As hospitals and insurance providers increasingly analyze data on the length of patient stays and strive to prevent rehospitalization, Cabrini of Westchester has positioned itself to be a partner and pacesetter for delivering innovative services to the aging population.
The paradigm shift in senior care was brought about by a reassessment of the traditional skilled nursing facility model, which repositioned such entities not only as providers of inpatient senior care, but of outpatient and in-home senior care, as well. The leadership of Cabrini of Westchester, a nonprofit eldercare organization, has been ahead of the curve, providing comprehensive senior services while making quality care more available and more effective. Its success stems from a top-down commitment to creating a patient-centered philosophy that results in enhanced outcomes, underscored by the clinical experience of the leadership team.
“My medical background helps me understand patients’ needs as well as what our medical staff requires to meet those needs,” says Ralph Lucariello, MD, FACP, Chair of Cabrini of Westchester’s Board of Trustees. “I’m a practicing internist, and I was a medical director of an acute-care hospital for 30 years.”
“We’re centered on patient care, and our main goal is to maximize health benefits and patient welfare.”
— Ralph Lucariello, MD, FACP, Chair of Cabrini of Westchester’s Board of Trustees
Collaboration and Communication
The systemic push to reduce healthcare costs is transforming traditional hospital operations from an inpatient-based model to one predicated upon outpatient care. Although some patients require hospitalization, outpatient facilities are increasingly offering services that were previously only found in hospital settings.
“Hospitals are interested in discharging patients sooner,” says Dr. Lucariello. “Medicare and Medicaid are interested in reducing costs through managed care, and that requires us to increase our ability to provide treatment for more acute patients with more complex conditions. The idea of extended hospital stays is long gone.”
To discharge patients sooner and prevent additional health risks, hospitals can partner with Cabrini of Westchester, which provides a more advanced level of care than skilled nursing facilities have traditionally been able to offer. For such collaboration to succeed, Cabrini of Westchester has enhanced communication with hospitals and other referring institutions to ensure that every minute detail of a patient’s care plan is carried out.
“It’s vital to ensure close collaboration with our partners so we are fully informed about patients’ needs before they arrive,” says Jeffrey Nichols, MD, CMD, Medical Director and Vice President of Medical Services at Cabrini of Westchester. “For example, if we’re going to treat a tracheostomy patient, we need to know what size tracheostomy they’re using to make sure we have all the necessary supplies in place before he or she enters our facility.”
Promoting Rapid Recoveries
Once patients arrive, the goal is to minimize the length of their stay in Cabrini of Westchester’s sub-acute unit. Patients recovering from abdominal, cardiac and orthopedic surgeries, as well as patients receiving pulmonary, stroke or wound care, need a greater depth and breadth of skilled services than has typically been available from skilled nursing facilities.
Assen Bogdanov, MD, of ArcWell Medical Group, who oversees Cabrini’s sub-acute unit, consults with a patient regarding a wound treatment plan in preparation for a prosthesis.
To meet those needs, the staff at Cabrini of Westchester includes internists and geriatricians, with specialists on call to provide consultations. Registered nurses and nurse assistants are trained to identify and report even subtle changes in well-being that could extend the sub-acute stay, or require rehospitalization, if not corrected early.
Examining Root Causes of Rehospitalization
Ron Cole, RRT, Cabrini’s full-time registered respiratory therapist, monitors a patient in Pulmonary Therapy.
By taking an in-depth look at exactly why patients were going back to the hospital in the first place, Cabrini of Westchester has identified conditions that often lead to readmission and instituted preventive measures that have reduced rehospitalization rates below the industry average.
“Other institutions primarily looked at congestive heart failure rehospitalization because that’s what Medicare was introducing penalties for,” Dr. Nichols says. “In fact, the rate of rehospitalization for patients with respiratory problems is higher than it ever was for heart failure, but many facilities didn’t really address that.”
To fill the service gap and extend accessible treatment options for patients who previously had few viable alternatives, Cabrini of Westchester significantly enhanced its own Pulmonary Rehabilitation Program, led by a trio of pulmonologists, a full-time registered respiratory therapist, and physical, occupational and speech therapists, who assess patients and deliver personalized treatments.
