It is fascinating that, even with memory impairment, people do not lose the ability to give advice or their opinion! We publish a weekly Dear Gardenview newsletter and post it in our elevators for all to read and enjoy.</div>
<h2 class="ms-rteElement-H2">Enjoying Fine Art</h2>
<div>Art Appreciation is another successful program that has been added recently for the Gardenview community. The residents observe art from a variety of artists, including Monet, Norman Rockwell, and Van Gogh. Discussion is based on questions such as, “Do you like this painting?” “Would you hang it in your home?” “What is the mood of the painting?” Even if residents do not have a history of engaging in art, they have the opportunity to express their likes and dislikes.<br><br></div>
<div>The main focus of all three programs is for residents to actively participate. These programs are successful because they are resident-centered, they provide opportunities for residents to make choices, and they focus on the contributions that these elders still have to offer. <br><br><em>Ellen Meagher, M Ed, is director of life enrichment at The Converse Home, an assisted living community in Burlington, Vt.</em></div>
| The Converse Home is an assisted living community located in the heart of Burlington, Vt. Established in 1886 as a private, nonprofit organization, the center has 50 traditional assisted living apartments, as well as a memory care community called Gardenview.
| 2014-12-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/1214/gardenview_t.jpg" style="BORDER:0px solid;" /> | Caregiving;By You, For You | Column | 12 |
Keeping QAPI Simple, One Step At A Time | https://www.providermagazine.com/Issues/2014/Pages/1214/Keeping-QAPI-Simple,-One-Step-At-A-Time.aspx | Keeping QAPI Simple, One Step At A Time | <div>Late in 2012, the Centers for Medicare & Medicaid Services (CMS) released “QAPI at a Glance.” This 42-page guide previewed principles and tools needed to establish a Quality Assurance/Performance Improvement (QAPI) foundation in a nursing facility. </div>
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<div>While the guidance is a comprehensive resource to create a solid QAPI program, there are simple steps the facility quality manager can utilize to systematically address problems and improve outcomes, an important QAPI goal when the guidance is finalized.</div>
<h2 class="ms-rteElement-H2">Source Available To Guide Quality Efforts</h2>
<div>Many quality strategies provide proven methods to positively impact operations through continuous improvement. <br></div>
<div><br>The Baldrige Criteria for Health Care Excellence, Six Sigma, and Lean Healthcare are a few examples institutions have integrated into their business models.</div>
<div><br>Villa St. Vincent, a 2008 American Health Care Association Gold Award recipient, uses elements from multiple quality improvement approaches.</div>
<div><br>“The greatest challenges as a leader today are assuring regulations are met, expectations exceeded, financial health maintained, and doing all this and more each and every day,” says Judy Hulst, RN, administrator of Villa St. Vincent and a 34-year veteran of the facility, 28 of those as the director of nursing. </div>
<div>“It is crucial to address quality problems efficiently to not just survive, but thrive. Using simple steps for success is our mantra.” </div>
<div><br>Villa St. Vincent, a Benedictine Health System facility, has longstanding integrated quality management practices, including:</div>
<div>■ Leadership support with resource allocation;</div>
<div>■ Setting a goal—know where you are and where you want to be;</div>
<div>■ Base your decisions on data-collect information: Track, trend, and analyze;</div>
<div>■ Assure methods to listen to your customer and respond; and</div>
<div>■ Keep evaluating as you fix (in-process review).</div>
<div>Villa St. Vincent groups opportunities to improve into two categories: poor outcomes that need correction or work processes that need improving. <br></div>
<div>By following some simple steps, positive change and improved outcomes will likely result. Two performance improvement projects (PIPs) will describe a formula easily replicated at any facility. </div>
<h2 class="ms-rteElement-H2">Outcomes Needing Improvement</h2>
<div>Villa St. Vincent was typical in terms of the prevalence of off-label antipsychotic medication use in elders with dementia, at 21 percent in 2012. As new research came to light and CMS urged action to decrease these medications, a PIP was initiated.<br></div>
<div><br>1. A team was formed with wide interdisciplinary representation (IDT). </div>
<div><br>2. A Problem Scope Worksheet was completed with a goal to reduce the percentage of residents on antipsychotic medications without qualifying diagnosis to less than 9 percent by March 31, 2015. </div>
<div><br>3. Root cause analysis via Fishbone Chart determined core reasons for higher-than-desired prevalence of antipsychotic medications in residents with dementia, including: </div>
<div>■ Staff and medical providers were not aware of the new evidence/directive. “It is how we have always done it” was the attitude.</div>
<div>■ Systematic review of medications occurred quarterly vs. more frequently.</div>
<div>■ Gaps in ongoing training for “behavior” management.</div>
<div>■ Fewer pain management programs in clients with dementia.</div>
<div><br>4. An Action Plan based on root causes included the “owner” and timeline for completion. </div>
<div>■ Educate the IDT, medical providers, and families on the new guidance, including in-services, webinars, bathroom boards, mailings, and 1:1 training. </div>
<div>■ Communicate frequently to staff and family, and send letters to the medical providers; include graphs on progress.</div>
<div>■ IDT to review monthly all care plans, documentation, and reduction status. </div>
<div>■ Modify nurse assistant orientation to include a mentor with role playing to help learners understand “behaviors” are “communications” and how to therapeutically respond.</div>
<div>■ Review pain assessment processes; make comfort a high priority.</div>
<div><br>5. Monthly, the team reviews action. A group collaborative with Benedictine Health System sister facilities shared best practices. Halfway through the PIP, Villa St. Vincent met the target of 9 percent, with notable improvements also seen in anti-anxiety/hypnotics and overall behavior indicators. Further decreases are anticipated. </div>
<h2 class="ms-rteElement-H2">Work Processes Need Improvement</h2>
<div>Villa St. Vincent surveys key customers annually. “Since we want to be an excellent facility, we seek and report the ‘excellent’ responses,” notes Nancy Moser, licensed practical nurse quality assistant. </div>
<div>“In 2010 our assisted living unit, The SUMMIT, revealed low scores in ‘Food Appeal’ so this became a priority PIP,” she says.</div>
<h2 class="ms-rteElement-H2">Identifying The Next Target</h2>
<div>A Share the Survey meeting is held after each reporting cycle, led by Housing Manager Cindy Hulst, with tenants’ concerns outlined on a flip chart. “Don’t try to explain away the data, but drill down and look for core problems,” says Hulst.</div>
<div><br>Foods not consistently served piping hot, especially the cooked vegetables, pointed to a work process improvement opportunity. Initial data for “Food Appeal” showed only 23 percent scored “excellent.”
