Partnerships@Work: Using nutrition to battle readmissions

All post-acute care (PAC) facilities want to reduce hospitals lower readmission rates. While the benefits to patients are obvious, keeping them healthy also helps hospitals rein in Medicare fines levied against them for preventable readmissions. PAC providers can better position themselves in the marketplace by being proactive in reducing relapses. Those who aren’t addressing common readmission causes risk being left out of health systems’ referral networks. CHE (Catholic Health East) Trinity Senior Living Communities, based in Livonia, Mich., positioned itself to be good partners to hospitals by reducing these occurrences.

While many factors contribute to hospital readmissions, good nutrition can prevent many of them. With its foodservice provider, Unidine Corporation, Trinity has been working to reduce nutrition-related causes of readmission—namely, dehydration, urinary tract infections and unintended weight loss—among PAC patients. Overall, the initiatives have succeeded, lowering Trinity’s rate of hospital readmissions by about three percent.

Unidine became Trinity’s foodservice provider six years ago because, according to Kelly Gasior, vice president, strategy and housing operations at Trinity, the contractor’s philosophies dovetailed well with Trinity’s. “We wanted to focus on what we did best…the overall culture [of the facilities], and we wanted to find a dining partner to match our mission and goals and incorporate nutrition and wellness,” she explains. “Unidine was unique in its focus on fresh food. Our desire for quality and novelty was something that we knew we’d found in this partner.”

Moreover, Unidine shared Trinity’s view of what a foodservice partnership should be. “This wasn’t just putting out an RFP [request for proposal],” Gasior recalls. “We didn’t just ‘outsource dining.’ We want to be great providers with a relationship-based structure, and we need [companies] to actively bring us innovations.”

Unidine helped Trinity develop innovations that have helped in its readmission reduction efforts, and, notes Gasior, an essential aspect of these innovations is that they often begin at the community level. “Innovations run in both top-down and bottom-up directions. The organic roots of the program are really important.”

Adam Snyder, regional vice president of operations for Unidine, agrees. “A couple of cooks may try something, and when we see that it works, we translate it to the corporate level and then push it back throughout the system,” he says. Three such programs have helped Trinity reduce its patients’ readmission rates.

HYDRATION MOTIVATION

Those who work in skilled nursing know how difficult it can be to encourage residents to drink water, so it is not surprising that urinary tract infections and other complications of dehydration are a leading cause for hospital readmissions.

“The traditional water-pass scenario and the big yellow jugs just weren’t working,” Gasior recalls. “We needed help, so we reached out to dining.”

The solution fused Trinity’s clinical expertise with Unidine’s culinary capabilities, resulting in a portfolio of recipes for fruit- and vegetable-infused waters. Because people “eat with their eyes,” an attractive display featuring clear glass dispensers garnished with fruit, vegetables and herbs gets residents excited about drinking. More than 40 varieties of water are offered such as Pomegranate & Orange, Strawberry & Fennel, Pineapple & Sage and Peach & Ginger.

Hydration stations are located in prominent places throughout the facilities (activity areas, nurses’ stations, entrances). All of the communities’ dining directors are trained in the program. And clinical staff is trained to serve the water, not just offer it, and to “talk about the water, the recipe and get the residents excited about drinking it,” explains Robert Teplansky, senior director of marketing for Unidine.

The Hydrate for Health program has been instrumental in reducing incidents of UTIs says Gasior. In 2012, about 2.4 percent of Trinity’s residents experienced the infections. That number was reduced to about 1 percent in 2013.

MODIFIED FOODS

Trinity and Unidine also worked together to combat another contributing factor in readmissions, unintended weight loss, particularly among patients with dysphagia. “Everyone knows that on a modified diet, people don’t eat as much, because the food is unappetizing and embarrassing,” says Gasior. Puree with Purpose began when the dining staff in one of the Trinity communities eschewed the “frozen pucks” of pureed food and instead experimented with pureeing the unmodified menu items and presenting them in ways that more closely resembled the day’s standard offerings. “If dinner is herbed chicken, modified diet residents get the same herbed chicken,” explains Gasior.

Diners did respond, and following the success in that community, Unidine’s corporate staff and Trinity’s clinicians enhanced and formalized the program and rolled it out across the organization. Staff is trained to use a series of molds and piping techniques, including the use of ricers to make “spaghetti.”

“Puree With Purpose is another great example of the clinical and the culinary coming together,” says Gasior. This initiative has contributed to better clinical outcomes, namely, a drop in the number of residents experiencing unintended weight loss from 3.7 percent in 2011 to 1.3 percent in 2013—well below the national benchmark of 2.5 percent.

FOODS VS. SUPPLEMENTS

A third initiative is the Fresh Benefits program, which is also geared toward stemming weight loss and providing each patient with required daily nutrients. Trinity and its residents were looking to better alternatives to liquid nutritional supplements. Teplansky says, “For one, they are not that appealing, and second, if you’re filling up on these instead of meals, they can be self-defeating.”

Two years ago, a Trinity dietician led an initiative to add calories and nutrients to everyday snacks, such as muffins, and came up with a series of fortified smoothies to replace bottled drink supplements. In addition, Unidine came up with recipes to enhance mealtime foods, including oatmeal, gravy and potatoes with additional calories and nutrients.

Snyder adds that the initiative has had additional benefits for Trinity. While bottled supplements carry an institutional connotation, he notes, the Fresh Benefits approach to supplementation “is more in keeping with Trinity’s ‘sanctuary’ facility model.” Moreover, it has lowered Trinity’s spending on supplements. In three years, the company’s supplement expenses have gone from about $124,000 to about $70,000 annually.

OTHER PARTNERSHIP BENEFITS

In fact, the Trinity team discovered that many of the seemingly expensive changes put in place over the last few years have saved the chain money or at have at least been budget-neutral. Training dining staffs to be more productive allows for more use of fresh, more labor-intense foods. This in turn, has had another positive consequence in the form of improved employee morale. “They are gaining important culinary skills and using those skills to move up in their careers,” Gasior says, adding that many line staff have been promoted to lead cooks and supervisors.

Gasior says other care providers can accomplish what Trinity has. Finding a motivated partner is crucial. “Anyone can have a vendor relationship, but what we have [with Unidine] is a real partnership.” In fact, Unidine is even helping to design one of Trinity’s new CCRCs. Says Gasior, “It’s a huge piece of why our numbers are different, and frankly, better.”

Gina LaVecchia Ragone is a Cleveland-based freelance writer.

See other articles in our Partnerships@Work series here.