Between January 1, 1985 and January 1, 2010, the FDA received 828 incidents of patients caught, trapped, entangled, or strangled in hospital beds. The reports included 493 deaths, 141 nonfatal injuries, and 194 cases where staff needed to intervene to prevent injuries.
Some siderails extend the full length of the bed; others, called half rails, are about 2-1/2 feet long. Some are metal, others plastic. Most can be raised or lowered.
Siderails are divided, either vertically or horizontally, with slats spaced about six or more inches apart. This space can trap an elderly person's head, causing him or her to strangle; or, to allow a thin, frail person to squeeze between the rails and fall to the floor.
Often mattresses fit loosely in the frame, leaving gaps large enough to trap the resident between the mattress and siderail, also leading to suffocation.
“Rails decrease your risk of falling by 10 to 15 percent, but they increase the risk of injury by about 20 percent because they change the geometry of the fall,” says Steven Miles, geriatrician and bioethicist at the University of Minnesota, in a 2010 article published in The New York Times.
Current Job Postings
Thursday, January 5, 2012
Signs of Nursing Home Abuse
Physical abuse
Some of the more commonly observed types and signs include:
Assault
Battery
Sexual Assault
Sexual Battery
Rape
Unreasonable physical restraint
Prolonged or continual deprivation of food or water
Use of a physical or chemical restraint or psychotropic medication for any purpose not consistent with that authorized by the physician
Giving too much medication
Not giving needed medication
Unexplained injuries
Caretaker cannot adequately explain condition
Open wounds, cuts, bruises or welts
Elder reports of being slapped or mistreated
Slapping, pushing, shaking, beating
Forcing an older person to stay in a room
Neglect
Some of the more commonly observed types include:
Physical neglect: disregard for the necessities of daily living
Medical neglect: lack of care for existing medical problems
Failure to prevent dehydration, malnutrition, and bed sores
Failure to assist in personal hygiene, or in the provision of food, clothing, or shelter
Unsanitary and unclean conditions
Infections
Failure to protect from health and safety hazards
Poor access to medical services
Verbal and emotional abuse
Creating situations harmful to the resident's self-esteem.
Possible signs of verbal or emotional abuse may include resident behavior such as:
Emotionally upset or agitated
Extremely withdrawn and non-communicative
Unusual behavior (sucking, biting, rocking)
Humiliating, insulting, frightening, threatening or ignoring behavior towards family and friends
Wanting to be isolated from other people
Other warning signs
Other signs to look for if you think nursing home abuse or negligence has occurred include the following:
Injuries requiring emergency treatment or hospitalization
Any incident involving broken bones, especially a fractured hip
Any injury or death occurring during or shortly after an episode of wandering (including outside the facility) when the staff is not aware that the resident is missing for some period of time
Heavy medication or sedation
Rapid weight loss or weight gain without physician or family notification and a change in treatment being provided
Unexplained or unexpected death of the resident
One nursing home resident injures another resident
Resident is frequently ill, and the illnesses are not promptly reported to the physician and family
Some of the more commonly observed types and signs include:
Assault
Battery
Sexual Assault
Sexual Battery
Rape
Unreasonable physical restraint
Prolonged or continual deprivation of food or water
Use of a physical or chemical restraint or psychotropic medication for any purpose not consistent with that authorized by the physician
Giving too much medication
Not giving needed medication
Unexplained injuries
Caretaker cannot adequately explain condition
Open wounds, cuts, bruises or welts
Elder reports of being slapped or mistreated
Slapping, pushing, shaking, beating
Forcing an older person to stay in a room
Neglect
Some of the more commonly observed types include:
Physical neglect: disregard for the necessities of daily living
Medical neglect: lack of care for existing medical problems
Failure to prevent dehydration, malnutrition, and bed sores
Failure to assist in personal hygiene, or in the provision of food, clothing, or shelter
Unsanitary and unclean conditions
Infections
Failure to protect from health and safety hazards
Poor access to medical services
Verbal and emotional abuse
Creating situations harmful to the resident's self-esteem.
Possible signs of verbal or emotional abuse may include resident behavior such as:
Emotionally upset or agitated
Extremely withdrawn and non-communicative
Unusual behavior (sucking, biting, rocking)
Humiliating, insulting, frightening, threatening or ignoring behavior towards family and friends
Wanting to be isolated from other people
Other warning signs
Other signs to look for if you think nursing home abuse or negligence has occurred include the following:
Injuries requiring emergency treatment or hospitalization
Any incident involving broken bones, especially a fractured hip
Any injury or death occurring during or shortly after an episode of wandering (including outside the facility) when the staff is not aware that the resident is missing for some period of time
Heavy medication or sedation
Rapid weight loss or weight gain without physician or family notification and a change in treatment being provided
Unexplained or unexpected death of the resident
One nursing home resident injures another resident
Resident is frequently ill, and the illnesses are not promptly reported to the physician and family
See Me
What do you see, nurses, what do you see?
Are you thinking, when you look at me --
A crabby old woman, not very wise,
Uncertain of habit, with far-away eyes,
Who dribbles her food and makes no reply,
When you say in a loud voice -- "I do wish you'd try."
Who seems not to notice the things that you do,
And forever is losing a stocking or shoe,
Who unresisting or not, lets you do as you will,
With bathing and feeding, the long day to fill.
Is that what you're thinking, is that what you see?
Then open your eyes, nurse, you're looking at ME...
I'll tell you who I am, as I sit here so still;
As I rise at your bidding, as I eat at your will.
I'm a small child of ten with a father and mother,
Brothers and sisters, who love one another,
A young girl of sixteen with wings on her feet.
Dreaming that soon now a lover she'll meet;
A bride soon at twenty -- my heart gives a leap,
Remembering the vows that I promised to keep;
At twenty-five now I have young of my own,
Who need me to build a secure, happy home;
A woman of thirty, my young now grow fast,
Bound to each other with ties that should last;
At forty, my young sons have grown and are gone,
But my man's beside me to see I don't mourn;
At fifty once more babies play 'round my knee,
Again we know children, my loved one and me.
Dark days are upon me, my husband is dead,
I look at the future, I shudder with dread,
For my young are all rearing young of their own,
And I think of the years and the love that I've known;
I'm an old woman now and nature is cruel --
'Tis her jest to make old age look like a fool.
The body is crumbled, grace and vigor depart,
There is now a stone where once I had a heart,
But inside this old carcass a young girl still dwells,
And now and again my battered heart swells.
I remember the joys, I remember the pain,
And I'm loving and living life over again,
I think of the years, all too few -- gone too fast,
And accept the stark fact that nothing can last --
So I open your eyes, nurses, open and see,
Not a crabby old woman, look closer, nurses -- see ME!
This poem was found among the possessions of an elderly lady who died in the geriatric ward of a hospital. No information is available concerning her -- who she was or when she died.
