Ohio Directors of Nursing Administration in Long Term Care (ODONA/LTC)

Back	Friday, September 03, 2010

Please meet Peggy Kish, RN the new Chairperson of ODONA

Peggy Kish RN is a Hocking College graduate with over 18 years experience in long term care. Peggy has worked as a nurse aide, an LPN, and a RN. During this time she has held titles of Director of Nursing, Assistant Director of Nursing, RN Supervisor, and Case Manager.

She is currently the Clinical Services Director for the Zandex Corporation in Zanesville, which operates seven long-term care facilities and two assisted living facilities. She is the Program Coordinator for 3 Nurse Aide Training Competency Evaluation Programs, is Resident Assessment Certified for the MDS process, and has extensive experience in writing of policy and procedures, state and federal regulations, survey process and over all operations of long term care.

Peggy is the chairperson for ODONA, the Zandex Wellness Program, and Nurse Aide Olympics.

Peggy has been honored as The October "Hero of the Month" by the Ohio Health Care Association where she is described by Administrator Joni Fox, "She posses the knowledge that is takes to be successful in the long term care setting, and seeks out new ideas. When Peggy starts a project, she carries it through with enthusiasm"

As Chairperson of ODONA, Peggy wants to increase the awareness to DON's that we are an organization that is designed to assist in all areas of management in long term care. She realizes the many challenges DON's today are facing and wants to raise the bar of this organization to meet whatever needs are there. With the environment in our business we are going to have to pull together as a team and focus on the future. We are willing to consider options for meetings to accommodate DON's needs to be in their facilities. Peggy hopes those of you that had challenges in joining our group will offer strategies to make it easier in the future.

Introducing Krysta Berkfield, the new Co-Chairperson of ODONA

Krysta Berkfield RN, LNC is the Clinical Services Director for Autumn Healthcare Corporation. She is responsible for the development, implementation and monitoring of all Clinical Health Services programs at eight of Autumn Healthcare's facilities. Prior to joining Autumn Healthcare Corporation, she worked at several companies including, consultant Director of Nursing for National Church Residencies, Rehabilitation Admissions Nurse for Genesis Healthcare Systems, Regional Marketing Director for Enduracare Therapy, and Clinical Services RN for Zandex Healthcare Corporation.

Krysta Berkfield resides in Nashport Ohio with her husband Clint and their son Austin, along with their two labs Goldie and Cinnamon.

Krysta looks forward to serving as co-chair with colleague and friend, Peggy Kish, and hopes that the organization will grow in membership, as well as continue to bring support and education to all Directors of Nursing.

Nancy George Bio

Nancy George is a founding member of ODONA and has served in the capacity of area coordinator, region director, treasurer, vice president, and president over the course of many years. She now again serves as treasurer, advisor and trustee of the ODONA organization.

Nancy is a registered nurse currently employed as the director of nursing at Colonial Manor Health Care Center in Loudonville, Ohio. Her first experience in the nursing field began as a nurse aide in 1977. She then went on to become a graduate LPN from North Central School of Nursing in 1980, an RN graduate of Marion Technical School of Nursing and obtained a Bachelors Degree in Business Administration from the Mt. Vernon Nazarene College in 2000. Nancy has been employed in long term care for thirty-three plus years.

Nancy was the recipient of the OHCA Director of Nursing of the Year award in 1995 and was voted Employee of the Year by the employees at Colonial Manor for 2010, a very humbling experience to say the least.

Lisa Maleszewski Bio

Lisa Maleszewski, RN, BSN
In 2010, Lisa marks more than 20 years in health care. Currently the Director of Clinical Services with Peregrine Health Services at The Columbus Alzheimer Care Center, she has been the DON for the past twelve of her 16 years at CACC. Lisa serves on the ODONA board as Regional Director for Central Ohio, and Recording Secretary for the ODONA Board. She also serves in a leadership capacity for the Central Ohio Directors of Nursing in Long Term Care Administration (CODONA).

Although Lisa has worked in many areas of nursing, including home health, acute care, and long term care, she is a passionate advocate for the improvement of dementia care. She has served on Directors of Nursing Advisory Boards, as a speaker at OhioKepro QI lectures and panel discussion seminars, and on corporate policy writing committees. She has recently served on a committee with the Ohio Department of Health regarding the revision of restraint regulations. Lisa has also served as a legal consultant in litigation involving dementia residents in long-term care.

A graduate of The Ohio State University, Lisa is also committed to the education of our nurses of the future. CACC hosts an average of eight clinical nursing groups per quarter at the facility. Her passion lies in the belief that the nursing process is a never-ending opportunity to expand one's knowledge base, with the end result of improving the quality of consumers and health-care workers in Ohio alike.

Lisa is a resident of Western Coshocton County, where she lives with her husband, three young children, and an assortment of animals. She enjoys all outdoor activities, particularly those that involve water.