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<div><br>1. The IDT was formed. </div>
<div><br>2. The Project Scope Worksheet was completed, with the goal: “Improve satisfaction of food appeal to 35 percent answering excellent by the 2011 survey by improving food serving temperature.”</div>
<div><br>3. A flow chart mapped the start point when the food left the kitchen to the end service to the tenant. Gaps revealed a lack of solid flow and an inconsistent process.</div>
<div><br>4. The root cause analysis revealed: </div>
<div>■ Hot food served on cold ceramic plates;</div>
<div>■ Warmers turned on too late;</div>
<div>■ Plates being dished more quickly than they could be delivered; and</div>
<div>■ Staff turnover impacted by orientation gaps. </div>
<div><br>5. The Action Plan included: </div>
<div>■ Cook will turn on hot tables one hour prior to meal;</div>
<div>■ All ceramic plates will be heated via the steam table prior to the meal;</div>
<div>■ Temps tracked and documented through the meal;</div>
<div>■ Culinary services manager or second cook will assist with serving at all meals; and</div>
<div>■ Check-off sheets for orientating new culinary services staff developed.</div>
<div><br>6. Satisfaction in food appeal improved in 2011 to 28 percent scoring “excellent” and subsequently up to 47 percent in 2012. While the scores leveled off in 2013 to 41 percent, the “Recommendation Rate” rose to a high of 66 percent “excellent,” with a frequent comment being, “They take quality improvement seriously around here.”</div>
<div><br>“Villa St. Vincent uses different core concepts of many QI strategies” says Hulst. </div>
<div><br>“While we have a pretty large box of ‘quality tools,’ the same basic approach is very effective and gets results fast. </div>
<div><img width="116" height="145" src="/Issues/2014/PublishingImages/1214/JillBrown.jpg" alt="Jill Brown, RN" class="ms-rtePosition-2" style="margin:5px;" /><br>“It is easy to get wrapped up doing the work and not analyze the very work process occurring to make more efficient and accurate work flow. So, sometimes just stop, step back, and do a rapid improvement. Grab that diverse team, and let the PIP magic begin,” Hulst says. </div>
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<div><em>Jill Brown, RN, C CN-E, is quality management coordinator at Villa St. Vincent, a Benedictine Health System organization, in Crookston, Minn.</em></div> | While the guidance is a comprehensive resource to create a solid QAPI program, there are simple steps the facility quality manager can utilize to systematically address problems and improve outcomes, an important QAPI goal when the guidance is finalized. | 2014-12-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/1214/JillBrown_t.jpg" style="BORDER:0px solid;" /> | Caregiving;By You, For You | Column | 12 |
Project: Zero Tolerance For Pressure Ulcers | https://www.providermagazine.com/Issues/2014/Pages/1214/Project-Zero-Tolerance-For-Pressure-Ulcers.aspx | Project: Zero Tolerance For Pressure Ulcers | <div>Pressure ulcers are a devastating life safety issue impacting individuals when their health may be very vulnerable. They are associated with increased cost, pain, infection, and death. Residents in long term care facilities often present with varying health conditions that put them at an increased risk for the development of pressure ulcers. <br></div>
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<div><br>Also known as pressure sores, bedsores, and decubitus ulcers, a pressure ulcer is defined as “localized injury to the skin and/or underlying tissue, usually over a bony prominence as a result of pressure or pressure in combination with shear” by the National Pressure Ulcer Advisory Panel. </div>
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<div><br>An estimated 2.5 million pressure ulcers are treated annually at a staggering cost. </div>
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<div><br>The financial impact of treating pressure ulcers is significant, as the cost associated with the treatment of a full-thickness wound can be as much as $70,000. The projected cost in the United States for treating pressure ulcers is $11 billion per year, according to M. Reddy, S.S. Gill, and P.A. Rockon, reported in the Journal of the American Medical Association.</div>
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<h2 class="ms-rteElement-H2">Patient Trauma High</h2>
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<div>While treatment cost is a major concern, it is overwhelmed by the impact of this demoralizing safety issue on the patient. The presence of a pressure ulcer imposes many physical restrictions and lifestyle changes. </div>
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<div>The incidence rate demonstrates the impact that pressure ulcer events place not only on the patient but the health care system. The incidence of pressure ulcers in the long term care setting ranges from 2.2 percent to 23.97 percent, according to J. Maklebust in Nursing Clinics of North America (<em>see theclinics.com</em>). People with impaired mobility, such as those with stroke, spinal cord injury, or cognitive impairment, are at risk for the development of pressure ulcers. <br></div>
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<div><br>Diabetes mellitus, end-stage renal disease, and thyroid disease also predispose individuals to the development of pressure ulcers.</div>
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<div><br>A risk assessment should be completed to identify individuals who may be at risk. A reliable tool utilized to predict individuals at risk for the development of pressure ulcers is the Braden scale. </div>
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<div><br>Evidence-based guidelines for the prevention and treatment of pressure ulcers are available and easily obtainable. With so much information and knowledge at hand, why do care providers fail to implement these protocols in practice? In long term care, the literature reveals that nurses may be aware of best practices and still not utilize them. It is critical that nursing facilities implement educational programs and evidence-based guidelines to prevent and treat pressure ulcers. </div>
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<div><br>What is also important is the implementation of training in core competencies for all levels of nursing staff, including registered nurses, licensed practical nurses, and certified nurse assistants. </div>
<h2 class="ms-rteElement-H2">
A Case Study
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<div>The decision was made to review a long term care facility whose pressure ulcer incident rate was 21 percent and determine what best practices could be implemented to reduce it. The aims identified for the project were to increase staff knowledge of evidence-based intervention for skin care and prevention of pressure ulcers and decrease the incidence of institutionally acquired pressure ulcers and decrease the severity of ulcers in residents who reside in long term care centers.</div>
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<div><br>To increase staff knowledge and to develop the evidence-based pressure ulcer and treatment protocols, the project team conducted a systematic review of existing literature. </div>
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<div><br>After completing the review, the first phase of the project examined whether a sample of nurses’ knowledge would increase after receiving training on preventing pressure ulcers. The methodology entailed implementation of a knowledge pre-test, provision of a curriculum, and implementation of a post-test with 46 employees at the facility. The desired outcome was that the intervention group would have better scores on a post-test, compared with pre-test scores, after receiving education based on learning objectives. </div>
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<div><br>The second phase of the project examined whether implementing an evidence-based pressure ulcer prevention protocol could decrease the incidence of pressure ulcers among a sample of patients. The second phase also looked at the implementation of an evidence-based wound treatment protocol to improve upon the severity of pressure ulcers that already existed. </div>
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<h2 class="ms-rteElement-H2">The Results</h2>
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<div>After receiving extensive training on preventing pressure ulcers, the 46 participants’ knowledge of pressure ulcers was tested using a 10-item test before the intervention (pre-test) and after the intervention (post-test), which allowed for an assessment of their gain in knowledge over time. </div>
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<div><br>As shown in Figure 1, a review of the results revealed the nurses were able to answer on average, 5.74 questions out of the 10 correctly before training, and were able to answer 8.28 questions correctly after training. The results of a correlated t-test show that the increase in the nurses’ knowledge from pre-test to post-test was statistically significant, t (45) = -9.40, p <. 001. </div>
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<div><div style="text-align:center;"><img width="457" height="164" class="ms-rtePosition-4" src="/Issues/2014/PublishingImages/1214/Wright_fig1.jpg" alt="" style="margin:15px 5px;" /></div>
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<div>Data analyzed from a sample of 66 residents of a nursing home included demographics, health risk for developing pressure ulcers, pressure ulcer stage before and after the implementation of the training, and protocols. </div></div>
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<div><br>The residents’ ages ranged from 50 to 97 years. </div>
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<div><br>The primary outcome variable was whether the residents developed a pressure ulcer after the implementation of evidence-based protocols. No new cases of pressure ulcers emerged among the 61 residents who began the program with no pressure ulcers, suggesting that the prevention program was effective. </div>
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<div><span><img class="ms-rtePosition-1" src="/Issues/2014/PublishingImages/1214/Wright_fig2.jpg" alt="" style="margin:20px 15px;" /></span><br>For those residents who had a pressure ulcer prior to the project’s implementation, an evidence-based <br>protocol on treatment was used to determine if worsening of the pressure ulcer could be prevented. The five residents with existing pressure ulcers started with a treatment program, which was also effective, as the severity of the pressure ulcers did not worsen: Sixty percent of the pressure ulcers improved or healed, and 40 percent remained the same. </div>
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<h2 class="ms-rteElement-H2">In Summary</h2>
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<div>The project demonstrated that there was a statistically significant change in knowledge from pre-test to post-test. It appears that these gains in knowledge may impact practice. In addition, during the course of this project, with the introduction of education and evidence-based protocols, the incidence of new pressure ulcers was zero, the severity of pressure ulcers decreased, and the overall pressure ulcer incident rate decreased to 3.08 percent.<br></div>
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<div><br>Although the organization was pleased with the results, the facility was keenly aware of avoidable vs. unavoidable pressure sores and the difficulty in ensuring that knowledge endures and treatment and change in behaviors are sustained. Thus, the training continued for nursing employees, and new protocols were implemented throughout the facility, with the goal of zero tolerance for pressure ulcers. ■</div>
