AHCA, NCAL Gold Quality Award Achievers Talk Strategy, Sacrifice<blockquote><h4><span class="ms-rteThemeForeColor-6-4 ms-rteFontSize-2">National Quality Awards Ceremony </span></h4><h4><span class="ms-rteThemeForeColor-6-4 ms-rteFontSize-2"><strong>Don’t miss the Live National Quality Awards Ceremony, which begins at 2&#58;00 p.m. ET Thursday, Oct. 22, in the General Session and Special Events Theater in conjunction with AHCA/NCAL’s 70th Virtual Convention &amp; Expo. </strong></span></h4><h4><span class="ms-rteThemeForeColor-6-4 ms-rteFontSize-2"><strong>All 719 Bronze, 147 Silver, and 4 Gold recipients will be honored. Attendees are invited to join in the chat function to share congratulatory messages and shout out to other 2020 recipients. </strong></span></h4><h4><span class="ms-rteThemeForeColor-6-4"><strong class="ms-rteFontSize-2"> Registration for the convention closes Friday, Oct. 23. Not signed up?</strong><span class="ms-rteFontSize-2"> </span><a href="https&#58;//www.eventscribe.com/2020/AHCANCAL/aaStatic.asp?SFP=WURZVUdSWVlAMzk3NA%29"><strong class="ms-rteThemeForeColor-6-4 ms-rteFontSize-2">Register now.</strong></a> </span></h4></blockquote><p></p> <style> p.MsoNormal, li.MsoNormal, div.MsoNormal { margin:0in; font-size:11.0pt; font-family:"Calibri",sans-serif; } a:link, span.MsoHyperlink { color:#0563C1; text-decoration:underline; } span.MsoHyperlinkFollowed { color:#954F72; text-decoration:underline; } .MsoChpDefault { font-size:11.0pt; font-family:"Calibri",sans-serif; } .MsoPapDefault { margin-bottom:8.0pt; line-height:107%; } div.WordSection1 { } </style> <p>A quartet of providers has received the preeminent Gold National Quality Award designation from the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) for 2020 and is being honored for their achievement during the association’s annual convention that runs on a virtual basis through the month of October.</p><p>Jane Martin, RN, director of nursing, Treutlen Health and Rehabilitation, Soperton, Ga., says for her 50-bed facility in rural Georgia the latest attempt to achieve Gold started five years back when the organization earned Bronze from AHCA/NCAL, then Silver in 2017.</p><p>“That is when we decided to go for the Gold,” she says. “We [earned] a site visit last year and then this year got the Gold award.”</p><p>Going for the top honor and going for the Bronze or Silver are worlds apart, Martin notes. “The Gold is so much different, and you really need to dedicate time to it.” This work includes copious writing down to report quality-based outcomes for residents, since getting positive results is what the award process is all about, she says.</p><p>“Probably the most difficult things is collecting the data. Everything has a different measurement time frame, so I really rely on LTC Trend Tracker [from AHCA/NCAL], NursingHome Compare…You need to know all of these data today on a regular basis.”</p><p>Once all the hard work resulted in the Gold, Martin says sharing the good news, in a COVID-sensitive manner, was a great feeling for staff and residents alike.</p><p>“We were in a huge open area when we told them, and it was a lot of yelling through masks,” she says. “It was kind of sad that we could not hug or have family there, but we did our best.”</p><p>As for what she would tell fellow providers about the award program, Martin says facilities should do it; even though it is not easy, it is well worth it. “We all learned so much through the process, and there were so many little things along the way, it has changed the way we live and work here.”</p><p>Kristin Thrun, administrator, Burgess Square Healthcare and Rehab Centre, Westmont, Ill., says her nursing home got into the quality award world because back in 2012 when accountable care organizations and other value-based care entities emerged in her area, it became imperative for her facility to set itself apart.</p><p>“The focus became even more pronounced on overall performance outcomes and quality measures, and becoming part of the AHCA award process helped us to do this in a systematic way,” she says.</p><p>After receiving some local awards for their work with residents, the facility earned Bronze from AHCA/NCAL in 2017 and then eyed going for Gold after that. </p><p>“I think the biggest challenge is continuing to push forward in terms of meeting the criteria and putting our programs in place and sustaining them despite the external challenges brought on by things like changes in payment models [person-directed payment model] and keeping pace with those,” Thrun says.