Bits & Pieces

According to the 2008 National Survey of Consumer and Workforce Satisfaction in Nursing Homes (from A Comprehensive Report on the Quality of Care in American Nursing and Rehabilitation Facilities. 2009):

Eighty-three percent (83%) of facilities in the survey found that empowering employees to take action on quality problems produced positive results.
Ninety percent (90%) discovered that systematically evaluating resident and employee satisfaction data improved quality.
Ninety-two percent (92%) stated that using interdisciplinary employee teams to analyze and improve processes was a successful quality improvement tool.
Resident overall satisfaction (defined as "excellent" & "good") rose from 81% in 2005 to 86% in 2008.
Family overall satisfaction (defined as "excellent" & "good") rose from 83% in 2005 to 86% in 2008.
Nurse overall satisfaction (defined as "excellent" and "good") rose from 54% in 2005 to 58% in 2008.
Nursing assistant overall satisfaction (defined as "excellent" and "good") rose from 54% in 2006 to 58% in 2008.
Residents and their families identified "choices/preferences,' "management responsiveness," "grooming" and "nursing assistant care" as opportunities for Long-Term Care Facilities to improve satisfaction.
Nursesand nursing assistants both identified "help with job stress and burnout," "management listens," management cares," "training to deal with difficult residents," "supervisor appreciates," and "adequacy of equipment/supplies" as opportunities for Long Term Care Facilities to improve workforce e satisfaction.

From the OHCA NewsBites for 2010: The Patient Protection and Affordable Care Act (PPACA) has expanded the pilot requiring criminal background checks on employees and consultants who provide direct care in long-term care facilities project nationwide, with certain changes.

The first thing to know about the national program is it is voluntary for states to participate, and we do not know at this time if Ohio will participate.
Congress has sweetened the pot for states by providing 75% of the funding for the background check program, up to $3 million per state. The state is to provide the remaining funding directly or through public or private donations. It is not clear whether Ohio's system of charging fees to providers to complete background checks would qualify as state match under this language.
Other differences between the current Ohio program and the PPACA program are that the federal legislation would require FBI checks on all applicants, not just those with less than 5 years of state residency, and that the PPACA calls for states to implement a process for notifying providers of convictions entered after the initial background check.
The federal legislation mentions a 60 day provisional hiring period, although this is an outside limit and can be shortened by participating states (like Ohio's 30 day period).
Another difference is the PPACA covers volunteers who may be alone with patients. The PPACA seems to suggest that states develop greater coordination of background check information through a single agency so providers do not have to make multiple searches.
In other areas, such as designating disqualifying convictions, states are given considerable latitude to create their own requirements.

The Ohio State University College of Social Work conducted a research study to examine the contributing factors and barriers to a successful consumer transition to the Assisted Living Medicaid waiver program. Some of the key findings from the study include the importance of the resident awareness of what to expect from the transition; the availability of a licensed social worker within the facility was perceived as having little importance for transition success; and areas of education received least frequently by waiver participants prior to admission

Some assisted living members are seeking to better understand the rules governing AL waiver recipients receiving care from a family member working within their licensed residential care facility. The Conditions of Participation rule OAC 173-39-02 governs all types of ODA-certified long-term care providers including assisted living providers. With respect to this specific rule found in section:

173-39-02 Conditions of participation http://codes.ohio.gov/oac/173-39-02
(E) Assisted living providers: These are the conditions for any provider who seeks to become or to remain an ODA-certified long-term care assisted living provider:
(4) Provider qualifications: (d) The provider shall not allow a staff person to provide a service to a consumer if the person is a spouse, parent, parent, step-parent, legal guardian, or authorized representative of the consumer.

The Elder Justice Act (EJA), aimed at preventing and punishing mistreatment of elders, establishes a new reporting requirement that was effective March 23, 2010, for long-term care facility employees and contractors.

The new reporting requirements apply to long-term care facilities that receive at least $10,000 in federal funds.
The mandate attaches to individuals, including all employees, agents, and contractors of the facility.
The reporting requirement is triggered by a reasonable suspicion that a crime has been committed against a resident or person receiving services from the facility.
Under the EJA, the report must be made within two hours after the individual forms the suspicion if there is serious bodily harm and within 24 hours if there is not.
These timeframes do not excuse compliance with more stringent time frames under other applicable regulations such as Medicare/Medicaid certification.
Of course, there are new penalties for failure to report (include heavy civil money penalties and exclusion from federal programs) and for retaliation against employees who report. Facilities are required to post a notice (which will be specified by the Secretary) of employee rights.

Seniors who wear multifocal prescription glasses could reduce their risk of falling if they switch to a single-focus lens while walking outdoors, new research reported in the British Medical Journal finds.

Overall, falls were reduced by 8% among the single-focus lens cohort.
There was a 40% reduction among those who were used to walking around outside.
Seniors who typically spent their time inside saw an increased risk of falling, suggesting that switching to a single-focus lens might not be a good solution for those seniors.

Excerpted from the National Survey of Consumer and Workforce Satisfaction in Nursing Homes from A Comprehensive Report on the Quality of Care in American Nursing and Rehabilitation Facilities, 2009 and 2010 OHCA NewsBites.

