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.

“History has provided us with many examples of nurses’ contributions to mankind. But what sets us apart as a recognized profession?” asks Karen Novak, Director of Health Services. “Tradition! Florence Nightingale was a change agent and seemed to do it without compromise; leadership techniques and advocacy were many of her strong points. It is important to have these traits to
provide nursing students with the tools necessary to promote health.”

The tradition of nursing care is alive and passionate at Plymouth Harbor. Suncoast Technical College’s (STC) Licensed Practical Nursing (LPN) program partnered with Plymouth Harbor’s Smith Care Center (SCC) years ago, but somehow that tradition fell through the cracks. Dedicated leadership at Plymouth Harbor decided to get things back on track, and the revival of the tradition resumed in November 2016.

STC’s LPN program is a one-year program where students gain both classroom and real-world experience — completing six months in a “freshman” course and their second six months in an advanced course. As a result, half of their time is spent honing skills in the classroom, while the other half is spent completing student clinicals at numerous healthcare sites, including Plymouth Harbor.

According to Clinical Instructor Michelle Boudreaux, there are three clinical instructors. Students rotate between healthcare facilities, allowing them to work in different environments with different instructors. Boudreaux notes that while the maximum number of students allowed by law in a class is 12, STC limits theirs to seven, ultimately providing a much more in-depth, hands-on experience.

By working in environments such as Plymouth Harbor, students are able to learn delegation, management, and can witness first-hand how facilities function as a team. At the end of each clinical rotation, students are asked to provide a “head-to-toe” assessment to their instructor, along with a Medicare note and patient history. Additionally, the students conduct a daily “post-conference” in which they discuss items that came up and how they solved them. Under supervision, students are able to perform general patient care and some skills such as IVs, dressing changes, vital signs, and patient assessments.

To succeed in nursing, a strong and broad foundation must be laid to build upon. SCC’s tenured nurses are all too happy to contribute to building this foundation, seeing these novice nursing students bloom right before their eyes. For some SCC nurses, it is a completion of the circle they started many years ago, as they, too, were in the shoes of the students not so long ago. SCC LPN, and STC graduate, Manny Flores remembers it well, and now facilitates the growth of many students as they learn.

“To touch the life of a student and give them wings to grow is our goal here at Plymouth Harbor,” Karen says. “Who knows, you might find them one day in our healthcare center taking care of you!”

Every year every skilled nursing facility across the country is surveyed by its state licensing agency as directed by the Federal Centers for Medicare and Medicaid. The purpose of this survey is to determine the level of compliance each facility has with the approximately 200 rules and regulations that apply to skilled nursing facilities. These annual surveys are unannounced and usually involve four to six surveyors who spend an entire week reviewing the facility.

Smith Care Center’s (SCC) annual survey began on Monday, November 14, bright and early. The survey team began by touring SCC, including the kitchen, as well as conducting resident visits to
determine their and family members’ level of satisfaction. Questions, comments, and concerns expressed by residents, family, and visitors typically drive the next phase of the survey. In addition, staff are queried on an array of topics; delivery of services and care are observed.

We had an idea that something special was about to happen when the lead surveyor told us that they would be leaving early Wednesday afternoon (instead of Thursday or Friday). At the surveyors’ exit conference with SCC administrative staff we were informed that we had a deficiency-free survey for resident care! For comparison, the State and National average is about seven deficiencies. A deficiency-free survey is very rare.

It is a pleasure to work with such a great team of professionals in SCC. There is a dedication to doing things right and performing at a high level. We are fortunate to have the talent and support of so many staff members throughout every department of Plymouth Harbor. There is a common theme I have found with our staff. We truly care about the people who reside in Plymouth Harbor and we enjoy assisting you to live life to the fullest.