</p><p>An example she gives is the challenge it was to make the systemic change on medication reconciliation when a resident moved from the hospital to the nursing home. “We worked with the hospital to change the process and reduce errors tied to these transitions of care and created a pharmacy position that just does admission reviews for new patients coming in,” she says. </p><p>The third achieving group says its journey to Gold began 18 years ago, according to Gail Cushing, RN, executive director, Applewood Center, Winchester, N.H.</p><p>“It has been a long journey for sure, but we continued to forge on throughout the time, but it did not prevent us from getting to where we wanted to go,” she says.</p><p>The greatest thing about the Gold process, Cushing says, is that it gave Applewood Center and its staff new skill sets to be able to adapt to new demands. “We can take new problems and adapt very quickly. An example is with COVID-19; I have said handling the pandemic was made more manageable because we went through a dress rehearsal with the Gold awards.”</p><p>For her, the award application has taught her and her people to communicate better, get feedback, educate, teach, and fix pitfalls. One example is that during the pandemic, her staff came up with a way to clean their goggles when there was no water source in an area where people were working.</p><p>“The whole Gold process is a concept really that provides a facility&#160;with new means to achieve success, and the more you practice, the better you become and the more ingrained it all becomes,” Cushing says.</p><p>Katie Frederick, administrator, Heritage of Bel-Air, Norfolk, Neb., started out talking about the end game of achieving Gold, which was the joy she, her 160-strong staff, and residents felt at accomplishing so much. Even though the pandemic has made a true celebration difficult, she says the pride all in the community feel about making Gold is real.</p><p>For her, making changes to be more efficient and better at evaluating results and outcomes is the lasting impact going through the award process will have. </p><p>“Evaluating and learning is what this has all been about. And, really getting better at communicating, listening to each other, and putting ideas into practice. That has all worked for us,” Frederick says.</p><p>Looking ahead to 2021, AHCA/NCAL said the deadline to submit an Intent to Apply for a 2021 National Quality Award is Nov. 12 by 8 p.m. (ET). For more information, visit the Quality Award <a href="https&#58;//www.ahcancal.org/Quality/National-Quality-Award-Program/Pages/default.aspx">website</a>.</p>2020-10-21T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/0220_News2.jpg" style="BORDER&#58;0px solid;" />Quality AwardsPatrick ConnoleAll Quality Award recipients are being honored Oct. 22 at the association’s 70th Virtual Convention & Expo going on this month and live on Thursday the 22nd.
Measuring Quality<p>There will need to be ongoing attention to developing quality measures that address quality of life, says Michael Wasserman, MD, CMD, and a geriatrician in California.<br></p><p>For instance, “If someone has end-stage Alzheimer’s disease and is in terrible pain and discomfort, is death a bad outcome? A good outcome is one that respects the dignity and wishes of our patients,” he says. <br></p><p>“This is the real determinant of whether we are delivering person-centered care. This is where quality measurement needs to go.”<br></p><p><img src="/Monthly-Issue/2020/August/PublishingImages/kumar.jpg" alt="Rajeev Kumar, MD" class="ms-rtePosition-1" style="margin&#58;5px;" />Facilities and their care teams take quality and quality measurement seriously, says Rajeev Kumar, MD, CMD, chief medical officer at Symbria.<br></p><p>“Health care quality is always about best practices that define a path to optimal outcomes. It is the guardrail that keeps us on track to success,” Kumar says.<br></p><p>However, he admits that the pandemic “has exposed gaps in our systems and processes as we seek to define quality in post-acute and long term care. Any quality measures that we use or create to track our success with a pandemic must include and account for external factors that impact our performance and, sometimes, are beyond our control.”​</p>2020-08-01T04:00:00ZQuality“Health care quality is always about best practices that define a path to optimal outcomes. It is the guardrail that keeps us on track to success,” Kumar says.
