Quality First

Edition: March 2009 - Vol 17 Number 03
Article#: 3146
Author: Laura Thill

What does it take to become an award-winning nursing home or long-term-care facility? For one, steer clear of such sterile-sounding terms as "nursing" or "facility," according to Elsie Norton, senior vice president of quality care, ACTS Retirement-Life Communities (www.actsretirement.com), and Michele Wasserlauf, corporate director of resident health and outreach services, ACTS Retirement-Life Communities. Second, when purchasing equipment, focus on the social aspects of the operation. That's where sales reps can help.

Reportedly one of the nation's largest nonprofit continuing care retirement communities, with 19 centers in six states and a total of 4,500 staff members, ACTS offers a combination of independent living, assisted living and skilled nursing care.

"We believe we excel on a journey toward culture change, which we call the ACTS signature experience," says Norton. "We have a greater resident-directed approach to care and service." In fact, two of the retirement communities' accomplishments speak volumes: First, ACTS Retirement-Life Communities recently received the 2008 Quality First Award from the Florida Association of Homes and Services for the Aging (FAHSA), an organization that represents over 370 senior housing providers statewide. The award recognizes a commitment to outstanding care and service in the aging services field. In addition, two retirement centers in Boca Raton, Fla. - Edgewater Estates and St. Andrews Estates - recently received the Gold Seal Award, one of the highest honors presented by the state of Florida. Both awards reflect ACTS' mission to provide engaging settings for the elderly, with strong ties to the community at large.

Ten elements

The Quality First initiative, which began in 2004, calls for the chairman of the board of directors to sign an agreement with FAHSA to support the following elements of quality:

Governance and accountability.

Leading-edge care and services.

Community involvement. This focuses on the involvement of the organization, residents and staff in the community at large.

Continuous quality improvement.

Human resources development.

Consumer-friendly information.

Consumer participation.

Research findings and education.

Public trust and consumer confidence.



Consumers include residents living at ACTS retirement communities, potential residents and seniors in the community at large, according to Norton. "If the [retirement community] does its job by adhering to the first nine elements, it should gain the trust of the community at large," she says.

Norton believes that ACTS qualified to receive the Quality First Award through its excellence in several of the above areas, including leading-edge care and services; community involvement; governance and accountability; and research and findings. Leading-edge care is its strongest suit, she explains. "We don't wait for the state to come in and conduct surveys," she says. "We look at specific activities within our 19 organizations, and go in and conduct mock surveys."

With regard to community involvement, she says ACTS "has focused on social accountability and recognizes the need to promote social accountability." Headed by Wasserlauf, the program involves residents and staff in various community activities. "For example, we have clothing, food and blood drives," she says. "One of our communities works with a local senior citizen center to ensure [its members] get a [holiday] meal on Thanksgiving. Then, we must document these activities to ensure our accountability. We are working on a computer program that will enable us to do this."

In the area of governance and accountability, ACTS works with the accrediting organization, CARF-CCAC (the Commission of Accredited Rehabilitation Facilities and the Continuing Care Accreditation Commission). "This is over and above our state surveys," says Norton.

Finally, in the last 10 years, ACTS founded its corporate university and its gerontological research institute, which facilitate the organizations' focus on research findings and education. "All of these things helped us to be selected for the Quality First Award," says Norton.

Gold Seal Award

The Gold Seal Award, given out by the governor's panel on excellence in long-term care since 2002, evaluates retirement communities and long-term care settings on specific criteria, says Norton. For example, an organization cannot have class 1 or class 2 deficiencies on a state survey or a conditional license for 30 months prior to the award. Additionally, the panel expects organizations to show evidence of the following:

Stability.

Evidence of providing satisfaction surveys for residents, along with their feedback.

Community involvement.

A stable workforce and a low turnover rate.

An outstanding record with regard to the number and types of substantiated complaints reported.

In-service training and a quality assurance program.

An innovative program for residents, which meets or exceeds the panel's expectations.



Finally, the organization must incorporate an automation initiative. "We have an initiative for establishing an electronic health record, and our chief information officer is a member of the American Association for Homes and Services for the Aging's Center for Aging Services Technology," Norton points out. Currently, ACTS employs an electronic system for "nursing assistance" and "nursing notes."

Reps' role

While resident care and safety are key in creating an award-winning long-term-care environment, distributor reps can focus on some nuts-and-bolts steps to help their customers move from a medical to a social model of care, suggests Norton. Take equipment, for example. "The right equipment can make dining halls much nicer," she points out. "Everything from furniture to delivery equipment and food trays can make a difference." And, design elements are just as critical. "When food must be carted too far [to tables], residents will complain it is cold," she says.

"There are practical ways to help [organizations] move from a medical environment to one that's more social, without taking away from the quality of care," she continues. "Medical carts, linen carts and even trash receptacles don't need to look so institutional. Bathing equipment, such as tubs, are often antiquated." And, as necessary as lifts may be, they create an institutional atmosphere, she adds, noting that if tubs were designed differently, it might be possible to forego lifts in many circumstances.

Indeed, these are the kinds of changes ACTS depends on to maintain its high-quality status. "We are mission-driven," says Norton. And, there is a reason why they boast such a low turnover rate among staff. "Many of our staff members see this as their calling, not a job."