A message from Plymouth Harbor

Gov. Ron DeSantis announced an executive order Wednesday afternoon, March 11. The order restricts visitors from nursing homes and assisted living facilities for a period of two weeks after they: Show symptoms of any respiratory infection or are sick, travel internationally, have been aboard a cruise ship, visited an area with community spread of the virus or live in an area with community spread.

The Department of Health (DOH) began visiting all skilled nursing facilities this week. Our Smith Care Center was inspected on Tuesday, March 10, with the focus on reviewing infection control procedures and outcomes and what procedures we have in place to screen residents, visitors and staff for the potential infectious disease. The Surveyor found no deficiencies at Plymouth Harbor and noted he was impressed by procedures and communications we had in place.

In addition, our Seaside Assisted Living and Starr Memory Care Residence also received a visit from DOH. They were also complemented on the procedures they had in place for infection control.

Residents in our Smith Care Center now have a new activity to enjoy, thanks to the Plymouth Harbor Foundation. On July 10, an Eldergrow therapeutic sensory garden was installed in the SCC Living Room, bringing nature inside for our residents to enjoy year-round.

Eldergrow gardens are raised, mobile soil beds equipped with an indoor lighting system that allows plants to flourish inside year-round. The gardens are sustainably sourced, eco-friendly and energy efficient, and are accessible for both seated and standing gardeners. These therapeutic sensory gardens and the accompanying programming provide residents with a meaningful way to connect with nature that engages all the senses. “We try to make sure there are things to touch and feel, things to smell, and magical colors,” said Katherine, the Eldergrow Educator who came on site to perform the installation.

The installation began with Katherine bringing around a lavender plant, encouraging residents to touch and smell it. She did the same with a rosemary plant, and then with a “pink polka dot plant.” After introducing the plants, each resident was invited to choose one to call their own and place it in the soil, creating together a community garden full of diverse flora.

Now that the garden is up and running, residents will share daily tasks to keep the garden healthy, such as watering and pruning plants and tilling the soil. Every two weeks, Katherine will visit our residents to teach them about garden maintenance and host activities centered around the plants they are growing, usually using them to create crafts or even to cook! These classes allow the garden to further enrich the lives of residents by providing them with structured ways to use their motor, cognitive, and social skills. The activities help residents to engage with their community and their environment in meaningful ways.

Eldergrow is based on the concept of therapeutic horticulture and the healing powers of nature. Gardening has the power to change lives, with evidence showing it can improve motor skills, elevate mood, reduce agitation, and act as an antidepressant, among other things.

Leanne Beach, SCC Director of Activities, first learned of the program through a monthly Activity Director meeting and was immediately intrigued. “Several of our residents in the Smith Care Center are unable to get outdoors to enjoy the sunshine and see the flowers like they used to, and this seemed like a wonderful opportunity for them,” Leanne said.

The idea for Eldergrow gardens stemmed from this same problem. Eldergrow’s founder, Orla Concannon, came up with the idea for an indoor garden when her grandmother moved into a nursing home and no longer had
access to the gardens she loved to work in. While earning her Healthcare Executive MBA at Seattle University, Orla created Eldergrow in honor of her grandmother to bring the therapeutic benefits of gardening and nature to senior communities. After graduating in 2015, she successfully completed the University of Washington’s Jones and Foster Accelerator Program for Innovative Start-Ups and was awarded seed money for Eldergrow.

Now, there are 100 Eldergrow gardens across the nation, and ours is the third in Florida. “I am so happy and grateful that the “Eldergrow Program” has been welcomed to Plymouth Harbor,” Leanne said. “The support and enthusiasm was truly felt by our residents.”

On June 4, 2019, The Rev. Dr. Jack A. Smith passed away in the very building that was named after him: The Smith Care Center.

He graduated from Ohio Wesleyan University with a degree in finance and then went on to attend the Oberlin Graduate School of Theology and Vanderbilt University where he earned his doctorate degree. Before coming
to Plymouth Harbor, he was a business owner.