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<div> <span><span><span><span><span><em><img width="115" height="144" class="ms-rtePosition-1" src="/Issues/2014/PublishingImages/1214/RosalindWright.jpg" alt="" style="margin:20px 15px;" /></em></span></span></span></span></span></div>
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<div><em>Rosalind Wright, RN-BC, doctor of nursing practice, RAC-CT, CNHA, Fellow, has more than 30 years of </em><span><span><span><em></em></span></span></span><em>leadership experience in long term care, acute care, and academia.</em> <em>Wright serves as vice president of quality management for VMT Long Term Care Management and administrator of Unique Residential Care </em><span><span><em></em></span></span><em>Center, a 230-bed skilled nursing facility, in Washington, D.C. She successfully administered her facility to a Five-Star nursing home rating from CMS.</em>
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<div>Acknowledgement: The author would like to acknowledge the following people for their assistance in this project: Laila Alamgir, MD, medical director; Jacqueline Holmes, director of quality and staff development; and Francise Dyson, executive assistant. </div>
| Also known as pressure sores, bedsores, and decubitus ulcers, a pressure ulcer is defined as “localized injury to the skin and/or underlying tissue, usually over a bony prominence as a result of pressure or pressure in combination with shear” by the National Pressure Ulcer Advisory Panel. | 2014-12-01T05:00:00Z | <img alt="" height="150" src="/Issues/2014/PublishingImages/1214/RosalindWright.jpg" width="150" style="BORDER:0px solid;" /> | By You, For You;Caregiving | Column | 12 |
Does QIS Provide Quality-Of-Care Benchmarks? | https://www.providermagazine.com/Issues/2014/Pages/1214/QIS-Expert-Quality-Of-Care-Benchmarks.aspx | Does QIS Provide Quality-Of-Care Benchmarks? | The answer is yes, but not in the way that you might think. QIS provides a critical benchmark against which all nursing homes should be compared. This benchmark is the continuous quality improvement process that QIS dictates. <br><br>A benchmark is a standard, or yardstick, against which one can compare oneself, and so it can be a process. And the benchmark in this case is the process of continuously improving quality based on the full range of Quality of Care and Life Indicators (QCLIs) in QIS.<br><br>Because QIS is a process, the benchmark that it sets is a process benchmark. That process is for nursing centers to continuously conduct quality assessments using rigorous methods and to improve their performance. This process requires attention to the wide array of QIS measures, from interviews with residents, families, and staff to observations and record reviews.<br><br>Some may contend that the QIS thresholds are the numerical QIS benchmarks that one should strive to achieve. It is true that these QCLIs represent the translation of the legal language in the regulations of the Omnibus Budget Reconciliation Act of 1987 into measurable constructs and questions: They provide the most comprehensive numerically defined set of quality metrics available. <br><br>But while the threshold rates offer an absolute standard—not a relative standard based on a group of peers—they only represent the minimum standards necessary to be in compliance with the regulations. <br>Not a resounding benchmark! It is hard to argue that one should strive for only minimum compliance with the regulations. But there is no higher benchmark in the QIS process or elsewhere to indicate what providers should strive to achieve, and no benchmarks for the “acceptable” percentage of negative responses for the individual questions and QCLIs. There is not a value for each indicator that one can claim represents “good enough quality.”<br><br>The other extreme, of course, is zero tolerance. And that is not reasonable to expect to achieve in every situation, such as pain management, choices, and certain infections. For example, some residents may choose to experience some pain in order to avoid sedation from heavy doses of pain meds. <br><br>So what do you compare your performance to in order to determine where you are relative to a benchmark? <br><br>The answer is relatively easy: Your benchmark is to continuously improve on your current performance. At no point will you reach an acceptable rate of resident quality concerns—there is always room for improvement. And when you improve your current rate of performance on a QCLI or question, then your benchmark should be the next measurable level for that QCLI or the questions underlying it. <br><br><div>To the residents in your building, traditional benchmarks such as the national average, your state average, or your peer group rate do not matter. Don’t the residents deserve for you to continually strive to improve the care you provide them? </div><br>This is the QIS benchmark. | A benchmark is a standard, or yardstick, against which one can compare oneself, and so it can be a process. And the benchmark in this case is the process of continuously improving quality based on the full range of Quality of Care and Life Indicators (QCLIs) in QIS. | 2014-12-01T05:00:00Z | <img alt="" src="/Articles/PublishingImages/headshots/AndyKramer.jpg" style="BORDER:0px solid;" /> | Quality | Column | 12 |
Rebel Chef With A Cause | https://www.providermagazine.com/Issues/2014/Pages/1214/Rebel-Chef-With-A-Cause.aspx | Rebel Chef With A Cause | <div>Organic, local, unprocessed, and sustainable are among the many well-known mantras of the Green and Farm-to-Table movements over the past decade. Yet, the cultural shift toward healthy foods has still left a large and growing portion of our population untouched—older adults in senior living and health care. </div>
<h2 class="ms-rteElement-H2">How I Got Here</h2>
<div>Prior to working in the health care industry, I worked in hospitality in a variety of settings, including corporate food service, hotels, and private residences to country clubs. I’ve had many different titles in the culinary industry—chef, executive chef, culinary administrator, evaluator, and educator. </div>
<div><br>In 2013, I joined The Goodman Group as national director of culinary operations, heading foodservice at the company’s multistate, 33 senior living and health care communities. I quickly became aware that the traditional approach in health care to food operations has been primarily clinical or institutional, rather than culinary. </div>
<div><br>The Goodman Group is family-owned and has an entrepreneurial outlook, and was looking to change the direction of culinary operations to fit with their mission statement of enabling residents to achieve an optimum level of well-being. This means not simply providing residents with three meals a day, but actually improving their quality of life through nutrition. </div>
<h2 class="ms-rteElement-H2">The Transformation Begins…</h2>
<div>In early 2013, our Culinary Operations developed a new initiative, Food for Life, designed to enable us to transform the overall dining experience at our 33 communities. Our vision includes having residents experience the greatest health gains achievable through culinary means. Embracing culinary perspective and discipline as integral to providing excellent care is a relatively new concept. As a health care organization, we found that healthy food choices can favorably alter the course of health and disease, enhance the quality of life, and even reduce or eliminate the need for some medications. <br></div>
<div><br>In the past two years, we’ve taken on the opportunity of providing a wide variety of whole, minimally processed foods and maximizing nutritional value, flavor, and presentation. I’d call it a culinary revolution.</div>
<h2 class="ms-rteElement-H2">…And It Starts With The Chefs</h2>
<div>So how does this process, this shift in thought about menu development and food offerings begin? First and foremost, it begins with education. It begins with each and every chef and dining director at each property. As a former dean of culinary at the Culinary Institute of Michigan, I saw many students deciding to apply their skills and knowledge in the growing health care industry. </div>
<div><br>The health care industry will only be as strong as the people involved. We need more chefs with a passion for driving healthier, high-quality food options for our seniors. It is paramount that we also attract more culinary talent from other fields with food knowledge and experience to our industry. I think we can elevate the food operations across the country, but first we need the right people. </div>
<div><br>The Food for Life initiative relies not only on getting the right chefs into our kitchens, but training them on our 14 standards and ultimately working with them to develop menus and plating standards.</div>
<h2 class="ms-rteElement-H2">Go Healthy, But Make It Tasty</h2>
<div>To guide the recipe and menu options at our communities, we have developed and implemented 14 goals structured around offering more plant-based nutrition and doing away with pre-processed foods completely. Essentially, this means tackling the same challenges a new restaurant would bring, though in this case, the scope is regional. <br></div>
<div><br>With 33 properties extending from Washington to Florida, we also seek to customize our food offerings to address regional preferences specific to each area. We want to be sure residents feel empowered in their food choices, but also that we introduce them to new, healthy alternatives to classic favorites. </div>
<div><br>By taking their old favorites, things they grew up with, we look at the recipe and modify it to be a healthier version with all the flavor they love and crave. That’s where having a broad culinary arts background becomes essential—cutting the fat here, tweaking and modifying ingredients or seasonings—and it’s the part that makes a chef’s career in health care tremendously fulfilling.</div>
<div><br>At times, dishes the residents prefer and what is healthy for them are not the same thing, so we introduce new foods to both residents and their families through educational classes, workshops, and events. We offer menu and recipe ideas as samples and ask for feedback. The responses from families have been overwhelmingly positive. Families appreciate that each of our communities purchases local, in-season organic food through our vendor network and local growers and farmers.</div>
<h2 class="ms-rteElement-H2">A Good Presentation Stimulates Appetites</h2>
<div>Our standards for health care dining are parallel to those in the culinary field and restaurant industry. We strive to incorporate all the elements of a great plate, including texture, balance, color, flavors, taste, and aroma. </div>
<div><br>At times in a health care setting, medications and swallowing issues can make it unsafe or uncomfortable for a resident to be served a regular diet. Taking the culinary approach, we work with color, presentation, and the use of fresh herbs and spices to take special restricted diets from bland to appetizing. Everyone “eats with their eyes,” so the food has to look and taste appealing. </div>
<div><br>On modified diets, along with flavor, we like to keep the food’s texture. For someone on a special diet who was used to chewing and swallowing food, it can be difficult. We want to try to keep the dish as close to the real thing as possible to stimulate the appetite by putting out a high-quality meal. In our memory care units this is especially important, as caregivers help residents identify the dish and encourage eating and enjoyment. </div>
<div><br>Whether our residents live at independent, assisted, or skilled nursing facilities, all deserve nutritionally strong, high-quality food choices. </div>
<div><br>For many years, food has been considered secondary to excellent care, but it needs to become the first and foremost concern in every health care facility. Everything we’ve rolled out in our communities has led us to believe that this is the best option. </div>
