Gateway Senior Living Lincoln, NE

1. Gateway Senior LivingLincoln, NE Mission Retention

2. A little bit about Gateway • The first retirement community in the city of Lincoln, built in 1963 • Independently owned by Russell V. Peterson • Dual licensed: Duplex unit, 54 ALF apartments & 18 SNF beds • Amy Fish hired in 2007, with 22 years of healthcare administrative experience, licensed preceptor for the state • 80 staff members: nursing, therapy, dietary, activities, social services, administration, & environmental services • Participates in the Medicare, Medicaid, and Medicaid waiver programs • Current occupancy is 98%

3. Goals of Mission Retention • Improved orientation to the campus • Improved training systems • Enforcement of personnel policies • Better management of staff & resident needs • More involvement of direct care staff • Routine measurement & evaluation of our progress

4. Day-to-Day Applications of Mission Retention • FISH philosophy • Employee Booster Committee • Other committees: safety, QA, RSP • Dish with Fish • S.H.A.R.E. • “Are We Meeting Your Expectations” • “Caught ya Caring” cards & program • Communication tools: newsletter, caretracker, etc. • Training programs on teamwork & customer service • Enforcement of the attendance policy • Interviewing & Hiring practices • Impromptu moments & celebrations

5. Outcomes Balanced Scorecard Measurements: • Turnover statistics • Staff Satisfaction Survey questions: Overall Satisfaction Quality of Teamwork Quality of Inservice Education Recommendation for job Recommendation for care Staff to Staff Communication Safety in the Workplace

6. Statistics Turnover: 200820092010 Dietary 95% 61% 38% NA/MA 159% 50% 50% Staff Satisfaction Survey return rate: 2008 37% 2009 63% 2010 89%

7. At the End of the Day It’s Really Very Simple……. and doesn’t cost a lot!

8. Maintaining Higher Occupancy - A joint program to increase resident's length of stay by managing difficult behaviors. Kathy Pietrocola Executive Director The Chelsea at East Brunswick

9. Mission Possible: Changing Culture, Changing Practice, Changing Care. • A joint venture with NJ Geriatric Education Center, the NJ Division of Mental Health Services and the Department of Health and Senior Services • Purpose of program • to enhance overall capacity to better serve those in our care • to develop a site specific behavioral management plan • to increase resident length of stay

10. Our initial interest in the University Behavioral Health Program: • We have two programs that we felt could benefit from an innovative team approach. • The Country Cottage – Dementia Program • The Crossings Program – unique to assisted living designed for residents with a psychiatric diagnosis.

11. Goals for our involvement: • to maintain higher occupancy and length of stay by creating unique approaches to challenging care needs • to try new approaches for challenging behaviors rather than medication alone • to decrease instigating triggers • to provide individualized care by increasing staff awareness • to create alternative responses to resistant behavior • to foster a staff “buy in” to the concept that some behaviors can be changed/avoided with proper early interventions and approach

12. Team approach • We attended the meeting as a team: Exec Dir, RN, Cottage Dir, Certified Medication Aides and CNAs • Met as a group during our training to decide what our focus would be and we decided our dementia program would be our starting point

13. Know your resident • The Cottage Director took photos of each cottage resident and put them in a photo album. • She then created a “getting to know you” sheet about each person. • These sheets were then placed on the opposite side of the resident’s picture in the photo album. • All staff was required to read over the information and get to know the residents in a new way.

14. Selecting our first residents • As a group, we selected residents we felt had specific behaviors we could address. • Resident #1 had lived in our AL community for years and had been transferred to the Cottage. • Resident #2 was new to our community and was directly admitted to our Cottage.

15. Resident #1- • Targeted behaviors- • unstable wandering • touching (and often ripping) anything within her reach • limited focus • Targeted approaches – • sensory table with sensory videos • sensory boxes • staff awareness

16. Resident #2 • Targeted behaviors- • exiting the secured area • extremely difficult to redirect • very limited verbal skills • Targeted approaches – • creation of the “Walking club”

19. Walking Club

20. Our results after two weeks • Resident #1 • was calmer • had periods of engagement with the sensory boxes • increased staff interactions • Resident #2 • responded well to the walks • less exit seeking behavior

21. Resident #1 and #2 today • Resident #1 just recently moved to a nursing home with overall physical decline and a need for 24 hour nursing supervision. We were able to keep her in our community six months longer using the new techniques and methods. • Resident #2 is doing well. Continues to participate in the walking club and is overall, more content. There is no longer a discussion of not being able to care for him in our community.

22. Ongoing efforts • As with any new program, change is constant so we continue to adapt our plan using new interventions. • What works this week may not next week. We currently have two new residents who are sundowning with extreme agitation, and we are now looking at options to avoid the triggers for them.