Are you thinking, when you look at me --
A crabby old woman, not very wise,
Uncertain of habit, with far-away eyes,
Who dribbles her food and makes no reply,
When you say in a loud voice -- "I do wish you'd try."
Who seems not to notice the things that you do,
And forever is losing a stocking or shoe,
Who unresisting or not, lets you do as you will,
With bathing and feeding, the long day to fill.
Is that what you're thinking, is that what you see?
Then open your eyes, nurse, you're looking at ME...
I'll tell you who I am, as I sit here so still;
As I rise at your bidding, as I eat at your will.
I'm a small child of ten with a father and mother,
Brothers and sisters, who love one another,
A young girl of sixteen with wings on her feet.
Dreaming that soon now a lover she'll meet;
A bride soon at twenty -- my heart gives a leap,
Remembering the vows that I promised to keep;
At twenty-five now I have young of my own,
Who need me to build a secure, happy home;
A woman of thirty, my young now grow fast,
Bound to each other with ties that should last;
At forty, my young sons have grown and are gone,
But my man's beside me to see I don't mourn;
At fifty once more babies play 'round my knee,
Again we know children, my loved one and me.
Dark days are upon me, my husband is dead,
I look at the future, I shudder with dread,
For my young are all rearing young of their own,
And I think of the years and the love that I've known;
I'm an old woman now and nature is cruel --
'Tis her jest to make old age look like a fool.
The body is crumbled, grace and vigor depart,
There is now a stone where once I had a heart,
But inside this old carcass a young girl still dwells,
And now and again my battered heart swells.
I remember the joys, I remember the pain,
And I'm loving and living life over again,
I think of the years, all too few -- gone too fast,
And accept the stark fact that nothing can last --
So I open your eyes, nurses, open and see,
Not a crabby old woman, look closer, nurses -- see ME!
This poem was found among the possessions of an elderly lady who died in the geriatric ward of a hospital. No information is available concerning her -- who she was or when she died.
CNA CLASS practice questions
1. While applying a binder, it becomes loose or wrinkled. What does the nursing assistant do?
A. Secure pins so they face the incisional area.
B. Reapply the binder so that firm, even pressure is exerted over the area.
C. Make sure the binder is always warm and dry.
D. Only reapply binder if it becomes soiled.
2. During a 24 hour urine specimen collection, Mrs. Jones flushes her own urine. What must the nursing assistant do?
A. Report to the nurse and continue collection.
B. Report to the nurse and start test over.
C. Scold Mrs. Jones for flushing the urine.
D. Call the doctor.
3. Mrs. Black has returned to her room from the hospital by stretcher. The nursing assistant uses a three person lift to transfer her to bed. What type of resident would require this type of transfer?
A. Resident with dysphasia
B. Resident with diabetes
C. Resident with hypertension
D. Resident on complete bed rest
4. The nursing assistant will lift and move the resident onto the stretcher on the count of:
A. 4
B. 3
C. 2
D. 1
5. Fred puts on his call light and requests help to the bathroom. The nursing assistant is walking in the hall to go on break. What action should the nursing assistant take?
A. Tell Fred he has to wait until break is over.
B. Tell Fred another nursing assistant will help him.
C. Let the light ring until someone else responds.
D. Take Fred to the bathroom and then go on break.
6. Mrs. Potts goes to the bathroom to void. When the nursing assistant empties the urine, what would be MOST important to report to the nurse?
A. Light yellow color
B. Large volume
C. Reddened color
D. Amber color
7. Mr. Halo states, "I feel constipated." The nursing assistant knows this means:
A. the passage of hard, dry stool.
B. the passage of liquid stool.
C. the passage of gas (flatus) through the anus.
D. a fecal impaction.
8. What attitude should a nursing assistant display when dealing with a terminally ill resident?
A. Compassion
B. Distance
C. Negligence
D. Enthusiasm
9. The nursing assistant finds the terminally ill resident crying in bed. What is the nursing assistant's best response to this situation?
A. Encourage the resident to stop crying.
B. Offer to stay with resident and discuss the situation.
C. Assure the resident it will be okay.
D. Leave the room to provide privacy.
10. Which of the following is true about fecal impaction?
A. Lubricant is not needed for unresponsive resident.
B. Fecal impaction is an emergency. The doctor should be notified immediately.
C. Fecal impaction can cause abdominal pain and cramping.
D. A resident with loose, watery stool cannot have an impaction.
1. B
Q3: CORRECT! Only Response D indicates a physical situation that requires a stretcher transport. Mosby 7th ed pages 268 and 269
CNA TASK: Transport resident by stretcher.
Q4: CORRECT! Common protocol dictates using a 1-2-3 count. Mosby 7th ed page 269 Procedure Box: Moving the Person to a Stretcher
CNA TASK: Transport resident by stretcher.
Q5: CORRECT! Because caring for the patient’s toileting needs is imperative, the nursing assistant should assist the resident to the bathroom then take their break Mosby 7th ed page 364 Box 21-3 Nursing Measures for Persons With Urinary Incontinence
CNA TASK: Maintain resident's right to quality care.
Q6: CORRECT! Red tinged urine indicates the presence of blood and should be reported immediately. Mosby 7th ed page 356
CNA TASK: Calculate, report and record output.
Q7: CORRECT! Constipation is defined as the "passage of hard, dry stool" as described in Response A. Mosby 7th ed page 380
CNA TASK: Recognize and report abnormal signs and symptoms in common diseases and conditions.
Q8: CORRECT! The resident dealing with terminal illness needs the nursing assistant to approach them with compassion as they carry out their duties. Mosby 7th ed page 772
CNA TASK: Provide care for terminally ill resident.
Q9: CORRECT! Response B offers the resident compassionate support. Mosby 7th ed page 772
CNA TASK: Provide care for terminally ill resident.
Q10: CORRECT! Fecal impaction can cause symptoms as described in Response C. Mosby 7th ed page 381
CNA TASK: Recognize and report abnormal signs and symptoms in common diseases and conditions.
A. Secure pins so they face the incisional area.
B. Reapply the binder so that firm, even pressure is exerted over the area.
C. Make sure the binder is always warm and dry.
D. Only reapply binder if it becomes soiled.
2. During a 24 hour urine specimen collection, Mrs. Jones flushes her own urine. What must the nursing assistant do?
A. Report to the nurse and continue collection.
B. Report to the nurse and start test over.
C. Scold Mrs. Jones for flushing the urine.
D. Call the doctor.
3. Mrs. Black has returned to her room from the hospital by stretcher. The nursing assistant uses a three person lift to transfer her to bed. What type of resident would require this type of transfer?
A. Resident with dysphasia
B. Resident with diabetes
C. Resident with hypertension
D. Resident on complete bed rest
4. The nursing assistant will lift and move the resident onto the stretcher on the count of:
A. 4
B. 3
C. 2
D. 1
5. Fred puts on his call light and requests help to the bathroom. The nursing assistant is walking in the hall to go on break. What action should the nursing assistant take?