<div><br><img src="/Issues/2014/PublishingImages/1214/ChefRob.jpg" class="ms-rtePosition-1" alt="" style="margin:5px 15px;" />Everything that comes from our kitchens is good for you. The Goodman Group has gone full force with the initiative, and the results have been quite miraculous. Bringing the “green culinary movement” into the heart of the kitchens of senior living and health care communities is a huge cultural shift. </div>
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<div><em>Chef Robert (Robb) White is national director of culinary operations, The Goodman Group, and recipient of a 2014 Cutting Edge Award from the American Culinary Federation.</em></div> | Organic, local, unprocessed, and sustainable are among the many well-known mantras of the Green and Farm-to-Table movements over the past decade. Yet, the cultural shift toward healthy foods has still left a large and growing portion of our population untouched—older adults in senior living and health care. | 2014-12-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/1214/ChefRob.jpg" style="BORDER:0px solid;" /> | By You, For You;Management | Column | 12 |
Seeking Solutions To Senior Isolation | https://www.providermagazine.com/Issues/2014/Pages/1214/Seeking-Solutions-To-Senior-Isolation.aspx | Seeking Solutions To Senior Isolation | <div>June Johnson lives alone in her home. It’s the home she and her husband built 40 years ago, and it’s where she’s most comfortable.</div>
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<div>June doesn’t drive anymore, and with all of her family in another state, she can no longer attend church services or community events. As she ages, June loses experiences that once were foundational in her life.</div>
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<div>The loss of meaningful connections to people and social events can cause depression, which has more serious health consequences in older adults than any other age group.</div>
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<div>But could technology connect June—and millions of people like her—once again to the things she loves the most? Could technology allow once-isolated seniors to attend a granddaughter’s recital, family reunions, church services, or book clubs?</div>
<h2 class="ms-rteElement-H2">Creating A Good Fit</h2>
<div>Many technologies already exist to virtually connect people around the globe. But for people who are not tech savvy, these technologies can be cumbersome and confusing. The technology also isn’t designed to meet the specific needs of people who deal with vision and hearing loss.<br><br></div>
<div>Innovation teams at Verizon Wireless and the Good Samaritan Society are working to repackage videoconferencing technology to make it easier for seniors to use. That might mean bigger screens, one-click access, and better sound quality. The program, still in the testing stage, is called Window to the World. In one test, a woman was able to connect virtually with the quilting group she hadn’t attended for several years because she did not want to leave her husband home alone.<br><br></div>
<div>“The ability to connect with others is crucial, especially as we age,” says Kelly Soyland, director of research and innovation at The Evangelical Lutheran Good Samaritan Society. “Today, 11.3 million Americans age 65 and older are living alone in their own homes.”</div>
<h2 class="ms-rteElement-H2">Challenges To Being At Home</h2>
<div>While it’s generally considered a good thing that seniors are able to stay in their familiar home and community surroundings, there are new challenges to seniors’ preference to be at home.<br><br></div>
<div>“They may become less mobile and unable to easily leave their home,” says Bruce Thalacker, senior pastor at South Canyon Lutheran Church in Rapid City, S. D., a third partner in the research. “Their friends often find themselves in the same situation. Family may live at a distance. And over time, seniors with limited mobility often become isolated from the world.”</div>
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<div>The three partners hope they’re creating a product that can help solve some of the challenges of senior isolation. </div>
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<div>For more information: Visit <a target="_blank" href="http://www.good-sam.com/vivo">www.good-sam.com/vivo</a> to follow Window to the World’s progress. <br><br><em>Kelly Horazdovsky is a communications consultant, writer, and editor for The Evangelical Lutheran Good Samaritan Society.</em></div>
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Innovation teams at Verizon Wireless and the Good Samaritan Society are working to repackage videoconferencing technology to make it easier for seniors to use. That might mean bigger screens, one-click access, and better sound quality. The program, still in the testing stage, is called Window to the World | 2014-12-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/1214/KellyHarazdovsky.jpg" style="BORDER:0px solid;" /> | By You, For You;Technology | Column | 12 |
Smart Shoppers Club Formed To Help Caregivers Save Some Money | https://www.providermagazine.com/Issues/2014/Pages/1214/Smart-Shoppers-Club-Formed-To-Help-Caregivers-Save-Some-Money.aspx | Smart Shoppers Club Formed To Help Caregivers Save Some Money | <div>“Meaningless activity corrodes the human spirit. The opportunity to do things that we find meaningful is essential to human health.” This is Principle Number 6 of the Eden Alternative, and the pursuit of meaningful activities that provide greater purpose in elders’ lives has been the focus of the Life Enrichment Team at Buckingham at Norwood in New Jersey. </div>
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<div><img width="297" height="222" src="/Issues/2014/PublishingImages/1214/coupons1.jpg" class="ms-rtePosition-2" alt="" style="margin:10px;" />Buckingham is an Eden Alternative-registered home and has been on a culture change journey since 2010. Elders play an integral part in planning their daily activities, programs and outings, and their daily menu. There is a cadre of volunteers who visit, teach, entertain, and comfort residents in order to combat those plagues of loneliness, helplessness, and boredom.</div>
<h2 class="ms-rteElement-H2">Wanting To Make A Difference</h2>
<div>But something was missing. The elders at Buckingham knew they needed to find deeper meaning and greater purposefulness in what they were doing. It wasn’t always about themselves. They wanted a way to give back to the community, in particular to the staff care partners who work around the clock providing the comfort and “worry-free” environment they live in. From that premise, the Smart Shoppers Club was born. </div>
<div><br>When elders move into a home, most goods and services are easily available, and no one has to worry about shopping or budgeting. The days of visits to the supermarket and shopping malls are more irregular and so is the satisfaction of finding a good bargain and saving a few dollars. </div>
<div><br>Buckingham’s elders decided to help their care partners save money at the supermarket, mall, or specialty stores by providing coupons to use when they shop. Signs were posted around the center asking families, visitors, and staff care partners to bring in newspapers, circulars, magazines, and coupons.</div>
<div><br>Smart shoppers comb through these pages seeking a variety of coupons for everyone’s shopping needs. Elders consult with care partners to learn what stores and items they use and need, and the coupon clipping begins.</div>
<h2 class="ms-rteElement-H2">Residents Go To Work</h2>
<div>Most Tuesdays (after the Sunday circulars), Buckingham elders are busy clipping, classifying, and organizing coupons to share with all. The coupon file is in a central location, easily accessible for staff care partners to sit and browse to find what they need.</div>
<div><br>In the several months since this initiative started, relationships have grown stronger as elders and care partners get to know each better by sharing their shopping preferences, experiences, and stories.</div>
<div><br>The elders are excited with the success of this project. They created a purposeful activity and have the satisfaction of making a difference for staff care partners. In return, the care partners know that they are appreciated and are able to save some of their hard-earned money. </div>
<div><br>The Smart Shoppers Club has “leveled the playing field” and is truly a partnership. The conversation has changed; it’s not just about what “I” need and want, now it’s about, “What do you need to buy for your family, and how can I help you?” That’s what caring and sharing is all about! </div>
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<div><em>Helaine Ledany, MPA, CNHA, FACHCA, is administrator of Buckingham at Norwood, a Windsor Healthcare Community in Northern New Jersey providing post-acute and long term care and services to 240 elders. She is president of the New Jersey Chapter of ACHCA (American College of Health Care Administrators). Ledany is on the board of the New Jersey Long Term Care Leaders Coalition and has been active for many years in the New Jersey Long Term Care Ethics Consortium. She may be reached at <a target="_blank" href="mailto:hledany@buckinghamcc.com">hledany@buckinghamcc.com</a> or (201) 768-6222.</em></div>
<div> </div> | Buckingham is an Eden Alternative-registered home and has been on a culture change journey since 2010. Elders play an integral part in planning their daily activities, programs and outings, and their daily menu. There is a cadre of volunteers who visit, teach, entertain, and comfort residents in order to combat those plagues of loneliness, helplessness, and boredom. | 2014-12-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/1214/coupon_t.jpg" style="BORDER:0px solid;" /> | By You, For You;Caregiving;Management | Column | 12 |
The Administrator’s Door | https://www.providermagazine.com/Issues/2014/Pages/1214/The-Administrator’s-Door.aspx | The Administrator’s Door | <br>There’s a little knock outside my door,<br>Oh, it’s a resident who has come once more<br>to ask me if she’s going home<br>she can’t leave her children there alone.<br>Yesterday she came to say<br>“Have you seen my mom or dad today?”<br>You see this lady is very old,<br>she’s confused and will again be told<br>“No ma’am your folks aren’t here right now”<br>she’ll cry and I’ll comfort her somehow, <br>Because for one brief moment it is clear<br>that her folks have passed and her home is here.<br>Her children are grown with lives of their own<br>but they knew mother couldn’t be left alone<br>so they brought her to our home for care<br>but they’re filled with guilt leaving mother there.<br>It’s my job to make her feel secure,<br>and safe and happy and reassure – <br>her family – that the staff is good<br>and we’ll care for her like they think we should.<br>So every night as I kneel and pray<br>I ask the Lord to guide my way.<br>To give me patience and to understand<br>that the residents need a gentle hand.<br>I ask for strength to endure<br>When I’m called upon to reassure<br>When the residents feel the need to talk<br>and to smile when I hear that little knock.<br><br><em><img width="117" height="141" src="/Issues/2014/PublishingImages/1214/poetry_Lantz.jpg" class="ms-rtePosition-1" alt="Kathy Lantz" style="margin:5px;" />My name is Kathy Lantz, and I am a regional vice president for Medicalodges, a long term care company based in Coffeyville, Kan. I have worked in health care for the past 30 years, starting out in occupational therapy, providing services to area nursing homes in my home town. It didn’t take long for me to realize that long term care was where I wanted to be, all the time—not just on a consulting basis. I returned to school to become credentialed as an administrator, and the rest is history!</em><br><br><em>Lantz can be reached at kllantz@medicalodges.com or (620) 988-0341.</em> | I ask for strength to endure
When I’m called upon to reassure
When the residents feel the need to talk
and to smile when I hear that little knock.
