Independent Tray Service: A Program To Enhance Meals | https://www.providermagazine.com/Issues/2015/November/Pages/Independent-Tray-Service-A-Program-To-Enhance-Meals.aspx | Independent Tray Service: A Program To Enhance Meals | <div> </div>
<div><img width="212" height="246" src="/Issues/2015/November/PublishingImages/caregiving.jpg" class="ms-rteImage-2 ms-rtePosition-1" alt="" style="margin:10px;" /><br>In society, the consumption of a meal (“breaking bread”) is closely linked to holiday observance, life cycle celebrations, visits with friends and family, as well as business meetings. In fact, consuming a meal is a significant experience, be it a special occasion or a thrice daily occurrence to satisfy hunger and provide nutrition.</div>
<div> </div>
<div>In the nursing care center, it is often the defining experience of morning, afternoon, and evening each day. Residents look forward to their mealtimes, and their satisfaction is a direct result of how well providers meet their expectations and preferences, as well as the overall quality of their mealtime experience.</div>
<div>By recognizing the impact that mealtimes have on residents, dining service teams can directly influence and contribute to residents’ health and well-being.</div>
<h2 class="ms-rteElement-H2">Malnutrition And Dehydration</h2>
<div>Dysphagia affects hundreds of thousands of seniors, dealing a blow to their independence and thwarting attempts to retain a semblance of normalcy. Dysphagia’s dangerous byproducts—malnutrition, dehydration, and asphyxia—threaten safety and health.<br><br></div>
<div>Research confirms that residents with swallowing disorders are at a high risk for consuming less than adequate nourishment and fluid.Amsterdam Nursing Home, a 409-resident facility located in New York City, conducted an eight-week study of 16 residents with dysphagia. In a four-week assessment period, the staff observed that residents tried to open packages rather than wait for assistance, drank thin beverages before they were thickened, or refused them altogether after watching them be thickened.<br><br></div>
<div>Based on these observations, the dining services team modified how residents were served and measured corresponding intake. In the four-week study, the team sought to: <br><ul><li>Increase fluid intake of residents with swallowing difficulties; </li>
<li>Restore resident dignity, quality of life, and desire to enjoy mealtime; and</li>
<li>Re-establish a personal level of independence during meal service. </li></ul></div>
<div>Changes to the prepared food, drink, and tray presentation included:</div>
<div><ul><li>Serving beverages ready-to-drink, using a stable prethickened water or juice as the base of each recipe, which eliminated the need to thicken liquids in front of the residents.</li>
<li>Pouring all beverages below the top of the cup, for example, 4 oz. of juice in a 7 oz. cup, to minimize spillage from shaking hands, thereby boosting the confidence to self-serve.</li>
<li>Serving prethickened ready-to-eat soups and a variety of flavored broths prepared with a honey consistency-thickened water.</li></ul></div>
<div>These relatively simple changes delivered significant improvements in multiple areas, including increased independence while eating—measured by fewer requests for help during each meal—a 13 percent increase in fluid intake, and a 23 percent increase in caloric consumption at mealtimes.<br></div>
<div>Further, the team began offering a variety of prethickened beverage flavors in each unit, served with snacks at the bedside and when taking medications, delivering a 44 percent increase in hydration throughout the day.<br><br></div>
<div>Staff members noted significant improvements in consumption after the switch to prethickened water and flavored beverages.<br><br></div>
<div>Residents who required assistance no longer needed to be coaxed or encouraged at each sip, while other more independent residents were able to self-feed more easily and safely.</div>
<h2 class="ms-rteElement-H2">The Icing On The Cake</h2>
<div>The study also measured the costs associated with purchasing and using prethickened water and juices and the staffing cost associated with premeasuring liquids into cups and creating the resident-friendly tray.</div>
<div>In total, Amsterdam realized an average of 40 percent dollar savings, or approximately $1,000 per resident per year. However, the popularity of the new beverages and corresponding increase in product usage will likely shift long-term average savings to approximately 30 percent, or $767 per resident per year, staff noted.<br><br></div>
<div>The health and financial gains were matched by the emotional benefits observed by staff. Residents commented positively about the flavors as well as their ability to serve themselves. For those unable to speak, staff noted their improved moods and interest in eating. <br><br></div>
