The Morrison Way: Healing & Serving Better With Rehabilitation

G N I V MO UR TO O G! B LO HEALING AND SERVING BETTER WITH REHABILITATION A MESSAGE FROM THE PRESIDENTS

BY KEVIN SVAGDIS & JOE GORMAN OWNING YOUR REHABILITATION Customized Nutrition and Collaboration Signal Best Practices in Rehab Care PROFESSIONAL CARE WITH A PERSONAL TOUCH Associates and Amenities Set St. Johnland Apart A HABIT OF TRANSPARENCY At Holly Creek, Connectivity is King GOING ABOVE AND BEYOND Evangelical Homes of Michigan Ramps up Holistic Care FOOD RULES Serving a Course of Education

REHABILITATION:

AN OPPORTUNITY TO SERVE BETTER, HEAL BETTER

A MESSAGE FROM THE PRESIDENTS

The facts are simple: the more satisfied residents and patients are with their rehabilitation services, the better their clinical results and the more function they regain. Their satisfaction— and thus their healing—rests on more than specific therapies and nutritional choices. It’s also about how the services are delivered. Are the programs holistic and carried out through post-discharge? Are there elements in place to support ongoing educational, clinical and nutritional needs? From our experience and perspective, the answer must be yes.

In this issue, you will read about insights and best practices that elevate and drive positive rehabilitation outcomes. From creative approaches to team collaboration – each story touches on the person-centered care that is critical to a successful rehabilitation program. Our work is never done, and we thank our community partners for encouraging the constant pursuit of service excellence and growth. The better we serve, the more lives we heal.

Kevin Svagdis West Division President

Joseph Gorman East Division President

O W N I N G YO U R R E H A B I L I TAT I O N CUSTOMIZED NUTRITION AND COLLABORATION SIGNAL BEST PRACTICES IN REHAB CARE

Just as continuing care retirement communities erased stereotypes of nursing homes, rehabilitation services are transforming how clients get back on their feet. Focused on personalized care and individual priorities, rehabilitation programs are adopting an approach that reflects the trend in senior living toward a service model. More than ever, the client and their expectations are driving – and raising the bar – on rehab care.

This new approach to rehab care includes helping patients eat well to nurture the body as well as developing knowledge about nutrition to help continue their recovery. Patients admitted to rehab centers should experience the benefits

of food and nutrition to allow them to recover to their fullest potential. Dining options that meet their schedules, culinary and wellness needs are very important in this stage of recovery.

Having access to a holistic program to heal, educate and support residents across the continuum of care is also a key factor for success and client satisfaction. Knowledgeable registered dietitians are instrumental in leading the discharge plan and helping the client participate and acclimate to lifestyle changes related to rehabilitation.

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Top-notch rehabilitation care emphasizes…

CARING VALUES

CREATING HABITS

• Flexibility to individual preferences and limitations.

• Substitutions of ingredients for better health, such as herbs and spices instead of salt.

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• Adaptability, especially with the demands of rehabilitation scheduling. A client who is fatigued from physical therapy may not focus as well with the registered dietitian.

• Studying food labels (which change every few years) for optimal shopping results.

• Vigilance, especially in monitoring progress. Levels of sodium, for instance, are important to track for many cardiac patients.

• Strategies for possible follow-up to ensure the client is not re-admitted.

After discharge, a client may feel supported by the rehabilitation care team designating a central contact person for any questions or issues.

This planning begins as soon as the client is admitted and involves collaboration with physicians, therapists and other members of the care team. The rehabilitation team understands that each client learns differently (as a visual learner, hands-on learner, etc.), which guides how new information is presented. Having support resources like integrated dining and in-home delivery can ensure an extension of support after the patient is discharged.

“A strong team approach to caring for an individual considers the person’s goals, needs and preferences, and helps create a nutritional and wellness plan that is appropriate,” said

Carole DeBonte, a Morrison Community Living director of clinical and wellness support based in upstate New York.

It is important to remember that rehabilitation does not stop with a patient’s discharge from a care center. Morrison Community Living’s rehabilitation approach ensures that patients are ready for home care with follow-up programs that support their health, diet and wellness needs. This long-term outlook paired with customized care helps patients achieve their recovery goals — from entering the community to going home.

PROFESSIONAL CARE WITH A PERSONAL TOUCH ASSOCIATES AND AMENITIES SET ST. JOHNLAND APART At St. Johnland Nursing Center on Long Island, the journey from rehabilitation to back home is shortened because St. Johnland offers key comforts of home—and the warm professionalism of the multi-disciplinary staff.