A. Tell Fred he has to wait until break is over.
B. Tell Fred another nursing assistant will help him.
C. Let the light ring until someone else responds.
D. Take Fred to the bathroom and then go on break.
6. Mrs. Potts goes to the bathroom to void. When the nursing assistant empties the urine, what would be MOST important to report to the nurse?
A. Light yellow color
B. Large volume
C. Reddened color
D. Amber color
7. Mr. Halo states, "I feel constipated." The nursing assistant knows this means:
A. the passage of hard, dry stool.
B. the passage of liquid stool.
C. the passage of gas (flatus) through the anus.
D. a fecal impaction.
8. What attitude should a nursing assistant display when dealing with a terminally ill resident?
A. Compassion
B. Distance
C. Negligence
D. Enthusiasm
9. The nursing assistant finds the terminally ill resident crying in bed. What is the nursing assistant's best response to this situation?
A. Encourage the resident to stop crying.
B. Offer to stay with resident and discuss the situation.
C. Assure the resident it will be okay.
D. Leave the room to provide privacy.
10. Which of the following is true about fecal impaction?
A. Lubricant is not needed for unresponsive resident.
B. Fecal impaction is an emergency. The doctor should be notified immediately.
C. Fecal impaction can cause abdominal pain and cramping.
D. A resident with loose, watery stool cannot have an impaction.
1. B
Q3: CORRECT! Only Response D indicates a physical situation that requires a stretcher transport. Mosby 7th ed pages 268 and 269
CNA TASK: Transport resident by stretcher.
Q4: CORRECT! Common protocol dictates using a 1-2-3 count. Mosby 7th ed page 269 Procedure Box: Moving the Person to a Stretcher
CNA TASK: Transport resident by stretcher.
Q5: CORRECT! Because caring for the patient’s toileting needs is imperative, the nursing assistant should assist the resident to the bathroom then take their break Mosby 7th ed page 364 Box 21-3 Nursing Measures for Persons With Urinary Incontinence
CNA TASK: Maintain resident's right to quality care.
Q6: CORRECT! Red tinged urine indicates the presence of blood and should be reported immediately. Mosby 7th ed page 356
CNA TASK: Calculate, report and record output.
Q7: CORRECT! Constipation is defined as the "passage of hard, dry stool" as described in Response A. Mosby 7th ed page 380
CNA TASK: Recognize and report abnormal signs and symptoms in common diseases and conditions.
Q8: CORRECT! The resident dealing with terminal illness needs the nursing assistant to approach them with compassion as they carry out their duties. Mosby 7th ed page 772
CNA TASK: Provide care for terminally ill resident.
Q9: CORRECT! Response B offers the resident compassionate support. Mosby 7th ed page 772
CNA TASK: Provide care for terminally ill resident.
Q10: CORRECT! Fecal impaction can cause symptoms as described in Response C. Mosby 7th ed page 381
CNA TASK: Recognize and report abnormal signs and symptoms in common diseases and conditions.
Wednesday, January 4, 2012
Florida Nursing Facilities Rise Above Challenging Times
January 2012
Patrick Connole
Page Content
Florida has suffered deeply from the effects of the Great Recession and its aftermath, with once booming housing and construction markets gone bust and even the 12-month-a-year tourism trade unable to prop up an otherwise weak economy that has left nearly 1 million without work.
In a state known for its older-skewing populace, along with Disney World, space launches, and the beach, the economy has left another mark on Florida. The Sunshine State is now thought of as a leading foreclosure market in a country full of depressing stories about lost real estate dreams.
The gloomy economic scene has put intense pressure on state lawmakers to find ways to eliminate huge budget deficits. Fiscal year (FY) 2011-2012 saw the need to bridge a $4.6 billion deficit, and FY 2012-2013 could see a $2 billion hole. As Provider went to press, Florida Gov. Rick Scott (R) was preparing to release his 2012-2013 budget recommendations, which long term care providers anticipate will include another round of Medicaid reimbursement reductions.
Medicaid costs rose to $20.3 billion projected for this fiscal year in Florida, from about $19.8 billion in 2011, with the state’s share surging 23 percent, to $9.48 billion, from $7.7 billion, Florida legislature reports said. The state’s share of Medicaid is forecast to rise 2.7 percent, to $9.74 billion, in 2013, and total costs may rise 15 percent by 2015.
Florida’s legislature last year also passed a proposal to shift almost all Medicaid beneficiaries into managed care plans to reduce costs, but the state has not received a waiver from the federal government to start the process of making the change.
Overall, the short-term picture is clear in Florida: Medicaid reimbursement dollars will decline while beneficiary rolls rise and the economy lags behind in keeping up with rising costs.
Medicaid Under The Spotlight
Gov. Scott specifically pointed to the growing costs of the Medicaid program as a main drag on the rosier state income picture for 2011.
The governor told the media in late November that when he releases his proposed budget, it will have recommendations to deal with rising Medicaid costs. Beyond immediate measures to help balance the budget, Scott would like the federal government to let states run the Medicaid program, a popular notion among many in his party who call for “block granting” Medicaid dollars as opposed to managing the federal-state partnership that currently exists.
Talk of what could be in the offing for next year has J. Emmett Reed, executive director of the Florida Health Care Association (FHCA), working hard to limit what will certainly be another reduction in reimbursement dollars for long term care providers.
“It was bad last year, but then you’re dealing with a $4.6 billion budget hole. We weren’t happy but it could have been worse, and it was worse for other providers,” Reed says.
Things didn’t look so bleak for FY 2012 about six months ago, he says, but things took a turn for the worse by end of summer, and now the negative reports project the aforementioned $2 billion budget hole.
Double Whammy
At the same time the state has hit health care providers hard in the Medicaid program, the federal government has reduced Medicare reimbursement for nursing care providers, a virtual tsunami of cuts, as Reed puts it.
“Seventy percent of our costs are our people [staff], and the residual effects go to the vendor level,” he says.
A lot of FHCA members are assessing their bottom lines anew with the reimbursement uncertainty now a seemingly constant reality, with some likely in line to reduce staffing while many more try to figure out ways to avoid such steps, Reed says.
“We have a lot of members who are not cutting. They are working with frontline caregivers to manage hours,” he says. “Caregivers working at facilities have knowledge of the residents, they work with residents.”
Reed notes that all the work being done to creatively work around the 2011-2012 reductions could be a mere footnote to what lies ahead. “If there is another round of cuts, all bets are off,” Reed says. “But providers are bending over backwards to make it work and keep caregivers there to serve residents.”
