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On the MendOnce ranked one of the worst nursing homes in the state, the Northampton Rehabilitation and Nursing Center has new owners, new management and the money to make things better.
On a recent afternoon in an activity room at Northampton Rehabilitation and Nursing Center, teacher’s aide Julie Mitchell is helping a group of residents make instant pudding. Holding a bowl containing water and a powdered mix, Mitchell moves to each person in turn, taking their hands in hers as she stirs with a spoon, then with an electric mixer. The people, all in wheelchairs and mostly in their 20s and 30s are severely disabled. “C’mon, Marisol, help me give this a good stir,” she says to one young woman. “That’s the way-can you feel the motion you’re making?” Once the pudding is made, Mitchell spreads blobs of it on paper-lined trays in front of each person. Taking the left hand of Dana Oliver, a silent 35 year old man, she leads his fingers through the green-yellow mix. “Feel that, Dana?” asks Mitchell. “Kind of cold and sort of wet, isn’t it?” The spacious room, decorated with posters and drawings and stocked at one end with elevated mats for physical therapy, is part of the center’s pediatric unit-a ward that has given the nursing home the status of being only one of four facilities in the state with such units. While many of the 33 people who live in this section of the nursing home are not actually children, most were when they arrived. Just a few years ago they, and all of the rest of the patients in the facility, were on the verge of losing their home. Former owners of what was then called Northampton Nursing Home had filed for bankruptcy. That action followed years of problems: complaints of understaffing, employee/management disputes, money troubles, dingy conditions and a rash of patient deaths and illness during one year. As recently as last fall, the facility was rated among the lowest-performing nursing homes in the state by the Department of Public Health. “Basically, this building was in as much trouble as a nursing home can be.” says administrator Eric Fritz, who took over last June, two months after the ownership changed. “Poor staff morale, lots of turnover, open positions, empty beds, the need to hire temporary workers-it had all the negative indicators.” The activity room where Mitchell was working on the pudding project once was cluttered with old furniture and discarded items. Today it is one stop on a tour of a place that staff and a new management team are eager to show off, the result of more than $2 million the new owners have spent on improvements.
“To be honest, there was a time when I couldn’t have imagined working here,” says registered nurse Kathy Stosz, who became the center’s Medicare case manager last year. “But it’s very exciting to be part of the changes taking place.” Those changes include spruced-up rooms with new beds, new furniture for the common rooms and mechanical lifts to help staff members move non-mobile patients from one spot to another. There are new department heads, revised program activities and other improvements that the owners and management team – Northampton Health Care Associates LLC and Landmark Health Solutions, respectively - have added in their bid to turn the nursing home’s performance around. In particular, they’ve introduced a post-acute unit for people recovering from severe injuries or surgery. The unit joins three others: one for standard long-term care of the elderly, another for dementia patients and the pediatric unit for children and young adults with disabilities. In addition, new employees, some drawn by what they say is Landmark’s good reputation in the health care business are working alongside veteran staff who have been dedicated to the care of the individual patients, particularly in the pediatric unit. Regular staff has increased from about 125 to over 170, according to Landmark’s Steven Raso, executive director of the Northampton facility; the company plans to bring that number to over 200 by later this year.
Some in the community say they’ve taken note of the changes. When Kathy Washut’s 88 year old mother, Lucy Grella, fell ill last fall and needed nursing home care, Washut didn’t consider Northampton Rehabilitation and Nursing Center. A medical technologist from Florence, Washut knew its reputation. “I’d been in there once and it looked really run down,” says Washut. “There were buckets in some places because the roof leaked. Years ago I would never have sent [my mother] there.” Now, though, Grella, recovering from surgery in February, is staying in the nursing center’s post-acute care unit. And aside from two incidents at the beginning of her stay that Washut attributed to staff miscommunication, Washut says she’s been pleased with the treatment her mother has received. “She’s gaining weight now, she’s talking again, she’s doing better overall,” says Washut. “I sleep better at night knowing she’s getting the kind of attention and care she needs.” Madelyn Breen, a registered nurse and case manager at Cooley Dickinson Hospital, says she and other employees at CDH have noticed improvement and feel confident about sending patients there. “We’ve had very positive feedback [about the nursing home] from patients and their families,” says Breen. “The changes they are making are not just cosmetic.” The Northampton Nursing Home had struggled for years under its previous owners, the Lash family of Fall River, who in 2003 filed for bankruptcy. They listed $3.2 million in debt, including about $700,000 owed to Northampton in back taxes, fees and utility bills. “There was a lot of uncertainty and confusion,” says Corie Baker, a certified nursing assistant, teacher’s aide, and the manager of the “Dayhab” program, where the older pediatric patients receive therapy. Baker, who began working here 10 years ago as a student intern from Northampton’s Smith Vocational & Agricultural High School, says “No one knew what was going to happen.”
