| AHCA Builds Infection Control and Prevention Confidence with Fresh Foundation | https://www.providermagazine.com/Articles/Pages/AHCA-Builds-Infection-Control-and-Prevention-Confidence-with-Fresh-Foundation.aspx | AHCA Builds Infection Control and Prevention Confidence with Fresh Foundation | <p><img src="/PublishingImages/Headshots/PamTruscott.jpg" alt="Pamela Truscott" class="ms-rtePosition-2" style="margin:5px;width:130px;height:163px;" />As we’ve learned these past two years, infection prevention and control training and education aren’t one and done. The knowledge and clinical evidence are evolving, staff turns over, and new misinformation pops up and spreads via social media and other sources. Working with the Centers for Disease Control and Prevention’s (CDC) Project Firstline, AHCA/NCAL will help lead a ripple effect with training that will provide engaging, innovative, and effective infection control training for frontline workers and others. <br></p><p>“The overarching goal is to improve infection prevention and control practices in long term care using an umbrella approach and an understanding that everyone plays a key role,” said Pamela Truscott, Director of Clinical and Regulatory Services at AHCA/NCAL. </p><h2>Evolution of New Training Approach </h2><p>Project Firstline is a collaboration of diverse health care and public health organizations. It involves extensive content usable for a variety of audiences, regardless of their previous training or education background. The materials, information, and resources aim to help them understand and confidently apply infection control principles and protocols necessary to protect themselves, their facility, their family, and their community from infectious disease threats including COVID-19. <br></p><p>CDC put out a call for proposals last year for all entities and settings to apply. AHCA/NCAL received an initial grant to conduct a social media campaign promoting COVID vaccination as part of its Vaccinate with Confidence program. That led to the organization’s involvement in these educational/training efforts. <br></p><p>AHCA/NCAL’s agreement with the CDC goes from October of last year through September of this year. “We will embark on three separate aspects,” said Truscott. “The first is aimed at educating residents and their families. The second is designed to engage and empower staff closest to the work in infection prevention and control efforts. The third involves implementation of an innovative approach using shift coaches to provide a “see something, say something” philosophy. This will provide just-in-time feedback to ensure staff are doing infection prevention and control the right way every time.” <br></p><p>“The training will be multimedia in nature, with some reading materials but also innovative videos, Power Point presentations with voiceover, and other offerings. Instead of a traditional toolkit, this will be presented in “bite size” modules,” said David Gifford, MD, MPH, AHCA Director of the Center for Health Policy Evaluation in LTC and AHCA Chief Medical Officer, “and adapted according to users’ needs.” <br></p><p>In the upcoming months, all the training will be available on the <a href="https://educate.ahcancal.org/" target="_blank">ahcancaled</a> platform and available to everyone, not just AHCA/NCAL members. There will be programming for leadership, middle management, frontline staff, residents, families, visitors, and others. “We want to involve everyone because they’re all part of the solution,” said Truscott. </p><h2>The Why, The How, and More </h2><p>The efforts to engage and empower staff are unique in that they help teams understand the ‘why’ behind infection prevention and control efforts. Truscott explained, “For instance, people know that they have to wash their hands, but they don’t necessarily know all aspects of the ‘why.’ When we help them understand that, the ‘how’ and ‘what’ become more efficient.” <br></p><p>Gifford added, “There is a fair amount of data showing that peer monitoring for [tasks such as] handwashing prior to COVID was an effective strategy to increase rates. The challenge with COVID is that you have to engage in practices consistently; it’s not enough to do it 80-85% of the time.” He further noted, “Data also suggest that people forget and need reminders.” Gifford worked with Brown University on a pilot program about peer coaching, and AHCA/NCAL took the lessons learned in that and incorporated them into this <a href="/Articles/Pages/Project-Firstline-Curriculum-Descriptions.aspx" target="_blank">curriculum</a>. </p><h2>Taking Information from Cloudy to Clear </h2><p>The program will do more than just educate, train, and inform. It will enlighten. This