The Rev. Dr. Smith became the second Administrator of
Plymouth Harbor in 1972. A former minister in the Florida Conference of the United Church of Christ, The Rev. Dr. Smith also had a business degree and administrative experience. During that time, Plymouth Harbor was struggling to keep pace with rising costs of operation and existing resident contracts contained clauses restricting increases in fees. In an impressive show of devotion, The Rev. Dr. Smith, trustees, and residents raised enough money to save Plymouth Harbor and get it back on solid financial footing. If it weren’t for him, Plymouth Harbor very well may not have made it to the present day.

Prior to the Smith Care Center, Plymouth Harbor had a small infirmary located on the second floor of the Tower, where the Callahan Center is now, with 43 beds in 14 rooms. In 1988, the North Garden was built and the infirmary was moved into the new, improved space and renamed the Health Center. It was later renamed again the Plymouth Harbor Health and Rehabilitation Center to more fully describe its capabilities. At its 40th anniversary celebration, the center underwent a final name change in recognition of the former Executive Director and became The Jack A. Smith Care Center.

In 1989, The Rev. Dr. Smith retired after 18 years as Administrator, however he returned as interim CEO in 2004 during the year before Harry Hobson came aboard. The Rev. Dr. Smith has left his legacy at Plymouth Harbor, and we are grateful to have had him as part of our story.

Plymouth Harbor’s Health Services staff conducted their fifth annual Skills Fair for nurses and certified nursing assistants in the Club Room, September 24th-27th. While annual training is required, a skills fair allows it to be “hands on,” which is the best way of ensuring our nursing staff is competent and knowledgeable in the latest techniques and skills.

The Skills Fair was well attended by our team members. The Smith Care Center had a total of 27 CNAs and 25 nurses attend; Our Home Care department had 23 CNAs and 6 nurses attend; And the Seaside Assisted Living and Starr Memory Care Residences had 22 CNAs and 10 nurses attend. That’s a total of 113 direct care team members. Harry Hobson attended as well!

There were several stations where team members were asked to perform a variety of skills from hand washing (required minimum of 20 seconds), catheter care/insertion (using a life-like mannequin donated by the Plymouth Harbor Foundation), glucometer use, infection control, oral care, skin/wound care, and transferring residents using a mechanical lift. Each skill was explained and demonstrated to the attendees who were then required to do a return demonstration of the skill and get it checked off that they completed the skill satisfactorily. Once they completed their skill sheets, they were able to put their name in for a drawing for one of two gift baskets donated by the Foundation. Congratulations to Andrea Davis and Maria Chavarria, the winners of the baskets.

Plymouth Harbor is committed to the education and growth of our nursing staff, and the Skills Fair ensures we continue providing our staff with the training they need to give our residents the care they deserve.

At the March 2017 Café Chat, Chair of our Board of Trustees, Dr. G. Duncan Finlay, introduced Plymouth Harbor to the Florence A. Rothman Institute (FARI), where he serves as President and CEO, and The Rothman Index.

According to Dr. Finlay, healthcare in the United States is beset by upward spiraling and financially unsustainable costs and quality that is disappointing at best. Early efforts to address this issue have had inconsistent results in terms of quality and cost measurements. These approaches are commonly patient-centered, and thus require a means to accurately measure and follow a patient’s condition at any level of care, from hospital care through skilled nursing, home health care, and assisted and independent living organizations.

The Rothman Index
This is where the Rothman Index (RI), an acuity metric developed at Sarasota Memorial Hospital, comes in. The RI is a score of a patient’s general condition that is calculated automatically from information that is routinely collected in the electronic medical records (EMR) system. The score is displayed in a graphical format that depicts the patient’s condition over time. The RI has been validated with over 30 peer-reviewed articles and is used in over 60 hospitals nation-wide. Preliminary studies in skilled nursing facilities appear to support its accuracy outside the hospital.

Plymouth Harbor’s Involvement
FARI wanted to explore if this same index could be constructed for persons living independently, and as a result, asked Plymouth Harbor residents for their participation in a trial study where patients conduct their own medical self-assessments, answering a series of questions. The study officially began on May 9, 2017, with 46 independent living participants. A total of 30 females and 16 males participated, with an average age of 83. These volunteers answered 14 ‘yes’ or ‘no’ questions about possible symptoms pertaining to their own body systems.