Residents and Staff Get Front Row Seats to Broadway Show<div>​</div> <div> </div> <div>COVID-19 has changed most aspects of daily life. Everything from eating out to going to the movies has a new normal—don’t do it. For residents of long term and post-acute care centers, the challenge is especially hard. Not only must they stay inside the building, but they often must stay in their rooms or apartments to protect themselves.</div> <div> </div> <div><br></div> <div><img src="/Monthly-Issue/2020/May/PublishingImages/Broadway_still.jpg" class="ms-rtePosition-1" alt="" style="margin&#58;5px 15px;width&#58;235px;height&#58;197px;" />Staff share a unique challenge of keeping up with the constant wave of changes from the government in managing the disease, while building hope and keeping anxieties in check to care for the most vulnerable.&#160; </div> <div><br></div> <div>Robert Van Dyk, president and chief executive officer of Van Dyk Health Care, wanted to offer the residents and staff at Van Dyk Park Place, an assisted living community in Hawthorne, N.J., home care services clients of At Home With Van Dyk in Ridgewood, N.J., and clients of the Van Dyk Memory Care Center in Hawthorne (adult day care) something special as they dealt with the present-day challenge. So he tapped his chief operating officer to put together a special event designed for residents and staff alike. </div> <div>&#160;</div> <div>The result was “When Broadway Goes Dark Van Dyk Goes Live, virtual edition,” a one-hour concert featuring songs performed by a cast of Broadway stars, including Catherine Brunell, Natalie Cortez, Nick Spangler, and James Moye. “If our families are not allowed to visit Broadway, then we’re bringing Broadway to them,” says Van Dyk.&#160; “We’re all feeling the effects of social isolation. We need music in our lives, especially now. We’re hoping that this virtual show is a creative and fun way to remind our staff and our families how much we care for them.”</div> <h2 class="ms-rteElement-H2"> How They Did It</h2> <div>The show was the third Broadway concert hosted by Van Dyk Health Care. The first two were live, in-person concerts performed on stage for Van Dyk residents and families. The first concert was performed at Park Place, and staff arranged for a sound system and stage inside the facility.&#160;</div> <div><br></div> <div>“The response was so great that the second year, we rented the performing arts center in Englewood, New Jersey,” says Van Dyk. “And now we have COVID so we’re not able to do this one live, but Natalie and Nick and James and Catherine cannot wait to come back and perform for the residents and staff.” </div> <div><br></div> <div><img src="/Monthly-Issue/2020/May/PublishingImages/JamesMoye.jpg" alt="James Moye" class="ms-rtePosition-1" style="margin&#58;5px 15px;" />When planning the first event, Michael Wissot, chief operating officer at Van Dyk, reached out to Moye, his friend, and explained what they wanted to do.</div> <div><br></div> <div>“His eyes immediately lit up, and we started painting from a blank canvas,” says Wissot. “We were trying to imagine what’s the right format, the right number of performers, and the right songs. And that’s where the fun began because we were able to put together a program that allowed people to connect, especially to the theme of Alzheimer’s awareness.”</div> <div><br></div> <div>The first two concerts were designed for the residents. So staff asked the residents which songs they’d like to hear and came up with a list that was shared with the performers, along with a list of Van Dyk employees and the different departments. </div> <div><br></div> <div>“Songs like, ‘It All Fades Away,’ ‘You Will Be Found,’ and ‘Memory,’ they really strike a chord for the residents but also the family members,” says Wissot.&#160; The concerts hold special meaning for the performers, too—Moye, Brunell, Cortez, and Spangler all have family members who have been affected with Alzheimer’s disease in some way. </div> <h2 class="ms-rteElement-H2">New Challenges</h2> <div>From the idea to production, it took about three weeks to put the virtual event together. “It would have taken shorter under normal circumstances because we had to remind ourselves we had to focus on continuing to anticipate and adapt to the precautionary measures that we needed to put in place in order to keep residents safe,” says Wissot.</div> <div><br></div> <div><img src="/Monthly-Issue/2020/May/PublishingImages/CatherineBrunell.jpg" alt="Catherine Brunell" class="ms-rtePosition-2" style="margin&#58;5px;" />This meant putting work on the virtual event to the side to deal with other COVID-19 priorities as they arose. “I was not readily available during the traditional hours, and thankfully the performers were very flexible and adapted to my schedule,” he says.&#160;</div> <div><br></div> <div>Keeping the event virtual also meant figuring out the Zoom platform and ensuring that all performers were able to produce it from their own homes individually. In each case the team adjusted for sound and quality to achieve an ideal balance.