23. Looking to the future . . . • New ideas we feel may be successful- • Creating a “Sensory Aide” position. • responsibilities will include: • ensuring that the sensory plans are carried out each day • maintaining the equipment for the program • training new aides • Expand program to The Crossings • Create interventions for: • social isolation • anxiety • lethargy

25. Creating real life-changing transformation for nursing home residents and staff since 1994

26. What is Wellspring A quality improvement program that: • fosters culture change (e.g., resident-directed care, staff empowerment, a homelike environment) • assists participating senior care organizations through ongoing education and support

27. Wellspring History • Launched in 1994 in Wisconsin as the Wellspring Innovative Solutions for Integrated Health Care • Was one of the first efforts to affect culture change • Has assisted nursing homes throughout the country in advancing excellence in their settings • Now part of The Beacon Institute

28. Core Principles • Care decisions need to take place at the level closest to the resident • A substantial knowledge base is required by all staff to equip them to participate in decision making • An empowered workforce increases resident and employee satisfaction and reduces staff turnover

29. Why Wellspring? Customized Programming Recognizing that every nursing home is different in terms of its staff, resident population, physical plant, resources, and other factors, Wellspring tailors implementation strategies to enable a nursing home to participate in Wellspring regardless of where they are on their journey of culture change.

30. Why Wellspring? Affordable There is no need to make expensive changes to the physical environment or invest large sums of money. There are options to participate in Wellspring for every budget.

31. Wellspring Achieves Results Research has demonstrated that Wellspring: • improves the quality of care, resident satisfaction, employee satisfaction • helps to reduce pressure ulcers, falls, incontinence, weight loss, restraint usage, immobility, and psychotropic drug use in residents • increases resident and staff satisfaction

32. Wellspring Education Workshops address Best Practices and timely topics: • Culture Change 101 • Culture Change Nurse Coordinato Preparation • Leading Culture Change • Leadership for Frontline Staff • Observing and Understanding the Older Adult • Best Practices in Elimination and Incontinence Care • Nutritional Needs from a Holistic Perspective • Restorative Care for Falls Prevention • Best Practices in Pressure Ulcer Prevention, Identification, and Treatment • Best Practices in Caring for Persons with Dementias • Holistic Palliative Care • Best Practices in Infection Control • Others…

33. Wellspring Education But dynamic classroom instruction isn’t all… Wellspring has developed strategies to assist with the most challenging aspect of education: real life implementation

34. Wellspring Program Options There are a variety of ways that a nursing home can participate in the Wellspring Program based on their unique characteristics, budget, and progress on their culture change journey

35. Wellspring Program Options Culture Change LaunchProgram Consists of: • Onsite presentation of three full day educational programs: • Culture Change 101 • Culture Change Nurse Coordinator Preparation • Developing Best Practice Teams • The nursing home is responsible for proving the site for the program, participant food, an LCD projector, and reproduction of handout materials. • Nurse consultation via email for one year • The monthly Wellspring e-letter and updates for one year

36. Wellspring Program Options Alliance Member An Alliance consists of 8-10 nursing homes that are located within several hours’ driving distance of each other. The Alliance members contract to be part of the Alliance and: • Participate in the same Wellspring educational modules • Receive nursing consultation by the same nurse consultant(s) • Each have a staff person designated as their Wellspring Coordinator who networks and participates in meetings with other Alliance Coordinators • Input monthly data using My InnerView which is compared among Alliance members • Receive the monthly Wellspring e-letter and updates

37. Wellspring Program Options Individual Wellspring Workshops and Consultation Services • An individual nursing home can purchase educational programs and consultation based on individual needs without committing to the full implementation of the Wellspring model.

38. The Business Case for Wellspring Wellspring is an investment which leads to increased efficiencies resulting in cost savings and enhanced revenue. Research shows that among Wellspring’s benefits are reductions in resident falls, pressure ulcers, incontinence, and staff turnover.

39. The Business Case for Wellspring Consider the following costs: • $4,000+ Turnover cost for one nursing assistant • $15,000+ Turnover cost for one nurse • $5,300+ Nursing home added expense related to a fall • $11,000 Treatment of facility acquired pressure ulcer • $4,000 Annual cost for incontinence care per resident • $2,000 One day consultant visit to address a problem Just one occurrence of each of the above could cost $41,300,in addition to the nonfinancial costs that result (reputation, morale, poor ratings, etc). This is several times what it would cost to implement the full Wellspring Program.

40. Invest in Your Future! Join the leaders who improved the quality of care & life for residents, and the quality of work for employees by implementing The Wellspring Program

41. Contact Sandy Douglass, CEO/Administrator The Methodist Home of DC www.methodisthomeofdc.org sdouglass@methodisthomeofdc.org 202.777.3301

42. For more information… Isabella Firth Beacon Institute President 410-381-1176 ifirth@lifespan-network.org Charlotte Eliopoulos Wellspring Executive Director 410-665-2158 charlotte@HealthEd.net Wellspring web site: http://www.WellspringProgram.org