<div>Based on the findings of the 16-person study, all 50 residents with dysphagia at Amsterdam now receive prethickened beverages on the independent tray model and in-unit beverage offerings.<br><br></div>
<div>Ina Garten, also known as The Barefoot Contessa on television, has said, “Food is not about impressing people. It’s about making them feel comfortable.” This is good advice for long term care dining service teams everywhere—to remember seniors may struggle with hand dexterity or swallowing, yet they absolutely should still find dining a safe and enjoyable experience. <br><br><em>Howard Rosenberg is director of dining services at the Amsterdam Nursing Home in New York City. </em></div>
<div> </div> | Dysphagia affects hundreds of thousands of seniors, dealing a blow to their independence and thwarting attempts to retain a semblance of normalcy. Dysphagia’s dangerous byproducts—malnutrition, dehydration, and asphyxia—threaten safety and health. | 2015-11-01T04:00:00Z | <img alt="" src="/Issues/2015/November/PublishingImages/caregiving_t.jpg" style="BORDER:0px solid;" /> | Caregiving;Management | Column |
What To Look For In A Turnaround Property | https://www.providermagazine.com/Issues/2015/November/Pages/What-To-Look-For-In-A-Turnaround-Property.aspx | What To Look For In A Turnaround Property | <div>Turnaround properties in the seniors housing market can offer plenty of opportunities for success. After all, the facility is already in place and has an existing customer base and staff. In some cases, an infusion of funds and more efficient business practices could lead to profits relatively quickly. But, in other cases, low-performing properties may have serious, underlying issues that could be difficult to overcome. </div>
<div>Success is not just about investing in a turnaround and pulling a profit; it’s also about avoiding a bad investment in the first place. Here are some things to keep an eye on when getting involved in a turnaround property.</div>
<h2 class="ms-rteElement-H2">Assess Expertise</h2>
<div>The most important thing for borrowers to understand is their own expertise and strengths. Turning around properties isn’t a hobby, and it isn’t easy. If an investor has a particular expertise and can apply this skill set to a struggling business, he or she often can turn failure into success. <br><br></div>
<div>Expertise in the seniors housing market comes in many forms. Some investors are well-versed in creating new clinical programs, or are experts in the overall operations of such facilities. Others may have access to capital to invest in the aging infrastructure of a property. Whatever one’s expertise is, know it, and keep it front and center when evaluating the investment. </div>
<h2 class="ms-rteElement-H2">Identify The Problem, Check Compatibility</h2>
<div>Properties in need of a turnaround are faltering for reasons that can vary dramatically from property to property. A facility may suffer from a bad reputation, or it may be outdated and seem unappealing. Other properties may be too expensive or in an undesirable location. In some cases, the property could be inefficiently managed. <br><br></div>
<div>Banks will conduct extensive due diligence on the target property before providing funding. But smart borrowers should do their own due diligence and research to identify specifically why a property needs a turnaround.<br><br></div>
<div>Once a property’s strengths and weaknesses have been evaluated, an honest assessment is needed to see if the property and investor make a match. <br><br></div>
<div>For example, if an investor is experienced and highly knowledgeable about the latest clinical programs, a property that’s poorly managed or has a bad clinical reputation might be a good fit if the investor is able to partner with local hospital systems or physicians and offer new and innovative therapy programs. However, if a facility has a lot of deferred maintenance or is in a state of disrepair, then bringing therapies and services without an infusion of capital to upgrade the infrastructure may not be a good match.</div>
<div>Remember: Discovering that an investment is not the right one is, in and of itself, a success.</div>
<h2 class="ms-rteElement-H2">Present The Plan</h2>
<div>As previously noted, good lenders will do their own due diligence. However, even if research indicates the investor’s target has good potential, lenders will want to see that the borrower has done his or her homework as well with a coherent, thorough presentation. <br><br></div>
<div>It’s important to work with a lender and show how one plans to get from point A to point B. Tell the lender about your expertise. Tell them what you believe is currently impeding the property’s success. Explain how your company is uniquely equipped to address those current impediments. And, finally, lay out your strategy for making the property a success.</div>
<h2 class="ms-rteElement-H2">Red Flags</h2>
<div>Many turnaround properties can be made into viable, successful facilities by the right investor with the right plan. However, some red flags make lenders (and perhaps even investors) think twice about investing:<br><br></div>
