Tuesday, June 18, 2024 – COLER’ MEMORY UNIT SUCCESSES
TONIGHT AT 6:30 P.M. NYPL BRANCH,
504 MAIN STREET
Advancing Health Care Equity:
A Memory Care Unit
in a
Large New York City
Public Nursing Home
By
CARING FOR THE AGES (C)
TUESDAY, JUNE 18, 2024
ISSUE # 1255
| Deepa Vinoo and I are pleased to announce that our article “Advancing Health Care Equity: A Memory Care Unit in a Large New York City Public Nursing Home” was published online in Caring for the Ages, which is the official newspaper of AMDA, providing timely and relevant news and commentary to post-acute and long-term care professionals throughout our country. This article, which describes how we went about improving dementia care, is a testament to the hard work and dedication of the entire Coler team. We greatly appreciate the support that you have given to Coler over the years. Advancing Health Care Equity: A Memory Care Unit in a Large New York City Public Nursing Home – Caring for the Ages |
| The 150-bed memory care unit (MCU) at Coler Rehabilitation & Nursing Care Center has a two-thirds racial and ethnic minority population. The unit’s residents have been impacted by social determinants of health associated with poor health outcomes, such as poverty, homelessness, substance use disorders, mental illness, behavioral disorders, and lack of health insurance. In addition, over 20% have no available family or surrogates. Coler, which is operated by NYC Health + Hospitals (H+H), our nation’s largest municipal health system, serves as a safety net for those who otherwise would lack access to high-quality dementia care. Recently, Coler received the American Association of Critical Care Nursing’s Beacon Award for Excellence in recognition of the high-quality dementia care provided in its MCU, becoming the first U.S. post-acute care recipient. Coler’s MCU team remains committed to advancing health equity in dementia care for an aging minority population in need of palliative services. To them, the true test of leadership is identifying new challenges, finding solutions, and inspiring others — for advancing health equity requires a deep-seated commitment to providing the highest-quality care.Journey to SuccessThe journey began two decades ago when the dementia care model was aggressive medical treatment, involving a hospital transfer at the resident’s end of life. For Coler, the key initial step involved transforming dementia care from a predominantly medical model to a palliative one, which required changing the culture of care. The first target was tube-feeding in advanced dementia, which had been commonplace at Coler at the time. By contrast, emerging evidence-based medical literature was advocating maintenance of oral feeding as the more humane alternative (J Am Geriatr Soc 2014;62:1590–1593). Coler’s frontline MCU interdisciplinary team (IDT) took on the challenge, and they persuaded families to try this evidenced-based approach. As a result, within a relatively short interval they significantly reduced tube-feeding among their residents with advanced dementia. Coler’s efforts continue today, and currently no MCU residents are receiving tube-feeding. A key lesson learned from this experience was how to embolden team spirit and build off an initial success in implementing evidenced-based care.KindnessSince 2008, kindness has been the key ingredient in the MCU team’s recipe for success, enabling the MCU’s residents to find their “comfort zone” and to express themselves in more meaningful ways. Kindness is also the key that enables the MCU IDT to gain the respect and trust of families. As a case in point, early in the pandemic when family visitations were suspended, the wife of a MCU resident became extremely anxious and fearful for her husband’s safety. The head nurse explained the situation to the chief of psychiatry, who called the wife and reassured her that her husband was doing well. He even gave her his work cellphone number with instructions to call him with any concerns that she might have. When visitations were later resumed, the wife thanked the chief of psychiatry, commenting that his kindness completely rid her of her anxiety and fear; she said that she could sleep normally, knowing her husband was in good hands. Based on our experience, any organization wishing to improve dementia care should rely on kindness from the onset, as it will never fail them. In fact, NYC H+H later launched a systemwide initiative called ICARE With Kindness, which emphasizes the greater need for kindness in every aspect of care.Liaison With Mentoring OrganizationsColer’s MCU was fortunate to receive guidance and training from organizations dedicated to advancing dementia care, which included Caring Kind, Comfort Matters, the Center to Advance Palliative Care, and AMDA – The Society for Post-Acute and Long-Term Care Medicine. For organizations embarking on a similar path, it is essential to have dementia care support organizations by their side. For instance, as part of a research grant Comfort Matters trained all MCU IDT members in dementia care. The training received from these organizations was invaluable, building team confidence and paving the way for future successes, which were subsequently reflected in improved metrics.Person-Centered, Culturally Sensitive Dementia CareCare tailored to the residents’ needs and preferences that respects their values, beliefs, and cultural heritage has served Coler’s MCU residents well. Coler is fortunate to have culturally diverse IDT members, who serve as cultural liaisons to the residents and families. For advanced-stage dementia, comfort care is provided to spare the residents from nonbeneficial, burdensome treatments while enrolling them in Coler’s palliative care program. In a 2021–2022 quality study, 19 of the 20 MCU residents (95%) who died during that period were enrolled in Coler’s palliative care, and none were transferred to acute care in their last 30 days of life. Organizations seeking to improve dementia care should consider this approach, which can be tailored to the needs and preferences of diverse populations. |