Greek For Caring
Against this backdrop of mostly negative economic news, nursing and assisted living facilities conduct the day-in day-out work of caring for the state’s frail and elderly, a job Marilyn Wood, president and chief executive officer (CEO) of Opis Management Resources, Tampa, Fla., has embraced for 40 years. She worked first as a nurse and rose through the ranks to lead Opis, a word that comes from the Greek language and translates to “caring.”
Opis was founded in 2003, assuming control of properties owned by Kennett Square, Pa.-based Genesis HealthCare, which departed the state because of concerns about the business climate. Florida is not an easy state to do business in, with its high litigation costs tied to a friendly environment for trial lawyers.
Opis runs 10 skilled nursing and one assisted living facility across the state and prides itself on strict attention to quality, having won top honors from the state of Florida four times for its efforts to make a positive difference in elder care.
Wood sees long term care as a business prone to defined cycles, with the current one being as challenging as any one that has presented itself in the past. She has also seen how the acuity level of residents has shifted, transforming the work to a higher level of care at all settings.
Florida A Tough Market
As providers across the country face the challenges of reimbursement reductions and marketing their services in a down economy, Wood says Florida remains a unique case with its plentiful number of seniors and other factors.
“The litigation we have in our state is still a problem for us,” she notes. Also a challenge is the fact that Florida is a pacesetter in regulation. “I think this comes because of the scrutiny generated by the large population of seniors in our state,” Wood says.
The Medicaid issue is, of course, a leading challenge as well, but one she grasps. “The reality is the government has only so many resources; there are pressures to fund education and transportation beyond health care, for example,” Wood says.
All sectors have had to sacrifice, but the goal for long term care is to do so without compromising quality care. The jobs inside her facilities are all tied to making residents safe and as healthy as possible, so each is valuable to the overall operation.
Opis employs 2,300 people, and these workers are part of a family as well, putting food on their own tables and paying mortgages. “That’s what people have to understand. We take our staffing issues seriously and care for them passionately. Legislators need to understand that,” Wood says.
CCRC Attracts Residents Despite Economy
Tom Kelly, CEO of Village On The Isle in Venice, Fla., thinks his operation is getting it right in how to care for every long term care need within his continuing care retirement community (CCRC) just a few minutes from the Gulf of Mexico. Located south of Sarasota, the CCRC offers seniors skilled nursing, assisted living, and independent living options in a high-tech community wired with the latest technology to improve care quality and make living as comfortable as possible for residents.
A not-for-profit, faith-based provider, Village On The Isle is affiliated with the Evangelical Lutheran Church in America and strives to meets its commitments beyond the daily care of residents in a 100 percent ecumenical fashion, Kelly says. This effort includes catering a Meals on Wheels program to the local community, serving 180 meals per day all week.
“All of it is done out of our own pocket with volunteers,” Kelly says.
With a staff of 275 serving the 415 seniors in the CCRC, the breakdown of the living options are 210 residential apartment homes, 100 assisted living accommodations, and a 60-bed skilled nursing facility. Again, as part of the faith-based effort, 10 percent of the 100 assisted living spots are reserved for a special program for those who cannot afford to pay full freight. The maximum cost is $1,500 a month for the affordable care program, compared with the regular rate of $3,695, he says.
“There are no Medicaid waiver dollars involved,” Kelly says.
Technology Vital To The Mission
Village On The Isle takes technology seriously. The entire complex is wired for Wi-Fi, which is free for residents and guests as well as mobile Skype videophones that residents can use to video chat with their families and loved ones. Dining areas are equipped with digital signage for easy representation of daily menus, and health care facilities employ Electronic Medication Observation Systems to reduce medication errors.
Other tools include the Nurse Rosie system, which provides state-of-the-art equipment for gathering vital signs such as pulse oximetry, blood pressure, temperature, and blood glucose levels. The system interfaces with CareTracker to eliminate human error in the recording and transcription of vital signs.
Kelly praises the CCRC’s staff for devising new ways to make technology more than just software and hardware, but part of the resident’s experience and part of the staff’s care plan. The move to keep abreast of the latest tools for pleasing residents and their families is a strategy to maintain quality care and attract business even in the rough economy.
Jobs, Jobs, Jobs
Over the years, Kelly has built up a strong business that had a 20 percent vacancy rate when he took over. Now, the facilities have added and saved jobs with an attention to detail and made staff more capable with the use of technology.
With the high occupancy rate near 100 percent, Village On The Isle is a job beacon for the Venice community. “We have very high staff retention, and that is good because long-term employees are your best assets. This translates to consistent quality care, no lawsuits, and few worker comp issues,” Kelly says.
Kelly’s staff have 80 percent of their health insurance paid for, and there is a 20 percent employer match in a retirement plan with no vesting.
Village On The Isle also works with the local high school to attract young workers who often make the care community their first job.
“It’s $8.75 to start, and they can eat whatever they want,” Kelly says.
Some of the younger workers stay on for years to come, he says, noting his director of food services came out of the high school recruitment effort.
When the state Medicaid reimbursement reductions took effect July 1, 2011, and were followed in October by the federal cutbacks of more than 11 percent in Medicare payments, assessments had to take place on how to deal with the loss of funding, Kelly says.
“We expected the problem to occur, and we built operational budgets accordingly,” he says. This preparation resulted in no wage cuts or a job freeze for employees, even though the final Medicare percent rollback was on the high end of expectations coming in one fell swoop.
To combat the effect of the governmental reductions, Village On The Isle has sought to bolster its outpatient business, diversifying its services by providing potential clients with the latest low-gravity treadmill system for rehabilitation purposes.
By getting away in some respects from the unpredictable nature of Medicaid and Medicare reimbursement, the system of overall care across the CCRC can flourish, starting with the core mission of serving others, both the ones paying for care and the entire community surrounding the site.
Patrick Connole
Page Content
Florida has suffered deeply from the effects of the Great Recession and its aftermath, with once booming housing and construction markets gone bust and even the 12-month-a-year tourism trade unable to prop up an otherwise weak economy that has left nearly 1 million without work.
In a state known for its older-skewing populace, along with Disney World, space launches, and the beach, the economy has left another mark on Florida. The Sunshine State is now thought of as a leading foreclosure market in a country full of depressing stories about lost real estate dreams.
The gloomy economic scene has put intense pressure on state lawmakers to find ways to eliminate huge budget deficits. Fiscal year (FY) 2011-2012 saw the need to bridge a $4.6 billion deficit, and FY 2012-2013 could see a $2 billion hole. As Provider went to press, Florida Gov. Rick Scott (R) was preparing to release his 2012-2013 budget recommendations, which long term care providers anticipate will include another round of Medicaid reimbursement reductions.
Medicaid costs rose to $20.3 billion projected for this fiscal year in Florida, from about $19.8 billion in 2011, with the state’s share surging 23 percent, to $9.48 billion, from $7.7 billion, Florida legislature reports said. The state’s share of Medicaid is forecast to rise 2.7 percent, to $9.74 billion, in 2013, and total costs may rise 15 percent by 2015.