St. Johnland’s Livingston Pavilion for Subacute Care provides rehabilitation services for up to 24 clients recovering from accidents, injury, surgery or illness following hospitalization.

“Everything we do helps with their recovery and overall satisfaction, including offering conveniences that a person would enjoy in their own home,” said St. Johnland CEO and administrator Mary Jean Weber.

One example: “Most of our subacute clients like to eat in the dining room, and because they go to therapies so often, we try to accommodate those who don’t like to get up early.” she said. “For us, it’s OK to wear a bathrobe to breakfast.”

The pavilion, which also includes a specialty unit for 22 people with traumatic brain injuries, is at full occupancy at most times. Patients are served by specially trained staff who have been with St. Johnland for many years.

“What is special and unique about St. Johnland is the dedication of our associates to meet everyone’s needs individually,” Weber said.

“State-of-the-art therapy equipment is important for care, but the patients’ success depends on their willingness to participate.

And they participate because the team supports and cares for them.”

For example, when a person is admitted for rehabilitation, the care team’s mission is to

get that person moving at whatever level they can, and start treatment as soon as possible.

“Our therapists are patient and enthusiastic, and that helps them do what they need to,” Weber said. “If people around you have a great positive outlook, you’ll want to get better faster.”

The hub of medical treatment, nursing care and social work is the pavilion’s state-ofthe-art rehab gym, with a therapy kitchen and adaptive devices that support patients in regaining mobility and independence. The subacute care unit opened in 2005, a decade after the specialty unit for traumatic brain injuries. St. Johnland is celebrating their 150th anniversary this year.

Food is a big part of the rehabilitation journey.

One interactive dining idea that Morrison and St. Johnland customized is “neighborhood dining,” where a chef prepares meals while residents watch, allowing for greater socialization and choice.

“That makes a huge difference to all of our (250) residents, and especially to our subacute patients,” Weber said. “They are with us a relatively short period of time and their diet may be changing day to day. With neighborhood dining, they can get what they want when they want it, and the food is hotter and the smell of the food is right there. That sensory experience is so important because to get better, people need to eat what they like.”

A HABIT OF TRANSPARENCY AT HOLLY CREEK, CONNECTIVITY IS KING In the healthcare world, rehabilitation centers thrive or decline based on a critical number: how many clients are readmitted into the hospital within 30 days of discharge. Holly Creek Retirement Community near Denver is an example of a thriving center that has a very low readmission rate mainly because of one important habit: a weekly strategy meeting that brings together the resident, his or her family, and the entire care team.

These weekly grand rounds “are a miniature version of a care conference,” said Holly Creek associate executive director Gary Dickey, a licensed nursing home administrator since 1991.

“We meet in each resident’s suite, and we have representatives from nursing, medical, therapy, dining, and activities, along with the chaplain and unit manager, to hear from the resident how they are doing in their rehabilitation and what their needs are. We discuss the time frame for their discharge and strategy for when that happens. Families attend in person or by phone conference, depending on what is best for the resident. Everything we do is as transparent as possible to make the care as successful as it can be, and that sets the bar higher here than any skilled nursing setting I have worked in outside of a hospital.”

The weekly meeting is one reason why Holly Creek’s readmission rate in the past decade

has been so low—between 3 percent and 7 percent, Dickey said. For comparison, the national readmission rate in 2013 was 17.5 percent, according to the American Hospital Association.

Those figures are critical because they represent older adults who experienced setbacks that were serious enough to cause their return to hospital care. Another result is financial: When readmission rates rise, government reimbursements for rehab costs decline.

“We are very cautious when we determine discharge dates for residents,” Dickey added.

“We want their rehabilitation goals to be met and their support system in place. We want them to thrive, and when someone is readmitted to the hospital, we examine whether that happened because of something we did or didn’t do.”

“Our entire care team is sensitive to the fact that bouncing back to a hospital is difficult for seniors,” added Dickey. “Our goal is to prevent this scenario, which also impacts reimbursement.”

Established a decade ago, Holly Creek devotes 24 private suites to skilled nursing (rehabilitation) care, and another hallmark

of care is staffing. Holly Creek assigns one certified nursing assistant to every six residents and one nurse to every 12 residents. Resident service associates help with direct care and other daily tasks such as light housekeeping, life enrichment and dining room service.