means clearing up some misunderstandings and misconceptions. As Gifford explained, “We are taught since childhood that when you are sick, you spread germs, but many people don’t realize they can also spread illness when they’re healthy.” He added that there “also is a misperception that you wear masks to protect yourself from getting sick, but it actually protects other people and prevents the spread of droplets.” The same is true of other PPE. “If it was just to protect you, you wouldn’t need to change between residents,” said Gifford. <br></p><p>Truscott noted that misconceptions aren’t necessarily limited to non-licensed and non-certified staff, so this training is important for everyone. She added, “There is some logical confusion out there—‘If you have to do this here, why not everywhere?’” She explained that this is partly due to inconsistencies in the guidance as information and knowledge have evolved and changed over time. </p><h2>Vaccinate with Confidence</h2><p>Prior to Project Firstline, AHCA/NCAL received a grant to work on <a href="https://www.cdc.gov/vaccines/covid-19/vaccinate-with-confidence.html" target="_blank">Vaccinate with Confidence</a>, CDC’s strategic framework to strengthen vaccine confidence and prevent outbreaks of vaccine-preventable diseases, including but not limited to COVID. The grant included funding to build an educational course to help providers impact vaccine rates. <br></p><p><img src="/PublishingImages/Headshots/CourtneyBishnoi.jpg" alt="Courtney Bishnoi" class="ms-rtePosition-1" style="margin:5px;width:130px;height:163px;" />There has been a breakdown in trust throughout the pandemic, and this has been one factor affecting vaccine rates. Courtney Bishnoi, AHCA/NCAL Vice President of Quality and Programs, said, “We are trying to get at the root cause of where we see a lack of trust.” For instance, at the height of the pandemic, there often was a shortage of PPE. At the same time, guidance from CDC and other expert sources changed rapidly, leading some staff to question what they were being told from one day to the next. <br></p><p>“Misinformation is a huge problem,” Bishnoi said, adding “This is frustrating and hard to tackle. But if you have a high level of trust for your employer, you are more likely to seriously consider what they are telling you. We are trying to teach people to communicate differently.” <br></p><p>Bishnoi said, “We are trying to build a course that leaders can use to build trust, then have those often-difficult conversations around vaccinations and boosters. We hope that this will help nursing homes improve vaccination rates as well as the culture that contributes to residents’ lives and safety.” <br></p><p>Ultimately, Bishnoi stressed, “There is nothing else like this for long term care. It focuses less on the vaccines and more on why we can’t have conversations about them. We are trying to take a step back and address why people are having trouble with these conversations.” Then, she said, “We will give them the tools to have the conversation in a compassionate, empathetic way.” <br></p><p>There will be tremendous support for facility teams at all levels. For instance, there will be a train-the-trainer program and opportunities for people to share their successes and challenges. <br></p> | Working with the Centers for Disease Control and Prevention’s (CDC) Project Firstline, AHCA/NCAL will help lead a ripple effect with training that will provide engaging, innovative, and effective infection control training for frontline workers and others. | 2022-04-01T04:00:00Z | <img alt="" src="/Articles/PublishingImages/2022/CF_Firstline.jpg" style="BORDER:0px solid;" /> | Workforce;Infection Control | Cover Feature | Joanne Kaldy | 49 | 4 |
| New Pilot Could Mean Blue Skies for Staffing | https://www.providermagazine.com/Articles/Pages/New-Pilot-Could-Mean-Blue-Skies-for-Staffing-.aspx | New Pilot Could Mean Blue Skies for Staffing | <p>Imagine a solution to the staffing crisis that not only brings skilled and enthusiastic team members into a facility but also gives people new hope for their families and themselves. AHCA/NCAL is piloting such a solution with a partnership in Iowa and California to train and place refugees in long term care facilities. <br></p><p>According to Dana Ritchie, CAE, Senior Director of Not For Profit and Constituent Services, AHCA/NCAL has been working on a project with partners in prominent refugee organizations. Association leaders also participated in a virtual roundtable with CEOs from major U.S. companies to discuss Operation Allies Welcome, an effort by the White House to support Afghan refugees as they settle in the U.S. “We have two pilots with refugee organizations in California and Iowa, with more possible for the future,” said Ritchie.