Evidence-Based Practice Design in Long Term Geriatric Care, Tailoring to the Geriatric Population
[Applause] dr lydia crystalball is today's guest she's a healthcare executive who has worked in many healthcare settings with a special focus on pose acute and geriatric care with two degrees in nursing administration she's currently is the administrator for the hospital-based skill nursing facility so i'm excited to learn about her journey in caring for the older adults in post-acute in geriatric care lydia thank you so much for being here on woman living to share some of what you've learned throughout your career and welcome thank you it's a pleasure to be here all right so could we start with you sharing a little bit about yourself where you're from your work experience and what are you working on right now well i was born and raised in the philippines and my family and i emigrated uh here in the u.s when i was 18. so i started being a licensed practical nurse and that was when my first job in the nursing home happened and i grew up in long-term care and it was in those experiences that i realized that i've seen the rise and fall of leaders i've seen challenges situations and i was fearful i was fearful for my career i was fearful for the way that our patients were treated in a nursing home and that's when i told myself that when i become a leader then i will make that change and i will make things better for our geriatric population i will be their voice and hence i am in this journey being an administrator myself and slowly i'm keeping that promise and changing the way that care is delivered for a geriatric population congratulations on the impact that you're making so can you tell us a bit about the problem with high turnover in the nursing home yes so what my empirical evidence i've seen this all the time in every nursing home that i've been to and it's a known fact that administrators don't get to stay in their jobs usually it's like a year or two because of the the need to fill up the bets pretty much the administrator's job is to fill up the vets regardless of how that happens and if the administrator is unable to fill up the beds and that's the time they can possibly lose their job same thing with the director of nursing and because if there's no match a good partnership between the director of nursing and the administrator that's when the high turnover happens and as much as don't get me wrong there are really good administrators directors of nursing out there but the thing is they're not supported and so what happens is that when they try to start an initiative to the staff oh i'm the new administrator or hey i'm the new director of nursing let's do this project we get to make it and just when they started that's when they leave the job and here's the staff being affected by that high turnover like oh here's the same story again right here's a new person they're going to start put some initiative and then what for and so we need to figure out something and how we can take care of our leaders by providing mentorship by providing support for them and i think it's easy to say but very difficult to do so that's when the organizational stewardship falls into to action how are we really taking care of our leaders because if you take care of our leaders because most nursing homes are family owned and it's a business we have to make the money to be a sustainable business but we also have to consider that for an organization to be successful we have to take care of them because once we take care of our staff then they will take care of our patients and magical things happens as a result if you really care about our geriatric population we will take care of our leaders because once we take care of the leaders and staff the results will come out as they provide the best care for our geriatric population very true very true that was my next question is what is the role of organizational stewardship in providing an excellent patient experience so one thing is one and it's easy to do mentorship but it's hard to do because what happens in long-term care is that sort of staff is a lot of sort of staff and we don't put emphasis on having as simple as having a nurse practice counsel that's one of the things that contributes to organizational stewardship by taking care of the staff so if i'm a good person if i am a good nurse i want to care i came into the long-term care because i want to take care of old people and if i'm not supported by thoughts of innovation thoughts of improving my practice as a nurse then what's the point everything will just get task oriented and that's a sad reality and that's when it's important that we practice organizational leadership by promoting how we can advance into our practice and i know that it costs money in terms of having to allocate staff to attend nurse council to attend further education to improve what they do for for the nurses but if we actually invest on them we will get the return thereafter it's a investment and again it's easy to say but it's not usually practiced and it's not it's not usually being done in our long-term care settings so what would you say the biggest lesson that your facility has learned as a result of covet 19 this is where this is a time where we can find ways to use technology to connect this is the time where we can bring people closer understanding them um because of the covid then their visitation restrictions are in effect and so how do we allow our patients to connect with family and friends and it's a good thing that we have technology that we can we can use for as a matter of fact we had a patient who who has this 90th birthday and we allow the family to bring in his cake and balloons and we had a really good celebration by using facetime a video