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Rural Virginia Nursing Home Achieves Five Star Status

Laurel Meadows Shares Approach to Improving Quality Measures

This summer, Heritage Hall Laurel Meadows achieved an important goal: the facility garnered five stars on the Quality Rating System developed by the Centers for Medicare & Medicaid Services. Now, they want to share their successful approach with other nursing homes across the region.

Laurel Meadows is a 60-bed facility located in Laurel Fork, VA, a rural community near the Blue Ridge Parkway. W.C. Darnell, the facility’s administrator, says the five-star rating would not be possible without the dedication of his staff and their committed approach to long-term care

“When we hire, we look for people who are embedded in our community,” Darnell said. “Our staff have compassion for the residents they serve who are generally their neighbors in a small community like this.

Before becoming a nursing home administrator, Darnell was a forensic detective for more than 25 years. He employed those analytical skills to improve the facility’s quality measures. As the team reviewed data, two issues stood out: falls and urinary tract infections (UTIs).

Preventing Falls
“At Laurel Meadows, we developed a falls program that was adopted by the entire corporation. Rather than disciplining staff when residents fall, we reward staff when falls do not occur,” Darnell said.

Each month, the shift reporting the fewest falls receives a meal of their choice. To keep fall rates top of mind, a mural of a tree is located near the main entrance to the facility. When a fall occurs, a leaf is placed on the tree. The leaf’s color corresponds to the unit in which the fall occurred. This not only reminds staff to take steps to prevent falls, but creates transparency with family, friends and the community about the facility’s fall rate.

Laurel Meadows made two significant internal changes to reduce falls. First, the team added chairs throughout the building. During second and third shift, staff are seated along the halls, and when residents begin stirring, staff jump in quickly to help and reduce the chance of a fall.

Second, staff noticed that residents using reclining wheelchairs fell less often. “The [non-restrictive] reclining wheelchairs are more comfortable and residents are less likely to try to get up. Now, when equipment needs to be replaced, we purchase wheelchairs that recline,” Darnell said.

Reducing UTIs

Laurel Meadows found a surprising path to reducing UTI rates. Darnell teamed up with the activities director to ensure that fluids were available and logged at all events held for residents.

To support residents with limited mobility, they added cup holders to wheelchairs and Geri chairs. They also noticed that some residents could not lift large cups. So, they reduced the cup size by one third to ensure even their most frail residents could drink unassisted.

“Honestly, we were very surprised that these steps worked so well. Our UTI rates fell to almost zero,” Darnell said.

Leveraging Staff & Data

Laurel Meadows is now deploying staff in new ways to ensure residents have the best care. A Bath Team includes two certified nursing assistants (CNAs) with the responsibility for bathing all residents. Over time, the CNAs get to know the residents very well and notice any changes quickly. If they see redness or wounds, they notify a nurse so that treatment can begin immediately.

Department leaders are also getting more involved with the residents. Heritage Hall previously held morning “stand-up” meeting at its facilities, Monday through Friday, but Darnell received permission to reduce the frequency of the meeting to three days a week so department heads can spend more time with the residents and families.

Finally, Darnell encourages facilities to know their quality data. By working with Health Quality Innovators (HQI), Laurel Meadows kept track of their performance on various measures and knew which areas to target for improvement. They also learned better strategies for MDS (Minimum Data Set) coding accuracy to improve performance on their composite score.

“HQI was there to support us every step of the way. They are a great resource for nursing homes,” Darnell said.

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