But some feared the worst. Ann Jarvis of West Springfield, whose son Keith entered the pediatric unit when he was 10 months old and recently turned 18, faced the possibility that he’d be sent miles away. The only other nursing homes in Massachusetts that offer pediatric care are in the eastern part of the state. That the Northampton Nursing Home might close “was my biggest fear, says Jarvis. “That would have made it so difficult to see him on a regular basis.” “You would have been talking about an extreme tragedy had this place closed, and that’s really not an exaggeration,” says Fritz, who previously was the administrator for the Calvin Coolidge Nursing Home in Northampton. “A lot of people’s lives-patients, their families, staff-would have been disrupted.” The center’s financial crisis seemed to encapsulate a long fall from the days when the building opened with what former employee Timothy Molaghan says were “very high hopes. Because it was the only facility around with a pediatric care unit, it attracted some really dedicated staff,” he says. “But a lot of them ended up leaving over the years. Molaghan, a long time social worker from Northampton, worked at the nursing home in the late 1970s but was fired in 1979 after he alerted parents and spoke out publicly about staffing cuts that he and other employees felt were compromising the care of patients in the pediatric unit. Nursing home officials denied that Molaghan was fired for his actions, but declined to say publicly what the reasoning was; Molaghan says he was told it was for insubordination. Other problems cropped up over the years. There were battles between employees and management over salaries, workers’ efforts to unionize, and staffing levels. In 1999, six patients in the pediatric unit died from a viral infection that also sickened other patients. Health insurance lapsed for employees at one point when the owner failed to make a premium payment. A former administrator was placed on probation until he completed management training classes, and state inspectors discovered numerous problems and began stepping up their visits. Long term employees like Baker and Terry Major, a nursing assistant, say they were aware that the public perception of the nursing home was not a good one, despite the best efforts of the employees. “It didn’t have the best reputation,” says Baker. “Frankly, in no aspect of management did [the previous owners] do a good job,” adds Fritz. “There are many dedicated employees here who are devoted to helping people. But you’re never going to have a good nursing home without some consistency at the top.” Still, some staff have persisted at what can be difficult work, particularly in the pediatric unit.
Claire Lynch, a physical therapist who has been working at the center for 16 years, says not everyone can handle the emotional challenge of ministering to severely disabled children. “Some people have come up here and haven’t been able to stay,” she says. “But really what we’re trying to do is make someone more comfortable.” In the pediatric unit, special education teacher Carolyn Kipp has wheeled her three students close to one another for a lesson on fractions. She’s set up a small electronic spinner on a hand-drawn pie chart divided into four sections marked with percentages. She explains to 11 year old Daniel Gonzalez that it’s his job to press a switch on the front of his wheelchair which will activate the spinner. Then they’ll figure out what the percentage represents in terms of fractions. “And when we figure out the fraction, you’ll play with that amount of Play Doh,” says Kipp. “Are you guys ready to start?” The school setting at the Northampton nursing center is called the Hallmark Developmental School. Daniel and his two classmates – 12 year old Raymond Rodriguez and 9 year old Donesha Lynch like the other 30 patients on the pediatric ward, have profound disabilities stemming from brain injuries, rare disorders, and congenital problems. Most cannot communicate verbally-or at all-and virtually all have to be fed, some through tubes. Yet staff on the unit-teachers and teachers’ aides; physical, occupational, and speech therapists; nurses and nursing assistants-spend hours every day with them, trying to provide sensory experiences that relate to day-to-day life. It is impossible not to be moved by the gentleness with which they go about their work. In this case, Kipps helps Daniel press the switch-called a basic communication device –that activates the spinner. When it lands on a slot that says 25 percent, Kipps says, “And 25 percent is what in terms of a fraction? It’s one quarter.” She peels off a comparable amount of Play Doh from three clumps and presses them into the students’ hands. Gains on the pediatric unit are measured in subtle ways, Kipps explains. She notes that Donesha’s hands would recoil when she touched a new substance. Now, though, she is fingering the Play Doh ball. “That’s a big step for her,” she says, smiling at the girl. Lisa Jackstis, director of the Hallmark School, points out that many teacher’s aides and nursing assistants have spent years working with the same patients despite the past turmoil. “We have a great staff who try to make things as accessible as possible to the residents,” she says. Her aim, Jackstis says, is to expand on that work. “My goal is to get the least restrictive environment for our residents, and to give them as much control and different experiences as possible,” she says. With new ownership and management of the center, there finally has been money available over the past year for equipment like computers and renovations that have increased classroom space, Jackstis says. When she came to the facility a little over two years ago, funds were so short that she and other staff members were buying some supplies with their own money.