</p><h3>The Opportunity, The Need</h3><p>As of January 21, approximately 76,000 Afghan refugees have come to the U.S. following the political upheaval there, and more than 62,000 have already moved off military bases into communities across the country. A variety of organizations are working to help these individuals find homes, obtain needed training and skills, qualify and apply for jobs, and enroll their children in school. <br></p><p>According to Lucas Johnson, Workforce Development Manager at the International Rescue Committee (IRC) in Sacramento, Calif., over 50% of refugees enrolled in the organization’s employment programs arrive with a Bachelor’s degree and under 10% have professional experience in the medical field. <br></p><p><img src="/Articles/PublishingImages/2022/CF_BrodeyHanson.jpg" alt="Brodey Hanson" class="ms-rtePosition-1" style="margin:5px;width:150px;height:188px;" />Brodey Hanson, Executive Director at The Bridges at Ankeny, part of the Iowa pilot, said, “The growth of COVID highlighted some areas where staffing has become an issue across the nation. We had some openings we thought refugees could fill and believed it would be mutually beneficial.” He said, “I have friends from all over the world. Refugees need someone to help them get started, and we have an opportunity to help them and enable them to better their lives.”<br></p><p>Johnson, who is working with AHCA/NCAL on this pilot, is sharing some best practices on how to ensure refugees are ready for their new lives. “We take time to get to know refugees and potential employers,” said Johnson. They conduct assessments, address career goals, and provide soft skills and vocational training. Then they can match them with the right employer. He added, “We use a variety of technical assessments to make sure people are a good fit and can understand and meet expectations.” <br></p><p>Refugees need more than just specific job skills. Johnson said, “We have weeks of courses where we will go through professionalism, interview skills, resume development, professional writing, and more.” They also learn about adjusting to culture and work in the U.S., Johnson stresses, “Our job is to make sure the refugees we work with truly understand the cultural expectations of the workplace. We also try to engage the community as much as possible and work with local organizations to help with the cultural exchange.”</p><h2>Overcoming Barriers</h2><p>While many refugees have at least some command of English, this isn’t necessarily a dealbreaker for refugees who have an interest in health care but lack language skills. Hanson said that those who don’t speak the language well can possibly start in housekeeping or other positions that will give them a chance to learn English. At the same time, they are required to take English as a Second Language classes. As their communication skills improve, they can move into direct patient care or other roles that match their knowledge, talents, and interests. He added, “We can help train them, even if they don’t stay at our facility. We can train them and [transfer] them to other facilities when the time comes.”<br></p><p>People in the local community with language skills also can be helpful. For instance, Hanson said, “I have a friend who speaks the same language as many of the refugees and is willing to tutor some of them.” In the meantime, he noted, “We try to keep things easy to understand. For instance, we use things like checklists and short, simple instructions.”<br></p><p>Johnson said, “A big challenge is the lengthy process of becoming re-certified here. For a physician, for example, it can take years and tens of thousands of dollars.” This can be difficult for refugees who have the training, education, and even the experience to fill clinical or other specialized roles but lack certification or licensure.<br></p><p>Many refugees come here with little more than the clothes on their back. Churches and various community groups and organizations can help provide people with clothes, toys, and even food. Hanson noted, “To make these jobs more attractive, I’ve gone to apartment buildings and arranged a discount for refugees to live there.” He added, “It’s important to realize that it is pretty common for them to send most of their paycheck back home to help family there. If they can save on expenses, that is a benefit. He also observed that arranging rides or transportation to and/or from work also is a plus.