Long-term care success is about steady, reliable relationships. That’s my takeaway after attending two recent conferences that echo my experiences in the field.
The first event delivered the results thus far of an ongoing program that won a coveted grant from the Center for Medicare & Medicaid Services’ Center for Innovation. The OPTIMISTIC project is an effort of Indiana University and local partners, including the University of Indianapolis Center for Aging and Community. OPTIMISTIC is an acronym for Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care.
The model entails placing registered nurses in nursing facilities, as well as giving staff access to nurse practitioners. The nurses function as educational trainers and as resources for the team.
The consistent relationships with these nursing experts produced astounding results, including a 32.6% reduced relative risk of potentially avoidable hospitalizations and a net savings to Medicare of $3.4 million.
The second conference in which I participated was a National Readmission Collaborative event.
Keynote speaker Eric A. Coleman, M.D., discussed research on phone calls following up with patients after discharge from the hospital. While such contacts have been touted as an effective means of identifying and remedying precursors to hospital readmission, patients are often barraged with contacts from various service providers. These well-intentioned efforts thus become annoyances without real value to the patient and their family.
Having one consistent, informed care manager across the healthcare continuum proves more useful and effective, he reports.
As a psychologist, I’m not at all surprised. A significant element of my job is to provide steady support to people in crisis situations. For example, aside from family members, I’m often the only staff person to follow a resident from one floor of the nursing home to another and to provide some continuity of care.
This allows me to inform the team of changes in a resident’s demeanor that aren’t evident to a staff person new to the individual. I’ve notified nurses of changes in mental status, alerted them to upcoming medical appointments that would have otherwise been missed and asked them to check on a new admission who presented as obese but who turned out to have severe edema due to an acute life-threatening condition.
Very often, residents tell me about important symptoms they wouldn’t mention to a worker they barely know. Similarly, as a team member, when I go to the nursing station to relay information, I’m much more confident that the problem will be resolved when I speak with a well-established nurse who can easily address the issue rather than with a new nurse who’s already overwhelmed with the basics.
As skilled nursing facilities react to market pressures and create partnerships with hospitals and other post-acute providers, they become increasingly evaluated for their ability to reduce expenditures and to provide quality care, as noted in this article. Costs skyrocket and care quality plummets without staff members who know their residents and are trained to identify and report symptoms.
Whether by staff access to educational training by a consistent nurse leader, a steady presence throughout of the continuum of care or stable staffing that allows for continuity of care, relationships are the key to healthcare success.
Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with over 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.