<div>■ Major deferred maintenance. Construction time and costs can be notoriously difficult to project. Keep in mind that construction will often disrupt normal operations. For instance, if a wing needs to be rebuilt, then all of the patients in that wing will need to be relocated or discharged. This could result in added costs and a loss of revenue. In order to succeed, make sure that the company has capital set aside for those leaner cash flow times created by the construction schedule. <br><br></div>
<div>■ A poor clinical reputation. Unlike many investment factors, reputation cannot be easily measured, predicted, or controlled. <br><br></div>
<div>Some low-performing properties suffer from bad reputations that may have been caused by poor quality of services over a long period of time. Whatever the cause, once a facility has developed a bad reputation it can be extremely difficult to change the opinions of prospective clients. Rebranding efforts, such as name and logo changes, may be ineffective.<br><br></div>
<div>Most business is generated locally for health care facilities such as these, and a name change, new tagline or logo, or a fresh coat of paint won’t make prospective clients forget a bad reputation. Partner up with local hospital systems and prominent physicians in the local market before undertaking a turnaround of this kind. <br><br></div>
<div>■ Valuation exceeds cost of a new build. The cost of a new build is not a complicated formula, but it is a critically important one. There is rarely ever a reason to buy a turnaround property at a valuation that would actually exceed the cost of building a new facility (provided land is available and a borrower doesn’t need a Certificate of Need for the project). Most patients will opt for a newer facility over an older one.<br><br></div>
<div>An investor who pays more for an existing facility than the cost of a new build will have to demand higher prices than the market is willing to pay. If an investor is offering something unique in the marketplace such as urban location or amenities that would be hard to duplicate, then it might be a good fit. <br><br></div>
<div>There are certainly exceptions to every rule, and many turnaround properties can be revived and made into healthy businesses. Success will happen when an investor spots a property that is the right match.<br><br>Imran Javaid is managing director of Healthcare Real Estate at Capital One Bank. He can be reached at <a href="mailto:imran.javaid@capitalone.com" target="_blank">imran.javaid@capitalone.com</a> or (301) 280-0212.</div> | Success is not just about investing in a turnaround and pulling a profit; it’s also about avoiding a bad investment in the first place. Here are some things to keep an eye on when getting involved in a turnaround property. | 2015-11-01T04:00:00Z | <img alt="" src="/Issues/2015/November/PublishingImages/finance_t.jpg" style="BORDER:0px solid;" /> | Finance;Design | Column |
Why They Stay: Retention Strategies For Long Term Care | https://www.providermagazine.com/Issues/2015/November/Pages/Why-They-Stay-Retention-Strategies-For-Long-Term-Care.aspx | Why They Stay: Retention Strategies For Long Term Care | <div>Whether a provider operates a multi-site chain that is governed by a board of directors, is the sole proprietor of a single facility, or falls somewhere in the middle, turnover is a similar struggle for all.<br><br></div>
<div>Unfortunately, it is not just the turnover of direct care staff that plagues this profession—administrators and other managers churn as well. However, retention can be addressed in a thoughtful, systematic manner that yields greater commitment.</div>
<h2 class="ms-rteElement-H2"><img width="188" height="188" class="ms-rtePosition-1" src="/Issues/2015/November/PublishingImages/HR.jpg" alt="" style="margin:5px 15px;" />The Research</h2>
<div>With such startling turnover rates, it is important to delve into why employees choose to stay and commit to long term care (LTC). A turnover rate of all nursing facility employees of 40.0 percent was reported by the American Health Care Association (AHCA) in the “Report of Findings 2009 Nursing Facility Staff Retention and Turnover Survey.” Their findings, “that America’s nursing facilities still experience high levels of turnover and relatively low retention for nursing facility employees, especially direct nursing care staff,” are consistent with what is reported in the literature (AHCA, 2011, p.4) The median turnover rate reported by AHCA in the “2012 Staffing Report” was 43.9 percent. Clearly, the problem persists.<br><br></div>
<div>Narratives, shared by 39 LTC employees with tenure ranging from 10 to 34 years, revealed why they have chosen to stay with Opis Management Resources and in the LTC profession. <br><br></div>