| A case Illustration Mr. L was a 35-year-old male with AIDS-induced dementia who identified as a member of the LGBTQ+ community. He was combative and was receiving high-dose antipsychotic medication at admission, which caused parkinsonian-like extrapyramidal symptoms (EPS). He required one-to-one observation; the Behavior Rapid Response Team was frequently called to assist, and several staff members had been injured. Moral distress among the staff was high, and Mr. L was transferred to the Coler MCU. Upon his transfer, the MCU IDT held multiple huddles to explore the antecedents of Mr. L’s behavior. His next-of-kin were contacted to identify his preferences. After videoconferences with the family, a person-centered, culturally sensitive care approach was formulated. As part of this care plan, Mr. L received his favorite snacks and a personalized radio with his favorite music. Mr. L’s aggressive behavior completely subsided, and he was tapered off his antipsychotic medications, with subsequent lessening of his EPS. He responded well to nonpharmacological pain management. Mr. L was then enrolled in Coler’s palliative care program to receive comfort measures and pastoral care. His family participated in his end-of-life care via videoconferences. The IDT members comforted him in his final days, and Mr. L died peacefully in the MCU. Several IDT members attended his funeral. His family were deeply appreciative and wrote the team a touching thank-you message. |
| Key MetricsColer’s MCU leadership have used key metrics from the onset to improve dementia care in areas such as reducing falls, avoiding tube-feeding in advanced dementia, limiting antipsychotics, promoting systemwide deprescribing initiatives, expanding palliative care enrollment, and preventing end-of-life hospital transfers. They have presented their quality improvement data both within our health organization and to peer organizations such as the Society.Milestones/Distinctions• 2008–2011. Brown University sponsored research study: “Bathing Without a Battle: Creating a Better Bathing Experience for Persons With Alzheimer’s Disease and Related Disorders”• 2010. Two protected units with 47 beds developed for residents with dementia• 2011–2013. Antipsychotic stewardship leading to a major reduction in antipsychotic use in MCU• 2014. Development of full-fledged memory care programs• 2016. “Algorithm for the Unbefriended” introduced at Coler, a support tool to assist care teams in making end-of-life treatment decisions for patients who lack both decisional capacity and surrogates• 2018. Collaboration with Comfort Matters and Caring Kind to build a palliative care program for dementia• 2018. Medical Orders for Life-Sustaining Treatment (MOLST) quality improvement initiative launched to improve advance care planning• 2020–2021. COVID-19 pandemic, with no COVID deaths at Coler from July 1, 2020 to December 31, 2021 These milestones have helped us earn the recognition we have today as a quality facility, including the Quality Improvement & Health Care Outcomes Award from the Society (Caring for the Ages 2020;21[5]:23) and the recognition of our chief medical officer, Rani Rao, MD, FACP, CMD, as the Society’s Medical Director of the Year (Caring for the Ages 2023;24[3]:7).Take-Home Points• Leadership’s role is to seek new challenges, find solutions, and inspire others.• Advancing health care equity for America’s rapidly growing minority elders requires a deep-seated commitment to provide the highest-quality care.• Facilities must build off their successes.• Kindness is the key ingredient in the formula for success.• To succeed, it is essential to form liaisons with mentoring dementia care organizations.• Person-centered, culturally sensitive dementia care can be tailored to meet the needs and preferences of diverse populations. Throughout the process, leaders should utilize key metrics, measure your progress, set higher goals, present your quality improvement accomplishments to peer organizations, and collaborate with colleagues at annual conferences. Dr. Finger is attending physician/clinical ethics consultant at Coler Rehabilitation & Nursing Care Center and at Henry J. Carter Specialty Hospital & Nursing Facility. Dr. Vinoo is associate director nursing for the Coler Memory Care Unit.Article infoIdentificationDOI: https://doi.org/10.1016/j.carage.2024.05.015CopyrightScienceDirectAccess this article on ScienceDirectRelated ArticlesEmpowering Care Through Connection: How Peer Mentoring Transformed a South Carolina Nursing Home’s Staff RetentionPischel et al. Caring for the AgesPreviewFull-Text PDFMedicare Home Health Care Outcomes Different by RaceJeffrey S. Eisenberg Caring for the AgesPreviewFull-Text PDFPartnering With Nursing Home Administrators to Improve Diabetes CareCarolyn Kazdan Caring for the AgesPreviewFull-Text PDFAcute Care in Nursing Homes May Be Better Than Hospital Care for Some ConditionsJeffrey S. Eisenberg Caring for the AgesPreviewFull-Text PDFA Year in Review in Long-Term Care: Virtual Reality, Breast Cancer Overdiagnosis, and Decolonization Interventions in Nursing HomesStaff Caring for the Ages |
COLER STAFF CELEBRATES
The Beacon Award for Excellence
FROM THE
AMERICAN ASSOCIATION OF CRITICAL CARE NURSES
THEIR RECEIVING A PRESTIGIOUS AWARD FOR
EXCELLENT CARE OF MEMORY UNIT RESIDENTS.
For patients and their families, the Beacon Award signifies exceptional care in a unit that puts patients first. For nurses, this award can mean a positive and supportive work environment with greater collaboration, higher morale and lower turnover.
he Beacon Award program comprises three distinct modules: Patient Outcomes, Work Environment and Nursing Workforce. While units must complete all three modules to be eligible for the Beacon Award, a unit may still receive recognition for top-tier performance at the module level even if only one module is completed.
| CREDIT CARING FOR THE AGES (c) HOWARD FINGER, MD |
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