Florida’s legislature last year also passed a proposal to shift almost all Medicaid beneficiaries into managed care plans to reduce costs, but the state has not received a waiver from the federal government to start the process of making the change.
Overall, the short-term picture is clear in Florida: Medicaid reimbursement dollars will decline while beneficiary rolls rise and the economy lags behind in keeping up with rising costs.
Medicaid Under The Spotlight
Gov. Scott specifically pointed to the growing costs of the Medicaid program as a main drag on the rosier state income picture for 2011.
The governor told the media in late November that when he releases his proposed budget, it will have recommendations to deal with rising Medicaid costs. Beyond immediate measures to help balance the budget, Scott would like the federal government to let states run the Medicaid program, a popular notion among many in his party who call for “block granting” Medicaid dollars as opposed to managing the federal-state partnership that currently exists.
Talk of what could be in the offing for next year has J. Emmett Reed, executive director of the Florida Health Care Association (FHCA), working hard to limit what will certainly be another reduction in reimbursement dollars for long term care providers.
“It was bad last year, but then you’re dealing with a $4.6 billion budget hole. We weren’t happy but it could have been worse, and it was worse for other providers,” Reed says.
Things didn’t look so bleak for FY 2012 about six months ago, he says, but things took a turn for the worse by end of summer, and now the negative reports project the aforementioned $2 billion budget hole.
Double Whammy
At the same time the state has hit health care providers hard in the Medicaid program, the federal government has reduced Medicare reimbursement for nursing care providers, a virtual tsunami of cuts, as Reed puts it.
“Seventy percent of our costs are our people [staff], and the residual effects go to the vendor level,” he says.
A lot of FHCA members are assessing their bottom lines anew with the reimbursement uncertainty now a seemingly constant reality, with some likely in line to reduce staffing while many more try to figure out ways to avoid such steps, Reed says.
“We have a lot of members who are not cutting. They are working with frontline caregivers to manage hours,” he says. “Caregivers working at facilities have knowledge of the residents, they work with residents.”
Reed notes that all the work being done to creatively work around the 2011-2012 reductions could be a mere footnote to what lies ahead. “If there is another round of cuts, all bets are off,” Reed says. “But providers are bending over backwards to make it work and keep caregivers there to serve residents.”
Greek For Caring
Against this backdrop of mostly negative economic news, nursing and assisted living facilities conduct the day-in day-out work of caring for the state’s frail and elderly, a job Marilyn Wood, president and chief executive officer (CEO) of Opis Management Resources, Tampa, Fla., has embraced for 40 years. She worked first as a nurse and rose through the ranks to lead Opis, a word that comes from the Greek language and translates to “caring.”
Opis was founded in 2003, assuming control of properties owned by Kennett Square, Pa.-based Genesis HealthCare, which departed the state because of concerns about the business climate. Florida is not an easy state to do business in, with its high litigation costs tied to a friendly environment for trial lawyers.
Opis runs 10 skilled nursing and one assisted living facility across the state and prides itself on strict attention to quality, having won top honors from the state of Florida four times for its efforts to make a positive difference in elder care.
Wood sees long term care as a business prone to defined cycles, with the current one being as challenging as any one that has presented itself in the past. She has also seen how the acuity level of residents has shifted, transforming the work to a higher level of care at all settings.
Florida A Tough Market
As providers across the country face the challenges of reimbursement reductions and marketing their services in a down economy, Wood says Florida remains a unique case with its plentiful number of seniors and other factors.
“The litigation we have in our state is still a problem for us,” she notes. Also a challenge is the fact that Florida is a pacesetter in regulation. “I think this comes because of the scrutiny generated by the large population of seniors in our state,” Wood says.
The Medicaid issue is, of course, a leading challenge as well, but one she grasps. “The reality is the government has only so many resources; there are pressures to fund education and transportation beyond health care, for example,” Wood says.
All sectors have had to sacrifice, but the goal for long term care is to do so without compromising quality care. The jobs inside her facilities are all tied to making residents safe and as healthy as possible, so each is valuable to the overall operation.
Opis employs 2,300 people, and these workers are part of a family as well, putting food on their own tables and paying mortgages. “That’s what people have to understand. We take our staffing issues seriously and care for them passionately. Legislators need to understand that,” Wood says.
CCRC Attracts Residents Despite Economy
Tom Kelly, CEO of Village On The Isle in Venice, Fla., thinks his operation is getting it right in how to care for every long term care need within his continuing care retirement community (CCRC) just a few minutes from the Gulf of Mexico. Located south of Sarasota, the CCRC offers seniors skilled nursing, assisted living, and independent living options in a high-tech community wired with the latest technology to improve care quality and make living as comfortable as possible for residents.
A not-for-profit, faith-based provider, Village On The Isle is affiliated with the Evangelical Lutheran Church in America and strives to meets its commitments beyond the daily care of residents in a 100 percent ecumenical fashion, Kelly says. This effort includes catering a Meals on Wheels program to the local community, serving 180 meals per day all week.
“All of it is done out of our own pocket with volunteers,” Kelly says.
With a staff of 275 serving the 415 seniors in the CCRC, the breakdown of the living options are 210 residential apartment homes, 100 assisted living accommodations, and a 60-bed skilled nursing facility. Again, as part of the faith-based effort, 10 percent of the 100 assisted living spots are reserved for a special program for those who cannot afford to pay full freight. The maximum cost is $1,500 a month for the affordable care program, compared with the regular rate of $3,695, he says.
“There are no Medicaid waiver dollars involved,” Kelly says.
Technology Vital To The Mission
Village On The Isle takes technology seriously. The entire complex is wired for Wi-Fi, which is free for residents and guests as well as mobile Skype videophones that residents can use to video chat with their families and loved ones. Dining areas are equipped with digital signage for easy representation of daily menus, and health care facilities employ Electronic Medication Observation Systems to reduce medication errors.
Other tools include the Nurse Rosie system, which provides state-of-the-art equipment for gathering vital signs such as pulse oximetry, blood pressure, temperature, and blood glucose levels. The system interfaces with CareTracker to eliminate human error in the recording and transcription of vital signs.
Kelly praises the CCRC’s staff for devising new ways to make technology more than just software and hardware, but part of the resident’s experience and part of the staff’s care plan. The move to keep abreast of the latest tools for pleasing residents and their families is a strategy to maintain quality care and attract business even in the rough economy.
Jobs, Jobs, Jobs
Over the years, Kelly has built up a strong business that had a 20 percent vacancy rate when he took over. Now, the facilities have added and saved jobs with an attention to detail and made staff more capable with the use of technology.
With the high occupancy rate near 100 percent, Village On The Isle is a job beacon for the Venice community. “We have very high staff retention, and that is good because long-term employees are your best assets. This translates to consistent quality care, no lawsuits, and few worker comp issues,” Kelly says.