conference and to celebrate with the family we can think of ways to change to prevent isolation and it's very tough even the nurses are also overwhelmed in terms of staff but with the event of the kovit and what it brought us it made us realize too that if we're working as a team it brings us closer together because the challenges that we face we only have each other and and it's a great thing and this is when we actually had the time to stop and smell the roses that wow we are a great team and we're able to get through it together very true team usually wins so that's a great philosophy now as far as the biggest thing that you learned personally in your own life from working through this pandemic do you have any lessons learned well prior to the pandemic i was already looking into telehealth because i know that boomers we know that boomers want their independence and so the way that traditional nursing homes are set up is pretty much not where you want to be as a matter of fact is statistics show that six and ten americans would rather die than being in nursing homes and there's a stigma related to that so then the question is how are we going to change the kind of care that we deliver i personally do not believe in traditional nursing homes anymore because that's where the stigma comes in i believe the greenhouse project i believe in a different care model and and so what can we do to change it the way that the care is delivered but we have to ask the right questions first and for me i was armed with education to practice evidence-based practice so are we really doing that are we asking the right question to change the kind of care that we do even if it's stressed in small steps so for instance in my current uh job right now in carepoint one of the things with the evidence-based project that we had as simple as music therapy it's a complimentary treatment where we can where the patient's pain is going to pain management will be effective rather with the use of music therapy in addition to pain medications and another one that we have today as well is horticultural therapy to improve the quality of life and improve activities of daily living so when we do projects like that we have to disseminate we have to tell the world that it works and then we have to do something about it to change the care model that we provide and it's very important in our profession to always ask the questions and how we can change now sadly for long-term care again everything is fast oriented let's just get through the day we give the patients their medications they do their activities everything is like all over again but i think that there's a need and i'm calling out to all post acute care leaders out there that we should use this opportunity to leverage collaboration with entrepreneurs and high-tech industries how can we change the way that care is delivered through innovation for example if i would want my father in other words my father has dementia and he lives alone what are the ways that we can use technology for him to be safely at home there are the cameras at home or motion detectors when they move around the house by us collaborating with entrepreneurs enables us to think about what technology can be created to allow our boomers to stay at home safely because that's what they want to do they want to stay home they want to have their independence and they there there are technology out there but we just have to tap into that yeah i think there are a lot of technologies perhaps operating in separate entities i think it needs to be more of a coordinated orchestration of all of these segregated technologies to work in a harmonious fashion do you agree yes totally yeah i've had a couple of folks as guests on this show and they've shared some great innovation technologies and i think that absolutely they exist and there's going to be more that will be flourishing in years to come as a result of the pandemic but i think more importantly how do we orchestrate all of these technologies into one that's very robust into a smart home let's say these are very good points so let me ask you so what do you think geriatric care will be in five years it will be really be home based and that's the thing of the future because and we've seen a lot of nursing homes that capacity shrinks because nobody wants to be in a nursing home if we have the smart home and we can leverage that then i think that's the future and we can see that from other countries where they are putting emphasis as well for home care and the mere fact that a lot of providers are now able to go to the patient home to give the care or use technology and to use telehealth for that matter i think out of this pandemic telehealth telemedicine television you know however is being used has exponentially grow and i think it will continue to do so um to serving the aging population so let's say in the long term 50 years or so what big changes will you see to geriatric care what do we need to do to get there i again as i mentioned i love uh the concept of the greenhouse model and i'm sure it's going to be well known and it's going to grow but if you to answer your question about 50 years from now i just think that by that time we have already thought of ways to change the way our reactive care is delivered not an as an institution but more of a greener house and one of the things that i advocate for is evidence-based practice design and sadly a lot of the long-term care industry or the senior living industry they continue to build models of home by construction and because it's aesthetically pleasing but not using evidence-based practice that really tailors to the geriatric population for instance as simple as color as simple as how the architecture of the environment is designed it's as