| 2014-12-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/1214/poetry_admin_lantz_t.jpg" style="BORDER:0px solid;" /> | By You, For You | Column | 12 |
The Antipsychotics Reduction Issue: Finding Solutions | https://www.providermagazine.com/Issues/2014/Pages/1214/The-Antipsychotics-Reduction-Issue-Finding-Solutions.aspx | The Antipsychotics Reduction Issue: Finding Solutions | <div>Culture change plays an important role in successful psychotropic reduction. This case study shares ways to reduce psychotropic use in a skilled nursing center and how reducing psychotropic use affects quality measures and outcomes.</div>
<h2 class="ms-rteElement-H2">Meet Cameron</h2>
<div>Let me start with a story. Meet Cameron. When he turned a year old, it was clear that something was not quite right. He was oversensitive to stimulation such as sun, touch, and noise. His speech was delayed, and he was not walking by the age of 18 months. By the time he was two, his behaviors included banging his head on the floor, being up at all hours, hitting out at others, and intolerance of various stimuli. </div>
<div>Now, what advice would you give me for handling Cam?<br></div>
<div><br>It was clear that Cam’s interaction with the outside world was different from the “normal” baseline, that his processing of stimulation was altered, that he was unable to make his wants and needs known through “normal” communication, and that he showed his frustration by screaming. </div>
<div><br>One wise expert, my mother, who is a speech therapist, counseled changing my approach to communicating with Cam—change his environment, give him a way to communicate his wants and needs, and allow him to have control in his environment, she said. In other words, accommodate him.</div>
<div><br>Now, when I asked for suggestions, would you have suggested putting an alarm on Cam to keep him in his seat or give him an antipsychotic to sedate him? Probably not, yet these are behaviors that some residents display on a daily basis, and these are our common responses to them.</div>
<h2 class="ms-rteElement-H2">Segue To Residents</h2>
<div>Culture change is essential to making necessary accommodations for residents who in the past might have simply been medicated. </div>
<div><br>To understand that our residents may not see the world the way they used to requires making changes in care delivery to accommodate this different perception without relying on psychotropic drugs.</div>
<div><br>In order to be effective and positively impact outcomes, however, culture change must permeate every level of practice in a skilled nursing center. It starts with strong, committed leadership and builds with thorough staff awareness of the issues. The entire center team must buy into the idea that the old ways of doing things (alarms, psychotropic drugs) are no longer acceptable. </div>
<div><br>This takes thorough education; every staff member must understand why reducing psychotropics is important to the well-being of their residents—and how to achieve it. Each employee must buy into the cause and feel that they are contributing to the success of the initiative.</div>
<div><br>Employees need tools and skills to treat and manage behaviors without resorting to drugs. As we have found, these do not have to be costly. Emotional support and positive reinforcement from a center’s leaders are important. Transparency must be the rule: Let people know what is working and what’s not. Frontline staff have an important role, as do the administrative and support staff. Huddles and early warning tools such as the INTERACT system for documenting patient condition when transferring from one health setting to another can help.</div>
<h2 class="ms-rteElement-H2">The Search For Alternatives</h2>
<div>Environmental changes, such as eliminating overhead paging and the constant, overstimulation of noise from televisions and radio, are important. Try to keep lighting that matches the natural day; turn on lights in the afternoon during winter. Limit staff chatter outside resident rooms. Consistent assignments help residents to feel a sense of control over their setting while ensuring that caregivers know individual routines and needs. A roommate change may also be in order. </div>
<div><br>The medical chart for each resident receiving psychotropics must be reviewed. Does everyone have a diagnosis that supports the drug used? Is there a cluster of patients in the building, or do certain staff always ask for a psychotropic? When was the drug started, and has the issue that prompted the order been long resolved? </div>
<div><br>These are all good questions to ask. Remember, the CASPER minimum data set report indicates who is on a psychotropic without exclusionary diagnosis. </div>
<div><br>When reducing antipsychotics, start with low-hanging fruit. Check PRNs with infrequent use and limit or eliminate Compazine. Review admissions for antipsychotic use. Ask that antipsychotics without proper diagnosis begun in the hospital be discontinued prior to admission. Do not continue antipsychotics begun as sleep aids in the acute care setting.</div>
<h2 class="ms-rteElement-H2">Antipsychotics High On List </h2>
<div>Don’t forget the basics of a simple head-to-toe exam. Is there a new skin issue causing pain? Is immobility causing discomfort? Is the patient hungry, thirsty, bored, or overstimulated? Do patients have their glasses or hearing aids? </div>
<div><br>Before any antipsychotic drug is given, ask one question: What nonpharmacologic interventions were tried? You can be certain that this is the first question a surveyor will ask. If the answer is none, there should be no antipsychotic. Some of the most cited tags when discussing psychotropic medications include F309 (Dementia Care), F248 (Activities), F329 (Unnecessary Drugs), and F241 (Dignity Concerns). The state survey is the No. 1 factor in the Centers for Medicare & Medicaid Services Five-Star report, so just one citation can be a very big deal. </div>
<div><br>Psychotropic drug rates are reported via the CASPER report. The CASPER then populates the clinical star of the Five-Star rating. The clinical star is second in importance only to the survey star and can assist in improving a Five-Star standing. </div>
<h2 class="ms-rteElement-H2">The Bottom Line</h2>
<div>But improved outcomes are the real winner here. The data are clear: An initiative to reduce antipsychotic drugs has a clear link to overall quality. In centers that were early adaptors to culture change, quality measures improved dramatically and quickly. </div>
<div><br>In summary, why would providers treat elderly patients differently than young patients? If it is unacceptable to use psychotropics as a first line of treatment for children, why would it be acceptable to do so with elders—given that other approaches are available? By looking at patients in a skilled setting through the lens of culture change that promotes accommodations, it is possible to produce better outcomes. </div>
<div>This isn’t to say that it is easy, it is not—but providers have an ethical responsibility to do the right thing at the right time, every time. </div>
<div><br>As for Cameron? He was eventually diagnosed with pervasive developmental disorder and Asperger’s autism. Today, he is a happy, healthy, and communicative 8th grader who has learned to accommodate the world around him. </div>
<div><br><img width="121" height="152" src="/Issues/2014/PublishingImages/1214/KateLynchSherer.jpg" class="ms-rtePosition-1" alt="" style="margin:5px 15px;" />As with Cameron, making appropriate accommodations within your center will ensure that every resident is functioning at an optimal level while improving overall center outcomes. </div>
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<div><em>Kathleen Lynch Scherer, RN, BSN, is director of nursing services with Exeter Center - Genesis HealthCare, in Exeter, N.H.</em></div> | In order to be effective and positively impact outcomes, however, culture change must permeate every level of practice in a skilled nursing center. It starts with strong, committed leadership and builds with thorough staff awareness of the issues. The entire center team must buy into the idea that the old ways of doing things (alarms, psychotropic drugs) are no longer acceptable. | 2014-12-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/1214/caregiving_antipsychotic_t.jpg" style="BORDER:0px solid;" /> | Caregiving;By You, For You | Column | 12 |
The Benefits Of Purposeful Rounds | https://www.providermagazine.com/Issues/2014/Pages/1214/The-Benefits-Of-Purposeful-Rounds.aspx | The Benefits Of Purposeful Rounds | <div>At nursing homes around the country, the risk of residents falling and injuring themselves is a daily concern for staff. Special programs are often implemented as a result, but at EPOCH Senior Healthcare of Harwich, Maine, we’re learning that sometimes the simplest solution is the most effective. </div>
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<div>Since July 2014, we have been taking an all-hands-on-deck approach to reduce the risk of falls through special, purposeful rounds that combine checking on resident safety with involved social interaction. Every shift, all staff members—not just our nurse assistants—spend 30 minutes making these rounds, which go beyond quick in-and-out check-ups.</div>
<h2 class="ms-rteElement-H2">Conducting The Rounds</h2>
<div>During the rounds, our staff inquire about the resident’s comfort and evaluate the resident’s surroundings for safety, ensuring all personal items or items in use by the resident are in reach. <br><br></div>
<div>The attention-to-detail assessments are undertaken to prevent a scenario in which a resident falls while attempting to retrieve, for example, a book or TV remote that has fallen out of hand’s reach.<br><br></div>
<div>Staff members also encourage residents to spend time in supervised areas, and, perhaps most appreciated, they dedicate valuable face-to-face time with our residents.<br><br></div>
<div>Because all staff members make one of these 30-minute rounds each shift, residents are receiving more face time than ever, greatly improving their morale and feeling of security. But it’s not just our residents that appreciate the rounds—our nurse assistants are grateful for the support of the other staff, creating a positive team environment for all.<br><br></div>