<div>Participants in this study consented to a single, individual interview. Stories were gathered about why employees have chosen to stay with a provider and in the profession.<br><br></div>
<div>The research included enough subjects to get a deep understanding of life in this LTC setting. Additionally, the research did not target specific positions. Rather, it examined the full range of employees in a facility, including nurses; certified nurse assistants (CNAs); and staff and management from dietary, laundry, maintenance, admissions, social services, and activities.<br>\</div>
<div>The sample represented a diverse cross-section of Opis employees. The 39 interviews provided a glimpse into the lives of employees tasked with the care of the people who are elderly and infirm. Of that sample, three employees were Asian, 17 African American, five Hispanic or Latino, and 14 Caucasian.<br><br></div>
<div>These participants came from skilled nursing centers throughout Florida; each of the company’s 10 facilities was represented. These people provided vital information about why they stay. </div>
<h2 class="ms-rteElement-H2">The Findings</h2>
<div>The findings can best be explained by reviewing the key themes that emerged during the interviews. The single, overarching theme is that the organization inspires positive feelings. These positive feelings are woven throughout the interviews. <br><br></div>
<div>For example, a staff person in the dietary department told of being offered another position but opting to stay with the company because “I like this company better.” A CNA said that she is “very dedicated to” the company, and, as a result, “no other company can pull me away.”<br><br></div>
<div>This inspiration was reflected in an attachment to, identification with, and involvement in the organization. The impact of the company’s mission and the good feelings that exist toward the organization were clear throughout the interviews. It was also clearly reflected in the other three primary themes that drive commitment and retention: leadership behavior, a sense of connectedness, and opportunities for growth and recognition. </div>
<h2 class="ms-rteElement-H2">Lead By Example</h2>
<div>Leadership behavior is a forceful driver of commitment and retention. Employees freely, often emotionally, cited examples of ways in which leaders throughout the organization have impacted their lives. <br><br></div>
<div>One such story was shared by a CNA, who detailed a practice that is commonplace in her facility. In her own words: “When your bosses come around and they know what section you work in, every morning they walk and they look and they tell you, ‘You know, your section looks good, you’re doin’ a good job,’ it motivates you to do a good job and try to do better. It means a lot to that staff member because you know that they recognize your work, and especially when they call you by your name. It makes a lot of difference when they call you by your name.”<br><br></div>
<div>While addressing an employee by her name may sound very basic, those who have been around awhile know that it is not a practice that is consistently or universally employed.<br><br></div>
<div>When examining leadership behavior, five clear categories of behavior emerged: leaders emphasizing learning, leaders focusing on employee needs, leaders making employees feel heard, leaders taking action, and leaders demonstrating charisma. Decisions made by leaders to model ethical standards and treat employees with respect were integral themes that ran throughout the interviews.</div>
<h2 class="ms-rteElement-H2">There Is No ‘I’ In Team</h2>
<div>A sense of connectedness emerged as a central, driving factor in commitment and retention. Whether the connections are to managers, peers, or residents, the human connection is a profound and undeniable theme. The voices shared through the interviews told stories of relationships, bonds, and connections.</div>
<div>For example, a director summed it up when she said, “The atmosphere is like a family atmosphere, where everyone is respected and has a connection with the other one…people are concerned about if they don’t see you, they’re concerned about where you are, where you’ve been, what’s goin’ on with you.” <br><br></div>
<div>The fact that the organization offers opportunities for growth on many levels is another finding that was noted repeatedly. Multiple examples were offered, ranging from advanced training being important to CNAs, to the focus on leadership development for administrators, to the excitement of being offered the chance to try a new role for an admissions staff person.<br><br></div>
<div>A social worker said, “The company has helped me in so many ways, such as personal and professional development. I have always been given the opportunity to participate in different committees. I have had input in making decisions and then seeing them come to life. They just give you so much opportunity.”</div>
<div>These opportunities contributed to the sense of satisfaction, to commitment, and to staying in the employ of the organization.</div>