“Now we’re able to bring back a number of things that were eliminated, like field trips to the Big E, to Look Park, to the zoo,” says Jackstis. The center also has its own van now for transporting people on these trips, she says. Fritz, the nursing home’s administrator, says he hopes such improvements will boost admissions. Few children have moved into the pediatric unit over the last several years. Though there are 33 people there now, ranging in age from 5 to 50, the unit has room for 43. “People may have forgotten about us, or they’ve been put off by the building’s reputation,” says Fritz. “We’re looking to change that.” Jackstis and Kipp say they still need more staff. Another teacher and two or three teacher’s aides would be welcome. “But when you look at the big picture, there’s certainly been improvement,” says Kipp who’s been there for 2 ½ years. The facility was purchased last April by Northampton Health Care Associates LLC, a private for-profit company, for $3.5 million, after the company made a bid for the nursing home and the sale cleared the tangle of bankruptcy court. The company’s principal is Dr. Craig Flashner who owns other nursing homes in Massachusetts, including a nursing and rehabilitation center in Braintree that is also managed by Landmark, Although Landmark does not co-own the Northampton facility, three of its employees-Raso, chief operating officer Robert Baranello and principal John Albert-are minority owners of the nursing home. Raso, the executive director of the home, says that when Landmark took over a year ago, there were just 98 residents in the 166-bed facility.
“It was losing $1.6 million a year,” says Raso. “There were major problems.” Now, though, patient numbers are up to 130, reflecting the company’s belief that the nursing home could be turned around. “We saw a lot of potential,” says Raso. “We felt this was an important resource for the community, and that it had a lot of attractive things about it.” The pediatric unit is one of those assets, he says. Location is also key, says Raso, who notes that there are relatively few long-term care facilities in western Massachusetts. Baranello says that Landmark operates eight other facilities in the state, as well as one in New Hampshire, and specializes in clinical and financial management for long-term care centers. It’s built its reputation, he says, by reviving troubled healthcare units, and he projects that the Northampton facility is just about at the break-even point financially after losing money for years. Baranello says Landmark helped turn around a nursing home in Worcester a few years ago that was on a federal watch list for poor performance but earned a perfect inspection record in 2003 and favorable records in 2004 and 2005, according to state Department of Health records. “We focus on the details to run [facilities] as efficiently as possible,” says Baranello. “Good management strategies, good fiscal practices, and paying attention to critical issues of compliance and patient care.” State health inspectors, who are expected to visit the Northampton Rehabilitation and Nursing Center this month, noted four problems during their last inspection in October, down from 29 recorded during visits in April 2005 and October 2004. For his part, Fritz says he was drawn to work at the nursing home by the challenge involved in trying to improve it, and because he thought highly of Landmark, having worked with some of its consultants in a previous job. “I knew of the building’s reputation, but I also knew of its potential,” he says. Donna Rheaume, a spokesperson for the Department of Health, agrees that Landmark has “a good reputation” for its management practices and says that the most recent inspection of the nursing home last October, noted improvements. Some employees who also came on board after the change of ownership say they overcame reservations about the nursing home’s reputation to be part of the new effort. Lisa Oppenheimer, hired last year as the program director for the dementia unit, recalls that when she told friends she was considering a job at the Northampton center, their response was, “You’re going there? Why?” But Oppenhimer, a licensed practical nurse who previously worked in an Alzheimer’s unit in Agawam, knew Fritz and was attracted to the idea of building an activity program for the dementia patients and establishing stronger links with the patients’ families. “This is such back-to-basics nursing, where your job is to improve [patients’] quality of life,” she says. Still, for all of the improvements, Fritz says the new incarnation of the nursing home has a ways to go to reach optimum staffing levels. The center has about 80 certified nursing assistants; the staff that Stosz says “really determines the level of care people receive.” But Fritz notes that there are only 30 full-time and part-time licensed nurses, whereas the ideal number would be 50. The center, as many of the nursing homes do, hires temporary nurses through health agencies on a per day and more extended basis to make up the difference, Fritz says. To hire more permanent nursing staff, he says, the facility must compete with other institutions such as hospitals where nurses-in short supply-can earn better pay than in nursing homes. “Nursing improvement is pretty much our primary goal right now, but it is a challenge,” he says. Ann Jarvis, the West Springfield woman who has a son on the pediatric unit, says staffing numbers, not quality, always seemed to be the issue in the past. “The staff