</p><h2>The Elephant in the Room</h2><p>While everyone isn’t necessarily embracing of immigrants, Hanson said that intolerance doesn’t seem to be a problem. “Our biggest challenge is residents who have dementia and may revert to old ways of thinking about people who are different.” He suggested that conversations with families and staff are key to working through these challenges and helping to create an environment of acceptance and understanding. <br></p><p>Bringing in refugees actually presents an opportunity for staff and others to learn about another culture and for immigrants to share their traditions, food, and other aspects of their homeland with their new colleagues. At the same time, staff can participate in helping refugees get acclimated to life in American and understand how they can be successful in work and life.<br></p><p>The family structure is different in countries like Afghanistan, and parents and grandparents often are cared for in the home. “It is helpful for refugees to see what care is available in nursing homes. At the same time, many individuals we work with have formal or informal caregiving experiences, which is a valuable skill set in long term care,” Johnson said. He added, “Right now, 90% of individuals going through our nursing assistant courses are refugee women, and we are seeing high completion rates.”<br></p><p>This requires a lot of work and heavy lifting upfront, Hanson said, “We are developing policies and procedures that are not specific to our facility and can be adapted by others for use in their buildings. These include ‘cheat sheets,’ onboarding instructions, etc.”<br></p><p><img src="/Articles/PublishingImages/2022/CF_ClaireEnright.jpg" alt="Claire Enright" class="ms-rtePosition-1" style="margin:5px;width:150px;height:188px;" />Johnson observed that when the team— including refugees—focuses on caring for residents, “the strengths they bring become clear.” Especially when there is a huge staffing crisis, teams can focus on refugees’ skills and their contributions to resident care that ease the burden on other staff.<br></p><p>“You have to be open minded, and you need a workforce that is unique, nurturing, and respectful. It takes a real concerted effort and some self-examination,” said Claire Enright, Executive Director of the Quality Care Health Foundation, another partner in the pilot. While this takes work, in the end facilities can provide an oasis away from the chaos and difficulties both refugees and staff have experienced in the past year, and they can work together to create something positive they can all take pride in.</p><h2>Adapting the Pilot’s Vision</h2><p>In addition to California and Iowa, Texas, Arizona, Oklahoma, Maryland, Michigan, Virginia, Missouri, New York, Georgia, North Carolina, Alabama, Arkansas, Delaware, Louisiana, Mississippi, Montana, North Dakota, Alabama, and Mississippi are all expected to receive refugees. While some states are expected to get more refugees than others, this presents an opportunity to attract new workers to nursing homes and other long term care settings. <br></p><p>Enright noted, “We are looking at what processes can be documented to make onboarding of refugees easier. Many aspects of this program can be duplicated in other locations and various settings.”<br></p><p>These programs often start from seeing the need for various skill sets. “We have skilled refugees arriving from Afghanistan looking for a career, and there are some with either experience or an interest in health care,” Johnson said. “If you want to be part of something like this, there are IRC offices throughout the U.S., and employers can reach out to them. These organizations provide excellent career development,” he said. </p><h2>Addressing the Reckoning</h2><p>“I think an internal reckoning—looking at what we’re doing and what we can do differently—is a way to find a light at the end of the tunnel,” suggested Enright. “We need to look at what has brought us to this workforce crisis, why some of us have stayed in the field, and why others have left. This pilot will help enlighten us about that.”<br></p><p>Ritchie said, “This pilot lays the foundation for other programs, and we look forward to the possibility of more partnerships in the future. We want to welcome our new neighbors to work in our centers and create a great career path.” <br><br><em>Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa.</em><br></p> | AHCA/NCAL is piloting a partnership in Iowa and California that not only brings skilled and enthusiastic team members into a facility but also gives people new hope for their families and themselves. | 2022-04-01T04:00:00Z | <img alt="" src="/Articles/PublishingImages/2022/CF_Refugee.jpg" style="BORDER:0px solid;" /> | Management;Workforce | Cover Feature | Joanne Kaldy | 49 | 4 |
