From the Center of My Care Team

by Janet Pollock, Kentucky

In 2002, I began an exciting career journey with the Kentucky Quality Improvement Organization (QIO). During my early days with the QIO, my focus was outreach – teaching Medicare beneficiaries about their benefits, when and how to file a complaint, and what to expect as a resident in a nursing home. I even had the fun experience of being spotlighted in a commercial that ran for a month in Kentucky when Medicare Part D was launched.

Our quality improvement work is always evolving based on current healthcare needs. We have been charged with a wide variety of tasks like physical restraint and pressure injury reduction, spreading person-centered care, and registering facilities in the National Healthcare Safety Network (NHSN) database to report clostridium difficile (C. diff) infections. Whatever quality improvement challenge we faced, there was always one consistent common denominator – involving the front-line caregivers.

The year 2015 brought a new opportunity for all nursing homes to participate in regionally offered, statewide person-centered care training. The Centers for Medicare and Medicaid Services (CMS) funded this University of Louisville-sponsored training where certified nursing assistants (CNAs) were required to be a part of the team in each enrolled home. Throughout the last five years, the QIO staff in Kentucky has routinely reached out to engage all levels of nursing home staff in educational events. After all, we know there is no such thing as “just” an aide or “just” a housekeeper. More facilities are looking at universal staffing – making sure that staff, like a unit secretary or CNA, are cross-trained in various areas of need (pro re nata – PRN). This is the exact process the QIO has found most beneficial within our organization. We have multi-pronged tasks and individual subject matter experts, but the most robust outcomes are achieved when all of us are educated to reach the team’s goals.

From the Center

This background brings me to another part of my journey. Recently, I had severe healthcare concerns and was hospitalized in Louisville. I was provided a list of rehabilitation facilities to choose from. My work with many nursing homes in the area provided some insight, and I ultimately chose Nazareth Home.

I chose it because its mission is compassion, spirituality, and excellence. What more could I ask for? Would it hold true for me, I wondered? After all, I had high expectations for them to live up to.

I was admitted on a Wednesday evening. The staff in charge had me sign-off to allow the use of side rails for positioning for therapy if needed. I chose to use the side rails, and after I signed the form, they snipped the zip ties, placed after cleaning, that held the side rails secure. This allowed me to check off the first couple of items on my care list, compliance with no restraints and involvement of the patient with care plan decisions.

During the next hours, aides, nurses, therapists, and administrative staff came to introduce themselves and provide care. I watched for hand-hygiene compliance, glove usage, communication with me as a patient, and teamwork among the staff. I have been delighted to receive not only excellent care but genuine concern for me as a person. One of the first to gain my attention and great appreciation was Kim. She has been a CNA for nearly 40 years! Her tips and tricks to help make my day smooth were never-ending. When I asked her why she has done this work, she responded “I want to serve and help people. I never had the opportunity to help my parents as elders because they died in their 50s and 60s, so I treat people the way I would treat my family.”

She added that she had no desire to be a tech or a Licensed Practical Nurse (LPN) because the most significant principle that we practice is teamwork. “We know each other, and we have each other’s backs,” she said.

Each day I was there, her comments were exemplified, and I discovered a second benefit to consistent assignment that I hadn’t understood previously. Kim Hobson, Director of Nursing (DON), said Nazareth has been practicing consistent assignment for nearly a decade. I witnessed that not only did the staff know the resident, me, but they were efficient, compassionate, and successful because they knew and respected one another.

Jamie was my day nurse for several weeks and quietly, with the utmost respect, responded to questions and suggestions I offered. You know it has to be tiring to always hear, “Now what medicines are these?” When asked what her greatest success in working in a nursing home is, she shared that it doesn’t have that preconceived “nursing home feel.” It doesn’t smell like a nursing home. It doesn’t feel like an old building, and working in a nursing home is not just a job for her. She said, “We are a family every day.”

Marla was my evening nurse, and Margaret was my evening CNA for several weeks. Both of these ladies took time to share who they are as individuals and what was going on in their personal lives. That may sound like more information than a patient or resident would want or need to know, but it opened the door for emotional well-being. I listened to their life stories, and they heard mine. Healing can begin when you feel a genuine concern from another person.

The last area of care and the priority of my stay was therapy. When energies were low, and pain accompanied every effort, this group of professionals cheerfully pushed the residents on, constantly encouraging with verbal and physical support. The energy and synergy of this group made me want to work hard to make them proud. What great direction they provided, enabling me to move forward with confidence as they taught me and shared many of their personal struggles. The tenderness Angela expressed and the dignity afforded me in occupational and physical therapy was exemplified many times by Carolyn, April, Liz, Aida, Gretchen, and others.

I want to spotlight the superb care I received because it is replicated in a multitude of nursing homes across Kentucky and the Qsource states. There were some concerns I noted and shared with leadership, but overall, I saw great effort to do things correctly.

Please celebrate caregivers in the long-term care industry. Re-educate those who fail to do their jobs well and ask the QIO for assistance. We continue to provide education and consultation upon request. Also, accept my heartfelt gratitude. I was the recipient of outstanding care, which is demonstrated by a successful collaboration between the QIO and the nursing home’s staff of caring individuals. These individuals leave their families every day and join together to care for another special type of family, their nursing home family.

Thank you to my care team!

Janet Pollock, BA, Qsource Community Manager 

Janet is the Community Manager for Qsource, the Kentucky Quality Improvement Network-Quality Improvement Organization (QIN-QIO) and Qsource member. Her QIO work includes years of community collaboration in provider initiatives including nursing homes, pharmacy, hospitals, care transition communities, and patient-centered care. Her goal is to promote individualizing care and processes to improve healthcare culture for patients, families and staff of nursing homes, hospitals, and healthcare organizations. Janet has also served as a long-term care ombudsman and coordinator with the State Health Insurance Program (SHIP), presenting at community, civic, and provider meetings on various health care promotion and disease prevention topics.