Harmony Healthcare Blog

AHCA Provider Lounge Series: Small Facility Leads the Way in SNF Memory Care (video)

Posted by The Harmony Team on Tue, Dec 13, 2016

Edited by Kris Mastrangelo

Interview with KJ Page, Administrator - Chaparral House

Kris Mastrangelo, President of Harmony Healthcare International (HHI) interviews KJ Page, Administrator at Chaparral House in Berkeley, California in the AHCA Provider Lounge.  KJ discusses how she created a state of the art memory care program and helped her facility become one of the first to receive Joint Commission accreditation and certification for memory care and post-acute care.



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Transcribed Audio:            

Kris Mastrangelo:  Hi everyone.  It’s Kris Mastrangelo and we're here at the Provider Lounge today with KJ Page.  KJ why don’t you tell the audience about your facility and where you're from and then we're going to have some questions for you.

KJ Page:  From Chaparral House. It's a very small nonprofit in Berkeley.  We were founded by a former Berkeley mayor back in 1975 so we don't have any big corporate ownership; we don't have any faith based - we're totally independent.  One of the few freestanding nonprofits in the whole country and there's very few in the whole state too so we're excited to be different - that makes it nice and challenging at the same time.

Kris: Right - the state of California and for those that don't know tell us a little bit about your patient population and do you think that with the impending reimbursement and policy changes that your customer base will evolve.

KJ: So we have 49 beds which is very small and we recently got Joint Commission accreditation and certification.  We were the first in the United States for memory care and post-acute certification.

Kris: Congratulations.  That's really impressive.

KJ: Thank you.  Well when we got that certification we were then invited to the tables to speak to the larger hospitals.  Because we were such a small hospital in such a large area with a lot of other big facilities that we couldn’t even get a seat at the table for the ACO conversation.  ‘Oh you're 49 beds - you don't take people 24-7; we’ll talk to somebody else.’ But once we got Joint Commission accreditation that's something the insurers and the players understood. We've always been five stars and we are very proud of that but it didn't matter because we weren't large enough to have their attention but we're one of the few Joint Commission accredited in the whole area and so they are listening to us now so we have the seat at the table.  So yes our population is evolving. The major hospital that’s our primary referral source now is the 90-day pocket of money that accountable care organization the whole joint process for the knees and hips and they're going into pneumonia and a couple of the other things. They've actually signed up earlier than for that a lot of the other demonstration products.  It’s the bay area and it's a big demographic for CMS and so we're seated at that table we've had a few of our few joint people already so that's a challenge in getting them in shorter, shorter, shorter.  We haven't gotten the seven days or die yet but it's coming - it's coming.  We’re about 14 days for a hip.

Kris:  Are you actually participating in a CJR program or you are one of the MSAs and so they're coming through and everyone's learning about this so we know that.  How many patients a month on average are you admitting under that CJR model?

KJ: It's probably one to two.  We just got our first one last month and then our second one right before I left was scheduled to come in this week.  So they haven't really started a big volume yet but they're feeling out little by little and the hospitals have been having meetings with the skilled nursing facilities in the area and we have to record for them every readmission we get; every admission from them and every readmission so they actually look at that and they discuss it in a group of other SNFs. So you have to know your stuff and then be prepared to defend why it went back or what the decision was made and they asked questions right there in front and if you don't know what they're talking about it's embarrassing.  So it's kind of - I don't want to say group shaming - but it is certain is a nice way of keeping your competition up and keeping your ability to talk about what happened at 5 o’clock on Friday afternoon why the person went to the hospital.  You know all of that stuff.  Your clean laundry as well as your dirty shirts all get out at the same time so that's kind of exciting keeping people on point and keeping people talking about it and making sure our systems behind-the-scenes work really well.

Kris:  That's fantastic and within that context of having orthopedic - you know about the total hips, total knees and you know that's what the CJR bundled program is about but in your facility you have other patient populations - memory care, can you tell us a little bit about memory care and what you and again today's events and the videos on memory care and I truly believe with more of the understanding and compassion and empathy versus 20 years ago.  Tell me how is it going within your organization and also what else do you see the future holding.

