Special Edition, Nurse Managers and VPs of Nursing
• Page 30
The Sisters of the Living Word (SLW) is a community of more than 70 religious sisters who provide education and counseling to youth and adults in need. Based in Chicago, the community faces an aging population of sisters whose health care needs have become more complex.
Five years ago, LivHOME began working with SLW to craft a proactive, comprehensive wellness program to increase the health and quality of life for the sisters.
When we began analyzing the community, we had to consider three key factors early on:
• Mindsets about care. The philosophy of providing care in this community is entirely different than in other non-religion-based organizations. For these sisters, the community includes a commitment to provide lifelong care for each other and to embrace a holistic belief in mind, body and spirit. Care managers initially found that many sisters, especially the older ones, were simply not accustomed to advocating for their own health.
• Geography. Typically, a religious community has a central location or infirmary where members can get immediate assistance and care management. These sisters work and reside not only throughout the Chicago area, but across nine states and 12 archdioceses. While LivHOME works primarily with the 47 sisters scattered throughout Chicago, a comprehensive plan needed to be able to reach across many miles and different living arrangements.
• Age spectrum. With the sisters ranging in age from 40 to 92, care managers were also faced with managing a health spectrum that ranged from the fully active to the infirmed. The sisters live alone and in groups, with the majority of those over 70 living together. Problems of isolation and depression were present in those living alone.
The assessment process uncovered challenges with medication compliance, increased instances of falls, difficulty responding to emergencies, limited understanding about treatments and physician recommendations, and uncontrolled diabetes and hypertension. We found that health challenges existed in both types of living arrangements.
We worked initially with SLW to establish a structured plan that could support consistent assessment, reporting, communication and innovation. An existing Health Taskforce Committee consisting of eight sisters was expanded to include our care manager and administrator. This committee served as a forum to develop and implement new ideas and action plans. Today, this committee still serves as the driving force behind new ideas, problem-solving and ongoing care management.
Next, all sisters, regardless of age or current health condition, participated in a health assessment. This gave us a baseline measure of each person's health and engaged the sisters through inquiry and physical exams. Individual care plans included goals for physical, emotional, environmental and spiritual wellness.
Health education has become a key factor in developing the proactive wellness plan. In 2008, LivHOME Care Manager Lidia Golden, RN, BSN, began working with the sisters and identified the need for more education. Golden and the sisters organized educational inservice trainings at the community's central meeting facility.
The sisters participate in sessions covering nutrition, eye care, fall prevention and disease education. The increased education, especially around topics like Alzheimer's disease and memory loss, has helped alleviate the fear and anxiety of aging. Playing games and working puzzles helps with memory deficits and socialization. Nutrition education includes learning how to read food labels and determine nutritional value.
Golden also focused on how to best use the meeting facility, which needed further development to reach maximum use potential. The space continues to evolve beyond access to a treadmill, stationary bike and whirpool. Today, Golden and the sisters are considering other options for physical activity, such as yoga and Pilates. The Healthcare Task Committee is also exploring the idea of using the Wii gaming system to increase mobility and physical activity.
ACCESS TO CARE
We also worked on solving problems associated with access to appropriate equipment. For example, the older sisters had difficulty using the whirlpool because of physical limitations, but the addition of a Hoyer lift now allows them to do so.
Another component of the wellness plan involves managing medical care, including doctor's appointments, medication monitoring and follow-up care. The sisters now better understand their own health care needs. Golden acts as the central hub in the complex network of care management that includes social workers, nurses and caregivers, ensuring that there are no gaps in service.
One way LivHOME and the community have been able to raise the quality of care is by identifying problems with providers. In one instance, one of the sisters experienced poor care at a local rehabilitation hospital. After her discharge, Golden investigated seven other rehabilitation facilities and narrowed down two as possible choices for future use. Shortly after, when another sister required rehabilitation, the community chose one of the new facilities and everyone was pleased with the excellent care.
After five years of working together, the sisters have become more active and now approach LivHOME with care suggestions or ideas. Connections between the sisters and outside health care providers have grown as a result of the wellness program.
Regular team meetings and quarterly reports provide updates on the sisters' conditions and progress. Emergency room visits and the incidence of falls have decreased.
Greater understanding of the health care process has given the sisters increased confidence. The sisters are better equipped to handle unexpected emergencies and feel more empowered to challenge any inadequate care received from health care providers.
We continue to explore creative living arrangements among the sisters, allowing them to age in place. By increasing opportunities for physical and mental stimulation, monitoring medicines and appointments, and providing consistent reporting, LivHOME partnered with the sisters to help the maintain a high quality of life.
Mary Beth Hardy is the regional director of the Midwest region for LivHOME, based in Los Angeles.