<h2 class="ms-rteElement-H2">The Implications</h2>
<div>There are three clear implications from the findings of this research. The first is that human capital utilization needs to be an intentional focus by long term care leadership. How talent is acquired and managed needs to rise to the top of the priority list for companies interested in retaining, engaging, and earning the commitment of their employees.<br><br></div>
<div>It is important for LTC organizations to create a culture and climate that people actually enjoy and with which they want to be involved. Not only will this create mutual goodwill between the employee and employer, it will also change the dynamics between workers and residents.<br><br></div>
<div>While it is easy to pay lip service to valuing human capital, this research makes it clear that skillful human capital utilization requires a clear, compelling strategy. That strategy should include attention to creating an organizational culture and a climate that generates goodwill. It should also focus on a clear strategy for developing talent at all levels of the organization.<br><br></div>
<div>While education and training are components of talent development, there are other elements that should be considered. They include creating multiple methods of engagement, ranging from committees and task forces to external community service.</div>
<h2 class="ms-rteElement-H2">Commitment Goes Both Ways</h2>
<div>The second implication from this research is the reciprocal nature of commitment. Employers expend tremendous energy and resources looking for ways to build commitment while overlooking the most basic. Employees are committed to employers who are committed to them.</div>
<div>A director summed it up in the most basic terms when she said, “I have a commitment to the company because I feel like the company has a commitment to me.”</div>
<div>Employers can measure their degree of commitment to employees by thoroughly analyzing their policies and procedures from the employee’s perspective. Cumbersome, antiquated policies and practices do not signal commitment to the employee.</div>
<h2 class="ms-rteElement-H2">Making The Mission Personal</h2>
<div>While the literature on organizational commitment suggests that identification with corporate goals drives commitment, this research suggests something slightly different. The third implication of this research entails identification with the corporate mission. Crafting a meaningful mission and integrating it into the culture of the organization served the organization in this study well.</div>
<div> </div>
<div>Employees from all levels and functions mentioned the mission and its impact on their work. Employees repeatedly identified the corporate mission as an important part of how they conduct the business of elder care.</div>
<div> </div>
<div>The question of why employees stay has been answered. They stay because they approve of the way that they are treated by leaders and peers. They stay because they have opportunities to learn, grow personally and professionally, and advance, should they choose.</div>
<div> </div>
<div>They stay because the environment is characterized by positive emotions and positive experiences. They stay because of deep attachments to each other and to their charges. They stay because they are recognized for the effort they exert on behalf of people who cannot help themselves. </div>
<div> </div>
<div>They stay because they are valued. </div>
<div> </div>
<div><em>Joanne L. Smikle, PhD, provides consulting and leadership development to long term care organizations. She partners with clients to create organizations where retention, commitment, and engagement are the norm. Smikle can be reached at info@smiklespeaks.com or (301) 596-3140.</em></div>
| With such startling turnover rates, it is important to delve into why employees choose to stay and commit to long term care (LTC). A turnover rate of all nursing facility employees of 40.0 percent was reported by the American Health Care Association (AHCA) in the “Report of Findings 2009 Nursing Facility Staff Retention and Turnover Survey.” | 2015-11-01T04:00:00Z | <img alt="" src="/Issues/2015/November/PublishingImages/HR_t.jpg" style="BORDER:0px solid;" /> | Workforce | Column |
Innovation, Data Sharing Discussed At Provider Roundtable On Medicare Reimbursement Models | https://www.providermagazine.com/Issues/2015/November/Pages/Innovation,-Data-Sharing-Discussed-At-Provider-Roundtable-On-Medicare-Reimbursement-Models.aspx | Innovation, Data Sharing Discussed At Provider Roundtable On Medicare Reimbursement Models | <div style="text-align:center;"><img src="/Issues/2015/November/PublishingImages/2015_roundtable2.jpg" alt="" style="margin:5px;" /></div>
<div> </div>
