She taught me the importance of quality and that it counts.
She taught me that no meal is a quality meal without an excessive number of sides.
Sides made from scratch, by hand, that you start after breakfast and timed to perfection to be served timely by lunch.
She taught me that dressing to impress was a must during weekend shopping, anytime you travel, and on visits to see family. This often meant brushing my knotted hair and covering up my scabbed knees when I spent weekends with her and my grandfather as a child.
She taught me that a clean house was one that was scrubbed at the surface level as well as under, over, beneath and between all surfaces, including the refrigerator.
Everything was ironed, including bed sheets, and laundry was completed daily even when it requires climbing multiple flights of stairs and even if you have aching, tired knees.
She is my grandmother, and she decided last month to have an elective knee replacement, at 89 years of age, followed by a stay for rehab in a skilled nursing facility.
Quality matters to her and therefore I wanted to know that she would receive the same quality care during her recovery.
How could we ensure she would receive quality care and select a quality SNF?
Well, I was told, the family had toured some local nursing homes and found one that was clean with a therapy team she liked.
No deep diving, no review of quality measures, not even searching the local SNFs on Nursing Home Compare. The decision was being made based on warm fuzzies and the site that made everyone feel safe and with a team of nurses and therapist that were kind.
“Did you even Google it?” I asked my dad.
“I mean, seriously, have you all reviewed ratings online!?”
“Renee, those ratings don't have a thing to do with therapy. They are just about the nursing home side of the building.”
Right, Dad, because I have no idea what I am talking about ... I did not say this aloud. I just picked up the phone and did what anyone would do when Dad doesn't listen — I called Mom.
Now, more than ever, providers need to understand that quality therapy is imperative to achieving quality outcomes, quality measures and a quality 5-Star rating.
For instance, Quality Reporting Program data collection will begin in October of this year, impacting FY2020 annual payment for approved measures, including changes in skin integrity post-acute care: pressure ulcer/injury, change in self-care, change in mobility, discharge self-care, and discharge mobility.
Key clinical areas within data collection will be sourced from Section GG with many additions being greatly impacted by skilled therapy team members, including the addition of the following to Self-care:
• GG0130E. Shower/bathe self: The ability to bathe self, including washing, rinsing, and drying self (excludes washing of back and hair). Does not include transferring in/out of tub/shower.
• GG0130F. Upper body dressing: The ability to dress and undress above the waist; including fasteners, if applicable.
• GG0130G. Lower body dressing: The ability to dress and undress below the waist, including fasteners; does not include footwear.
• GG0130H. Putting on/taking off footwear: The ability to put on and take off socks and shoes or other footwear that is appropriate for safe mobility; including fasteners, if applicable.
And addition of the following to mobility:
• GG0170A. Roll left and right: The ability to roll from lying on back to left and right side, and roll back to back on the bed. GG0170G. Car transfer: The ability to transfer in and out of a car or van on the passenger side. Does not include the ability to open/close door or fasten seat belt.
• GG0170I. Walk 10 feet: Once standing, the ability to walk at least 10 feet (3 meters) in room, corridor, or similar space.
• GG0170L. Walking 10 feet on uneven surfaces: The ability to walk 10 feet on uneven or sloping surfaces (indoor or outdoor), such as turf or gravel.
• GG0170M. 1 step (curb): The ability to step over a curb and/or up and down one step.
• GG0170N. 4 steps: The ability to go up and down four steps, with or without a rail.
• GG0170O. 12 steps: The ability to go up and down 12 steps, with or without a rail.
• GG0170P. Picking up object: The ability to bend/stoop from a standing position to pick up a small object, such as a spoon from the floor.
So how did the SNF that provided my grandmother's care rate in achieving above targets, you ask? Was a quality outcome received?
It was indeed, and in a 2-star rated facility.
Her caregivers were kind and attentive during her stay and her rehab team helped her to achieve the quality outcomes we all hoped for.
She is now home, spending quality time with family and friends, back to making quality meals that, I hear, include delicious tenderloin and world famous potato salad.
I am now anxiously awaiting when she will be able to come for a visit. Break out the mop, everyone make your beds, someone fire up the stove, and everyone please put some decent looking clothes on.
Time to get this place looking ready for an overdue visit from Grandmother.
Renee Kinder, MS, CCC-SLP, RAC-CT, is Director of Clinical Education for Encore Rehabilitation and is the Silver Award winner in the 2018 American Society of Business Publishing Editors competition for the Upper Midwest Region in the Service/How To Blogs category. Additionally, she serves as Gerontology Professional Development Manager for the American Speech Language Hearing Association's (ASHA) gerontology special interest group, is a member of the University of Kentucky College of Medicine community faculty, and is an advisor to the American Medical Association's Relative Value Update Committee (RUC) Health Care Professionals Advisory Committee (HCPAC).