The team’s goal is to restore pulmonary functional capacity using exercise training on treadmills and recumbent elliptical machines, oxygen therapy and breathing retraining, and vital sign monitoring. The program also includes an educational component so patients are better able to understand and manage their healthcare needs. In addition to basic self-management, clinicians also provide nutritional education. Psychological support and counseling are also available.
Bringing Service Into the Community
“We strongly feel that, for many seniors, home-care services work better than inpatient services, in terms of cost and quality,” Dr. Lucariello says. “Our commitment to creating effective, patient-centered care is reflected in our strategic plan, which is geared toward providing more community-based services.”
Service in the Home
Many seniors prefer to remain in their own homes to receive care. That, and the fact that nursing homes are often the most expensive healthcare option for this population, led Cabrini of Westchester’s leadership to create two innovative home-care options.
- Cabrini Care at Home offers personalized health care delivered by certified home health aides, registered nurses, and physical, occupational and speech therapists. Home health aides also meet frail seniors’ basic everyday needs, offering assistance with administering medication, bathing and dressing, cooking, light household chores, shopping, and transportation to medical appointments.
- Cabrini Certified Home Health Agency provides comprehensive, in-depth medical services such as anticoagulation management and respiratory care. Providing this standard of care allows seniors to remain in their homes and reduce their medical expenses, increasing their level of independence, while still receiving the quality of care they require.
Innovative Models of Adult Day Care
Miriam Hunte, PTA, and Pritesh Patel, PT, DPT, utilize a state-of-the-art LiteGait device to improve the gait pattern of a patient with abnormality of gait and lack of postural control.
While home care is the best option for some seniors, others benefit more from facility-based outpatient care, which Cabrini of Westchester provides in the form of a medical model adult day program. For up to six days per week, seniors come to Cabrini of Westchester, where they have access to rehabilitation therapy, as well as a host of medical services, including dentistry, radiology, psychiatry, optometry and podiatry. Seniors can also participate in a number of activities, including art, discussion groups, exercise, horticulture, movies and music, along with meals and personal care.
The success of the program inspired Cabrini of Westchester to initiate a four-day-per-week social model adult day program aimed at patients for whom social isolation posed as much of a health risk as any medical need.
“Some patients need adult day services but don’t qualify for medical day programs because what they need isn’t nursing or dietary monitoring — they need social support,” Dr. Nichols says. “So we’ve opened a social-model adult day program for patients who are likely to deteriorate because they need a higher level of cognitive support or other activities than their family is able to provide.”
“We don’t think of ourselves simply as people who run a nursing home, even though lots of patients really need that care and benefit from it. That’s a limited view of what we can make available for a growing population of frail seniors — most of whom are happier to stay in their own homes, if they can.”
— Jeffrey Nichols, MD, CMD, Medical Director and Vice President of Medical Services at Cabrini or Westchester
Together, these day programs provide seniors with the care and services they need at a cost that’s lower than living full-time in a skilled nursing facility. Additionally, the programs allow patients who might otherwise require full-time inpatient care to remain in their homes. Transportation to and from Cabrini of Westchester is available for patients in both programs.
Ends, Not Means
Drs. Lucariello and Nichols have positioned Cabrini of Westchester to succeed in a changing senior care environment, not by providing care options most suited to the traditional skilled nursing facility, but by providing the care options best suited to the seniors in the local community.
Lois Cartica, LCSW, Director of Cabrini of Westchester’s Medical Model and Social Model Adult Day Care Programs, enjoys a moment with a long-time client. These two programs help both frail elders and developmentally disabled adults remain at home in the community.
“Our mission today is the mission of healing, teaching and caring that Mother Cabrini established,” Dr. Lucariello says. “Our main focus is patient care, not generating a profit.”
“There’s no one-size-fits-all solution,” Dr. Nichols adds. “You look at patients as individuals and develop appropriate, effective programs for them, whether at the inpatient level, in community or adult day programs, or simply by providing awareness and case management. We want to have all of those options available for people and provide quality care seamlessly between those alternatives.”
Hospitals and referring agencies seeking a partner for advanced care of frail and acute seniors can view Cabrini of Westchester’s complete list of programs and services at cabrini-eldercare.org.