In addition, residents in Holly Creek’s independent or assisted living can participate in a Lifecare Contract which guarantees them skilled nursing care when needed. “Our mindset is providing personalized care through staff who develop relationships with those who are cared for,” Dickey said. “We go above and beyond for our residents.”

Holly Creek managed to impress a particularly tough customer: a local investigative journalist who spent three months in rehabilitation care.

“He wrote us a letter about how nervous he had been after dealing with so many horror stories about health care,” commented Dickey. “He had spent more than 20 years investigating reports from people dissatisfied with issues in the Denver metropolitan area and reporting the results on TV. So it was very rewarding when he sincerely complimented everyone who had helped with his care and reiterated how it had changed his life. For him, Holly Creek was a very satisfying choice for rehabilitation.”

GOING ABOVE AND BEYOND HARNESSING TECHNOLOGY, EVANGELICAL HOMES

This “Life Trail” is set

OF MICHIGAN RAMPS UP

up in a way that allows

HOLISTIC CARE

residents to learn how to live their lives again

The top rehabilitation programs strive to go beyond what the doctor ordered and improve clients’ lives not only physically but also by focusing on better nutrition, emotional wellbeing, social connections and spiritual health. That’s why there is a waiting list at the 32,000-square foot Redies Center for Rehabilitation and Healthy Living near Ann Arbor, Mich., where clients benefit from a myriad of amenities and holistic offerings.

These items include hotel-like room suites with a flat-screen TV and printer; dedicated areas for physical and occupational therapy; a pool, spa and massage suite; outdoor walking paths and fitness stations; a salt water therapy pool, chapel, library and internet café; and a 24-hour staff hotline. Clients have access to a concierge, eight personal trainers, three massage therapists and a yoga instructor and a team of nutritionists.

“The Redies Center for Rehabilitation and Healthy Living resulted from an intentional decision that we are not only doing physical health and wellbeing, but also impacting the quality of life and health and wellness practices for our clients before they return home, in preparation for a lifetime transformation,” said Denise Rabidoux, president and CEO of Evangelical Homes of Michigan. The community operates The Redies Center and the Pathways TransitionCare program, a multidisciplinary approach for people seeking greater independence after serious illness or injury.

With 52 beds at the Redies Center (representing about half the 104 rehabilitation beds across the EHM system) and 1,150 rehab clients served in 2014, EHM has a monumental task of integrating and tracking

We are focused on more than rehabilitation – our goal for clients is healthy living for life.

clients’ care, progress and choices. To meet those challenges, the center uses a number of technologies. For instance, the point of sales system in the center’s Blossoms Cafeteria is linked to a client’s recommended dietary selections. The wait staff can refer to those suggestions to help the client make optimum choices (such as no sugar added options), and a registered dietitian can monitor client’s nutritional intake. “It helps us get rehabilitation clients comfortable with good nutrition and healthy choices before they return to restaurants in their own towns,” Rabidoux said. “It’s a wonderful way to merge rehabilitation and create changes that will impact the individual’s future health.”

iPad. The community leadership team uses the quick feedback to resolve any concerns and tailor each client’s experience. A flash drive comes in handy when a client uses it with the fitness machines in the gym. The data from that workout goes into the client’s profile. These pieces collectively drive positive outcomes and help with the healing process.

iPads are another tool used to collect data and customize care. Within the first 72 hours in subacute rehabilitation care, each client is asked to complete an 11-question survey delivered via

“We are focused on more than rehabilitation – our goal for clients is healthy living for life,” commented Rabidoux.

EHM strategically plans for continued growth, including extending care to the home. Every client returns home with a flash frozen meal prepared

by Morrison’s Executive Chef who works at The Redies Center. To continue the service, Great Living Meals provide balanced nutrition available by delivery to clients in their home.

FOOD RULES SERVING A COURSE OF EDUCATION For rehabilitation clients, dining takes urgency and adaptation, because food choices often need to change to ensure better health.

For these clients, the clock is ticking: In their relatively short span of care, many must learn to change their diets for good.

“It’s very much about education,” said John Rifkin, Senior Corporate Executive Chef for Morrison Community Living. “It’s important to start on day one with explaining the food they need to learn to eat, and how to shop and prepare it, to help them regain full health. The goal with rehabilitation clients is to make sure when they leave, they don’t come back again.”

Rifkin shared several important elements of a best-in-class dining service for rehab clients...

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