<div>In partnership with editorial staff at <em>Provider</em> magazine, providers from both large and individually owned long term/post-acute care centers came together for an Executive Roundtable titled, “Emerging Reimbursement Models: Preparing for What Lies Ahead for Skilled Nursing.” Sponsored by American HealthTech, the event was held during the 2015 American Health Care Association (AHCA)/National Center for Assisted Living Annual Convention & Expo.</div>
<div> </div>
<div>Medicare, which turned 50 this year, is undergoing a makeover. In January, Health and Human Services (HHS) Secretary Sylvia Burwell announced measureable goals and a timeline to move the program, and the health care system at large, toward paying providers based on the quality rather than the quantity of care they give patients. </div>
<div> </div>
<div>HHS has set a goal to tie 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and 50 percent of payments to these models by the end of 2018. Additionally, HHS set a goal to tie 85 percent of all traditional Medicare payments to quality or value by 2016 and 90 percent by 2018 through programs such as the Hospital Value-Based Purchasing and the Hospital Readmissions Reductions programs.</div>
<div> </div>
<div>“It’s something we need to discuss,” said Bill Levering, roundtable participant and president and chief executive officer of Levering Management, a family-owned company comprised of skilled nursing facilities, assisted living, senior living apartment communities, and home care. “Long term care has to be part of the handling of the payment…We simply can’t be last in line for payments and expect the outcomes to be the same as today.”</div>
<div> </div>
<div>Four alternative payment models have emerged to accomplish HHS’ goals. The first is fee-for-service that is not linked to quality or efficiency but rather quantity or the volume of services. This model is falling by the wayside as most Medicare payments are now linked to the second model, fee-for-service based on quality, which includes hospital value-based purchasing, physician value-based modifier, and the readmissions/hospital-acquired condition reduction programs.</div>
<div> </div>
<div>The third and fourth models, which the majority of the panelists said they participated in, include ACOs and bundled payments. AHCA Senior Director of Medicare Research and Reimbursement James Michel said that the association is tracking these payment programs. He added that the messaging around the topics is changing, from fear of the unknown to acceptance and understanding, and recently, how to </div>
<div>innovate.</div>
<div> </div>
<div>“Our goal is not only to prepare the overall industry … but to position our members ahead of our industry as well,” said Michel. “We are tracking provider members engaged in models two and three. When we look at the overall provider participants, skilled nursing facilities make up over half of these models. We’ve shown CMS [Centers for Medicare & Medicaid Services] that we are stepping up.” </div>
<div> </div>
<div>One way providers are facing the challenges is through data sharing and innovation. </div>
<div> </div>
<div>“That’s where it starts, being on the forefront and knowing what those changes are. I can make those changes before they want it,” said David Norsworthy, vice president of strategic planning with Central Arkansas Nursing Centers. “If I’m not up front and not there, then I will get run over.”</div>
<div> </div>
<div>Software companies have emerged on the scene to help providers manage their health and outcomes records.</div>
<div> </div>
<div>“We’ve been talking interoperability for years,” said American HealthTech President Teresa Chase, who announced that a new data system related to Medicare payments will be launched in January. “It all rests on collaboration and coordination. If not, you will find yourself nickeled and dimed to death.” </div>
<div> </div>
<div>Concern was raised for the independent, single facilities and providers to rural communities.</div>
<div> </div>
<div>“It’s a whole different ball game for a single facility… [that] doesn’t have the software,” said Harry Baum, MD, president of C&H Healthcare. “I don’t want these people to be left out of the mix. They need to have a voice in this..If we lose [them] we’d lose a large part of what long term care is really all about.”</div>
<div> </div>
<div>Steven Hatlestad, senior vice president of Americare, a rural-based company in Missouri, shared with the panel how he is using AHCA’s TrendTracker data “to prove we’re not just rural American but sophisticated acute/post-acute services. I’m not telling them to call me, I’m calling them.”</div>
<div> </div>
<div>Chief Operating Officer of Medicalodges Fred Benjamin, who co-moderated the discussion with Provider Editor in Chief Joanne Erickson, said that AHCA is working on its own Medicare reimbursement payment models. “If everyone drinks at the same trough, we’re all going to be thirsty,” he said.</div>
<div> </div>
<div>At the summaries portion of the session, Senior Vice President of National HealthCare Corp. Gerald Coggin said that the emphasis should not only be on the financial bottom line.</div>
