A Collaborative Program to Rethink Nursing Home Care

By Michele Dula Baum and Clare Collins

Pitt Nursing student Hope Karnes with resident Roselyn Baum at The Willows nursing home in Oakmont, Pa.

When COVID-19 struck  in early 2020, nursing homes became the pandemic’s epicenter. Overwhelmed long-term care facilities found themselves unable to keep up with spiraling infections and deaths among residents. Overworked staff lacked personal protective equipment and were emotionally burdened by what they were witnessing. Refrigerated trucks functioning as makeshift morgues splashed across national news outlets and remain an indelible image of the time.

Advanced age, underlying frailty and communal living conditions combined to make nursing home residents acutely vulnerable to COVID-19, accounting for 25% of fatalities nationwide by the end of the first year of the pandemic. But the nursing home industry had struggled with chronic problems well before.

“What happened in nursing homes during the COVID-19 pandemic did not happen in a vacuum,” says Nancy Zionts, chief operating officer and chief program officer at the Pittsburgh-based Jewish Healthcare Foundation (JHF). “It involved decades of neglect – not paying attention to the workforce and the lack of resources for infection control protocols, staff and equipment.”

Recognizing the huge and urgent need coming out of the pandemic, Zionts and Karen Feinstein,  JHF president and chief executive officer, connected with Terry Fulmer, president and CEO of The John A. Hartford Foundation, and together they decided to revisit a concept from the 1980s called the Teaching Nursing Home Initiative. Conceived by the Robert Wood Johnson Foundation in 1981, the initiative targeted issues affecting the burgeoning elderly population living in nursing homes during the 1970s and ’80s.

“The original Teaching Nursing Home Initiative ran its course with some success,” explains Howard Degenholtz, professor of health policy and management at Pitt’s School of Public Health. “When the pandemic exposed our inadequacies in caring for elderly residents in long-term care, we said, ‘let's dust off this idea’ and see what can be learned from the past and really think about what we can do today to engage schools of nursing as well as nursing homes.”

The project, involving Pitt’s Schools of Public Health and of Nursing as well as several community partners, is an example of the kinds of collaborations that are happening across Pitt’s schools of the health sciences. “It’s the interconnectedness among disciplines, institutions and communities that amplifies, that energizes our awareness, and that’s the essence of public health,” said School of Public Health Dean Maureen Lichtveld.

In July 2021, a three-year pilot project to revisit the teaching nursing home was launched. By enhancing partnerships between academic nursing programs and nursing homes in Pennsylvania, the team of investigators sought to improve the quality of care provided to nursing home residents and the education nurses receive in geriatric care, and their perceptions of nursing homes as fulfilling places to work.

“In the past, if you were at a school of nursing and they were assigning clinical placements, and you were gone that day, all that was left was nursing homes,” says Elizabeth Schlenk, associate dean for graduate clinical education and associate professor of health and community systems at Pitt’s School of Nursing. “Everyone wanted the intensive care units, maternity or pediatrics. No one wanted the nursing home placements. This partnership has really shown us that by introducing nursing students to geriatric nursing, we can break the stigma of working in a nursing home, and now, we have true champions for working in long-term care facilities.”

Taylor McMahon

Taylor McMahon, director of nursing at Presbyterian SeniorCare Network, started her career a decade ago in long-term care to gain experience so she could pursue a career in emergency medical care. Then she fell in love with working with the elderly residents.

“This work is truly nurse-driven and involves critical thinking skills and a lot of autonomy,” says McMahon. “I can see the impact of my work by improving the quality of life for these folks and helping them age in place.”

McMahon helps nursing students recognize the intellectual challenges that come from working in long-term care facilities when she presents at orientation programs at Pitt’s School of Nursing. “It is really about looking at what matters to each individual older adult that we care for and aligning their needs with what they want,” says McMahon.

“What matters” is a cornerstone of the Pennsylvania Teaching Nursing Home Collaborative, which employs the age-friendly health system framework developed in 2017 by the Institute for Healthcare Improvement. Whatever is most important to individuals and orienting care around what they see as a priority is what matters.  Other core concepts are “medication,” “mentation” and “mobility.”

Medication requires careful consideration of pharmaceuticals like benzodiazepines and opioids that can have significant side effects in older adults. Mentation focuses on identifying modifiable factors associated with cognitive function, such as delirium, which is often associated with urinary tract infections, as well as diagnosis and treatment. Mobility is based on individual residents and their personal goals. “Do they want to focus on walking and gait, or do they want to focus on falls and fall prevention? It is up to the individual to define,” says lead evaluator Degenholtz.

After the successful conclusion of the pilot project in mid-2023, the initiative was officially named the Pennsylvania Teaching Nursing Home Collaborative, growing to 20 schools of nursing and 40 nursing homes across the commonwealth of Pennsylvania. The eventual goal is to expand nationwide.

McMahon is happy to play her part in encouraging the future generation of nurses to consider long-term care.

“Working with the elderly has changed my life personally and professionally and just made me a better person,” she says. “We have a lot of room to make this bigger and better, and I am excited to see where it leads.”
 

Photographs by Joshua Franzos

This article appears in the Fall 2024 issue of Pitt Public Health magazine.