Sitting on the north edge of town, up on a hill, is a prominent La Porte City facility. If you’ve not yet visited the La Porte City Nursing & Rehab facility, Administrator Pam Tallman wants to change that. If you’re not a fan of nursing homes, though, don’t try describing the facility with the word “institutional.” Don’t tell her that all nursing homes are the same, that they “stink,” or that the food is bad. And you definitely don’t want to suggest that the residents in La Porte City’s 46 bed facility are old, sick and dying.
“They are LIVING here,” she said with great emphasis.
The nursing home industry is one that is heavily regulated, and La Porte City’s facility is no stranger to the compliance checks that numerous state and federal regulations mandate. “The Lodge” was constructed in 2004 adjacent to the grounds where its predecessor, Colonial Manor, stood for many years. La Porte City’s nursing home is one of 44 operated by Care Initiatives, a non-profit organization whose mission is to provide for the health and convalescent care needs of the elderly in local communities through pleasant, secure and homelike health care facilities, staffed by professionally trained and caring personnel.
Recent changes the government has made to its Five-Star Quality Rating System have resulted some facilities experiencing a shift to a lower rating. The Five-Star Rating System for nursing homes is based on three parts: 1) Health inspections, 2) Quality Measures, and 3) Staffing. How do these measures impact the overall rating a facility receives?
Health inspection ratings are taken from the three most recent comprehensive annual inspections, with more emphasis placed on recent inspections conducted at the facility.
The Quality Measures (QM) rating is derived from clinical data reported by each nursing home.
Staffing ratings are based on two measures- the number of Registered Nurse hours per resident per day and total staffing hours, which include hours worked by other nurses, such as Licensed Practical Nurses (LPNs) and Certified Nurse Aids (CNAs).
Prior to the changes made in the rating system, La Porte City’s nursing home enjoyed a five-star rating, the highest rating possible. And while other facilities saw their ratings tumble, La Porte City Nursing & Rehab retained its five-star rating under the new guidelines.
At La Porte City Nursing & Rehab Center, nurses account for more than half of the entire staff, as 10 nurses are assisted by 24 CNAs. The facility has a total of 19 other employees that handle the workload in Dietary, Housekeeping, Maintenance and Activities, with the administrative duties handled by Tallman and Phyllis Clark. While misconceptions about nursing homes are common, Tallman describes the passion for her work simply:
“I love old people,” she said.
Staffing nursing homes is one of the biggest challenges administrators face. New staff members don’t always realize how difficult the work can be, Tallman noted. Even housekeeping has its demands. Try cleaning 34 bathrooms in eight hours, for example. Or take a run at handling the hundreds of pounds of laundry that must be processed each day.
“It’s hard work and can be overwhelming,” Tallman said.
With the high rate of turnover nursing homes can experience, there is a steady demand for educating staff and providing training, a task for which Tallman, who has a degree in Elementary Education, is well-suited. When she arrived in La Porte City as the new Administrator nearly 18 years ago, she was asked how an education degree fit with her new role as administrator. Her reply foreshadowed the common-sense approach she continues to use each day on the job.
“Just as in education, we have objectives, a plan and protocol. Then you analyze the results. Did the treatment and other things you tried work? If not, you make a new plan,” she explained.
The same planning, organizing, analyzing and deductive reasoning teachers use in the classroom are essential skills that can be applied in nursing homes to foster the development of effective teams. And when Tallman preaches teamwork, it’s easy to see she means it, having just come from the kitchen where she and three others, the Environmental Supervisor, Dietary Manager and maintenance man, had been working to reorganize a freshly painted stockroom. It was a job that needed to be done, one that was too big for one person, she explained matter-of-factly.
Tallman is quick to admit that it can be very easy to get bogged down in the vast number of the rules and regulations used to oversee and evaluate nursing homes. The focus, she insists, should first be on the quality of care the facility provides. A staff that is committed to providing excellent care and doing what is right for the residents will have fewer deficiencies when the rules and regulations are checked for compliance, she reasons.
High quality care has long been a hallmark of La Porte City’s nursing home. As a new Administrator in 1997, it didn’t take Tallman long to realize the home’s excellent reputation was well-deserved. Much of the credit, she acknowledged, could be traced back to longtime Director of Nursing, Rose Niemeyer-Hartsook. When Tallman arrived in La Porte City, she spent the first several months of her tenure observing and evaluating every area of the home’s operations.
“I went through everything. There was very little to change because it was already being done right. It was unbelievable. I was very fortunate,” she recalled.
“The passion is to provide quality care. For Rose, everything was about the residents,” she added.
While many nursing homes are experiencing a decline in numbers, La Porte City Nursing & Rehab continues to operate at or near maximum capacity. Along with the facility’s excellent reputation, Tallman credits the center’s size and location as contributing factors.
Making the move to a skilled nursing facility is one of life’s most difficult transitions, for the new residents and their families alike.
“Who wants to think about, ‘Well, when Dad turns 85 we better start looking at nursing homes and making a decision.’ No. You hope he never goes,” she said.
To help families work through the process, the staff at La Porte City Nursing & Rehab try to break down the mountain of medical and financial information that accompanies such a life change into smaller, more manageable pieces of information.
“We try not to overwhelm them,” Tallman said.
State and federal regulations require that each resident have a specialized care plan the facility must follow. It takes a diligent commitment to communication to make sure that each employee has the appropriate level of understanding of each resident’s individual needs. In addition to a steady stream of staff and department meetings, the home utilizes a series of charts, bulletins and logs, where extensive notations are recorded so that any employee who has been off from work can quickly get up-to-date with any relevant issues related to resident care.
Often the move to a nursing home is a decision arrived at due to some sort of trauma, perhaps because of a fall or as a result of a doctor’s recommendation. While the home has specialized medical care readily available for its residents, social activity is an important part of the residents’ lives. That is why Tallman is very passionate about bringing the community into the facility.
“We’re on the edge of town on the hill and we need to draw the community out here,” she said.
As part of the effort to dispel some of the nursing home misconceptions that exist, the La Porte City facility has partnered with local schools, resulting in regular visits from elementary and high school students the residents have enjoyed.
“It’s important for people to spend some time at the facility to see how it really is,” Tallman added.
To that end, the facility actively sponsors community activities like a visit from Santa Claus in December. The home also hosts the community’s annual Easter Egg Hunt on its grounds each Spring. The hunt is a major undertaking, as the residents are actively involved in the preparation of the hundreds of eggs children will gobble up on the facility’s front lawn. It’s a job so big, one that some nursing homes would choose not to attempt. For Tallman and her staff, though, the reason is simple:
“The residents are a vital part of this community and always have been.”