Kelly’s staff have 80 percent of their health insurance paid for, and there is a 20 percent employer match in a retirement plan with no vesting.
Village On The Isle also works with the local high school to attract young workers who often make the care community their first job.
“It’s $8.75 to start, and they can eat whatever they want,” Kelly says.
Some of the younger workers stay on for years to come, he says, noting his director of food services came out of the high school recruitment effort.
When the state Medicaid reimbursement reductions took effect July 1, 2011, and were followed in October by the federal cutbacks of more than 11 percent in Medicare payments, assessments had to take place on how to deal with the loss of funding, Kelly says.
“We expected the problem to occur, and we built operational budgets accordingly,” he says. This preparation resulted in no wage cuts or a job freeze for employees, even though the final Medicare percent rollback was on the high end of expectations coming in one fell swoop.
To combat the effect of the governmental reductions, Village On The Isle has sought to bolster its outpatient business, diversifying its services by providing potential clients with the latest low-gravity treadmill system for rehabilitation purposes.
By getting away in some respects from the unpredictable nature of Medicaid and Medicare reimbursement, the system of overall care across the CCRC can flourish, starting with the core mission of serving others, both the ones paying for care and the entire community surrounding the site.
Standing Out
An award-winning nursing center shines despite the hard times that have hit its Flint, Mich., location.
January 2012
Meg LaPorte
Mention Flint, Mich., to most anyone inside the “rust belt” and the responses could range from “sad and empty” to “crime-ridden and hopeless.” The city that gave birth to General Motors and the United Auto Workers now evokes images of blocks of boarded-up homes, parades of for-sale signs, and abandoned strip malls.
Not surprisingly, the statistics behind these images are bleak: double-digit unemployment rates that are higher than the national average, a poverty level of 34 percent (more than twice the national average of 14.3 percent), and a crime rate that ranks among the highest in the nation.
According to the Federal Bureau of Investigation, Flint now holds the dubious distinction of being No. 4 on its list of the most crime-ridden cities in the United States.
Making matters worse, thousands of denizens have fled the city in recent years, causing the population to drop by 18 percent between 2000 and 2010, according to the U.S. Census Bureau.
A Bright Spot
This story is not about Flint alone, however. This story is about a bright spot in the city: Willowbrook Manor, an award-winning 102-bed skilled nursing center located a few miles west of the city’s center.
Willowbrook shines as an example of how the human spirit, along with some persistence and hard work, can endure economic hardship and adversity.
On a cool day shortly after Thanksgiving, its lobby is festooned with a Christmas tree, festive lights, and sparkling decor. In contrast to the surrounding blight, staff members at Willowbrook emit cheerful, positive attitudes.
“I know everyone is down on Flint, but I think it’s making a comeback,” says Ryan Michelson, Willowbrook’s administrator, who was born and raised near Flint and attended the University of Michigan-Flint.
He says his experience with the embattled city has been mostly positive. “I went to school in downtown Flint, and I never had any brushes with crime,” he says.
Michelson brings this sanguine attitude to his job, which likely contributed to his facility’s success in receiving a Silver National Quality Award from the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) last year.
Based on the Malcolm Baldrige Performance Excellence Program, a public-private partnership housed at the National Institute of Standards and Technology within the U.S. Department of Commerce, the AHCA/NCAL Silver Award is not an easy feat to achieve.
Therapy Program, Staff Longevity Help Cause
According to the Silver Award application, criteria “focus on results and the conditions and processes that lead to results.”
For Willowbrook, successful rehabilitation programs, staff longevity, and customer satisfaction are some of the accomplishments that helped them garner the Silver Award.
The facility’s rehabilitation program, dubbed Home Express, sends more than 80 percent of its skilled therapy residents home or to less acute care settings.
Also noteworthy is the longevity of its staff (see Table 2, below). The director of nursing, assistant director of nursing, and Michelson have been with Willowbrook for 13 years. The minimum data set coordinator is a 14-year veteran of the facility, as is the environmental services director. Turnover is also low among Willowbrook’s 120 employees (see Table 3, below). Compared with Willowbrook’s owner, Ciena Healthcare Management, turnover is dramatically lower. In 2010, the rate for Willowbrook was 13 percent, while the Ciena turnover rate was at 40 percent.
Keeping the facility humming at such a high level, says Michelson, means constantly evaluating and analyzing data, which come from several sources. Customer surveys, discussions with family members and employees, concern forms, and suggestion boxes are some of the methods employed.
In addition, SWOT (strengths, weaknesses, opportunities, and threats) and environmental analyses are utilized. “Analysis of data sources helps us plan and prepare to meet the needs and expectations of future customers and to ensure their satisfaction,” says Michelson.
He also credits the facility’s commitment to its mission, its code of ethics, and code of conduct for its success.
“These things have helped us keep employee turnover low and create a successful rehabilitation program,” he says.
Union Challenges Present But Minimal
Michelson also points to Willowbrook’s “aesthetically appealing environment” and high quality of care as reasons for its recognition as a provider of choice in Michigan, “despite the disadvantage of location and unionization,” he says. Aside from location, being a “union shop” presents a challenge to Willowbrook’s management. All employees, except management and licensed nurses, are unionized at Willowbrook. Given that Flint has been dominated by the auto industry for decades, unionization has become part of the fabric of the city’s culture.
“Unions present unique challenges to employers,” says Michelson. “Willowbrook’s union contract dictates equal pay for equal work, which prevents us from rewarding employees with bonuses or raises based on performance.”
Michelson says this policy also prevents the promotion of unionized employees to management levels while maintaining their union status.
“Health care facilities need to remain focused on the care of customers, and unionization tends to divert that focus in alternate directions, which has the potential to decrease effectiveness,” he says.
Despite these challenges, Willowbrook has scored consistently high marks on its employee satisfaction surveys, and union-filed grievances have declined steadily over the past decade.
The secret ingredient to this success, says Michelson, is that “we are fair and consistent with all staff members.”
A Positive Outlook
Ciena Healthcare Management, headquartered in Southfield, Mich., owns and operates Willowbrook in addition to a stable of 35 long term care properties in Michigan and Connecticut. Kristine Halsey, chief operating officer for Ciena, notes that the company is expanding. “While others are retreating, we see the coming years as a time of opportunity for expansion,” she says.
Halsey reports that although the Medicare and Medicaid funding climate is poor, Ciena has not made any staff changes.
Expansion for Ciena means that it is building skilled nursing centers throughout lower Michigan, as well as hiring staff to oversee a new dining program that will eventually be implemented throughout the entire company.
Ciena recently broke ground on a new skilled nursing community in Grand Blanc Township, just east of Flint. The 68,000-square-foot facility, known as the Grand Blanc Care Center, will be a “state-of-the-art facility with 74 short-term rehabilitation and long term care suites with private baths in each,” says Halsey.
