Creating Seamless Transitions in Challenging Tımes<p>“The best transition of care is when there is no transition at all.” James Lett, MD, coined this maxim many years ago, and it’s still the mantra of post-acute and long term care providers.<br></p><p><img src="/PublishingImages/Headshots/RajeevKumar.jpg" alt="Rajeev Kumar, MD" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;145px;height&#58;186px;" />“Of course, sometimes transitions are necessary, so we need to focus on doing this as seamlessly as possible,” says Rajeev Kumar, MD, CMD, FACP, chief medical officer of Symbria in Warrenville, Ill. “Even though we are well into the third decade of meaningful EHR [electronic health record] use, we still have discordant records, and what happens in the hospital doesn’t always filter back to the nursing home, and vice versa.”</p><h2>Working Toward the Ideal Transition</h2><p>The Centers for Medicare and Medicaid Services (CMS) defines transitions of care as the movement of a patient from one setting of care to another. This setting may include hospitals, ambulatory care practices, ambulatory specialty care practices, long term care facilities, home health, and rehabilitation facilities. It involves care coordination that ensures accurate clinical information is available to support medical decisions by both patients and providers.<br></p><p>“An ideal transition is grounded in knowing who the patient is—their goals, wishes, needs, and support systems,” says Kathleen McCauley, PhD, RN, FAAN, FAHA, professor of cardiovascular nursing at the University of Pennsylvania School of Nursing. “And there have to be partnerships that happen between the person and their network and where they’re going in the continuum.”<br></p><p>McCauley refers to a study she was part of—a qualitative analysis of what patients and families feel on discharge&#58; “One thing that stood out was they often felt like they were out in the wilderness,” she says. “Good transitions anticipate what will be needed and help the patient and family prepare. You can’t do this in a 30-minute interview at the bedside. Everyone needs to work together, starting with identifying what’s important to the person and knowing what their goals are.” </p><h2>From Miscommunication to Connection</h2><p>Transitions have always been a challenge, plagued by miscommunication, lack of communication, and delays in communication. Value-based care initiatives have helped, suggests Kumar, “because no one wants to be penalized for high readmission rates or wasteful utilization.” This has motivated better communication between settings, but gaps still exist, he says, and while it may seem obvious that better communication is the answer, it’s easier said than done. <br></p><p>While EHRs have evolved over the years to improve communication, Kumar says, “Even today, we are facing challenges getting hospitals to understand what is happening in nursing homes. The hospitals and hospitalists are looking after their facilities’ interests and want to move COVID patients out sooner, but we need to protect our vulnerable residents, so we want patients tested first before they can enter our facilities.”<br></p><p>Nonetheless, some good has come out of the pandemic. Robert Choi, chief executive officer of Caraday Healthcare in Austin, Texas, says, “The pandemic revealed that hospital and skilled nursing facility partnerships are strong, and that nursing homes are seen as an essential part of the health care continuum. It also exposed opportunities for greater innovation, integration, and <a href="/Articles/Pages/Interoperability-Where-Do-We-Stand.aspx" target="_blank">interoperability</a>.”<br></p><p>Having a care management company or dedicated team to follow up on and track patients throughout the continuum can help promote seamless movement. “We formed our own home health and home-based care program to navigate patients from the hospital to the skilled nursing facility to home,” Choi says. “We also have strong partnerships with physician groups through the continuum of care who are essential across these transitions.” <br></p><p>Choi says his company has focused its internal analysis, research, and development of systems and processes with the goal of facilitating a safe discharge home. “We are building integrations and working with our health care partners and physicians to ensure we aren’t beholden to 17-plus different communication platforms and software subscriptions,” he says.<br></p><p>Despite these kinds of advances, data exchange continues to be a challenge. “We always strive to keep open lines of communication and provide real-time information,” Kumar says. “And we continue to highlight the challenges related to EHRs and the importance of nursing homes having access to real-time data. In particular, real-time medication reconciliation is crucial.”</p><h2>Warm Handoffs Are Hot</h2><p>Warm handoffs have always been shown to be effective, Kumar notes. Communication is important, but sometimes a lack of time gets in the way. “However, a quick text or a two-minute phone call can be a tremendous help when a patient is being transferred,” he says. “In fact, it goes a long way to help the physician and care team understand what is happening with that patient. It’s important to put some time and effort into it.” <br></p><p>Kumar says that it is also essential to have a protocol for “mandatory warm handoffs.” One option is to have a dedicated liaison who can talk to families, patients, and providers when patients leave or come back to the facility. That can go a long way toward ensuring patient safety, he says.<br></p><p>“It would be helpful to have nurse practitioners onsite who are trained in transitions of care and who can be contacted if a patient experiences an acute change,” McCauley adds. “They can focus on putting the pieces together and keeping patients out of trouble and, whenever possible, out of the hospital.”<br></p><p>It helps to have a good rapport with hospitalists so that patient transfers aren’t the only time providers initiate communication. “Periodically I go to their meetings, and sometimes they ask me to do educational presentations,” Kumar says. “For instance, I’ve talked about the Beers list and medications that should be prescribed carefully, particularly in frail, older patients.”<br></p><p>It also can help, McCauley suggests, to have tip sheets or checklists to address problems the patient is likely to experience, such as constipation or ambulation challenges. This can help prevent surprises and issues that can fall through the cracks after a transition. <br></p><p>Telemedicine helped enable virtual communication during the pandemic. However, Choi notes, “As a veteran of telemedicine and virtual care, I am the largest supporter of digital health. However, a telemedicine visit doesn’t solve the need for more information sharing and care coordination. There is a lot of communication and interactions among multiple parties that need to happen. There also are processes that need to be designed and implemented between health care ecosystem partners.”