Healthcare policymakers advocate teamwork as a means of assuring quality and safety in the delivery of services. In the case of skilled nursing facilities, the best benefits are realized when individual team members work in cooperation with each other to set and reach unit and individual goals.
The American Health Care Association (AHCA) stresses the value of care planning where everyone "pitches in" for optimal outcomes. Accordingly, the theme of this year's National Nursing Home Week (NNHW) is "Team Care" with an ancillary theme of "Everyone Pitches In." NNHW will be observed in skilled nursing facilities throughout the United States, beginning Mother's Day, May 12 and continuing through May 18, 2013.
According to the AHCA, this year's theme recognizes residents and patients in long-term and post-acute care settings and the dedicated staff who care for them. Observing NNHW is an opportunity to show support and respect for the individuals and staff who provide care and support services.
To celebrate NNHW, facilities across the country will host activities designed to foster intergenerational contact, strengthen family relationships and to encourage volunteerism by individuals and local organizations. The AHCA encourages facilities to hold open houses, tours welcoming VIPs and other guests, and special events for the residents, families, staff and community.
In long-term and post-acute care settings, a large team-including nurses, CNAs, physical, occupational, speech and recreational therapists and other support staff-contributes to achieving high levels of satisfaction.
Signature HealthCARE, a provider of long-term care services in the Eastern and Southeastern United States, operates 73 communities in six states with more than 12,000 employees. At each Signature facility, the rehabilitation team works together to develop a coordinated plan of care designed to meet patient needs. Rehabilitation works best when the disciplines work together, with each bringing its own special expertise to the table.
Under Signature Rehab's integrated care model, therapists work closely with other clinical caregivers to ensure residents and patients make a full recovery and a timely return to the activities they enjoy. To get a better understanding of how OTs, PTs and SLPs work together, ADVANCE spoke with 3 rehabilitation service managers from different Signature HealthCARE facilities:
· Denise Holland, PT, rehab service manager, Heritage Park Care & Rehab in Bradenton, FL.
· Tessa Perkinson, MS, OTR/L, rehab service manager, Bridge at Rockwood in Rockwood, TN.
· Shannon DuBose, CCC-SLP, rehab service manager at Signature HealthCARE of Gainesville in Gainesville, FL.
ADVANCE: Which Signature Healthcare community do you work in and what unique challenges are you presented with as the rehab service manager?
Holland: Our community at Heritage Park Care & Rehab in Bradenton, FL, has a mix of short- and long-term care patients. Our therapists tend to see more of the short-term patients as many of them are being discharged to assisted living, not necessarily to home. Our patient population ranges from orthopedic to cardiac and respiratory related issues and other illnesses.
We use a multidisciplinary approach which allows us to work side by side to coordinate the best care for our patients. We collaborate with each other but also with nursing and special services. Our PTs generally address pain and balance with exercise and manual therapy techniques including massage and myofascial release. We are not opposed to using all tools in the toolbox so our approach often involves pain management modalities/interventions including ultrasound, e-stim and diathermy.
Education and family involvement are crucial to the success of our patients. As a manager, I expect that my therapists educate the patient and/or the caregiver at least once a week. That's my standard and my expectation.
Perkinson: Treatment is a bit different in our community, Bridge at Rockwood in Rockwood, TN, than at a typical nursing home because we are a serenity building. Signature Serenity offers specialized care to individuals suffering from Alzheimer's disease and other forms of dementia. About 80% of our caseload is dementia and we focus on a functional approach for this patient population. We have developed an ability-based program for them and we trial and error various approaches with patients to determine what is best for each individual.
Our OTs develop cognitive programs for the dementia patients and work on ADLs that keep them safe. We do a lot of work with positioning, splinting, and pressure relief with nursing for wounds. Service delivery is important to us and we focus on patient-centered care.
DuBose: Our patient population at Signature HealthCARE of Gainesville in Gainesville, FL, is mainly composed of short-term patients who are discharged to home. We may have a 20-year-old with orthopedic issues from a motor vehicle accident or an 80-year-old who is having trouble swallowing from radiation treatments to his throat due to cancer.