At a cost of more than $8.5 million and expected to create more than 120 full-time and part-time jobs, Grand Blanc Care Center is slated to open next summer.
In addition to six bariatric rooms, a rehabilitative therapy room, and a spa, the community will feature several dining venues, including a main dining room, a restorative dining room, a private dining room, and an a la carte 24-hour room service menu created by an executive chef.
Ciena will open a new skilled nursing community in Ann Arbor, Mich., this fall. Regency at Bluffs Park, was renovated at a cost of more than $5 million.The 71-bed facility will feature 37 private rooms and 17 semi-private rooms, all with in-room showers and baths.
According to Ciena’s website, the new center is “designed to have the look and feel of a boutique hotel.” In addition to other amenities, each resident bed will have its own flat screen TV.
The 37,000-square-foot building is also expected to receive a Silver LEED Certification, as granted by the U.S. Green Building Council.
Also part of this project, Ciena donated more than one acre of land to the city of Ann Arbor to be used as a public access point to Bluffs Park.
A third Ciena community will open soon in Canton, Mich. The Regency at Canton will offer short-term rehabilitation and long term care, which includes 40 private rooms and 80 semi-private rooms.
dining next on list for upgrade.
Next on Ciena’s list of priorities is fine dining. Halsey says the company is revamping its entire dining program so that residents can enjoy better food and a more pleasant dining atmosphere.
“We hired a corporate chef from a well-known Detroit restaurant to train the cooks in all of our communities,” says Halsey, who notes that they will start with basic sauces and work their way up.
Many of the facilities will keep their existing cooks and take classes with the corporate chef. The overhaul includes menu planning and dietary requirements for all Ciena chefs.
A “quality dashboard” created in-house by Ciena enables facility staff to see, on a daily basis, how the residents are doing on a number of indicators.
“It’s really about data,” says Halsey, “and giving them the information and tools to provider the best quality of care possible.”
This support is evident in the fact that eight of Ciena’s care centers, including Willowbrook, recently received five-star ratings from the Centers for Medicare & Medicaid Services’ quality rating system.
In addition, Willowbrook was recognized by U.S. News & World Report as one of America’s best nursing homes in 2011.
What’s more, Ciena selected Willowbrook as Facility of the Year three times over the past five years.
Don’t Count Flint Out
At press time, Flint’s troubles continued as Michigan Gov. Rick Snyder (R) appointed an emergency manager to oversee the city’s shaky finances. Although the move appears to be the latest indicator of Flint’s downward spiral, the city still has many supporters.
Richard Karp, a developer who specializes in historic preservation, is bullish on Flint’s prospects for a successful revitalization. He was instrumental in rebuilding the Durant, a once-legendary downtown hotel named for the founder of General Motors, William C. Durant, a grandson of Henry Crapo, the 14th governor of Michigan.
Built in 1920, the Durant thrived for nearly 50 years as a symbol of the city’s success. After sitting empty for more than 30 years, Karp began refurbishing the hotel in 2008.
Since its reopening as an apartment and commercial leasing space last January, interest in the project has exceeded Karp’s expectations.
“The apartments are 100 percent leased, and we have one commercial suite left,” he says. In addition, the project has won five awards thus far, including the Governor’s Award for Historic Preservation.
Karp says he was attracted to the Durant project for several reasons. “The expansion of the University of Michigan campus, a strong revitalization effort in the downtown area, and the lack of housing for students” pointed to its potential for success, he says.
Karp confirmed that he is eyeing two more projects for development in the downtown area in the near future.
In the meantime, Michelson remains upbeat about Flint’s comeback. He points to the city’s cultural establishments as examples of endurance: The Flint Institute of Music, the Institute of Arts, and several colleges and universities with campuses downtown are all thriving amid the city’s turmoil.
Flint has weathered much hardship over the years, and it could get worse before it gets better, but Flintoids are an enduring lot.
After all, it was built on steel and grit by the largest automobile manufacturer in the world.
And so, as the city wrestles with its ghosts, Willowbrook hums along efficiently, business as usual.
January 2012
Meg LaPorte
Mention Flint, Mich., to most anyone inside the “rust belt” and the responses could range from “sad and empty” to “crime-ridden and hopeless.” The city that gave birth to General Motors and the United Auto Workers now evokes images of blocks of boarded-up homes, parades of for-sale signs, and abandoned strip malls.
Not surprisingly, the statistics behind these images are bleak: double-digit unemployment rates that are higher than the national average, a poverty level of 34 percent (more than twice the national average of 14.3 percent), and a crime rate that ranks among the highest in the nation.
According to the Federal Bureau of Investigation, Flint now holds the dubious distinction of being No. 4 on its list of the most crime-ridden cities in the United States.
Making matters worse, thousands of denizens have fled the city in recent years, causing the population to drop by 18 percent between 2000 and 2010, according to the U.S. Census Bureau.
A Bright Spot
This story is not about Flint alone, however. This story is about a bright spot in the city: Willowbrook Manor, an award-winning 102-bed skilled nursing center located a few miles west of the city’s center.
Willowbrook shines as an example of how the human spirit, along with some persistence and hard work, can endure economic hardship and adversity.
On a cool day shortly after Thanksgiving, its lobby is festooned with a Christmas tree, festive lights, and sparkling decor. In contrast to the surrounding blight, staff members at Willowbrook emit cheerful, positive attitudes.
“I know everyone is down on Flint, but I think it’s making a comeback,” says Ryan Michelson, Willowbrook’s administrator, who was born and raised near Flint and attended the University of Michigan-Flint.
He says his experience with the embattled city has been mostly positive. “I went to school in downtown Flint, and I never had any brushes with crime,” he says.
Michelson brings this sanguine attitude to his job, which likely contributed to his facility’s success in receiving a Silver National Quality Award from the American Health Care Association and the National Center for Assisted Living (AHCA/NCAL) last year.
Based on the Malcolm Baldrige Performance Excellence Program, a public-private partnership housed at the National Institute of Standards and Technology within the U.S. Department of Commerce, the AHCA/NCAL Silver Award is not an easy feat to achieve.
Therapy Program, Staff Longevity Help Cause
According to the Silver Award application, criteria “focus on results and the conditions and processes that lead to results.”
For Willowbrook, successful rehabilitation programs, staff longevity, and customer satisfaction are some of the accomplishments that helped them garner the Silver Award.
The facility’s rehabilitation program, dubbed Home Express, sends more than 80 percent of its skilled therapy residents home or to less acute care settings.
Also noteworthy is the longevity of its staff (see Table 2, below). The director of nursing, assistant director of nursing, and Michelson have been with Willowbrook for 13 years. The minimum data set coordinator is a 14-year veteran of the facility, as is the environmental services director. Turnover is also low among Willowbrook’s 120 employees (see Table 3, below). Compared with Willowbrook’s owner, Ciena Healthcare Management, turnover is dramatically lower. In 2010, the rate for Willowbrook was 13 percent, while the Ciena turnover rate was at 40 percent.