<div>Since implementing the purposeful rounds as a part of our fall prevention program, we have reduced falls in our long term care units by 50 percent. In one unit alone, falls decreased from 13 in August to only two in September. <br></div>
<h2 class="ms-rteElement-H2">Communication Improved</h2>
<div>Purposeful rounds are successful in part because they take a proactive approach to ensuring resident satisfaction and safety and, as a result, improve resident and staff communication. The rounds also show our residents that we are available to them and concerned with their comfort and how they are feeling each day. <br><br></div>
<div>After only a few weeks of implementing the purposeful rounds at Harwich, multiple residents individually commented on the new practice, while some even thought we had increased staffing levels because of the improved face time.<br><br></div>
<div>The rounds have subsequently been mentioned at resident council meetings, and residents have made a point to let us know that the rounds have made them feel safe, more secure in their daily routine, and more appreciated by staff. In return, the increased morale amongst many of our residents positively affects the morale of our staff.<br><br></div>
<div>The program was spearheaded by our Director of Nursing (DON) Paula Benetti, RN, who has implemented purposeful rounds at other facilities in the past to great success. Having worked with Paula before, we knew there was no question that we should try the program at Harwich.<br></div>
<div><br><span><img width="114" height="143" alt="Lori Anderson, RN" class="ms-rtePosition-1" src="/Issues/2014/PublishingImages/1214/LoriAnderson.jpg" style="margin:5px 15px;" /></span>While successfully implementing the rounds required commitment and collaboration from our staff members who already tirelessly perform their jobs, being able to see the results and how positively residents have responded has emphasized for everyone the importance of providing regular, purposeful visits. <br><br><em>Lori Anderson, RN, is administrator of EPOCH Senior Healthcare of Harwich, Mass. She has spent the past 30 years working in the greater Boston area in both acute and long term care and served as a DON for eight years. She earned her administrator’s license in 2007.</em></div> | At nursing homes around the country, the risk of residents falling and injuring themselves is a daily concern for staff. Special programs are often implemented as a result, but at EPOCH Senior Healthcare of Harwich, Maine, we’re learning that sometimes the simplest solution is the most effective. | 2014-12-01T05:00:00Z | <img alt="" height="150" src="/Issues/2014/PublishingImages/1214/LoriAnderson.jpg" width="150" style="BORDER:0px solid;" /> | By You, For You;Caregiving | Column | 12 |
The Best Of Long Term Care And Its Challenges | https://www.providermagazine.com/Issues/2014/Pages/1214/The-Best-Of-Long-Term-Care-And-Its-Challenges.aspx | The Best Of Long Term Care And Its Challenges | <div>As administrators of two long term care facilities, Executive Directors Hal Garland and DeAnn Walters have successfully managed CMS Five-Star buildings—Golden LivingCenter - Greenville in Greenville, N.C., and Golden LivingCenter - Fresno in Fresno, Calif. They know that one of the important parts of their job is to build relationships.</div>
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<div>When asked about the challenges of long term care and why they work in this field, they had similar responses revolving around building relationships and how to keep them strong in a long term care setting. </div>
<h3 class="ms-rteElement-H3 ms-rteForeColor-1">What gets you excited about going to work? </h3>
<div><span class="ms-rteForeColor-9">DeAnn Walters: </span>This is the best job that anyone can have, so who would not be excited about coming in each day. It is definitely the people that keep this career exciting. The residents with their vast and colorful history, the staff with their challenges and dreams, and they all come together under one roof at GLC - Fresno. It is a business, a business about caring for people that makes it exceptional.</div>
<div><span class="ms-rteForeColor-9">Hal Garland: </span>There is never a dull moment from the time I come in to the time I leave. We have 35 admissions/discharges each week, and we get to meet the new residents and families. We always wish the discharged residents well and miss them. <br></div>
<h3 class="ms-rteElement-H3 ms-rteForeColor-1"><span><img width="304" height="202" class="ms-rtePosition-1" src="/Issues/2014/PublishingImages/1214/mgmt_2.jpg" alt="" style="margin:10px;" /></span>What is one thing you have learned about this work?</h3>
<div><span class="ms-rteForeColor-9">Garland:</span> It’s all about personal relationships and how to keep them strong, whether the relationship is with a staff member, resident, patient, patient’s family member, physician, referral source, or corporate employee. It’s personal, and it is more personal than ever with cell phones and technology to connect us 24/7. </div>
<div><span class="ms-rteForeColor-9">Walters:</span> There is never one thing to learn about this work. Each day has new experiences, new challenges, and so many new rewards. </div>
<h3 class="ms-rteElement-H3 ms-rteForeColor-1">How do you inspire and motivate your staff?</h3>
<div><span class="ms-rteForeColor-9">Walters:</span> I believe our teams are motivated to provide excellence even if I am not present. For me, I feel that I add a certain amount of focus. As the leader, I help them decide upon and begin the journey to a specified goal. Through this process I keep the team focused and help brainstorm ways to overcome challenges. I want to ensure that they are recognized for their hard work and accomplishments achieved. </div>
<div><span class="ms-rteForeColor-9">Garland:</span> My goal is to raise the team’s energy and make things as fun and enjoyable as possible. Recognition goes a long way to increase energy, morale, and teamwork. We surprise people with awards, such as the monthly top smiler, Golden Star, and associate of the month. </div>
<h3 class="ms-rteElement-H3 ms-rteForeColor-1"><img class="ms-rtePosition-2" src="/Issues/2014/PublishingImages/1214/mgmt_3.jpg" alt="" style="margin:5px;" />Name a challen<span></span>ge at your LivingCenter.</h3>
<div><span class="ms-rteForeColor-9">Garland: </span>The challenge was in creating short-term neighborhoods and long-term neighborhoods within the LivingCenter where short-term residents who did not make the necessary progress were moved to long-term neighborhoods. These residents did not want to move because they enjoyed being with short-term patients. We held open discussions with the residents and families, highlighting the advantages of moving to the long-term neighborhood. These advantages included roommate compatibility, fewer admissions and discharges, and easier resident care routines. Once their concerns were addressed, they were happy to move, and staff worked to ensure their comfort and care needs were met. </div>
<div><span class="ms-rteForeColor-9">Walters:</span> One challenge for our team was to move our LivingCenter from a Four-Star CMS rating to a Five-Star CMS rating. The team reviewed our quality measures resident by resident to see how we could affect them positively. We already had a great survey outcome, and our staffing exceeded requirements, so for us to move up in our rating, we looked at individual experience and quality outcomes. Through process improvement and root cause analysis, the team began to make individualized changes that improved our patient experience and outcomes. It took well over a half of the year, but the outcomes improved, and in that time, the LivingCenter achieved a Five-Star rating. <br><br><em><img class="ms-rtePosition-1" src="/Issues/2014/PublishingImages/1214/DeAnnWalters_t.jpg" alt="" style="margin:5px 10px;" />DeAnn Walters, executive director, has worked for Golden Living as a licensed nursing home administrator since 1998. She has also worked at Golden LivingCenter - Country View, also in Fresno, and Golden LivingCenter - Clovis. She has held the position at Golden LivingCenter - Fresno since January 2012. She served on the Board of Senior and Master Examiners for the American Health Care Association/National Center for Assisted Living National Quality Awards in 2012 and 2013. Hal Garland has worked for Golden Living for 32 years and has served as executive director for Golden LivingCenter - Greenville since 1988. He is a member of the Exam Writing Committee with the National Association of Boards and a member of the East Carolina University Masters of Public Health Program Community Advisory Board.</em></div>
| As administrators of two long term care facilities, Executive Directors Hal Garland and DeAnn Walters have successfully managed CMS Five-Star buildings—Golden LivingCenter - Greenville in Greenville, N.C., and Golden LivingCenter - Fresno in Fresno, Calif. They know that one of the important parts of their job is to build relationships. | 2014-12-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/1214/DeAnnWalters_t.jpg" style="BORDER:0px solid;" /> | By You, For You;Management | Column | 12 |
The Case For Radical Hospitality | https://www.providermagazine.com/Issues/2014/Pages/1214/The-Case-For-Radical-Hospitality.aspx | The Case For Radical Hospitality | <div>Radical hospitality is what we extend and show to everyone who comes through the doors of our care center. Let me give you a bit of history to show you how we came to this idea, what it means, and how it has changed us. </div>
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<div>Back in October 2003, I started my journey here at Maravilla Care Center. Under different management at the time, we were a traditional long term care facility. The people in our care were called “patients” or “residents,” and they lived by our rules. Breakfast was served at 7:30 a.m.—we never asked whether you had been up since 4:30 a.m., or whether you were even a “breakfast person.” Showers were scheduled and done on time, with no exceptions. </div>
<h2 class="ms-rteElement-H2">Program Inspires Change</h2>