The same self-assessment was then repeated on a second occasion separated by more than 24 hours — with an average separation time of 11 days. Then, the volunteers had a Registered Nurse independently perform a standard head-to-toe assessment for comparison.

The Results
The study was able to demonstrate significant inter-rater reliability (agreement) in 11 of the body system questions on the first pass, and in 10 questions on the second. The individual answers were consistent between the first and second answer periods.

Future plans include asking volunteers to use a handheld device, which was demonstrated at the Café Chat, to measure their own vital signs (blood pressure, pulse, respirations, and oxygen levels) and then answer the same questions on a smart phone. These will be combined to create a Rothman Index score and graph, which will give a picture of each volunteer’s overall wellness during the monitoring period. Please stay tuned for more information on this future study.

Since 2010, Plymouth Harbor has enjoyed a mutually beneficial relationship with Functional Pathways, a contract rehabilitation and therapy management service. Functional Pathways provides the staffing needed in our Rehab Department to offer superior inpatient and outpatient therapy to not only residents of the Smith Care Center, but to all residents of Plymouth Harbor. We are proud to share that satisfaction ratings from those receiving therapy services consistently exceed our benchmark.

Recently, the Residents Association Health and Wellness Committee requested more information regarding services that are available to residents as they try to improve the safety of their apartments relative to fall prevention. As a result, we have provided a summary of services below.

For the increased safety and independence of our residents, the Rehab Department offers individual assessments. Performed by a skilled Occupational Therapist, this one-on-one assessment is performed in the privacy of your home and usually lasts about 45 minutes. The therapist will evaluate your specific concerns and make any necessary recommendations to reduce your chance of an accident. Additionally, the therapist may offer an assessment plan to enhance the function of your home. For example, this most often includes rearranging items or furniture for ease-of-use, or adding select safety devices, such as grab bars, to aid in independent movement. As physical, sensory, or cognitive changes occur, the environment should change as well. Any recommendations made by the therapist will be provided to you in writing. From there, the Plymouth Harbor team, including Home Care, Housekeeping, and Maintenance, is available to assist you in implementing any changes you wish to make.

Therapy assessments are covered by traditional Medicare and most other health insurance plans under the following conditions: 1) You have experienced a new illness or injury; 2) You have a chronic condition that has worsened; 3) You are dealing with new equipment (i.e., a walker) or are adjusting to a new environment. Please note that the cost of equipment is often out-of-pocket.

If you would like more information on how a home assessment may benefit you, please call the Rehab Department at Ext. 166, and ask for Gina.

Since 1990, the American Nurses Association (ANA) has celebrated National Nurses Week from May 6th through May 12th, the birthday of Florence Nightingale – the founder of modern nursing. This annual event recognizes and celebrates the hard work and dedication exhibited each and every day by nurses across the country.

Additionally, National Nursing Home Week is celebrated annually, beginning May 14th and ending May 20th. Established by the American Health Care Association in 1967, and always beginning on Mother’s Day, National Nursing Home Week provides an opportunity for residents and their loved ones, staff, volunteers, and surrounding communities to recognize the role of skilled nursing care centers in caring for seniors. This year, Plymouth Harbor celebrated both annual events during the week of May 15th through May 19th.

Our campus-wide celebration honored our Home Care, Assisted Living, and Skilled Nursing staff, offering a small event each day, including: “Sundae” Monday, OJ and bagels on Tuesday, Staff Bingo on Wednesday, Taco and Potato Bar on Thursday, and the Blessing of the Hands on Friday.

Held in the Smith Care Center, the Blessing of the Hands offers a simple blessing to our caretakers through a cleansing with myrrh water. Aides, nurses, housekeepers, dining staff, residents, and administration alike are invited to attend, where we acknowledge the role each plays in caring for our residents. The following is said to each participant during the ceremony, “May the work of your hands bring comfort, dignity, and mercy to all the people your hands touch.”