</p><h2>Education Makes a Difference</h2><p>“The tool I’ve found to be most useful is education,” Kumar says. “People want to do the right thing, but there is a lot of misinformation, doubts, and questions. Having something like a one-on-one dialogue or a webinar to ensure everyone has consistent, up-to-date information helps.” <br></p><p>The need for education isn’t limited to providers and staff. “Sometimes families or patients misunderstand what they are told, and by the time they come to us, they can have a lot of misconceptions,” he says. “First we need to sit down and find out where they’re coming from and what happened. It’s all about transparency, honesty, and humility.”<br></p><p>Family communication and education also need to involve what the patient will need on returning home and what that involves, McCauley says. “We don’t have a system designed to meet the needs of elders when they go home. We expect family members to deliver care that would be challenging for a trained nurse, and the patient is stuck in the middle.”<br></p><p>Strong partnerships and consistent, ongoing communication between nursing homes and their primary care provider are key to ensuring no one feels that they’re in the wilderness or being asked to provide care that is beyond their skill and knowledge levels.<br></p><p>Most people are open to communication “if you take a blame-free approach and not point fingers,” Kumar says. “If there is a problem at the other end, we need to be able to talk about it, and we expect them to tell us if we could have done something better or different.” It is essential to espouse patient-safety culture with a focus on brainstorming for success instead of placing blame or making excuses. “We need to prioritize patient-safety culture to enable everyone to perform at their best,” he says. </p><h2>The Road Home</h2><p>“In our research, the most common goal patients have is to go home, live and function in their house, and not be a burden,” McCauley says. “That’s a phenomenal goal, but first you have to be safe, be able to make or get meals, take medications safely, and so on. You have to participate in physical therapy to get stronger and have the stamina to care for yourself and not deteriorate.<br></p><p>“Using goals as a driver is a way to get people motivated and help them appreciate small successes in physical therapy. “ <br></p><p>To identify these goals, it is essential to give patients and families, including family members who know the patients and their history, a place at the table and really listen to their goals and expectations. It’s important to realize they may have unrealistic expectations.<br></p><p>To help them focus on what they can do and to set realistic expectations, “We need to find out what gives them joy and what quality of life means to them,” McCauley says. “Start with what’s important to the patient, and then you can put a plan into place that includes good symptom management.”</p><h2>When Readmissions Happen</h2><p>It’s imperative to look at each readmission and understand what happened, Kumar says. “We do a root-cause analysis of every hospitalization—what happened, what caused it, and if/how it was avoidable.”<br>McCauley says that while it’s essential to prevent avoidable readmission, there are times when it’s appropriate to send a patient out.<br></p><p>“An urgent visit with the physician is better than an ER [emergency room] visit, and an ER visit is better than a hospitalization. But we need partnerships between nursing homes and the hospital to plan, communicate, and determine when a transfer is essential and what it will take to ensure a smooth transition.”<br></p><p>Putting all the pieces in place to ensure smooth transitions of care is easier than it used to be because value-based care principles and technology are available. However, transitions aren’t yet as smooth as they can be. Everyone has been stretched, but there will be greater opportunities to improve care transitions as the entire health care industry gains bandwidth. Then, all the lessons learned will present ways and means to re-evaluate and re-engineer gaps in care and communication. <br></p><p>Read More&#58; <a href="/Articles/Pages/Make-Advance-Directives-Mobile.aspx">Make Advance Directives Mobile</a></p><p><em>Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa.​</em></p>2021-10-01T04:00:00Z<img alt="" src="/Articles/PublishingImages/2021/1021/1021_CF1.jpg" style="BORDER&#58;0px solid;" />Culture Change;QualityJoanne KaldyCare coordination between nursing homes and hospitals is critical to ensure a timely exchange of clinical information.
Positive Culture Provides a Strong Foundation<p><span>​<img src="/Issues/2021/April/PublishingImages/Team-staying-warm.jpg" class="ms-rtePosition-1" alt="" style="margin&#58;5px;width&#58;290px;height&#58;306px;" /></span>Skilled nursing and assisted living providers have found that fighting COVID-19 has only underscored the importance of a positive company culture.<br></p><p>“The pandemic uncovered that we don’t always have a mutually supportive and reinforcing culture in nursing homes,” says Alice Bonner, PhD, RN, FAAN, senior advisor for aging, Institute for Healthcare Improvement.<br></p><p>“We have webinars and other programs telling people that we have to do better, but that’s not enough and not always the best approach.” She stresses the need to develop tools and resources to create and sustain a positive culture.<br></p><p>Then, she says, “We need to figure out how to get these into 15,600 nursing homes.”</p><h3>What Works</h3><p>During the pandemic when everyone was overwhelmed and staff were stretched thin, “The whole premise of our culture is that we treat everyone with respect and dignity,” says Paul Gerharter, RN, vice president of clinical services for Caraday Healthcare. “We make it clear that it’s okay to talk about family and life away from work.”<br></p><p>When staff feel like their managers understand what they’re going through and are empathetic, they are more likely to be engaged and embrace the organization’s vision. “It’s important for everyone to understand there will be bad days,” Gerharter adds. “We need to own up to mistakes, forgive people, learn, and move forward.”