<div>This was the typical setting when I started my health care career in 1987. We didn’t know at the time how much things were going to change. </div>
<div><br>In 2004-2005, our facility was very close to being shut down. Instead, through a miracle of circumstances, we were chosen to spearhead a pilot program called PCC (person-centered care), in which people would be cared for as individuals, rather than as a group.</div>
<div><br>My co-workers and I were instantly sold on the idea. Because our director of nursing at the time was overwhelmed with excitement and zeal for this new program, we were given the tools needed to make this program a success. </div>
<div><br>As part of that transition, we began to refer to those in our care as our “neighbors.” It was an important change. In today’s society, many have lost a huge part of our human compassion and have become desensitized to the core values we were taught as children: namely, to take care of our loved ones. </div>
<div><br>So many of us have family members in long term care (both of my grandparents lived out their lives there). Let me ask you, what certified nurse assistant (CNA) wouldn’t rather spend more time with neighbors and families?</div>
<h2 class="ms-rteElement-H2">Philosophy Sheds New Light</h2>
<div>Clearly this new PCC program was the change we needed, giving us a new focus and goal: to address the needs and preserve the dignity of our neighbors and to make this “transition of seasons” smooth for them. We decided to take the concept and kick it up a notch, by working even harder to show compassion and to be intentional and welcoming in our attitudes. </div>
<h2 class="ms-rteElement-H2">It Works</h2>
<div>Before long, by transforming our building into a family atmosphere, our Maravilla team saw a difference—not only in our neighbor’s demeanor but in staff as well.</div>
<div><br>In 2007, our family was delighted to receive our new Administrator Jeff, who in a very short period of time took this PCC concept in a new direction and to exceedingly higher heights. </div>
<div><img width="176" height="178" src="/Issues/2014/PublishingImages/0114/WendellAnderson.jpg" class="ms-rtePosition-2" alt="Wendell Anderson" style="margin:5px;" /><br>Now, our mission is, “Creating Life in Harmony with our Neighbors.” That’s radical hospitality! </div>
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<em>Wendell Anderson, CNA, is a good neighbor to the people who live in the Maravilla Care Center, Phoenix. Anderson, who has worked in long term care for nearly 30 years, was inspired to join the profession after seeing the excellent care given to his grandfather in Dallas. </em><a href="/Issues/2014/Pages/0114/Rising-Stars-In-Long-Term-And-Post-Acute-Care.aspx" target="_blank"><em>He was named one of Provider’s 2014 </em><em>20 To Watch in the profession.</em></a><br> | Radical hospitality is what we extend and show to everyone who comes through the doors of our care center. Let me give you a bit of history to show you how we came to this idea, what it means, and how it has changed us. | 2014-12-01T05:00:00Z | <img alt="" height="150" src="/Issues/2014/PublishingImages/0114/WendellAnderson.jpg" width="150" style="BORDER:0px solid;" /> | Management;By You, For You | Column | 12 |
The Sadness Before The Loss | https://www.providermagazine.com/Issues/2014/Pages/1214/The-Sadness-Before-The-Loss.aspx | The Sadness Before The Loss | <p>Picture the strongest person you’ve ever known. Someone who could do anything, fix anything, always remind you to change the oil in your car…Mr. Reliable. You love this person deeply, as he is your father. Now picture this person confined to a recliner 22 hours a day, struggling to breathe, unable to make a short trip to the kitchen table without becoming winded. </p>
<p>Dad now has trouble operating the remote control to the TV and forgets all but bits and pieces of conversations. You wonder why you cry after each visit and cherish those goodbye hugs more every time. You may be experiencing anticipatory grief.</p>
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<h2 class="ms-rteElement-H2">A Different Kind Of Grief</h2>
<div>Anticipatory grief is the emotional pain felt in advance of a loved one’s death. It is experiencing that person’s loss while he is still present. Anticipatory grief is very real grief. It can feel just as intense as grief felt after the loss of a loved one. <br></div>
<div><br>Those who have anticipatory grief often feel guilty and lonely. Guilty, because although they love that person deeply, they sometimes wish for the suffering to just be over, and lonely, because they can’t or won’t express those thoughts and feelings to others for fear of rejection and judgment. </div>
<div><br>Loneliness can also occur as the dying person draws inward and away from loved ones in anticipation of death. Death from chronic illness is like losing someone twice.</div>
<div><br>The dying can suffer from anticipatory grief as well, both from others withdrawing themselves from the painful process, as well as from grieving their own losses like things they can no longer do, life events they will miss, and a growing dependence on others. </div>
<h2 class="ms-rteElement-H2">Refrain From Judging </h2>
<div>A person who is dying can become lonely as well when friends and loved ones find the process too painful and pull away. Sometimes Dad just sits in his chair with his hearing aid off, staring out the window. He feels so far away, and yet he’s right there. How often are family and friends of chronically ill or dying residents subconsciously judged by others, even professionals, for “abandoning” their loved one, not visiting or calling enough, not staying long enough, not acting as we think they should? <br><br></div>
<div>Anticipatory grief can be hard for others to understand. After all, the individual is still here. Until you have experienced it, anticipatory grief can be easily overlooked or dismissed. It is important for professionals to help friends and family understand that their feelings are normal and understandable, and that they don’t need to keep them bottled up. Encourage them to talk to others, perhaps find a support group or even a counselor to share these feelings with.</div>
<div><br>Caregivers and loved ones also need to be encouraged to take time for themselves. It is critically important that they fill their own “bucket,” or eventually they will have nothing left to give.</div>
<h2 class="ms-rteElement-H2">When Hospice Can Help</h2>
<div>Professionals need to educate families about hospice care. They may be resistant at first, torn between hope that their loved one will get better and feeling like they are giving up, but keep trying, gently. Hospice can provide services as well as emotional support to all parties.</div>
<div><br>Hospice has been a true blessing for my family and my father. My mother has a wonderful support network of friends, family, and hospice, but she still struggles with anticipatory grief. She is losing her husband of 53 years slowly, bit by bit. She feels guilty every recertification period, as she wants him to be “better,” which means being discharged, and overwhelmed at the same time at the thought of caring for him without hospice care.</div>
<div><br>Sometimes, when I see my Dad dozing in his recliner while my Mom looks at him with a pained expression on her face, I wish everyone’s suffering was over. But then I think of the good times and remember there is a time to every purpose under heaven. “Grief is not a sign of weakness, nor a loss of faith, it is the price of love” (<a href="http://www.familyshare.com/" target="_blank">www.familyshare.com</a>). <br><br><em>Deborah Veley has spent her career in health care, with 10 years of it in long term care. She is now executive director of the Ohio Board of Executives of Long Term Services & Supports. She holds an MSW and an MBA and is a Licensed Nursing Home Administrator, a Licensed Independent Social Worker, and a Certified Executive in Assisted Living. Veley can be reached at <a target="_blank" href="mailto:dveley@neo.rr.com">dveley@neo.rr.com</a> or (937) 532-5084.</em><br><br></div>
<p></p> | Picture the strongest person you’ve ever known. Someone who could do anything, fix anything, always remind you to change the oil in your car…Mr. Reliable. You love this person deeply, as he is your father. Now picture this person confined to a recliner 22 hours a day, struggling to breathe, unable to make a short trip to the kitchen table without becoming winded. | 2014-12-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/1214/grief_t.jpg" style="BORDER:0px solid;" /> | By You, For You;Caregiving;Management | Column | 12 |
The Winters Of My Life | https://www.providermagazine.com/Issues/2014/Pages/1214/The-Winters-Of-My-Life.aspx | The Winters Of My Life | THE WINTERS OF MY LIFE<br><br>It is winter.<br>Trees are stripped and bare.<br>Now I can see through the woods tracks of deer and rabbit on the new fallen snow.<br>Trees create shadows on the glistening whiteness as far as my eyes can see.<br>I discover beauty not glimpsed before.<br><br>I am aware of the winters in my life:<br>Barren, empty, exposed uncluttered a stripped and naked spirit.<br><br>But also a chance to see new spaces contemplate realities unnoticed before.<br>Possibilities discovered vision stretched, deepened.<br>Understandings clarified, broadened.<br>New loveliness perceived for the first time.<br><em><img width="136" height="136" src="/Issues/2014/PublishingImages/1214/poetry_Bonneprise.jpg" alt="Sr. Rita Bonnerprise" class="ms-rtePosition-2" style="margin:5px;" /><br>Rita Bonneprise is a Sister of St. Joseph. She lives at Villa St. Vincent in Crookston, Minn., but has ministered in other places in Minnesota, Wisconsin, North Dakota, and New York. Most of her ministry years have been in teaching, school administration, adult religious education, prayer, and spirituality. Sr. Rita also counseled adults in the Hmong community, at drug and alcohol centers, and to prison parolees. Those she has served have inspired her works. Her book, “New Horizons Into Midlife and Beyond,” was made possible with a gift from Benedictine Health System’s Making Dreams Come True Program and subsequently sold out. </em><br><br> | It is winter.