KJ:  Well memory care is one of our really strong suits.  We’re really proud of that.  We took the CMS hand-in-hand training that they sent all facilities we've given it to all of our nurses’ aides and our activity staff and housekeepers and dietary staff so everybody has it whether or not they use it every day is not the point but they know what to do so we have zero psychotropic use for dementia in my building. I'm very proud of that.  People come in with them and we taper them off right away we get them engaged with the family and the caregivers and the case managers from day one.  We have really good geriatricians that work with us.  Our medical director is super and good nurse practitioners that are there every week.  So if somebody's having a crisis it's because we can't figure out what they need it’s not because they have dementia it’s because we don't understand them.  So once we get to know them sometimes it's a longer process than others but sometimes it's really quick if you sit down and listen to someone it's amazing what you can find out about them and listen to the family.  It may take them 30 minutes to give you the story, but once you know that story it's amazing how easy it is to understand that elder and what their needs are.  So we have people able to meet their needs whether they’re housekeepers.  You don't need a registered nurse to go fetch somebody water right and so all of that works together with a lot of the other dementia training we've had.  We used Alan Powers books when that first book came out.  I bought 30 copies and put a twenty-dollar bill in it and gave it out to staff at random and then everybody wanted a copy.  So we bought more copies for people and they read it.  They were all excited.  ‘Oh we're having a learning circle about this today. You want to come?’ And the CNAs did it themselves.  It was really exciting to see ideas that come on because they worked.  You could tell right away that the anxiety level went down, the calmness was everywhere and people weren't on drugs so it's a lot less nursing time, less side effect, fewer complaints, fewer falls.  It was really nice and it makes a nice atmosphere.  We spend a lot of time by our board directive and on purpose in activities.  We just won the National Nonprofit Activity award from American Health Care Association.  We’re so excited and I came to accept that award on behalf of our residents and staff but we spend a lot of time about 1,500 volunteer hours a quarter just in activities.  And that's the big community coming in.  We have high school kids start their freshman year and they're here very year and they don't want to leave when they graduate and then they continue that and they bring their kids so it's exciting to see them growing up with our people as their adopted grandparents or antes and it's really fun to see that.  It's amazing what a little cranky old person will do with those babies crawling around and crawling up on them and that's kind of fun you know it gives them something out of their routine and a chance to be themselves their authentic at peace self.   They don't remember anything and it's like when you hold a baby everything's just you again so that's kind of nice too.

Kris:  It sounds as though you're ahead of the curve. It sounds as though you've applied practices that the government is now putting on all 16,000 skilled nursing facilities across the country.  That the competency of your staff is where it needs to be with ongoing training and I think that a lot of organizations could learn from you and I think that your stories invaluable because when you impart that knowledge from the housekeeper to the receptionist on, whatever your facility assessment defines I think that they will realize that the operations becomes more seamless and more productive.

KJ: Yes, that's very true.  The more people that know and are comfortable with people with dementia the easier it is for everybody and when I finish those 713 pages I admit I did the last 50 on the plane ride down here and most of them we have already done.  I'm so excited because my staff was panicking and I sat through that overview on Sunday and oh my god but they will do the templates and I was already taking notes on what to put in the template - so we're right on speed.  All the Joint Commission accreditation standards that we meet that exceed CMS that's within the regulation.  There was nothing brand new that we never heard or hadn’t done so we're really excited. We feel like we're in compliance with the regulations before November when they start so that's always exciting for us.  We have a little tweaking to do; a little more formalization in the discharge plan but we already put a lot of time into discharge planning to keep people from going back to the hospital. You know in our hospitalization rate is very very low from skilled nursing and from discharges very low.  We've chosen some very smart home health partners.  So that the first time there's a crisis they have people on the ground dealing with it and they don't end up back in the ER and so that helps the numbers as well and now they're counting that.  So even though our locus of control is expanding we don't have a home health license we can't control what happens in your home but we make sure you have everything you need to get there and some numbers that you can call so there's no wrong door that if you don't get what you need call me, call the social worker, call somebody you know at Chaparral House and we'll help you get through to the next person.  And being small helps with that a lot to give control.

Kris:  We are so grateful for leaders like you in the industry and I'm sure many people are going to ask for help and advice and thank you so much. KJ Page from Chaparral House in Berkeley, California.  Thank you so much.

Tags: AHCA Provider Lounge Series, Memory Care

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