Just one more question

Like Lieutenant Columbo, the great TV detective, Long-Term Living

columnist Gary Tetz (Funny You Should Ask) always has one more question. In this bimonthly feature, he talks with long-term care leaders about anything that pops into his mind. He’s as surprised as you are that they’ll speak to him.

This Month’s Victim:

Carol Spedaliere


Port Chester Nursing and Rehabilitation Centre

Port Chester, New York

I’d been longing to interrogate an administrator at a five-star nursing home, so imagine my joy when a press release from one of them magically appeared in my e-mail inbox. Port Chester Nursing and Rehabilitation Centre in New York State had just received the happy news from the Centers for Medicare & Medicaid Services, and was offering Carol Spedaliere for an interview.

Carol has served as Port Chester’s administrator for 32 years and I was so impressed and distracted by this fact that I forgot to ask anything else about her. I don’t know if she has pets or who her favorite authors are, but I do know she cares about what she does and has been doing it a very long time.

Since this is the second consecutive “Oh, By the Way” conversation conducted while the interviewee is facing an approaching snowstorm, I’m starting to wonder if I’m causing them. The Biblical story of Jonah comes to mind, and perhaps my editor should throw me overboard to save the ship.

I visited your Web site this morning, and read a lot about Port Chester’s nurturing and supportive environment. So that’s what I’ll also try to provide throughout this conversation-nurture and support.

Thank you. I appreciate that.

Your facility just received a five-star rating from CMS. It’s true-I even looked it up. Is there anyone you’d like to thank? Keep your speech short, or the orchestra will start playing.

Obviously, my staff and residents. Although we have all the necessary quality programs and are actively in tune with the quality indicators, the most important thing is that we’ve never distanced ourselves from our staff, and we know what’s going on with our residents. We’ve been able to measure quality by keeping our doors open and listening to what staff and residents have to say.

How did you feel about the rating system before you got this news?

Quite frankly, from the beginning I’ve known there are some issues with it. I know people complain about the validity of the rating system, that it’s too subjective or inconsistent. And I still agree. But having said that, it’s good to be one that received five stars.

Here’s the typical situation. Someone is in a hospital, and will be discharged in 24 to 48 hours. Family members need to get some direction very quickly. Unfortunately, people don’t ever think they’re going to wind up in a nursing home, and they’re not really educated about it. So they need at least a starting point.

I still don’t believe the rating should be the be-all and end-all of where you’re going to place your husband, your wife, your mother, your father. I think you need to visit facilities, and see if people are smiling when you walk in. But there’s got to be something standardized for consumers so they have an idea of what they should be looking at.

Did the five-star rating come with a raise?

No, but it doesn’t matter. That’s not what I’m here for. I’ve been here 32 years, and I am getting towards that age where I’m more interested in care because I know that one day soon I may be receiving it.

That’s an impressive tenure in one building.

It is. And I have to tell you that many of my staff have been here as long as I have. We kind of stick together, and I think that’s another reason for the rating.

You think that’s an intangible that translates into quality.

It really does, because staffing and turnover have become such big issues in this business. And thank goodness, it’s something we haven’t had to deal with much here.

You sent out a press release with the five-star news. Aren’t you worried you’ll make all the other facilities jealous or feel bad about themselves?

No, because we’re working hard. Not that they’re not, but this is a place that for years and years always had to come up from the bottom. Because we weren’t the most beautiful facility in the area, we were the one that had to prove ourselves with care. And out of that came my staff and their willingness to accept nontraditional work roles. You’ll see my housekeeping staff playing dominos in the dining room with residents during break time. You’ll see my director of nursing doing whatever is necessary to keep the facility running in a snowstorm. That’s what made us, and why I really think we deserve this-because we care.

There’s a blizzard approaching. At least tomorrow all the facilities in your area will look the same when they’re covered with two feet of snow.

But ours will be better because the director of nursing and the administrator will sleep here tonight.

I hear quite a bit of pride in your voice for what your people have achieved and the care you offer.

There is. I take a lot of pride in my staff, and I think they take a lot of pride in this facility. I can trust my CNAs to rise to any occasion. My own mother was a resident here for a while-and I trusted them with her. She acted as my spy, and said they were great.

Part of the reason they work so well is that we educate them and bring them into every phase of the resident’s care. When a resident goes up on the floor, the CNAs who are going to be caring for them already know about them as people. We tell them who the resident was, because that’s part of who they still are. We tell them that the debilitated person they see in front of them is not the whole person, and I think that helps them give respect to the residents.

Speaking of staffing, your administrator to pseudo-journalist ratio this morning is one to one, which is quite impressive.

(Laugh) Thank you.

Be honest, how many times since you’ve received this news have you visited the Nursing Home Compare Web site to just look at the rating and gloat?

I actually did go there once, because I’m afraid it’s going to change somehow. We are very proud of it.

Did you print it out? Is it framed on the wall?


Well, that’s something you can do today during the snowstorm.

Now that you mention it, I should and I will.

Any final speeches?

As an older person who may someday be in need of care, I would just say that I would like people to look at what my aspirations are if or when I come into a nursing home. I’ll still have things I want to do with my life, and I hope the nursing home industry and the government will find a way to deliver person-centered care. That’s what I’m trying to do here at Port Chester.

But if you enter that nursing home, you’ll be a resident who has run a five-star facility of your own. That’s going to be very intimidating to the administrator and caregivers.

(Laugh) Yes, it will be. I have residents who were nurses, and they still make rounds. So maybe that’s what I’ll do too.

You’ll still have stand-ups, and take your framed five-star certificate everywhere you go.

I will! I’ll carry it around and say, “Hey, this used to be me.”

To send your comments to the editor, e-mail mhrehocik@iadvanceseniorcare.com.

Long-Term Living 2010 May;59(5):55-56

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