We are truly thankful for the work of our healthcare team and for all those who care for our residents here at Plymouth Harbor.

A. Rothman Institute, where he serves as President and CEO, and The Rothman Index. 

According to Dr. Finlay, healthcare in the United States is beset by upward spiraling and financially unsustainable costs and quality that is disappointing at best. He says, “These pressures have led to a broad conclusion by Centers for Medicare & Medicaid Services, and the industry as a whole, that the system must change from the current fee-for-service payment model to a ‘value-based’ reimbursement model.”
 
Early efforts to address this issue have had inconsistent results in terms of both quality and cost measurements. Common to these approaches, and any others likely to be proposed, is that they are patient-centered and thus require a means to accurately measure and follow a patient’s overall condition at any level of care, from the acute care hospital through skilled nursing, home health care, and assisted and independent living organizations.
 
The Rothman Index
The Rothman Index is an acuity metric developed at Sarasota Memorial Hospital. The Index uses data empirically, associated with severity of illness, and automatically computed, using data routinely entered in the electronic medical record — including nursing assessments, Braden Scale score, cardiac rhythm, vital signs, blood oxygen level, and lab test results.
 
The Rothman Index has been validated with over 30 peer-reviewed articles and is used in over 60 hospitals nationwide, including Methodist Houston, the Yale New Haven Health System, and the University of Florida Hospitals. Preliminary studies in skilled nursing facilities appear to support its accuracy outside the hospital.

Plymouth Harbor’s Involvement
It has been speculated that a functionally equivalent index of acuity can be constructed for those persons living independently. Therefore, the Florence A. Rothman Institute is exploring a trial study whereby patients conduct their own medical self-assessments by answering a series of questions.

In April 2017, Dr. Finlay formally invited our independent living residents to participate in the study, working collaboratively with The Rothman Index and Sarasota Memorial Hospital. The study officially began on May 9, 2017, with 43 Plymouth Harbor participants.
 
About the Study
The study consists of 43 independent living volunteers who will answer ‘yes’ or ‘no’ to 14 questions about possible symptoms pertaining to their own body systems. Then, the same volunteers will have a Registered Nurse independently perform a “standard” head-to-toe nursing assessment for comparison. This assessment will be repeated on a second occasion separated by more than 24 hours.

This study is funded by the Florence A. Rothman Institute (www.farinstitute.org) under the auspices of the Institutional Review Board of Sarasota Memorial Healthcare System.

We hope to have results to share from this study in the coming weeks.

By: Judy Sarnowski, ADC, CDP, Smith Care Center’s Activity Director

In any Skilled Nursing Facility, this adage unfortunately holds true when attempting to design an activity calendar that fits the leisure patterns of adults who have diverse backgrounds, levels of education, and religious preferences. Throw varying degrees of cognition into the mix and the challenge to provide activities that appeal to the majority of your residents, becomes
even greater.

Experienced activity directors know that the key to developing a successful program is to find a common thread within the patchwork quilt of each person’s interests, the three most common being some form of exercise, music, and reading. Once that is accomplished, the task of providing activities that have a global appeal to your resident population becomes much simpler.

The next step is to simplify each activity into segments that can be altered to match each resident’s specific abilities. Variations of card games like UNO allow residents with varying levels of cognitive ability the opportunity to participate and enjoy a positive experience. Adaptive devices and task segmentation can also be used to facilitate the participation of a large group of residents in a single activity.

For example, the task of building a birdhouse could evolve into a successful activity simply by assigning the more difficult aspects of the project, like measuring and cutting, to residents capable of performing these tasks, and allowing those with cognitive or physical limitations the opportunity to perform simpler tasks like sanding or painting.

In a Life Plan Community, activity offerings should address the individual needs and interests of residents within their specific level of care. At times, this can be difficult to achieve as residents whose needs are ever-increasing are unable to move through the care continuum due to lack of available space. As Plymouth Harbor nears the completion of our Northwest Garden Building —complete with state-of-the-art Memory Care and Assisted Living Residences — we will be able to offer enhanced activities for each individual resident and accommodate the influx of people searching for the ultimate destination in which to live life to the fullest.