| When Culture Impacts Quality Care | https://www.providermagazine.com/Articles/Pages/When-Culture-Impacts-Quality-Care.aspx | When Culture Impacts Quality Care | <p>The residents at Utuqqanaat Inaat, an 18-bed skilled nursing facility in Kotzebue, Alaska, are immersed in a rich and significant culture. Utuqqanaat Inaat, in partnership with the Maniilaq Health System, serves its community’s most vulnerable residents from the area’s 12 federally recognized tribes located in Northwest Alaska. Affectionately and traditionally referred to as Elders, Utuqqanaat Inaat’s residents live in a homelike environment that is intentionally created to reflect the local culture. <br></p><p><img src="/Articles/PublishingImages/2022/CF_FrozenKotzebue.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;" />In 2015, Utuqqanaat Inaat began a multi-year journey to bring their mission of providing culturally sensitive quality care to its food service. This endeavor was inspired by the center itself, whose name translates to “a place for Elders” and aims to make its settings feel as close to home as possible. In the case of its food service, creating a homelike environment meant serving traditional foods that many of its Elders were accustomed to preparing and eating, including seal oil, local tundra-grown vegetation, and caribou and moose meats. <br></p><p>Utuqqanaat Inaat recognized the cultural significance of these foods, but the center was up against an administrative battle. These locally sourced and locally cultivated foods were not approved for serving within a healthcare environment. Each food item would need special permission to be prepared for the Elders, and permission would need to be granted by multiple organizations on both the state and national levels. The journey to getting these foods approved ultimately took six years and an untold commitment by the long term care and hospital administrators, team members, and the Maniilaq Board of Directors.</p><h2>The Tundra Is our Garden</h2><p>The Alaskan tundra is home to many berries and plants that are commonly incorporated into the local diets and cuisine of families and residents, including those who called Utuqqanaat Inaat home. Items such as salmonberries, lingonberries, and sourdock grew in the tundra’s soft ground but were largely unavailable in traditional markets and food supply stores. Many families harvest their own berries, and Utuqqanaat Inaat believed their residents should be able to continue this lifelong tradition at their new home in the center. Thus began “The Garden Project,” which brought the tundra to residents so that as many as possible could reminisce or continue their subsistence lifestyle. There was a large space in the front of the facility that was available that was turned into a local garden for the Elders. Community members willingly donated their old dogsleds, seal oil caskets, and a fishing boat that could be repurposed as planters, which were designed to be accessible via wheelchair. <br></p><p><img src="/Articles/PublishingImages/2022/CF_Garden.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;width:300px;height:145px;" />Val Kreil, the administrator of Utuqqanaat Inaat, got in touch with the Kikiktagruk Inupiat Corporation and asked for permission on behalf of the Elders to transplant some of the plants to the nursing home garden. Because gardens above the Arctic Circle are rare, the corporation was glad to help in a tangible way. Staff at the facility worked over the summer to harvest everything from berries to beach greens for the garden and planted them into an old fishing boat with designated sections for each plant, much like a grocery store. </p><h2>The Seal Oil Project</h2><p>The Garden Project created both an avenue of recreation and sustenance for the Elders, but a critical part of the local cuisine was facing a complicated route to inclusion within the Utuqqanaat Inaat nutritional plan. Seal oil, which is commonly used in dipping and preparing meals in Kotzebue, was never approved by federal or state regulatory bodies for use within restaurants or to be sold in stores, primarily because of its high connection to botulism, a foodborne illness. Because of these regulatory restrictions, the use of seal oil within Utuqqanaat Inaat was prohibited by the Centers for Medicare & Medicaid Services.<br></p><p><img src="/Articles/PublishingImages/2022/CF_Salmon.jpg" class="ms-rtePosition-1" alt="" style="margin:5px;width:300px;height:211px;" />One hope prevailed: if Utuqqanaat Inaat and its larger team of Kotzebue supporters could prove a safe way to prepare and preserve seal oil that prevented botulism, seal oil could become part of the nursing home cuisine in an official way. <br></p><p>According to Pam Truscott, Director of Clinical and Regulatory Services at the American Health Care Association/National Center for Assisted Living, the commitment to person-centered care must include an appreciation for the culture and community in which residents live.