Trees are stripped and bare.
Now I can see through the woods
tracks of deer and rabbit on the new fallen snow.
| 2014-12-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/1214/poetry_winter_Bonneprise.jpg" style="BORDER:0px solid;" /> | By You, For You | Column | 12 |
This Is What We Do, This Is Who We Are | https://www.providermagazine.com/Issues/2014/Pages/1214/This-Is-What-We-Do-This-Is-Who-We-Are.aspx | This Is What We Do, This Is Who We Are | <div>Celina Manor is a skilled nursing facility located in the small town of Celina, Ohio. This is a typical farm community where everyone knows somebody and somebody knows everybody. It’s a tight-knit community, and people are always willing to lend a hand. One of our families had a special place in the hearts of our community.<br><br></div>
<div>Imogene Stott, we call her Pat, was devastated when she realized she could no longer care for her husband at home. Ted had been in and out of the hospital and was receiving therapy at Celina Manor. But, unfortunately, he was at the point that he could no longer live in their home. </div>
<h2 class="ms-rteElement-H2">A Love Story</h2>
<div>Pat and Ted were so in love, and it showed. After he moved into Celina Manor as a permanent resident, they sat in the lounge holding hands and sharing stories with the staff daily. Pat never said good-bye without a smile and kiss from Ted. <br><br></div>
<div>After some time, Ted’s condition began to deteriorate and his memory declined. However, he knew who his wife was and was able to express to her that she was the love of his life. </div>
<div><br>Pat was spending every waking minute at Celina Manor to be with him. Soon, she couldn’t find it in herself to say good-bye at the end of the day.</div>
<div><br>Meanwhile, the staff at Celina Manor began to notice changes in Pat: weight loss, confusion, tiredness. </div>
<div>We told Pat and her family how worried we were for her, and we wanted to make sure she was being taken care of. </div>
<div><br>After several months, the family called to discuss the likelihood of Pat living with her husband at Celina Manor. She no longer wanted to live without being by her husband. Pat knew she needed help and finally said, “It’s time. I’m ready to move in.” </div>
<h2 class="ms-rteElement-H2">The Difficult Decision</h2>
<div>It was very hard for her, but Pat finally had to admit to herself and her family that she was ready for this change. Friends and family supported and assisted with her move, and we worked hard to set up a room where she and Ted could be together again, housing the things closest to their hearts. </div>
<div><br>Pat and Ted were thriving. They enjoyed being together, and they enjoyed the company of those around them. Pat and Ted were easily becoming part of the Celina Manor family. </div>
<h2 class="ms-rteElement-H2">Connecting With Their Son</h2>
<div>Then something else began to weigh on Pat’s mind. Pat and Ted’s son George suffers from ALS (Lou Gehrig’s disease). Pat knew that with Ted’s decline and George’s illness, Ted would never see his son again, and her visits would be even fewer. <br><br></div>
<div>George and his wife, Linda, had lived in Celina for many years, owned two businesses, and were loved in the community. After his diagnosis, they had chosen to move closer to their own children in Tennessee. </div>
<div>As tough as it was to be apart, this is a close family relying on many telephone conversations to stay in touch. But as George and Ted’s diseases progressed, travel was not an option anymore, and communication was more difficult.</div>
<h2 class="ms-rteElement-H2">How Can We Help?</h2>
<div>We began brainstorming on a way to bring them together again. Celina Manor’s Activity Director Yvonne Miller discovered a way to connect Pat and Ted with their son George and daughter-in-law Linda, so they could see and hear one another as if they were visiting Tennessee. And there was no better time than on Christmas Eve. Yvonne had a plan. Nobody really knew what was going on, and especially not Pat. <br><br></div>
<div>Phone calls were made, and the time finally came. Pat was told to grab her walker and head to the chapel. Ted would be waiting for her there. Both were placed in front of the computer screen. Knowing how we are, Pat asked inquisitively, “What in the world is going on? What are you guys up to?” What she didn’t know was that in a few minutes she was going to be the happiest women in the world.<br><br></div>
<div>We asked Pat if she had ever heard of Skype. “What are you talking about?” she asked. We explained Skype was a technology tool you could use to communicate with people far away. She said, “What will they come up with next?” <br><br></div>
<div>Then, we asked her the question that would fill the emptiness in her heart and change all of us forever. “Would you like to talk to George?” The look on her face was priceless.<br><br></div>
<div>As she wiped the tears from her face, there was George with his wife Linda on the screen. Pat’s hand reached out to the screen to touch him as she cried, “Oh George, it’s you. Ted, do you see George and Linda?” Ted was smiling with tears in his eyes. It was a defining moment: Father, mother, and son, who could no longer be together, were reunited once again. </div>
<h2 class="ms-rteElement-H2">This Is Our Purpose</h2>
<div>Who possibly could have known that something that seems so ordinary to all of us could create such a defining moment in the lives of this family? With the help of a little technology, our compassionate staff was at its best, and we witnessed true love. </div>
<div><br>Pat and Ted were able to see George and be touched in a way that is unimaginable to most. True joy was brought to us all!</div>
<div><br>Ted has since passed away, and Pat has moved many miles away to be with her children and grandchildren. Just recently, the staff at Celina Manor’s Care Community supported ALS in honor of George by donating and participating in the Ice Bucket Challenge. Viewing the support on social media, Pat recently contacted us. She wanted to thank us for the support and love we had shown to her family with the dedication to her son, George. </div>
<div><br>On Sept. 30, 2014, we received word that George Stott had passed away a day earlier at his home in Knoxville, Tenn. Pat, George’s wife Linda, and their children were all at his bedside. A memorial was held in Celina, Ohio, for all the people who were impacted by the Stott family to have the opportunity to say good-bye. Pat made her way from Tennessee to visit us all again. </div>
<div><br>Although the circumstances were not what we had hoped to bring us together again, the smiles, tears, and friendships have all remained the same. Pat always says how we made her and Ted feel like the queen and king—little does she know the impact she has made on all of us. </div>
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<div><em>Stacy Beougher is director of customer relations at Celina Manor in Celina, Ohio. She can be reached at (419) 586-6645.</em></div> | Celina Manor is a skilled nursing facility located in the small town of Celina, Ohio. This is a typical farm community where everyone knows somebody and somebody knows everybody. It’s a tight-knit community, and people are always willing to lend a hand. One of our families had a special place in the hearts of our community. | 2014-12-01T05:00:00Z | <img alt="" src="/Issues/2014/PublishingImages/1214/whatwedo.jpg" style="BORDER:0px solid;" /> | By You, For You;Management | Column | 12 |