Consumer & Workforce Satisfaction

The 2008 National Survey of Consumer and Workforce Satisfaction in Nursing Homes represents the voices of 425,000 nursing home consumers (residents and families) and workers who completed satisfaction surveys during 2008. Included are responses from 223,449 employees, 54,711 residents and 146,949 family members in 5,075 nursing facilities across the United States.

The level of consumer and workforce satisfaction was stable from 2005 to 2007 and reached its highest level so far in 2008. Both consumers and workers consistently reported high levels of satisfaction with nursing homes. Eighty-five percent of consumers rated their overall satisfaction and their recommendation of the facility to others as either "excellent" or "good" place to work. Sixty-six percent of employees rated their facility to others as either "excellent" or "good" place to work, and 73% rated their facility as an "excellent" or "good" place to receive care.

Key Findings

Consumers rating their overall satisfaction as "excellent" increased from 31% in 2007 to 35% in 2008.
Consumer satisfaction increased across all demographic groups and facility characteristics.
Although rates of improvement varied, workforce satisfaction increased across job classifications demographic groups and organizational characteristics (e.g., type of facility ownership, geographic region, size and other facility characteristics).

Family and Resident satisfaction

Although their perspectives are not identical, both families and residents are important stakeholders who are able to provide valid feedback about the quality of nursing home care. Input from both groups can help improve nursing home performance overall.

Family and resident satisfaction are positively correlated. Facilities ranked high on family satisfaction also have high resident satisfaction, and facilities ranked low on family satisfaction also have low resident satisfaction.
The most powerful drivers of whether a resident or family member would recommend a nursing facility are workforce issues; care or concern shown by staff, competency of staff, quality of service, and attention to the resident's choices or preferences.
Differences exist in terms of how residents and family members experience care, as well as in the factors that are most strongly correlated with the recommendation of a facility to others.
In planning quality-improvement initiatives, providers need to look carefully at their results to better understand how the responses of families and residents are interrelated.
Resident overall satisfaction rose from 81% in 2005 to 86% in 2008.
Family overall satisfaction rose from 82% in 2005 to 86% in 2008.

Workforce and Consumer Satisfaction

The relationship between consumer and workforce satisfaction is seen in the factors that underlie satisfaction among these groups. For consumers, the care and competency of staff are the most important drivers of satisfaction. This holds true for both resident and family respondents. For employees, management practices are the most important drivers of satisfaction. Most importantly, these same management practices are among those rated the lowest by employees.

Facilities with higher workforce satisfaction also have higher consumer satisfaction.
Competent and caring staff is a consistent predictor of resident and family satisfaction.
The level of satisfaction in America's nursing homes can be increased through strategies to simultaneously enhance quality from the consumer's perspective and improve the work environment for staff. Clearly, an effective strategy for quality improvement has to include a focus on the workforce that provides care for residents and their family members.
Nurse overall satisfaction (defined as "excellent" and "good") rose from 54% in 2005 to 58% in 2008.
Nursing assistant overall satisfaction (defined as "excellent" and "good") rose from 54% in 2006 to 58% in 2008.

Opportunities for Improvement

National benchmarks for consumer and workforce satisfaction are powerful tools that providers can use to drive greater value for all stakeholders. By comparing the performance of individual facilities against national benchmarks, providers can identify opportunities for improvement.

Survey items that are important drivers of satisfaction, but are low scoring, are potential areas that facilities can prioritize for improved satisfaction. Residents and their families identified "choices/preferences,' "management responsiveness," "grooming" and "nursing assistant care" as opportunities for Long-Term Care Facilities to improve satisfaction.

Nurses and nursing assistants have identical results for primary strengths and primary opportunities. Survey items that are important drivers of global satisfaction based on the respondent's recommendation of the facility as a place to work, but are low scoring, represent potential areas that providers should target for improvement.

Help with job stress is the top priority item for both nurses and nursing assistants. Nurses and nursing assistants both identified "help with job stress and burnout," "management listens," management cares," "training to deal with difficult residents," "supervisor appreciates," and "adequacy of equipment/supplies" as opportunities for Long Term Care Facilities to improve workforce e satisfaction.

Implications for practice For the field of practice, this year's report contains very positive results. The level of satisfaction in the country's nursing homes is showing incremental improvements for the first time since these data were first collected in 2005.

This report highlights the interdependence of resident and family satisfaction. It also underscores the interdependence of workforce and consumer satisfaction. . . . [G]ood leadership, good management and good supervision are likely to have salutary effects on resident, family and employee satisfaction. . . . [L]eadership competencies are strongly associated with job satisfaction in nursing homes. We recommend that aging services professionals focus on leadership competencies and workforce development as key initiatives to sustain quality improvement efforts in nursing homes.

Compiled directly from the 2008 National Survey of Consumer and Workforce Satisfaction in Nursing Homes by report contributors: Leslie A. Grant, Ph.D.; Brad Shiverick, C.P.H.Q.; Peter Janelle M.P.P.; Michael Davern, Ph.D.; Amy Hu, M.S.; and Eric Lewerenz, M.S.

Excerpted from My InnerView, May 2009

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