<br></p><p>“Core characteristics of person-centered care revolve around the unique individuals wants, needs, desires, and wishes. Valuing and respecting each person as an individual who is an important member of society, while providing supportive opportunities for them to engage in their culture is essential,” Truscott said. “Residents grew up following certain customs and rituals. These traditions help make the person who they are. One way that long term care facilities can support resident needs is through culinary engagement. Bringing in foods that the individual person grew up eating, and that they enjoy, is part of their culture and is a great way to support the person and provide person-centered care.”<br></p><p>Because Canadian tribes and commercial manufacturers do not use a rendering process for seal oil, there was very little information available regarding the process of safely creating seal oil. This was complicated further by the fact that fresh blubber was required for the testing process, but access to seal blubber was limited to the seal hunting season, which for natives occurs only twice a year and generally for a window of less than two weeks. <br></p><p>The team of invested players grew in tandem with the complexity of getting seal oil approved for use in the Maniilaq Health System. The local Hunter Support Director for the Maniilaq tribal association, Cyrus Harris, as well as the area health sanitarian, Chris Dankmeyer, became integral to the Seal Oil Project. They worked alongside administrator Val Kreil, researchers Brian Himmelbloom and Chris Sannito, and Dr. Eric Johnson of the botulism lab at the University of Wisconsin in Madison. <br></p><p><img src="/Articles/PublishingImages/2022/CF_SealBlubber1.jpg" class="ms-rtePosition-2" alt="" style="margin:5px;" />With time and significant testing, the team was successful in finding a solution that kept the original rendering process intact—thus preserving the flavor and substance of the oil—but also meeting required safety standards as noted by the CDC. The safely rendered seal oil was put to the ultimate test: it was shared amongst locals to assess its taste, flavor, and thickness. The oil was not only accepted by the locals, but it was also considered an improvement in color and flavor. <br></p><p>The team wrote up a production plan and submitted it to the state for approval, including a variance that demonstrated the final step in the process—the one step that made seal oil consistently safe from botulism. In January 2021, the variance was approved for usage.</p><h2>Ramifications of the Traditional Foods Project</h2><p>Providing person-centered care was demonstrated through the Traditional Foods Project for the Elders at Utuqqanaat Inaat. A small-but-mighty team of dedicated staff, volunteers, and researchers committed themselves to a single issue: getting local foods, including seal oil, approved for serving to the Utuqqanaat Inaat Elders. This meant they were able to enjoy the foods they cooked with, ate, and served to others their entire lives. And while the population of 18 Elders cannot justify an official, replicable study, the staff know the impact of their efforts based on the joy they see among the Elders. <br></p><p>“Subsistence is their heritage. It’s their way of life,” said Kreil. “We see them eat better and socialize more because a part of their life has been brought back to them. For the team members, I think they all felt a sense of pride in being able to make a difference in the Elders’ lives ” <br></p><p>The reaction of their residents replicates results found in larger, similar studies that found that person-centered care can reduce agitation and symptoms of depression and improve the quality of life.<sup>1</sup><br>Above all, culture reigned supreme for the people of Utuqqanaat Inaat, and that culture created a quality of life and quality of care that are not found in text books or CDC recommendations. It comes from knowing and understanding the lives of the people who live within the walls of a center. <br><br><em class="ms-rteFontSize-1"><sup>1 </sup>Hunters Provide Traditional Wild Foods for Alaska’s Elderly-CityLab, Charlee Catherine Dyroff, July 25, 2018</em></p> | In 2015, Utuqqanaat Inaat began a multi-year journey to bring their mission of providing culturally sensitive quality care to its food service. | 2022-04-01T04:00:00Z | <img alt="" src="/Articles/PublishingImages/2022/CF_Alaska.jpg" style="BORDER:0px solid;" /> | Caregiving;Quality | Cover Feature | Valdeko Kreil | 49 | 4 |