<br></p><p><img src="/Issues/2021/April/PublishingImages/DallasNelson.jpg" class="ms-rtePosition-2" alt="Dallas Nelson" style="margin&#58;5px;width&#58;165px;height&#58;210px;" />One thing that has been crystal clear during the pandemic is, “You have to set up a culture of safety before a crisis hits,” says Dallas Nelson, MD, CMD, associate professor of medicine at the University of Rochester School of Medicine and Dentistry. “You need a system that shows you value employees, that they can bring up questions, fears, and concerns and be respected.” <br></p><p>She suggests that when this culture doesn’t exist, trust can suffer, and staff are hesitant to believe management has their best interests at heart. “You have to make staff feel safe before they can make other people feel safe,” she says.</p><p>In a culture of safety and trust, it is much more difficult for conspiracy theories, rumors, and misinformation to gain traction. This certainly doesn’t mean that management is always right or that leadership has all the answers.<br></p><p>“The idea that good leadership doesn’t change its mind is terrible,” Nelson says. “Changing course after new data come out isn’t a sign of weakness; it shows that leadership wants to do what is right for residents and staff. If you act like you know what you don’t know, you will lose trust, and people won’t trust you to keep them safe.”<br></p><p>“Those homes that have really transformed their culture to be more resident-centered and resident-directed had systems in place that helped them during the pandemic,” says Penny Cook, MSW, president and chief executive officer of the Pioneer Network. As a result of their cultures, they already had consistent staffing, effective ways to interact with families, and other elements that promoted engagement, <a href="/Articles/Pages/Transparency-Is-Telling.aspx" target="_blank">transparency</a>, teamwork, and empathy. </p><h3>What Can Help</h3><p>Culture change continues to be a significant opportunity for facilities, and it can be a “massive endeavor,” says Anna Fisher, DHA, CMDCP, CDP, director of quality and education for Hillcrest Health Services. However, it can be managed with the right tools, resources, guidance, education, and, of course, people.<br></p><p>For example, she says, “We were part of a pilot for the Artifacts of Culture Change 2.0, designed to help make a shift in culture and affect positive change.” Offered by the Pioneer Network, Artifacts is an internal implementation, inspiration, and self-assessment tool that shows assisted living and nursing homes a variety of beneficial changes they can make to increase resident autonomy, rights, and choice, as well as note their progress toward changing institutional culture. For more information, go to <a href="http&#58;//www.pioneernetwork.net/artifacts-culture-change" target="_blank">www.pioneernetwork.net/artifacts-culture-change</a>.<br></p><p>More than ever, making sure residents are part of culture change is key, Cook says. “I’ve talked to some communities during the pandemic where staff said relationships with residents helped them through it all.” &#160;<br></p><p>This power of reciprocal learning needs to be promoted more. For instance, Cook shares the story about how her 25-year-old son was stressed and exhausted, and a conversation with his grandmother boosted his spirits tremendously. “If residents know they have cheered up a staff member or made someone laugh or smile, that gives them a sense of purpose. We all need that,” she says.</p><h3>The Bright Way Forward</h3><p><span><img src="/Issues/2021/April/PublishingImages/Buslovich.jpg" alt="Steven Buslovich" class="ms-rtePosition-1" style="margin&#58;5px;width&#58;166px;height&#58;210px;" /></span>Even though the business of post-acute and long term care is serious, there is a place for humor. “Humor is a huge part of our day-to-day life,” says Gerharter. “When we have our weekly calls, we laugh. We are in a serious business, but we want people to feel at ease.”<br></p><p>“We were at a low point prior to the vaccine,” says Steven Buslovich, MD, CMD, MSHCPM, a New York-based geriatrician. “Now I am seeing a lot more optimism and the vaccine changing our way of life. This is exciting. If we continue moving forward where everyone follows a plan, that is the best path to ‘normalcy.’ The virus will be around indefinitely, but we will have a new normal way of life, and we have learned much that will ensure the best possible teamwork moving forward.” <br></p><p>The pandemic has shone a light on areas of opportunity in the system, suggests Fisher, and providers need to use this information to refine their processes and create ways to continue dialogues they’ve started with other stakeholders.<br></p><p>“You can look at our current situation as the glass half-full or half-empty. Yes, the pandemic has spotlighted issues within the system that need to be addressed, but people should celebrate all of the remarkable things they’ve accomplished this past year.” <br></p><p>In the meantime, “You have to stay resilient, and some things you just have to let roll off your back,” says Jeffreys Barrett, RN, MHA, NHA, executive director of Wellsprings of Gilbert in Arizona. “We have to prioritize more than ever before, and as leaders, we need to let other leaders do their jobs.” <br><br><em>Joanne Kaldy is a freelance writer and communications consultant based in Harrisburg, Pa.​</em></p>2021-04-01T04:00:00Z<img alt="" src="/Issues/2021/April/PublishingImages/0421-CS2.jpg" style="BORDER&#58;0px solid;" />COVID-19;Culture ChangeJoanne KaldySkilled nursing and assisted living providers have found that fighting COVID-19 has only underscored the importance of a positive company culture.
Ship Shape<p>Shirley Payne, of South Kingstown, R.I., grew up on the water. At age nine, she fell in love with boating while at summer camp learning how to canoe. It wasn’t long before she became a camp counselor and shared her love of the water with others.</p> <div> </div> <p></p> <div> </div> <h2 class="ms-rteElement-H2">Embarking On Life</h2> <div> </div> <div>A child of the Great Depression, Payne learned to appreciate the simple joys of life—even more so as she anxiously awaited her soon-to-be husband’s return from World War II. When Ken Payne returned, the two moved back to Rhode Island—a sailing mecca—and started their family. <br></div> <div> </div> <div><br><img class="ms-rtePosition-2" src="/Issues/2015/September/PublishingImages/sailing_18934988.jpg" alt="" style="margin&#58;5px 10px;" />Shirley Payne shared her passion with her three sons, 10 grandchildren, and numerous great-grandchildren. The sole woman in an all-male household, she relished the opportunity to lead a local Mariner Girl Scout Troop on the water and expose the young women to the joys of sailing.</div> <div> </div> <div><br>Payne entered college during World War II but left without her degree to start her family. Once her sons were grown, Payne, unwilling to sit around the house, went back to school, finished her degree, and embarked on a 25-year career as a librarian. She loved exposing younger generations to a world of knowledge—whether in the library or on the water.