St. John Specialty Care Center

St. John Specialty Care Center (SJSCC) is using state-of-the-art technology initiatives to achieve its most basic goal of providing residents, no matter their state of health, with what the gospel of St. John terms an “abundant life.”

Tom Prickett, administrator of the Mars, Pennsylvania-based facility, says the staff’s goal is to ask themselves every day, “How are we going to build today’s events in the most abundant way possible?”

“No matter the status of the resident, we provide the fullest available amount of choice in what they wear that day, what they will eat, as well as what activities they’d like to participate in both on-site and off-site,” he says. “This is our goal whether it’s a short-stay rehab patient or one who will call St. John home for the rest of their life.” Prickett admits offering choices is especially difficult with Alzheimer and dementia patients, but SJSCC has found it is well worth it and actually helps forestall dementia progression.

Dynamic facility

SJSCC, a Lutheran SeniorLife facility, is large and dynamic. Its 322 licensed beds, both personal care as well as skilled nursing care, sit on the 24-acre campus. It recently received insurance commission approval and is now licensed as a continuing care retirement community. Groundbreaking will begin this summer for a 30-bed Alzheimer assisted-living facility followed by a three-story, 53-unit independent-living facility with a subterranean parking garage.

Prickett joined SJSCC in 2006, and says the culture change mission was well under way. He and Diane Martinez, vice president of clinical services, have played a part in the selection and introduction of some of the latest technology, such as Nintendo Wii exercise programs that are also used for therapy during rehabilitation, the Dakim Brain Fitness System for use as fitness training with dementia residents, as well as Silverchair Learning Systems, an e-learning system that provides in-service staff training. Employees can go online at their convenience. It has eliminated the need to pull personnel away from the unit for training, Prickett says. Their latest technology, they say, has helped “transform” patient care. It is AccuNurse, a voice-assisted care system from Vocollect.

The staff says AccuNurse has eliminated paper, enhanced resident-staff interaction, and eliminated overhead paging. It has also increased case mix index (CMI) by 0.11, eliminated 45 to 60 minutes per day of documentation per caregiver, eliminated end-of-shift meetings, eliminated four hours per day that LPNs and RNs spend generating reports, eliminated 45 to 60 minutes per day spent searching for other employees, and addressed quality indicators for falls, weight, wound care, and incontinence. “The improvement in CMI, based on improved ‘real time’ capture of clinical data, translates to more than $500,000 a year in additional reimbursement,” Prickett says.

Each caregiver has his or her own headset and dictates resident care into the headset, rather than having to write notes and transcribe after their shift. This reduces paid staff time as well as getting staff on their way home quicker, which they appreciate. AccuNurse also provides residents’ specific care plans such as activity or even shampoo preferences. “We looked at touch-sensitive screens (for documentation). However, with our Alzheimer’s residents and unanticipated behaviors, we had a concern that touch-screen models would have to be enclosed in cabinets to be secure,” Prickett says. “Also, there is the potential for spread of infection with touch-screens.”

Staff does have to be aware of where and when they dictate into the headset because of HIPAA regulations. At the same time, Prickett said the staff was concerned that if the Alzheimer’s residents saw staff speaking into the headset that they could think the caregiver was “hearing voices and talking to herself.” That hasn’t happened. In fact, AccuNurse actually triggers interaction between resident and caregiver. “They see how the staff is documenting what they ate that morning, bowel and urine output, temperature, and other activities of daily living (ADL),” Prickett explains. “We have residents helping the documentation by saying, ‘I not only ate the toast, but later ate the cereal, too.’ It really does lend itself to our AbundantLife concept and being responsive to residents’ needs.”

Staffing based on need

Diane Martinez, vice president of clinical services for Lutheran SeniorLife, says one of the beauties of the system is “in combination with our MDS software, we’re able to identify in real time our residents ADL needs, identify numbers of medications to be administered, and with that we were able to establish a quasi-acuity system to adjust staffing based on real resident need. We could look at a unit on a particular day and see if the needs are greater that day because residents have fallen ill or had acute episodes and adjust staff up or down according to resident acuity. That has really helped the nursing department become much more efficient.”

Martinez also says the ability to minimize if not entirely eliminate overhead paging has also added to the AbundantLife concept. “No more hollering down the corridor,” she says.

Prickett and Martinez say because of how well the staff has embraced AccuNurse, they anticipate it may help in staff retention. “I think it would be hard for them to leave and go someplace that doesn’t have this technology,” Martinez says.

Culture change continues

And culture change continues at SJSCC with Prickett and his team setting their sights on a fine dining program for all of the “neighborhoods” at the facility. A few neighborhoods have them already, but in others, physical plant and service delivery challenges must be overcome.

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

Long-Term Living 2009 June;58(6):58-61