<div> </div>
<div>“Sadly, there’ll be winners and losers. We do have to accept [that] episodic payments are coming,” he said. “As long as we focus on continuing to care for our patients, we’ll be OK.”</div> | In partnership with editorial staff at Provider magazine, providers from both large and individually owned long term/post-acute care centers came together for an Executive Roundtable titled, “Emerging Reimbursement Models: Preparing for What Lies Ahead for Skilled Nursing.” Sponsored by American HealthTech, the event was held during the 2015 American Health Care Association (AHCA)/National Center for Assisted Living Annual Convention & Expo. | 2015-11-01T04:00:00Z | <img alt="" src="/Issues/2015/November/PublishingImages/2015_roundtable_t.jpg" style="BORDER:0px solid;" /> | Quality;Caregiving | Column |
Second Veterans’ Center In Oregon Makes A Splash | https://www.providermagazine.com/Issues/2015/November/Pages/Second-Veterans’-Center-In-Oregon-Makes-A-Splash.aspx | Second Veterans’ Center In Oregon Makes A Splash | <div id="__publishingReusableFragmentIdSection"><a href="/ReusableContent/4_.000">a</a></div><div>The Edward C. Allworth Veterans’ Home is the second veterans’ home in Oregon and one of the newest in the country, having received its initial state license in December 2014, and federal Veterans Affairs recognition in March 2015.</div>
<h2 class="ms-rteElement-H2">How They Made It</h2>
<div>The Allworth Home, most often referred to as the Oregon Veterans’ Home in Lebanon (OVHL), is already changing the perception of veterans’ facilities across the nation with its unique architectural design and operating model. <br><br></div>
<div><img width="252" height="273" class="ms-rtePosition-1" src="/Issues/2015/November/PublishingImages/veterans1.jpg" alt="" style="margin:5px 10px;" />Organized around the idea of an intentional community or neighborhood, this new veterans’ center offers residents a way to maximize normal living environments and routines and provides autonomy, a sense of community, and a high quality of life.<br><br></div>
<div>OVHL’s 12-acre campus consists of four neighborhoods with 11 Small Homes being the main architectural feature of the campus. The homes are accessible and adaptive; designed for ease of movement; and feature open kitchens, dining areas where family-style meals are served, a living room with a fireplace, and private bedrooms/baths for 14 veterans.<br><br></div>
<div>They are supported by a community center that houses a large activity room, commercial kitchen, canteen, therapy gym, barber shop, and other support services. The campus has a capacity for 154 residents (veterans, spouses of veterans, and Gold Star Parents) with 42 rooms dedicated to memory care needs.</div>
<div>There are three main characteristics of OVHL that serve to make it a special place to live and work: The Small Home design, the use of the Universal Worker care model, and a stewardship-conditions leadership model that encourages staff to be self-directed and intrinsically motivated.</div>
<h2 class="ms-rteElement-H2">Featured Amenities</h2>
<div>There has been much written about the Green House® and generic Small Home designs. The benefits are numerous and varied, depending on specific design features and amenities of the particular home.</div>
<div>OVHL’s homes have rooms that are functionally similar to a traditional nursing home but do so in a way that more resembles a noninstitutional bedroom. <br><br></div>
<div>The centerpiece to the room is the bed: The frame is a fully electric, hospital-grade model with a 42” x 84” pressure-relieving mattress. With a population of approximately 80 percent men, the larger beds provide greater comfort and have shown to decrease falls from bed. The beds lower to 7” if necessary and do not have foot boards, to reduce the institutional look.<br><br></div>
<div>There is also a love seat hide-a-bed for use by out-of-town family at no cost. Each room is equipped with a phone with a unique number that can be direct-dialed from the outside, includes voice mail, and provides free long-distance service thanks to low-cost VoIP technology.<br><br></div>
<div>A ceiling lift extends from over the bed and into the bathroom for ease of transfers to the commode. Digital thermostats in each room allow the occupants to precisely control their own bedroom temperature. A medicine box is mounted on the wall near the entrance of each room and allows the facility to completely eliminate the use of medication and treatment carts, a classic institutional artifact.<br><br></div>
<div>Finally, every room has a desk and chair, TV, dresser, and armoire for residents’ comfort and convenience.</div>
<h2 class="ms-rteElement-H2">How It Is Structured</h2>
<div>OVHL is owned by the Oregon Department of Veterans’ Affairs, and operated by Veterans Care Centers of Oregon (VCCO), a nonprofit company established to operate both Oregon veterans’ homes (the other is located in The Dalles).<br></div>