Keeping the facility humming at such a high level, says Michelson, means constantly evaluating and analyzing data, which come from several sources. Customer surveys, discussions with family members and employees, concern forms, and suggestion boxes are some of the methods employed.
In addition, SWOT (strengths, weaknesses, opportunities, and threats) and environmental analyses are utilized. “Analysis of data sources helps us plan and prepare to meet the needs and expectations of future customers and to ensure their satisfaction,” says Michelson.
He also credits the facility’s commitment to its mission, its code of ethics, and code of conduct for its success.
“These things have helped us keep employee turnover low and create a successful rehabilitation program,” he says.
Union Challenges Present But Minimal
Michelson also points to Willowbrook’s “aesthetically appealing environment” and high quality of care as reasons for its recognition as a provider of choice in Michigan, “despite the disadvantage of location and unionization,” he says. Aside from location, being a “union shop” presents a challenge to Willowbrook’s management. All employees, except management and licensed nurses, are unionized at Willowbrook. Given that Flint has been dominated by the auto industry for decades, unionization has become part of the fabric of the city’s culture.
“Unions present unique challenges to employers,” says Michelson. “Willowbrook’s union contract dictates equal pay for equal work, which prevents us from rewarding employees with bonuses or raises based on performance.”
Michelson says this policy also prevents the promotion of unionized employees to management levels while maintaining their union status.
“Health care facilities need to remain focused on the care of customers, and unionization tends to divert that focus in alternate directions, which has the potential to decrease effectiveness,” he says.
Despite these challenges, Willowbrook has scored consistently high marks on its employee satisfaction surveys, and union-filed grievances have declined steadily over the past decade.
The secret ingredient to this success, says Michelson, is that “we are fair and consistent with all staff members.”
A Positive Outlook
Ciena Healthcare Management, headquartered in Southfield, Mich., owns and operates Willowbrook in addition to a stable of 35 long term care properties in Michigan and Connecticut. Kristine Halsey, chief operating officer for Ciena, notes that the company is expanding. “While others are retreating, we see the coming years as a time of opportunity for expansion,” she says.
Halsey reports that although the Medicare and Medicaid funding climate is poor, Ciena has not made any staff changes.
Expansion for Ciena means that it is building skilled nursing centers throughout lower Michigan, as well as hiring staff to oversee a new dining program that will eventually be implemented throughout the entire company.
Ciena recently broke ground on a new skilled nursing community in Grand Blanc Township, just east of Flint. The 68,000-square-foot facility, known as the Grand Blanc Care Center, will be a “state-of-the-art facility with 74 short-term rehabilitation and long term care suites with private baths in each,” says Halsey.
At a cost of more than $8.5 million and expected to create more than 120 full-time and part-time jobs, Grand Blanc Care Center is slated to open next summer.
In addition to six bariatric rooms, a rehabilitative therapy room, and a spa, the community will feature several dining venues, including a main dining room, a restorative dining room, a private dining room, and an a la carte 24-hour room service menu created by an executive chef.
Ciena will open a new skilled nursing community in Ann Arbor, Mich., this fall. Regency at Bluffs Park, was renovated at a cost of more than $5 million.The 71-bed facility will feature 37 private rooms and 17 semi-private rooms, all with in-room showers and baths.
According to Ciena’s website, the new center is “designed to have the look and feel of a boutique hotel.” In addition to other amenities, each resident bed will have its own flat screen TV.
The 37,000-square-foot building is also expected to receive a Silver LEED Certification, as granted by the U.S. Green Building Council.
Also part of this project, Ciena donated more than one acre of land to the city of Ann Arbor to be used as a public access point to Bluffs Park.
A third Ciena community will open soon in Canton, Mich. The Regency at Canton will offer short-term rehabilitation and long term care, which includes 40 private rooms and 80 semi-private rooms.
dining next on list for upgrade.
Next on Ciena’s list of priorities is fine dining. Halsey says the company is revamping its entire dining program so that residents can enjoy better food and a more pleasant dining atmosphere.
“We hired a corporate chef from a well-known Detroit restaurant to train the cooks in all of our communities,” says Halsey, who notes that they will start with basic sauces and work their way up.
Many of the facilities will keep their existing cooks and take classes with the corporate chef. The overhaul includes menu planning and dietary requirements for all Ciena chefs.
A “quality dashboard” created in-house by Ciena enables facility staff to see, on a daily basis, how the residents are doing on a number of indicators.
“It’s really about data,” says Halsey, “and giving them the information and tools to provider the best quality of care possible.”
This support is evident in the fact that eight of Ciena’s care centers, including Willowbrook, recently received five-star ratings from the Centers for Medicare & Medicaid Services’ quality rating system.
In addition, Willowbrook was recognized by U.S. News & World Report as one of America’s best nursing homes in 2011.
What’s more, Ciena selected Willowbrook as Facility of the Year three times over the past five years.
Don’t Count Flint Out
At press time, Flint’s troubles continued as Michigan Gov. Rick Snyder (R) appointed an emergency manager to oversee the city’s shaky finances. Although the move appears to be the latest indicator of Flint’s downward spiral, the city still has many supporters.
Richard Karp, a developer who specializes in historic preservation, is bullish on Flint’s prospects for a successful revitalization. He was instrumental in rebuilding the Durant, a once-legendary downtown hotel named for the founder of General Motors, William C. Durant, a grandson of Henry Crapo, the 14th governor of Michigan.
Built in 1920, the Durant thrived for nearly 50 years as a symbol of the city’s success. After sitting empty for more than 30 years, Karp began refurbishing the hotel in 2008.
Since its reopening as an apartment and commercial leasing space last January, interest in the project has exceeded Karp’s expectations.
“The apartments are 100 percent leased, and we have one commercial suite left,” he says. In addition, the project has won five awards thus far, including the Governor’s Award for Historic Preservation.
Karp says he was attracted to the Durant project for several reasons. “The expansion of the University of Michigan campus, a strong revitalization effort in the downtown area, and the lack of housing for students” pointed to its potential for success, he says.
Karp confirmed that he is eyeing two more projects for development in the downtown area in the near future.
In the meantime, Michelson remains upbeat about Flint’s comeback. He points to the city’s cultural establishments as examples of endurance: The Flint Institute of Music, the Institute of Arts, and several colleges and universities with campuses downtown are all thriving amid the city’s turmoil.
Flint has weathered much hardship over the years, and it could get worse before it gets better, but Flintoids are an enduring lot.
After all, it was built on steel and grit by the largest automobile manufacturer in the world.
And so, as the city wrestles with its ghosts, Willowbrook hums along efficiently, business as usual.
Subscribe to:
Posts (Atom)