Established 50 years ago, Gateway Senior Living is the first retirement community in Lincoln, Neb. that began to provide both assisted living and senior health care to its residents. It is currently home to just over 60 residents and includes a small skilled nursing facility that works daily to ensure high-quality living standards and provided care.
Raising quality standards has been a core focus for the staff and leadership at Gateway. Amy Fish, Campus Administrator, discussed the two main areas they have been working to improve – capacity issues and technology challenges.
As Gateway has grown, the need for space and more staff has become vitally important. “We have a one-to-seven staff-to-patient ratio, and we want to maintain that,” Fish said. With building expansions ongoing, Gateway will be increasing its health care staff to consistently meet seniors’ needs, and will continue to build upon a variety of staff talents and backgrounds.
For the community’s short-term rehabilitation site, administrators will be hiring staff in orthopedic, cardiac and pulmonary care to meet specific patient needs. At the same time, they have established a medical advisory committee to help with best practices and training modules for staff to efficiently manage patient care.
In the area of technology, Gateway is using a variety of tools for their safety and security systems, online programs and more. “We need to be using technology to our advantage to quickly get the information to those who need it in the most efficient way,” Fish said. Technology tools help Gateway’s staff be more effective and provide better care for residents.
The retirement community has wireless systems in place, so staff can receive alerts via a two-in-one phone and pager to better track patients’ health and needs. Gateway is currently piloting the Interventions to Reduce Acute Care Transfers (INTERACT) tool to help reduce and prevent hospital readmissions.
Nebraska’s Quality Improvement Organization (QIO), CIMRO of Nebraska, has played an important role in providing Gateway with knowledge and education. “We use a lot of the tools offered through the Centers for Medicare & Medicaid Services (CMS) and through our QIO, as well as the National Nursing Home Quality Care Collaborative (NNHQCC),” Fish said. “We want to stay abreast of what is happening locally and nationally, to make sure we are providing the best of care because it benefits our residents. We have continued involvement with those who do it best – our QIO, CMS, and more, and we want to stay actively involved with our partners, learn from them and share experiences. Instead of reinventing the wheel, applying available tools and learning from best practices is key to Gateway’s quality improvement methods.”
In 2009, Gateway won the first Center for Excellence in Assisted Living (CEAL) Workforce Award for addressing and improving staff retention with the employment of new strategies and practices such as “Dish with Fish”(new employee lunch with Fish to discuss employee needs) and using nursing home survey tools. “We have our staff involved in a full-team approach because everyone needs to understand our goals and the impact on our residents,” says Jan Crocker, Gateway’s Director of Nurses. She adds that, “Our quality care focus is in line with NNHQCC’s goals – staff retention and patient-centered care.”
Family members and residents are also considered part of the team. When new residents first come to Gateway, they and their families meet with staff members who ask them what they want and what approaches are best for their loved ones.
“We consider family members to be part of our team,” Fish said. “It’s our job to be a resource to them. This is the first time they are experiencing this type of care, so we walk them through whatever they don’t understand, their goals our overall process.”
To help maintain quality, Gateway uses balance scorecards. The scorecards are integrated throughout the campus and help in setting target goals while measuring monthly successes. If no improvements are made, staff members work on re-evaluating and addressing the issues. Gateway also uses the CMS Quality Indicator Survey tool on a regular basis to garner comments and reviews from family members for more in-depth input.
When working through any quality improvement process, transparency with staff, stakeholders, patients and families is of the utmost importance, Crocker stressed. “Make sure they are a part of your goals, approaches and data. If you have a weak area, get them involved in helping to solve it.”