<div><span><img width="253" height="190" class="ms-rtePosition-2" src="/Issues/2015/November/PublishingImages/veterans2.jpg" alt="" style="margin:5px;" /><br></span>This unique public-private partnership enables the state to save millions of dollars in payroll costs and gains the operational expertise of VCCO’s subcontractor, Westcare, which has decades of long term care management experience.<br><br></div>
<div>The partnership’s nursing model utilizes the Universal Worker concept with certified nurse assistants (CNAs) performing several functions: They provide direct care, lead activities, cook, plate, serve meals, and wash the residents’ personal clothes.<br><br></div>
<div>OVHL has a higher health care professional-to-resident ratio (1:4.66 on days, 1:9.33 on nights), which means a superior level of care day and night.<br><br></div>
<div>CNAs (affectionately called personal assistants at OVHL) do their own scheduling and work 12-hour shifts due to the less strenuous workload allowing them more days off. The center’s call-off frequency experience is far below most facilities, and its annualized turnover in the first year was 12 percent.<br><br></div>
<div>Providers regularly schedule house meetings to problem-solve issues and concerns of each home and brainstorm better ways to serve the veteran residents. During the fill-up there was a need to ultimately hire 150 CNAs, and they have served to be the best marketing tool, recruiting their peers. Most have worked in standard institutional nursing facilities and say they wouldn’t even consider returning to that setting.<br><span id="__publishingReusableFragment"></span></div>
<h2 class="ms-rteElement-H2">Governing Themselves</h2>
<div>The mission of OVHL is to “Honor veterans through delivery of person-centered care in an innovative Small Home setting.” To fully accomplish this mission, OVHL needed to adopt a unique leadership model to complement its unique architectural design and operating model.<br><br></div>
<div>While many organizations function in a leader-follower model, OVHL utilizes a stewardship-conditions model. Stewardship is focused on creating the conditions where individuals lead, govern, and motivate themselves. For this reason, those in supervisory capacities see themselves as more stagehand than performer, and they view and treat employees not as question marks but rather as answers to the daily problems and challenges in health care. It is an environment where employees are more player than pawn, and genuinely feel needed and necessary to the outcome.<br><br></div>
<div>An example of this in action is the self-directed work teams where the CNAs coordinate the activities of each home and the licensed nurse acts more like a coach than a charge nurse in a typical institutional skilled nursing facility. In the end, a steward’s greatest success, quoting the physician and educator Maria Montessori, is to be able to say, the people “are now working as if I did not exist.”</div>
<h2 class="ms-rteElement-H2"><span><img width="320" height="240" class="ms-rtePosition-1" src="/Issues/2015/November/PublishingImages/veterans3.jpg" alt="" style="margin:5px 15px;" /><span></span><span style="display:inline-block;"></span><span></span></span>Benefits Are Obvious</h2>
<div>The results speak for themselves. OVHL’s customer satisfaction reports show marks well above national averages and even best-in-class scores. Many of the veterans have resided in other congregate settings prior to coming to the Edward C. Allworth Veterans’ Home and rave about the amazing difference in level of quality, increased staffing, excellent food (available 24/7), meaningful activities, and overall facility comfort.<br><br></div>
<div>The significant advantage the Small Home model provides is private bedrooms/baths for each veteran resident, which forestalls so many problems. <br><br></div>
<div>Also, not to be overlooked, the Universal Worker model of care adds another dimension that provides increased employee satisfaction as well.<br><br></div>
<div>And, finally, the application of the stewardship-conditions leadership model completes OVHL’s culture and helps accomplish its vision of a creating a community where its veterans, families, and employees can thrive. </div>
<div> </div>
<div><em>Kelly J. Odegaard, MBA, NHA, is administrator and Jeremy Woodall is program director at the Oregon Veterans’ Home in Lebanon. Odegaard can be reached at Kelly.Odegaard@ovhlebanon.org, and Woodall can be reached at jeremy.woodall@ovhlebanon.org.</em></div> | Organized around the idea of an intentional community or neighborhood, this new veterans’ center offers residents a way to maximize normal living environments and routines and provides autonomy, a sense of community, and a high quality of life. | 2015-11-01T04:00:00Z | <img alt="" src="/Issues/2015/November/PublishingImages/veterans_t.jpg" style="BORDER:0px solid;" /> | Caregiving;Quality | Column |