</div> <div> </div> <div><br>Today, at age 90, Payne is the picture of good health and retains the same passion for the water, sailing, and having fun as she always had. </div> <div> </div> <h2 class="ms-rteElement-H2">The Tide Is High (As Are The Demands)</h2> <div> </div> <div>An accomplished and compassionate senior and current resident of Brookdale Senior Living’s South Kingstown community, many of Payne’s wishes have come true. However, Wish of a Lifetime, a nonprofit organization committed to creating a cultural shift on how aging is viewed in the United States, granted her a very special wish&#58; Payne wanted to meet and sail with the women of Team SCA, the only all-female sailing team competing in the 2014-2015 professional Volvo Ocean Race (VOR), viewed as one of the most grueling sporting events in the world. <br><br>The VOR is a nine-month, round-the-world sailing race in some of the most challenging waters. When the teams are at sea, they are racing nonstop, sleeping in shifts. Members are allowed to take only one change of clothes for the entire voyage.</div> <div> </div> <div><br>No fresh food is on board—the team eats around four freeze-dried meals per day. Each woman burns 600 to 1,500 calories a day and loses around 17 lbs. over the course of the race (they have to lift sails that can weigh over 650 lbs. <br>each!). </div> <div> </div> <div><br>As one member of the team summed up, it is like “driving a convertible through a carwash”—they’ll experience unpredictable weather and temperatures ranging from 23° to 104° Fahrenheit.</div> <h2 class="ms-rteElement-H2"> Come Sail Away </h2> <div>In addition to meeting members of Team SCA, Payne, with several fellow residents from her Brookdale community, sailed around Newport Harbor in a companion boat while witnessing Team SCA in action, competing in the in-port Pro-Am race.<br><br></div> <div> </div> <div>The Pro-Am race does not count for the overall ranking for the greater VOR competition. Guests are allowed on the racing boats with the team, and spectator boats sail around watching the race. Payne got a chance to sail with several Team SCA sailors as well as have lunch with them.&#160; <br><br></div> <div> </div> <div>“This is a wonderful dream,” says Payne. “At 90, it’s nice to check a few things off the list.”</div> <div> </div> <h2 class="ms-rteElement-H2">Sail On Sailor</h2> <div> </div> <div>“Getting Shirley back on a sailboat exemplifies that older adults continue to dream and want to connect with the things they are passionate about and add meaning to their lives,” says Sara Terry, vice president of resident and family engagement at Brookdale. “For each of our residents, our focus is to seek out and find opportunities to enrich their lives and honor their spirit.”<br><br></div> <div> </div> <div>Wish of a Lifetime partnered with SCA, a global hygiene and forest products company that develops and produces personal care products, and Brookdale Senior Living, a leading operator of senior living communities throughout the United States and No. 1 this year on Provider’s Top 40 Largest Assisted Living Companies list, for Payne’s seafaring journey.</div> <div> </div> <div> </div> <h2 class="ms-rteElement-H2">Further Adventures Await</h2> <div> </div> <div>This summer, two additional senior women with a similar commitment to helping others and a passion for adventure also saw their wishes fulfilled through this partnership. <br><br></div> <div> </div> <div>SCA recently launched an initiative to recognize women around the world. Amazing Women Everywhere (<a target="_blank">www.teamsca.com/​aweonmosaic</a>) is a global storytelling platform that honors and celebrates women who have had a positive impact on others, their communities, and their surroundings—just like Shirley Payne. <br><br></div> <div> </div> <p></p>2015-09-01T04:00:00Z<img alt="" src="/Issues/2015/September/PublishingImages/sailing_t.jpg" style="BORDER&#58;0px solid;" />Culture Change;CaregivingJackie OberstShirley Payne shared her passion with her three sons, 10 grandchildren, and numerous great-grandchildren. The sole woman in an all-male household, she relished the opportunity to lead a local Mariner Girl Scout Troop on the water and expose the young women to the joys of sailing.
Stars In Their Own Right, Part 2<div><em><img class="ms-rteImage-1 ms-rtePosition-1" alt="20 To Watch" src="/Monthly-Issue/2013/PublishingImages/0213/20towatch2.jpg" width="224" height="159" style="margin&#58;5px 10px;" /><br>Provider’s</em> inaugural 20 To Watch continues this month with profiles of seven honorees who—just as they did <a href="/Monthly-Issue/2013/Pages/0113/Stars-In-Their-Own-Right.aspx" target="_blank">last month</a>—shine bright as glittering examples of what’s best in long term and post-acute care today.</div> <div>&#160;</div> <div>An assistant administrator, a director of engineering, a dietitian, a nurse, an administrator, an owner, and a founder of a nonprofit organization all have the spotlight this month.</div> <div>&#160;</div> <div>Stay tuned, as next month will feature the final seven profiles of 2013’s 20 To Watch. For the complete list, click <a href="/Monthly-Issue/2013/Pages/0113/Top-20-To-Watch-2013.aspx" target="_blank">here</a>.</div> <div>&#160;</div> <div><strong>Sponsored by Silverchair Leaning Systems</strong></div> <div>Silverchair Learning Systems works with senior care leaders who want to improve key business processes in their organizations. Silverchair Learning offers&#58; Silverchair For Staff, a user-friendly online training solution that improves compliance and eliminates record-keeping headaches; the Employee Feedback System, which easily delivers satisfaction surveys, provides in-depth analysis of results, and offers action tools to help reduce employee turnover; and Silverchair For Families, a resident family education and communication system that helps set expectations and solicit continuous feedback to help providers build strong family relationships and increase satisfaction. All Silverchair Learning products have been developed to help educate, empower, and inspire the senior care industry and to facilitate a higher quality of care. Silverchair Learning Systems is a Relias Learning company. Visit <a href="http&#58;//www.silverchairlearning.com/" target="_blank">www.silverchairlearning.com</a> to learn more.