</div> <div><br></div> <div>“Of course that’s difficult because each performer had their own set-up at home. None of them, of course, anticipated that they would need sophisticated equipment, but everyone worked together and communicated the whole way through, and we came up with something really unique,” says Wissot. </div> <h2 class="ms-rteElement-H2">Watching Together, Individually</h2> <div>Using a technology platform available via television in residents’ rooms and around the centers, residents watched the performance from inside their rooms. The platform is typically used to post announcements, schedules, and menus, and it was a first for the Van Dyk team to share the concerts with the platform.&#160;</div> <div><br></div> <div><img src="/Monthly-Issue/2020/May/PublishingImages/NatalieCortez.jpg" alt="Natalie Cortez" class="ms-rtePosition-1" style="margin&#58;5px 15px;" />The concert was made available on social media so that families and staff could also watch. “It is really important to make sure that everybody feels included in these kinds of experiences,” says Wissot. “One of the great things about going to a show is the conversations you have afterwards about what you thought about it. We wanted to let everyone know that we were at this concert together.”</div> <div><br></div> <div>In the same way they had reacted to the first two concerts, residents and staff enjoyed the performances immensely, says Van Dyk. “The reactions are always amazing, when the performers come to the community, the residents want to get up and dance,” he says. “And there is such a bond between the performers because they all have grandmothers, grandfathers, aunts, or uncles with dementia. The residents love it, families love it, and [the singers] love to see what we do for their parents.” Van Dyk says he’s received many thank you letters from families.</div> <div><br></div> <div>As the first two concerts were designed for residents, performers read out dedications to residents. For the virtual concert, the performers dedicated songs to different staff teams.</div> <h2 class="ms-rteElement-H2">Focus on Staff</h2> <div>COVID-19 has brought challenges and worries to almost everyone, says Van Dyk. “The residents struggle at one level, but they are being cared for every day,” he says.</div> <div><br></div> <div><img src="/Monthly-Issue/2020/May/PublishingImages/NickSpangler.jpg" alt="Nick Spangler" class="ms-rtePosition-2" style="margin&#58;5px 10px;" />“But what we are going through now is really hard on the staff. Every day they come in and they have personal worries, they worry about their children back at home, they worry about their spouse who in most cases is unemployed at home. They worry about bringing COVID home to their family; we in turn worry are they going to bring COVID in. So we are doing whatever we can to help staff recognize how important they are. Long after COVID becomes part of our history, our staff will be remembered as the heroes of this pandemic.”&#160;</div> <div><br></div> <div>As Van Dyk pens his Easter note to families, the topic is about sacrifices. “And staff are making sacrifices,” he says. His advice is to do everything and anything possible for staff, as small as it may seem. “I’ve been sending bushels of oranges up to my communities,” he says. “One, because they are delicious, and two because they help build up your immune system. And we just sent about 400 chocolate Easter bunnies up to the staff. It says, ‘Thank you, we’re thinking about you, you’re not alone.’” </div> <div>&#160;</div> <div>To watch the virtual concert, visit&#58; <a href="http&#58;//bit.ly/3bSreSI" target="_blank">http&#58;//bit.ly/3bSreSI</a>. </div> ​2020-05-01T04:00:00Z<img alt="" src="/Monthly-Issue/2020/May/PublishingImages/Broadway_t.jpg" style="BORDER&#58;0px solid;" />Caregiving;Quality;TechnologyAmy MendozaStaff share a unique challenge of keeping up with the constant wave of changes from the government in managing the disease, while building hope and keeping anxieties in check to care for the most vulnerable.
Interview: Rosemary Oldham<div>​</div> <div>​</div> <div> Sometimes, one finds their calling after their start. In an interview with <em>Provider,</em> Rosemary Oldham, RN, MDS coordinator and infection preventionist (IP) at <a href="https&#58;//www.hydenhrc.com/" target="_blank">Hyden Health and Rehabilitation Center </a>in Hyden, Ky., shares her career path from needing a job to choosing to stay and growing into different roles.</div> <br><strong class="ms-rteThemeForeColor-5-0"><em>Provider&#58;</em></strong> How did you get started in long term care?<br><div><span class="ms-rteForeColor-2"><strong>Oldham&#58;</strong></span> I needed a job. I started my journey in long term care truly for the job, and then I fell in love with it. I entered in as a staff nurse, I started on a floor at the current nursing home where I am. I did that for four and half years. I loved it and exceled. </div> <br><div>I truly do long term care just for the elderly. I love them. They are the reason why I stayed.