As a SLP, we work on cognitive issues including short-and long-term memory loss, word finding, orientation and problem solving. We teach patients with aphasia to speak again and learn how to follow directions. We also address safety awareness for a safe discharge back to home and teach patients who have a trach to communicate. For patients who are having difficulty communicating, we can teach them how to express wants and needs to caregivers and family members.
Today's patients need even more rehab because of shorter hospital stays and they are usually arriving with more complications. We have a full time respiratory therapist on staff, so that gives us an advantage on the medical side. As a result, we need the goals to be creative to engage our patients. Healthcare is always changing so as clinicians, we need to be flexible, creative and willing to change along with the system.
ADVANCE: How does your facility exemplify this notion of team care?
Holland: The multidisciplinary approach is threefold: consistency, coordination of treatment plans and preparation for discharge. Working together across all disciplines enhances skills, confidence and knowledge. When we can problem solve together, it helps us learn from each other each and every day. We collaborate on a case by case basis to exchange patient treatment information. Each team member complements the other as they work together to develop an appropriate treatment plan.
Our patients with stroke are perfect for our multidisciplinary care model. It's often difficult for PT to communicate with stroke patients. SLPs teach communication strategies and know how to give the right cues and get the response we are looking for. Overall, it's less frustrating (for the patient and the therapist) and facilitates a quicker recovery. Sometimes patients won't or can't communicate their abilities to us. OTs and SLPs are so creative in their approach and are great communicators. They often share approaches that work really well for our patient interactions.
It's critical for the disciplines to maintain open communication because we want to avoid doing the same thing with patients. We need to know how a patient is performing OT and then in SLP-it influences our plan of care. It helps me know when I can push them farther or start the next step in their care. Because we work side by side, OT and SLP can observe what I'm working on from across the room.
Perkinson: We have regular department meetings and we share office space with PT and SLP so we regularly bounce ideas off of each other and discuss resident needs. It helps to be aware of the other disciplines' strengths and use them to help patients. If we notice a decline in a particular area, then we know to notify the other discipline who can best address it.
A good example of teamwork is when a SLP is working with a resident because of weight loss and identifies the problem is her inability to feed herself properly. SLP will address swallowing issues and bring OT in to help the resident relearn how to feed herself. We may refer to PT if we notice that a resident's transfer rate has declined.
We are in the process of adding a sensory integration room that will be used by OT, PT and SLP. It will be a multi-sensory room to engage patients in various sensory experiences-it will include media that can be calming and will include visual, aromatic and musical components. The program is being initiated based on a research program that is just wrapping up in collaboration with the Signature Research Institute. Our plan is to train nurses to use the area with patients as well.
DuBose: Our clinical team works together to provide personalized care for our patients with the end goal of improving daily life. It's a rewarding work environment because many of our patients are not able to eat at all when they arrive. People take eating for granted and it's the first thing they want back. As an SLP, we often ask PT to help with proper positioning with a swallowing patient.
For a patient who is struggling to follow instructions, for example, we may do a cooking activity with OT to demonstrate following directions and sequencing. PT can be involved, too, by addressing the patient's balance and mobility in the kitchen.
ADVANCE: What will you be doing to celebrate National Nursing Home Week this year?
Holland: We celebrate every occasion that we have an excuse to celebrate so National Nursing Home Week is no different. We work in a challenging environment full of tremendous joys and great heartaches. Any cause for celebration helps liven up the average day. I'm excited to see how we honor NNHW this year.
Perkinson: We have week-long activities lined up with dress-up days for residents and staff members. Our staff members also partner with residents for a weeklong competition. Each team can earn tokens that can be cashed in for prizes. At the end of the week, we close the celebration with a community-wide picnic.
DuBose: For last year's NNHW, we decided on a tropical beach theme. We had dress up days and beach themed activities scheduled for residents. It can be a fun challenge coming up with exciting activities that involve the disparity in ages.
Rebecca Mayer Knutsen is on staff at ADVANCE and can be reached at email@example.com
Photos courtesy Signature HealthCARE.