</div> <div></div> <div>&#160;</div> <div><img src="/Monthly-Issue/2013/PublishingImages/0213/SharondaJenkins.jpg" alt="Sharonda Jenkins" class="ms-rteImage-1 ms-rtePosition-1" width="188" height="212" style="margin&#58;5px 10px;" /></div> <div><strong>Sharonda Jenkins, RN</strong></div> <div>Quality Assurance Nurse</div> <div>Highland Pines Nursing and Rehabilitation Center </div> <div>Longview, Texas </div> <div>&#160;</div> <div>Working with elders is a blessing for Sharonda Jenkins. In fact, Jenkins says, “it’s what God wanted me to do.” From her start as a certified nurse assistant (CNA), to becoming a licensed vocational nurse (LVN), to now being a registered nurse (RN), Jenkins says she wouldn’t change a thing. “I just love what I do; it’s where my heart is.” </div> <div>&#160;</div> <div>Prompting her entry into the world of long term and post-acute care was her daughter, who 18 years ago, at the age of just two, had a seizure. Jenkins’ mother administered CPR on the toddler, while Jenkins watched in horror, not knowing what to do. </div> <div>&#160;</div> <div>“After that, I said to my mother, ‘This is never happening again,’ so I became a CNA.” She went to work in a nursing home and now serves as quality assurance nurse at Highland Pines. </div> <div>&#160;</div> <div>“Sharonda is a caring, funny, and motivated nurse, striving to do her best each and every day. Her belief is that you should give your staff what they need to do the best job they can,” says Cindy Baldridge, director of staff development for Stebbins Five Companies, which manages the nursing home where Jenkins works. </div> <div>&#160;</div> <div>As a champion of staff training and education, Jenkins encourages staff to improve themselves both personally and professionally, says Baldridge. “She watches for those ready to receive more responsibility or duties and encourages those with LVNs to get their RN licenses.”</div> <div>&#160;</div> <div>Since joining Highland Pines, Jenkins has positively impacted the employees she supervises and the residents she is so compassionate about. “Not only does she provide daily training with the nursing staff, she monitors employee immunizations, provides annual check offs with the nurse assistants on their skills, and does extensive licensed nurse competency evaluations,” says Baldridge.</div> <div>&#160;</div> <div>Also among Jenkins’ accomplishments is a recent reduction of urinary tract infections (UTIs) in the facility. After noticing an uptick in facility-acquired UTIs, she initiated hands-on, side-by-side training with her CNAs, sure that better care, in addition to hand washing, would lead to a decrease in UTIs. </div> <div>&#160;</div> <div>She trained in groups of two aides, teaching them how to coach each other not to miss a step or break infection control procedures. “Whatever she thought would work, she did it,” says Baldridge. “Having such an open communication with the CNAs helped her to better help them. When they told her it was too hard to remember some steps, she gave them laminated pocket cards for the aides to carry and reference during care.”</div> <div>&#160;</div> <div>Jenkins’ efforts paid off—in July 2012, the facility logged two facility acquired UTIs; in August 2012, another two. In September, just one, and in October, there were zero facility-acquired UTIs. </div> <div>&#160;</div> <div>Always striving to be a team player, Jenkins says she takes the time to teach her co-workers from “A to Z,” which means she does what she can to make things easy to understand. “If someone has difficulty learning something, I will break it down to get through to them so they can learn it. I always start from A to Z and never leave out anything.” </div> <div>&#160;</div> <div>In response to her selection to 20 To Watch, Jenkins says, “I have lived for a moment like this; I’ll never forget it.”</div> <div></div> <div>&#160;</div> <div><img src="/Monthly-Issue/2013/PublishingImages/0213/GraceFlight.jpg" alt="Grace Flight" class="ms-rteImage-1 ms-rtePosition-1" width="201" height="205" style="margin&#58;5px 10px;" /></div> <div><strong>Grace Flight, RN </strong></div> <div>Executive Director</div> <div>Regency Heights of Stamford</div> <div>Stamford, Conn. </div> <div>&#160;</div> <div>As if developing the patient care record system that has been adopted by 95 percent of the skilled nursing facilities in the state wasn’t enough, Grace Flight has also established a long term care educational consortium and was the first in the state to challenge the prohibition of allowing pets in nursing homes.</div> <div>&#160;</div> <div>Flight, who is executive director of Regency Heights of Stamford, Conn., has always been guided by the resident voice, says Steve Vera, regional director of operations for Ciena Healthcare, the company that owns Regency Heights. </div> <div>&#160;</div> <div>“Plus, her invaluable commitment to mentorship has left an indelible mark on countless long term care workers, administrators, and company officers.” </div> <div>&#160;</div> <div>Working with and learning from Flight has been a pleasure, Vera says. “She leads by example, and she does not expect more from her staff then she does of herself,” he says. </div> <div>“She combines clinical background being a nurse and years of administration experience.”</div> <div>&#160;</div> <div>As Kristine Halsey, chief operating officer of Ciena, notes, “Her legacy is not what she will leave us with but what she has left in us.” </div> <div>&#160;</div> <div>Not surprisingly, Flight has a long string of initials on her resume, including RN and MBA. Even more impressive is the fact that she received the Connecticut Nurses Association “Doris M. Armstrong” Nurse Administrator of the Year award in 2011, which was preceded by many other awards, including Administrator of the Year from the University of Connecticut in 2004. </div> <div>&#160;</div> <div>What’s more, Regency Heights received a Bronze award last year from the American Health Care Association/National Center for Assisted Living Quality Award program. </div> <div>“Grace is an icon in the industry in Connecticut,” says Vera. “She’s won multiple awards and had such a large impact and continues to. Her own knowledge base and ability to teach people is invaluable.”</div> <div>&#160;</div> <div>Flight has racked up numerous awards and distinguished appointments. They include&#58; an advisor to the state Superior Court, several governor appointments, and the Nightingale Award for Excellence.</div> <div>&#160;</div> <div>Flight’s accomplishments also include the development of an Advanced Geriatric Nurse Aide Concourse Curriculum that is used by long term care facilities, founding a Committee on Geriatric Nursing Education, a non-profit organization of Long Term Care Para and Professionals dedicated to providing quality low-cost continuing education with a current membership of more than 800.</div> <div></div> <div>&#160;</div> <div><img src="/Monthly-Issue/2013/PublishingImages/0213/RichardKishaba.jpg" alt="Richard Kishaba" class="ms-rteImage-1 ms-rtePosition-1" width="219" height="182" style="margin&#58;5px 10px;" /></div> <div><strong>Richard Kishaba</strong></div> <div>President/Owner </div> <div>Ohana Pacific Management Co.