Written by Michel Dura Baume and Claire Collins
Pitt nursing student Hope Kearns and resident Roselyn Baum at Willows Nursing Home in Oakmont, Pennsylvania.
When coronavirus disease (COVID-19) emerged in early 2020, nursing homes became the epicenter of the pandemic. Overcrowded long-term care facilities found themselves unable to cope with rapidly increasing infections and deaths among their residents. Overworked staff lacked personal protective equipment and were emotionally taxed by the events they witnessed. The refrigerated truck serving as a makeshift morgue was splashed across news outlets across the country and remains a haunting image of the time.
A combination of advanced age, underlying frailty, and communal living arrangements made nursing home residents highly vulnerable to COVID-19, accounting for 25% of the nation's deaths by the end of the first year of the pandemic. . But the nursing home industry has long been plagued by chronic problems.
“What's happened in nursing homes during the COVID-19 pandemic hasn't happened in a vacuum,” said Robertson, chief operating officer and chief program officer at the Pittsburgh-based Jewish Health Foundation (JHF). says Nancy Ziontz. “It involved decades of neglect: a lack of attention to the workforce and a lack of resources for infection control protocols, staff and equipment.”
Recognizing the enormous and urgent needs created by the pandemic, Mr. Ziontz and Karen Feinstein, President and CEO of JHF, joined Terry, President and CEO of the John A. Hartford Foundation・I contacted Mr. Fulmer and together we decided to reconsider the concept of the foundation. In the 1980s it was called the Teaching Nursing Home Initiative. Conceived by the Robert Wood Johnson Foundation in 1981, the initiative focused on the rapidly growing elderly population living in nursing homes during the 1970s and 1980s.
“The original teaching nursing home initiative ran with some success,” explains Howard Degenholtz, professor of health policy and management at Pitt School of Public Health. “When the pandemic exposed our inadequacies in caring for older people in long-term care, we said, 'Let's dispel this idea,' and we looked at what we could learn from the past and partnered with schools. I seriously thought about what I could do today to help with nursing care and nursing homes.
This project involves Pitt's School of Public Health and Nursing, as well as several community partners, and is an example of the type of collaboration taking place across Pitt's School of Health Sciences. “The interconnections between disciplines, institutions, and communities that amplify and energize our consciousness are the essence of public health,” said Maureen Richtfeldt, dean of the School of Public Health. .
In July 2021, a three-year pilot project to rethink educational nursing homes was launched. By strengthening collaboration between Pennsylvania's academic nursing programs and nursing homes, the research team aims to improve the quality of care provided to nursing home residents, the education nurses receive in geriatric care, and the enrichment of the workplace. The aim was to improve people's awareness of nursing homes.
“Previously, you were in nursing school, you were assigned a clinical placement, and when you were gone for the day, all that was left was a nursing home,” said Elizabeth, associate professor and dean of graduate clinical education. Schlenk says. Pitt School of Nursing Health and Community Systems. “Everyone wanted an obstetrics or pediatric intensive care unit. No one wanted a nursing home placement. This partnership was designed to introduce nursing students to geriatric nursing and encourage them to work in nursing homes. It showed us that we can break through the stigma, and now we have a true champion for working in long-term care facilities.”
taylor mcmahon
Taylor McMahon, director of nursing at Presbyterian SeniorCare Network, began her career in long-term care 10 years ago to gain experience in order to pursue a career in emergency medicine. Then she fell in love with working with older residents.
“This job is very nurse-driven and requires critical thinking skills and a lot of autonomy,” McMahon says. “I see my work having an impact by improving the quality of these people's lives and helping them age well.”
Ms. McMahon presents at Pitt School of Nursing's orientation program to help nursing students recognize the intellectual challenges that come with working in a long-term care facility. “What's really important is to consider what's important to the individual seniors we care for and match their needs with what they want,” McMahon says.
“What Matters” is the cornerstone of the Pennsylvania Educational Nursing Home Collaborative, which employs the Age-Friendly Health Systems framework developed in 2017 by the Institute for Healthcare Improvement. It is important to orient care around what is most important to the individual and what they consider to be their priorities. Other core concepts are 'medical care', 'mentation' and 'mobility'.
Medication requires careful consideration of medications such as benzodiazepines and opioids, which can cause serious side effects in older adults. Mention focuses on identifying modifiable factors related to diagnosis and treatment as well as cognitive function, such as delirium, which is often associated with urinary tract infections. Mobility is based on individual residents and personal goals. “Do they want to focus on gait and gait, or do they want to focus on falls and fall prevention? It's up to the individual to define that,” says lead evaluator Degenholz. .
After the successful completion of the pilot project in mid-2023, the initiative was officially named the Pennsylvania Educational Nursing Home Collaborative and has grown to 20 nursing schools and 40 nursing homes across Pennsylvania. The ultimate goal is nationwide expansion.
Ms. McMahon is happy to play a role in encouraging future generations of nurses to consider long-term care.
“Working with older adults has changed my life, both personally and professionally, and made me a better person,” she says. “We have a lot of room to make this bigger and better, and I’m excited to see where it leads.”
Coaching Nursing Home Redux Partners and Collaborators
center care
Jewish Medical Foundation
pennsylvania state university
University of Pennsylvania School of Nursing
University of Pittsburgh School of Nursing
Department of Health Policy and Management, School of Public Health, University of Pittsburgh
UPMC Canterbury Place,
Wesley Enhanced Living
willows
Photo: Joshua Franzos
This article appears in the Fall 2024 issue of Pitt Public Health magazine.