simple as that and i can envision a future where we will practice evidence-based practice design where it is the environment is conducive to a holistic model of care and that's what we need and again it's the being in an institution is a thing of the past and and i think that we should put all our efforts to change that care and to do that we should also have our voices heard so if we know something that is not working then we should do as leaders to participate in getting our voices heard for cms for our um for a state base makes the decision for policy change because sometimes a lot of these care as much as we want the best innovation for our geriatric population sometimes it's cost prohibitive and it's it it's a sad reality but i'm sure again by collaborating with the best minds in the industry we can figure out a solution to change the model of care that will benefit everyone it's all about research right so we really have to emphasize data and research to improve the care that we provide what i hear in our conversation is that independence purpose contribution wellness and vibrancy all of that promotes living right and i think that's that's what we all want to be whether we are 50s 70s or 90s and what's your thought on that because i feel like everything that you're talking about yes we do need to provide better care geriatric care and promote wellness vibrancy engagement overall living because i think that's what you and i want and as humanity we all want that correct and and that's how we have to practice and this is our opportunity uh to change this is our opportunity to have our voices heard because if we do not convey that then nothing is going to change for other generations they work their life to contribute to the society and nobody wants to like oh okay i'm gonna work hard so i can be in a nursing home nobody wants that but we want to enjoy we want to age in a very in a very beautiful way where um life is beautiful and we live a very holistic healthy lives it's something that we and i know it's very easy to say but pretty much difficult to do but in small steps i'm sure sometime in the future i am hopeful that we can change it we just have to gather together and collaborate as leaders to make it better for our geriatric population yeah i agree i think now it's the best time ever because of covid it has uncovered the importance of this right it's in the media and all the good of the health line front care providers and workers i think mostly it uncovers the the shortcomings and this is when we can take on those shortcomings and improve and make it stronger for many decades to come because we have 10 000 folks turning 65 plus every day for the next several decades yeah we really have to position ourselves and it's the first time that i heard about um china and italy where there are more of the older people and we only have a few of the younger generations to care for them so what is our solution to tackle that problem so it's just a matter of what kind of culturally competent care can we provide that is also efficient as well that will provide the best outcome for our patients and i hope by having these conversations people that are voicing the concerns asking the questions the folks that really want to make an impact as opposed to just sitting back and just accepting the problem so i'm glad that we have this conversation and i'm hopeful that people will listen and there will be a stronger voice and eventually com folks coming together with some action items that are truly um executable solutions so that is the driving force behind the senior living the the podcast that i'm doing because i think it's very important it isn't just one sector it's all encompassing and it has to be a coordinated effort i agree and thank you for this platform and this is one of the things that can disseminate ideas and that i encourage leaders to to publish sometimes it's those good news stories if they just need to be heard what are those little things that we have done in our profession to improve our geriatric care we need to disseminate those important stories and as simple as that can probably inspire other people so it's just a matter of publishing and again it's the dissemination is of utmost importance for us to move forward very good now do you have any other thoughts that you would like to share i pretty much would like to have a wishing message to our leaders out there that i know with the the covet pandemic that happened it's very tough just living day to day but if again we come together as leaders and in long-term care or the senior living industry we can make things better in the future by supporting each other and that the simplest the simple action of supporting each other having used leveraging social media to support each other sometimes that's all we need to get through the day because it is tough it is tough we all i've known a lot of administrators who quit their job because they they said i've had it i'm done but sometimes it's those challenges that makes us stronger and if you really are passionate in the work that we do we will overcome that and it will make us stronger eventually it's such an honor and what a blessing to be it's very difficult but to be in the industry that we get to serve the aging population because you know what i believe it sets the direction how we're going to be cared for because we're all going in the same direction and as professionals in the industry we got to step it up because everything that we're doing for our parents and grandparents we're setting the stage for ourselves i agree i agree yeah i appreciate your time okay great thank you so much for this opportunity i really appreciate it enjoy this wonderful time with you all right thank you [Applause]
2021-01-18 09:33
