Community Living Centers at Milwaukee VA earn five-star rating

“This is a huge achievement,” said Sherry Cannizzo, acting division manager for Rehabilitation Extended Community Care, noting the survey took place during the recent COVID surge in early February. “The findings, given all that staff are doing during COVID, is impressive.”

In fact, the survey found no clinical deficiencies.

“To have a zero-findings survey is rather uncommon,” said Sue Gresser, RECC division manager. “We were very pleased.”

The unannounced survey took place virtually Feb. 7-9 and was conducted by Ascellon Corp., which surveys and certifies residential and non-residential health care facilities

For the CLC team, this was a chance to show the results of work that began after a two-star rating in 2020.

After that survey result, focus groups formed to zero in on metrics covered by the surveys.

“We had groups looking at all of these quality metrics in order to determine how we could get better outcomes,” said Kate Matz, CLC coordinator. These metrics range from the frequency of urinary tract infections to readmissions of Veterans to the CLC.

In addition, Milwaukee began a partnership with the Houston VA Medical Center, which has been able to improve and maintain the ratings for its CLC over the past few years.

'Neighborhood' meetings

A major result of that collaboration was the institution of daily 9:30 a.m. meetings for the four “neighborhoods” that comprise the CLC.

“We had very siloed neighborhood communication … and there wasn’t a good forum for those neighborhoods to exchange information,” Matz said. “What the 9:30 meeting did was bring everybody together … to have common interventions and to get everybody doing the same thing and on the same page.”

At a 9:30 meeting, one neighborhood might share insight about how they’re working to prevent falls. Another topic could be the best placement for a Veteran entering the CLC. And a common topic over the past two years has been ever-changing COVID rules.

“No matter what the challenge — whether it was pandemic related or not — it feels like ‘All hands on deck,’” said Andrea Klipp, a CLC program manager. “Everybody has each other’s backs … and we work as a team to identify the best outcome.”

“Staff education has been very important to us,” said staff nurse Nicole Mouradian, noting that the bedside nurses have been “empowered to lead performance improvement rounds. This has really optimized Veterans’ outcomes.”

Input from everybody

Another takeaway from the Houston VA was to incorporate all the departments that contribute to the care of Veterans, not just the medical staff.

“We needed to change philosophies … and pull in all the other licensed professionals outside of nursing to become successful,” said Mike Panfil, health system specialist for the nurse executive. “That’s what turned us around.  We finally started clicking with sustaining our improvement efforts.

“All these entities need to be concert for us to operate at the highest level. And when we were finally going down that path, it was reflected in our star rating.”

On top of these changes, the staff also worked to align what it was already doing with the metrics in the survey.

“We were providing high-quality care to our Veterans all along, (but) a lot of it was figuring out the algorithm … and if we were accurately reflecting the care we’re providing,” said Dr. Sarah Nickoloff, CLC medical director. “In some cases, the answer was ‘No,’ so just being able to accurately capture what we were doing was a big part of this.”

While the CLC provides palliative and hospice care for Veterans, it also provides transitional care and rehabilitation for Veterans returning to their homes or being placed in long-term care facilities in the community.

And in some cases, the community can’t compete with the VA care.

“The feedback we get from nursing homes (in the community) is that they can’t replicate what we’re doing here because it is so high quality and takes so much hard work on the part of the nurses,” Nickoloff said. “We couldn’t do this without the incredible nursing staff we have.”

'Like family to us'

Because many Veterans in the CLC are long-term patients, they are referred to as residents, while their wards are called neighborhoods. And in such a setting, the staff and Veterans often forge strong relationships.

“These Veterans become like family to us,” said Steven Frisch, assistant nurse manager for 9C South. “This is their home, so if a Veteran has a change in condition, everyone’s worried and wants to know how he’s doing.”

Matz agreed, saying life in CLC is different than her past experience in critical care.

“In long-term care, it’s a different philosophy,” she said, noting the importance of all team members, including the Veteran’s family/caregivers. “The care plan is very individualized for each Veteran, so the approaches we use … are time intensive but really satisfying when they work because of the collaboration. It’s an exciting place to work.”

“This is not easy work,” Gresser said, saying the CLC staff works to “make the Veterans feel special and well cared for. It’s a different calling to want to take care of Veterans long term. They are our family.

“I’m super proud of this team and everybody in our CLC. It’s a great place to work.”

And the staff plans to maintain its five-star rating for years to come.

“I’m really hopeful that we can follow that motto of ‘See one; do one; teach one’ and turn around other facilities and help model how good quality care can be achieved,” Matz said.