</div> <div><br></div> <span><strong class="ms-rteThemeForeColor-5-0"><em>Provider&#58;<span style="display&#58;inline-block;"></span></em></strong></span> What is your typical day like?<br><div><span><span class="ms-rteForeColor-2"><strong>Oldham&#58;<span style="display&#58;inline-block;"></span></strong></span></span> My day is busy. I come in, I do my rounds. If there are problems, I do my minimum data sets [MDS]. I work on infection control, I report, I work on scheduling, billing, you name it. It’s a busy job, and you have to stay on top of it.</div> <div><br></div> <span><strong class="ms-rteThemeForeColor-5-0"><em>Provider&#58;<span style="display&#58;inline-block;">&#160; </span></em></strong></span>IP—how did you get into that? <br><div><span><span class="ms-rteForeColor-2"><strong>Oldham&#58;<span style="display&#58;inline-block;"></span></strong></span></span> I got the position a year and a half ago. What happened is my director of nursing switched from the Medicare coordinator and infection preventionist to her current role. So I took over. I moved into her position. And the IP position, I love it. <br></div> <div><br></div> <span><strong class="ms-rteThemeForeColor-5-0"><em>Provider&#58;<span style="display&#58;inline-block;">&#160; </span></em></strong></span>Why do you love it?<br><div><span><span class="ms-rteForeColor-2"><strong>Oldham&#58;<span style="display&#58;inline-block;"></span></strong></span></span> I have enjoyed really learning. Your everyday nurse is not going to understand multi-drug resistant organisms [MDROs]. They are not going to understand really what is out there, how to report it. And so that learning process of transferring myself from a regular staff nurse into an IP nurse into that different side of nursing—I loved that challenge. I’m always ready to learn something new. <br></div> <div><br></div> The thing with the IP position is that it’s ever-evolving. And to keep up with it you’re always going to learn something. There’s always some new organism or some new thing you have deal with. So someone in this role has to figure out what that is, how you’re going to prevent it, and how you’re going to stop it, which to me is interesting. So this is a very educational position.<br><br><div><span><strong class="ms-rteThemeForeColor-5-0"><em>Provider&#58;<span style="display&#58;inline-block;"></span></em></strong></span> How do you lead education for the other staff on these topics?</div> <div><span><span class="ms-rteForeColor-2"><strong>Oldham&#58;<span style="display&#58;inline-block;"></span></strong></span></span> Inservices. I go around, and I talk to everyone. We have really highly inserviced staff, and in terms of infection prevention, we focus on what the standards are. </div> <br>I’ve invited people into our buildings from our state regulatory office to go over all areas. And so we have grown to improve, we have a lot more to go and it’s ever evolving. And when I say that I mean it leads back to antibiotic usage. To doctors, to your nurses, to orders, there’s so much to it. <br><div><br></div> <div><span><strong class="ms-rteThemeForeColor-5-0"><em>Provider&#58;<span style="display&#58;inline-block;"></span></em></strong></span> Will you stay in this role or take another?</div> <span><span class="ms-rteForeColor-2"><strong>Oldham&#58;<span style="display&#58;inline-block;"></span></strong></span></span> You never know. One thing that I will say is that, after doing IP, I realize that a license in epidemiology would be a nice thing. If I go further in that, I will try to get state certified. You have to go through a rigorous test, so then you are a certified infection preventionist.<br><div><br></div> <div><span><strong class="ms-rteThemeForeColor-5-0"><em>Provider&#58;<span style="display&#58;inline-block;"></span></em></strong></span> How do you keep up on your learning for IP?</div> <div><span><span class="ms-rteForeColor-2"><strong>Oldham&#58;<span style="display&#58;inline-block;"></span></strong></span></span> We do a lot with the Centers for Disease Control and Prevention. We also have people in Frankfort here in Kentucky who run our statewide programs, and I learned a lot from them. <br></div> <div><br></div> I also reach out to a lot of long term care facilities to see what they are doing to fight MDROs. It’s a very different role from acute care. I was a staff nurse in a hospital before, and working in long term care is much different because it’s a home environment. <br><div><br></div> <div><span><strong class="ms-rteThemeForeColor-5-0"><em>Provider&#58;<span style="display&#58;inline-block;"></span></em></strong></span> What advice would you give to someone who wants to grow in their role like you have?