</div> <div>Honolulu, Hawaii</div> <div>&#160;</div> <div>Understanding Richard Kishaba’s commitment to caring for Hawaii’s elders first calls for a lesson in the Hawaiian language&#58; “Ohana,” the namesake of his company, means family, and “kupuna” means elderly. </div> <div>&#160;</div> <div>Born and raised in Hawaii, Kishaba has been working in long term and post-acute care for 24 years, since he was 27 years old. But he has always held elders in high esteem. “Hawaiians have a lot of respect for elders, and we always treat them with dignity. That was always instilled in me,” says Kishaba.</div> <div>&#160;</div> <div>At a young age he realized that he needed to make a difference in the world and focused his energies in health care after a career in business, says Nadine Smith, his colleague at Ohana Pacific Management. “He became a nursing home administrator and accepted a position in his early twenties with virtually no experience. He took over the facility for the benefit of the staff, residents, and an intrinsic obligation to the owner.”</div> <div>&#160;</div> <div>Kishaba has since purchased four nursing facilities, two on Oahu and two on Kauai. He also acquired the Kauai Adult Day Health Center on Kauai to ensure the community continued to receive a needed service. </div> <div>&#160;</div> <div>“Richard views each and every resident as a family member, and when assessing the success of his business he uses resident outcomes, customer satisfaction, and employee engagement as his benchmarks,” says Smith.</div> <div>&#160;</div> <div>Perhaps most importantly, Kishaba invests highly in his staff and promotes and encourages them to achieve their highest goals, “even if that means leaving the organization,” says Smith. </div> <div>&#160;</div> <div>Many of the leaders within the state started at Ohana, including several who have gone on to influential positions, such as the director of operations for a state health plan and the Health Care Services Branch administrator for the state of Hawaii.</div> <div>&#160;</div> <div>“We put our residents first,” says Kishaba. “I think we go to great lengths to make sure we’re doing the proper things for elders, such as bringing in the right people and spending time building up staff, engaging staff, and treating them with dignity so they can treat our elders with quality care.”</div> <div>&#160;</div> <div>The company is also a strengths-based organization, thus allowing employees to do what they do best. “Richard seeks out opportunities for all employees to get the training support and mentoring necessary to promote their personal and professional growth,” says Smith. “Richard emulates all that is positive in health care in Hawaii. He demonstrates true leadership, collaboration, and commitment to providing high-quality care and customer service.”</div> <div>&#160;</div> <div>“I encourage people to take risks; we are an organization that allows people test things. I’m a real believer in empowering people to try new things,” says Kishaba.</div> <div>&#160;</div> <div>Amid the accolades from colleagues on his selection, Kishaba remains humble&#58; “In all honesty, I do very little for our organization successes,” he says. “The true honor should go to all my staff, who are the true backbone of our organization.”</div> <div>&#160;</div> <div>Kishaba is an active and influential leader in the Hawaiian Long Term Care Association and is always willing to share his company’s expertise and advice with fellow members, says colleague Susan Mochizuki. “He firmly believes in resident-centered care and delivers the highest quality care by respecting, valuing, and supporting employees, especially those who are closest to residents.”</div> <div>&#160;</div> <div>Kishaba relays a story of a recent visit to one of his facilities&#58; “The daughter of a resident just started crying as she expressed her appreciation for the loving staff that care for her mom. This happens on a routine basis because of the great team of people that we have in our ohana,” he says. </div> <div></div> <div>&#160;</div> <div><img src="/Monthly-Issue/2013/PublishingImages/0213/DebRuebbelke.jpg" alt="Deb Ruebbelke" class="ms-rteImage-1 ms-rtePosition-1" width="162" height="243" style="margin&#58;5px 10px;" /></div> <div><strong>Deb Ruebbelke, RD</strong></div> <div>LTC Consultant—Reliable RD</div> <div>Appleton, Wis. </div> <div>&#160;</div> <div>Deb Ruebbelke is more than a dietitian&#58; She is an educator, a leader, an author, and an “awesome” cook, according to longtime colleague, Barbara Thomsen. “Deb has a wonderful ability to work with all disciplines in our long term care facilities, engage our residents and their families, and promote good nutritional health. She is truly a blessing to our elder nutrition profession,” she says. “Her willingness to support dietary managers and the Association of Nutrition &amp; Foodservice Professionals by helping to mentor, proctor, and teach is truly amazing.”</div> <div>&#160;</div> <div>Ruebbelke, who consults for nursing homes and assisted living communities, and recently formed Reliable RD (<a href="http&#58;//www.reliablerd.com/" target="_blank">www.reliablerd.com</a>) to help educate long term and post-acute care staff about nutrition, is also a ServSafe instructor, holds a position on the Iowa Dietetic Association Board and Council, and serves as an instructor the for Des Moines Area Community College Certified Dietary Manager course.</div> <div>&#160;</div> <div>“Deb is a unique dietitian that supports the role of the certified dietary manager and encourages and helps educate them to participate in clinical processes as well as kitchen management, focusing on sanitation and safe food handling,” says Thomsen. “Her willingness to promote teamwork amongst all long term care disciplines has been greatly appreciated by all the administrators that she has had the pleasure of working with.” </div> <div>&#160;</div> <div>Thomsen notes that Ruebbelke was recently instrumental in helping free-standing assisted living facilities in Iowa lay out and plan their dining services, thus enabling them to be in compliance with the regulatory guidelines for both the state- and federal-level food code. </div> <div>&#160;</div> <div>Also on her resume is adjunct educator for an Iowa community college for its Certified Dietary Manager program, and most recently, Ruebbelke co-wrote a training manual on the minimum data set (MDS) for dietitians, which “helps long term care nutrition professionals understand how to document resident-centered care and the MDS clinical process,” Thomsen says.