</div> <span><span class="ms-rteForeColor-2"><strong>Oldham&#58;<span style="display&#58;inline-block;"></span></strong></span></span> Compassion. That is legit. You have to want to learn. Unfortunately, you have the fact that the everyday Joe can pass nursing school. But you have to have compassion in order to grow into anything in long term care. If you don’t, you will not survive, you will not evolve, you will not do well.<br><div><br></div> <div><span><strong class="ms-rteThemeForeColor-5-0"><em>Provider&#58;<span style="display&#58;inline-block;"></span></em></strong></span> What’s the biggest thing you’ve learned?</div> <div><span><span class="ms-rteForeColor-2"><strong>Oldham&#58;<span style="display&#58;inline-block;"></span></strong></span></span> I’m satisfied where I am right now. I learned a lot of things as far as people learning people skills, being around people, learning that life is not black and white, life is gray, everyone’s situation is different.</div> <div><br></div> This role gives you better people skills; you have to deal with the general public. It makes you softer in some ways but it makes you harder in some ways. Death is a hard one, but you deal with death better when you see it more than once.<br><div><br></div> <div><span><strong class="ms-rteThemeForeColor-5-0"><em>Provider&#58;<span style="display&#58;inline-block;"></span></em></strong></span> Do you have a story of a resident that stands out to you?</div> <div><span><span class="ms-rteForeColor-2"><strong>Oldham&#58;<span style="display&#58;inline-block;">&#160; </span></strong></span></span>Yes. This particular resident that I had changed the way I view long term care. I was a nurse for six months. I was living the hustle and the bustle, trying to get my shift done. He had a trach and could not talk to me. He tried and couldn’t speak. When I think about him now, I can see his face and the things that he asked me. <br></div> <div><br></div> <div>So one day he has an appointment to have the trach out. I was off for two days, and I came back in the morning shift. I worked day shift at the time. <br></div> <div><br></div> <div>I came back that morning, and I heard a resident that I’ve never heard before. And he was saying, “Rosemary, Rosemary,” and I hollered down to the nurse that I was going to get a report from, and I said, “Who is that?” and she said his name, and he was one of the residents that I cared for. </div> <br>And in that moment, I knew. I knew that resident. Every day I talked to him, and he knew me. He knew who I was. From that minute on, he never forgot my name, he hollered at me whenever he got mad. <br><div><br></div> <div><span><strong class="ms-rteThemeForeColor-5-0"><em>Provider&#58;<span style="display&#58;inline-block;"></span></em></strong></span> What did you learn from that?</div> <div><span><span class="ms-rteForeColor-2"><strong>Oldham&#58;<span style="display&#58;inline-block;"></span></strong></span></span> So for somebody who can’t talk, you think that they don’t see you, that they don’t hear you. You’re living that daily bustle, and my name was the first thing I ever heard him say. From that moment on, I knew I was doing the right thing. And that was the very first patient that in that moment I was like, “Oh my God, he knows my name, and he’s never said a word.” And that forever evolved me into nursing.</div> <div><br></div> <div>From that moment on, I have more than a little more for my patients with dementia. For my patients who anybody else would think that they don’t know. You walk into these rooms, and just because these people don’t talk to you, it doesn’t mean that they don’t understand you. I’m telling you, that moment was an ever-changing point for me in my career. <br></div> <div><br></div> <div>He saw me beyond my role; he saw me as Rosemary. He called me Rosemary Annie. And he continued to call me that until he left. And I still have people that call me Rosemary Annie. </div> <br><div>He was on a mechanical diet, thickening liquids. I would have to thicken his Sprite, and he’d drink that Sprite and he’d say, “Oh baby that’s good. That’s the best thing I ever drank.” Those type of relationships have kept me going. Those type of residents have pushed me to where I am now.</div> <div><br></div> That’s a story of the man I would never have thought knew my name, even though I talked to him every day. But to hear him, that was just a pivotal moment. <span style="display&#58;inline-block;"></span><br>2020-03-01T05:00:00Z<img alt="" src="/Monthly-Issue/2020/March/PublishingImages/RosemaryOldham_t.jpg" style="BORDER&#58;0px solid;" />Quality;CaregivingAmy MendozaRosemary Oldham, RN, MDS coordinator and IP shares her career path from needing a job to choosing to stay and growing into different roles.