</div> <div>&#160;</div> <div>“It’s very hard to talk about myself because, as a consultant dietitian in long term care, it’s a multidisciplinary team approach,” says Ruebbelke. <br></div> <div><h2 class="ms-rteElement-H2">Drawn From An Early Age</h2></div> <div>Her love of elders and long term care stems from her mother, who was a secretary to a nursing home administrator. Ruebbelke began volunteering at the nursing home at just 12 years of age. “At the facility, there was a dietitian, and I asked questions about what she did and why she liked her job. I’ve always been drawn to the elderly population,” she says. <br></div> <div><br>“When I did my internship in the late 1980s, I took it upon myself to shadow dietitians at nursing homes, and through that, I met a dietitian in Minnesota. When I graduated, she called me and asked if I would like to work for her.” </div> <div>&#160;</div> <div>Ruebbelke’s true calling is to “make a difference in an elder’s life,” she says. “I hope that I’m helping them to eat better, to help them have a better appreciation of nutrition, and that makes me feel good.” </div> <div>&#160;</div> <div>“Deb is a really great dietitian, she is very knowledgeable, and she has a knack for being able to educate and train as well,” says colleague Lisa Roeder. </div> <div>&#160;</div> <div>According to Roeder, her standout leadership qualities include having a “knack for being able to work with someone and bring the best part of them out and inspire them to want to do better. She makes people want to be better than they have been,” Roeder says. “Plus, she’s just awesome in general.”</div> <div>&#160;</div> <div>&#160;</div> <div><img src="/Monthly-Issue/2013/PublishingImages/0213/DanCohen.jpg" alt="Dan Cohen" class="ms-rteImage-1 ms-rtePosition-1" width="161" height="242" style="margin&#58;5px 10px;" /><br><strong>Dan Cohen, MSW</strong></div> <div>Founder, Music &amp; Memory</div> <div>Mineola, N.Y.</div> <div>&#160;</div> <div>With a viral YouTube video that was featured recently on “The Doctors” and National Public Radio, as well as a documentary about his organization, to his credit, Dan Cohen’s commitment to improving the lives of elders through music is indisputable. </div> <div>&#160;</div> <div>As the founding executive director of the nonprofit Music &amp; Memory, Cohen’s mission is to give elders living in nursing homes, assisted living communities, and in hospice care individualized musical playlists using iPods and related digital audio systems. </div> <div>&#160;</div> <div>As a Mineola, N.Y.-based social worker, Cohen combined an extensive background in high tech training, corporate sales, and software applications with his social work experience to create the Music &amp; Memory program, the goal of which is to enable those struggling with Alzheimer’s, dementia, and other cognitive and physical challenges to reconnect with the world through music-triggered memories.</div> <div>&#160;</div> <div>The viral YouTube clip is entitled “Henry,” and it demonstrates the power of Cohen’s program. Henry is a nursing home resident who comes alive as he listens to his beloved Cab Calloway on an iPod, donated to the home via Cohen’s organization. </div> <div>&#160;</div> <div>The goal of Music &amp; Memory is to make personalized music accessible for every nursing home resident nationwide. “Cohen has taught hundreds of nursing home administrators and other staff in the U.S. and Canada how to create individualized music programs for patients,” says Michele Nolta, a certified recreation therapist who has worked with Cohen.&#160; </div> <div>&#160;</div> <div>Through Music &amp; Memory, Cohen has “inspired and captured the enthusiasm of nursing home administrators, executive directors, nursing home staff from every discipline, retired music teachers, elder-law attorneys, high school key club members, news writers, and more,” says Nolta. “He has already drastically improved the lives of the residents who have been provided with digital music.”</div> <div>&#160;</div> <div>In fact, Cohen and his project so impressed the American Health Care Association, the California Association of Health Facilities, and the Gerontological Society of America, all three premiered his documentary “Alive Inside” at their 2012 annual conferences.</div> <div>&#160;</div> <div>“Dan Cohen has found a way to initiate patient awakenings, improve difficult behaviors, provide helpful and joyful interventions for nursing home staff, and inspire community members of every age to involve themselves with nursing homes,” says Nolta. “That’s impressive!”</div> <div>&#160;</div> <div>Cohen himself explains that when his program is implemented in a nursing home, it raises the morale of the entire facility and adds a new layer of response to residents who are agitated, depressed, and lonely. “So rather than responding with ‘let’s get this person some medication to calm him down,’ it’s ‘let’s get him some music quickly.’”</div> <div>&#160;</div> <div>That kind of change is real, Cohen notes. “Personalized music does not work for everyone, but it works for most people, and there’s often a great deal to gain.”</div> <div>&#160;</div> <div>Although Cohen says he is honored to have been selected for 20 To Watch, he believes “it signifies the recognition that so many people have raised—that it is critically important to give people we are caring for the same kind of lifestyle that we would have for ourselves and our families,” he says. “I think we’ve gotten away from that, and lifestyle goes beyond ADLs [activities of daily living]; it takes a focus, and it won’t happen just because everyone is safe and secure and medically attended to—that’s not enough.”</div> <div>&#160;</div> <div>Indeed, Cohen’s mission is to ensure that all elders can benefit from music whenever and wherever they want it.</div> <div>&#160;</div> <div>&#160;</div> <div><img src="/Monthly-Issue/2013/PublishingImages/0213/TimWintz.jpg" alt="Timothy Wintz" class="ms-rteImage-1 ms-rtePosition-1" width="159" height="236" style="margin&#58;5px 10px;" /><br><strong>Timothy Wintz</strong></div> <div>Director of Engineering &amp; Security </div> <div>Island Nursing and Rehab Center</div> <div>Holtsville, N.Y.</div> <div>&#160;</div> <div>Tim Wintz’s colleagues were thrilled to learn that he was selected as one of <em>Provider’s</em> inaugural 20 To Watch. Making the news especially exciting was that it came just two days after Hurricane Sandy had hit the East Coast and slammed into the building where Wintz and his team’s engineering prowess kept the generator running, the lights on, and communication channels open throughout the night as wind and water whipped the building where he has worked for nearly a dozen years.</div> <div>&#160;</div> <div>Embarrassed by the attention, Wintz demurred when told of his honor. “I really didn’t expect it,” he says. “I turned three shades of red. I’m nothing; I’m nothing without my team.” </div> <div>&#160;</div> <div>Wintz, who grew up on Long Island not far from the nursing home, credits “his guys” for the recognition. “It’s my guys who work for me that really make me shine,” he says. “My crew means the world to me.”</div> <div>&#160;</div> <div>David Fridkin, chief executive officer of Island Nursing and Rehab Center, has nothing but praise for Wintz, especially as a leader and a role model for other employees. “Tim stayed over during the hurricane and made sure that everything was still running in the building,” says Fridkin “This place is like his home away from home.”</div> <div>&#160;</div> <div>Fridkin adds that the knowledge and experience Wintz has demonstrated in analyzing difficult engineering situations have proven to be a real asset in the projects that he has developed at Island.</div> <div>&#160;</div> <div>“Tim has conducted a broad range of analyses in his project investigations,” says Fridkin. “Tim always asks the right questions, ensuring that our projects meet strict code and regulatory compliance.” What’s more, he says, Tim is “exceptionally sensitive” to the individual needs and preferences of the residents, families, and staff.</div> <div>&#160;</div> <div>In nominating Wintz, Fridkin noted that nursing home engineers often go unrecognized, despite the fact that their role is “invaluable in ensuring the safe, secure, and efficient operation of the building.”</div> <div>&#160;</div> <div>Wintz’s philosophy is communicated through ongoing education of his team to employ the same care and consideration when interacting with the residents and staff during the course of the ongoing facility maintenance projects. Tim always is available to provide support and time whenever another employee or resident needs assistance. </div> <div>&#160;</div> <div>Moreover, Tim is always cooperative, energetic, and insightful in his approach to problem solving, Fridkin says. “He possesses a broad range of engineering and construction experience, which enables him to handle a wide range of projects. In situations where unusual obstacles are encountered, innovative cost-efficient solutions are offered to resolve complex problems. It is a comfort to know that no problem is considered too insignificant to deserve his attention.”</div> <div>&#160;</div> <div>As with many who have chosen the long term care profession, work becomes a family affair, with Wintz’s being no exception. His 12-year-old daughter volunteers at the home. “She’s here right now, mingling with the residents and painting some fingernails, I think,” he told <em>Provider</em>.</div> <div>&#160;</div> <div>&#160;</div> <div>&#160;</div> <div><img src="/Monthly-Issue/2013/PublishingImages/0213/DeniseTollefson.jpg" alt="Denise Tollefson" class="ms-rteImage-1 ms-rtePosition-1" width="172" height="241" style="margin&#58;5px 10px;" /><br><strong>Denise Tollefson</strong></div> <div>Assistant Administrator</div> <div>Serenity Assisted Living</div> <div>Dilworth, Minn.</div> <div>&#160;</div> <div>Just as many in the field do, Denise Tollefson spends much of her life with residents and co-workers, and therefore she prefers to treat everyone she works with like family. </div> <div>&#160;</div> <div>In kind, her co-workers appreciate Tollefson as if she were a member of the family.&#160; Her flexibility and compassion, as well as her ability to listen well while being very detail-orientated when administering residents medication and carrying out their daily needs, are what got her nominated for 20 To Watch, says Elaine Anderson, administrator at Serenity Assisted Living. </div> <div>&#160;</div> <div>“Denise has been very instrumental in developing a philosophy and culture here at Serenity that is built around having highly trained staff who are experts in pain management and in providing support and counseling for all residents and families,” says Anderson. “She has recognized that a person is more than a physical body, and we provide skilled professionals and volunteers to assist with not only the physical needs, but emotional and spiritual needs as well.”</div> <div>&#160;</div> <div>Among Tollefson’s outstanding qualities, explains Anderson, are that “she treats everyone as an individual, she believes that it is unfair to classify everyone as the same, and every person out there has their own personality.” </div> <div>&#160;</div> <div>In addition, Anderson explains that Tollefson has “an awesome ability to listen as if the listening portion of the assessment is the most crucial part of medicine. Taking the time to hear those words that differentiate us all will allow a medical provider to implement a better plan in treatment and surprisingly enough just the mere fact of having someone to talk to may be all the medicine that is warranted.”</div> <div>&#160;</div> <div>What’s more, Tollefson puts the residents first while knowing her own limits and professional boundaries. “She truly is a very unique breed. When one considers that care providers need to meet the many requirements while at the same time possess other innate qualities that enable them to compassionately perform job functions, as per resident wishes and the wishes of their families,” Anderson says. “These special qualities are what make all the difference between average home care providers and excellent senior care providers, and Denise has them and uses them.”</div> <div>&#160;</div> <div>Making even more of an impact on her colleagues and on the residents, Tollefson recently implemented a very unique spirituality and wellness program at Serenity. Central to the program, she created a position for a chaplain and found a means to pay for that position and its enriching activities, says Anderson. </div> <div>&#160;</div> <div>After surveying the residents, Tollefson realized that they had a need for a spiritual/wellness program. “So we hired a part-time chaplain, who started in October. She does devotions two or three times a week and makes a theme with it,” says Tollefson. “They focus on different topics each week, such as the Sandy Hook school shootings or soldiers in Afghanistan, and they have a spiritually based discussion about it.” </div> <div>&#160;</div> <div>Tollefson, who has been with Serenity for seven years in April, came out of college as a writing and communications major and interned at the facility during school. “I never thought I would do this, but the time I spend here is the best fit ever. I think I will always be in long term care.”&#160; </div> <div>&#160;</div> <div>Her favorite part of the job&#58; “I like everyday interactions with residents. It’s so homey that you sit down with them every day. They are really important people in my life. We have just 26 residents, and you get to know them really well.&#160; They’re family members.”</div> 2013-02-01T05:00:00Z<img alt="" src="/Monthly-Issue/2013/PublishingImages/0213/top20_thumb.jpg" style="BORDER&#58;0px solid;" />Quality;20 to Watch;Culture ChangeMeg LaPorteProvider’s inaugural 20 To Watch continues this month with profiles of seven honorees who shine bright as glittering examples of what’s best in long term and post-acute care today.