have always provided wonderful care,” she says. “But at times I could see they felt frustrated because they weren’t able to provide the level of care they were used to giving” because of staff and budget cutbacks. But in recent months, Jarvis says, she has seen some former employees return to the pediatric unit. “That’s a very encouraging sign to me, that people are feeling better about working here.” she says. Perhaps the biggest change for the nursing home has been opening the sub-acute care unit for rehabilitating people-often elderly-who are recovering from serious injuries or operations and no longer require hospitalization but aren’t yet ready to go home. It’s here that Richard Dufraine of Easthampton is taking some slow steps one day in early March. He is moving with the assistance of a walker, as occupational therapist John Healy stands at his elbow, offering encouragement. “That’s it-you’re doing fine, Rich,” says Healy. “Nice and slow and steady.” Dufraine moves step by step about six feet across the room to a small row of chairs, then slowly pivots 180 degrees, turning his walker to keep it in front of him, until his back is to one of the chairs. He lowers himself slowly, straining with the effort not to plop down suddenly, then lets out a big “whew” as he reaches the chair. “I need to catch my breath,” says Dufraine, a tall man with curly salt and pepper hair and a crooked grin. Dufrain, 59, is feeling good about his accomplishment. After injuring his spine in a car accident in early November, he says, he’s lost almost all his movement ability. Now, following two months in the hospital and another two in the rehabilitation unit, he’s progressed to using a walker and parallel bars for walking and can dress and feed himself, though not without difficulty. It’s been a lot of work-physical therapy and occupational therapy every day, says Dufraine, “but the staff has treated me really good.” A short distance away, June Sporbert, 75, sits in a chair and flexes a weighted bar above her head. Then Sporbert, who’s been recovering from a broken leg, stands up just as Dufraine did and crosses to another line of chairs with the aid of a walker. “Voila!” says Anne Eastwood-Lyn, director of the rehab program, who’s been monitoring Sporbert’s progress. “You’re really coming along well.” “Well, I’m glad,” answers Sporbert, who lives in Haydenville. She explains that she hasn’t been home since Christmas Eve when she fell and broke her leg. “I want to get home and see my babies” – her dog and two cats-currently being looked after by her daughter. Kathy Washut, the Florence woman whose mother, Lucy Grella, is also a patient in the unit, says Grella is finally on the mend after her husband (Washut’s father) died. She had become incontinent, could barely walk, and was starting to have black-out spells, Washut says, prompting her to move her mother to Calvin Coolidge Nursing Home in November. But Grella seemed to get worse, and after a move to Hampshire Care, another area nursing home, she was diagnosed at Cooley Dickinson Hospital with a neurological condition that required surgery. Grella’s case manager at the hospital suggested that she be placed in the sub-acute unit at Northampton Rehabilitation and Nursing Center for more intensive care before the operation. “He said they were really making some welcome changes [at the nursing home],” says Washut. But during Grella’s first few days in mid-February, Washut wondered if she had made a bad decision. First came an episode in which Grella was left unattended in her bed for two hours, despite her need for help with personal care. A day or so later, says Washut, Grella was left at a lunch table with brackets on her legs that had been used to move her from bed via a mechanical lift. The result? Welts on her legs.
“I was just about beside myself,” says Washut. She believes the mistakes occurred because instructions were not communicated between two shifts of employees. To their credit, she says, staff were apologetic, and Fritz, the administrator, also apologized and promised better treatment. A few days later, Grella underwent successful surgery at Mercy Hospital in Springfield, and since her return to the sub-acute unit for follow-up therapy and treatment, “The staff have been very good to her,” says Washut. “I think they are trying very hard to turn things around there.” In the pediatric unit, across the hall from where Carolyn Kipp is working with her young students on a March afternoon, Corie Baker, Terry Major and other staff members are playing a game of Yahtzee with residents of the Dayhab unit, including Gina White and Michael Seda. The patients have been grouped in a semicircle in their wheelchairs, and now Major, after placing the Yahtzee box cover on White’s lap, takes the woman’s hands in her own; together they scatter five dice from a plastic cup into the box top. “Let’s see, we have a three, another three two fours-we have a full house!” says Major. “We don’t have to go any further, Gina.” White smiles and moves her lips soundlessly. A roll that Major makes with Seda yields a pair of twos and a three, a four, and a six. “Hmm, looks like we only got a two-pair here,” says Major. “Should we go for something else?” Major, a nursing assistant, has seen many ups and downs in 25 years at the nursing center. She, like other longtime employees such as Baker, have stayed in large part because of her bond with the individual patients. She remembers caring for Dana Oliver, the 35 year old man, when he came into the unit as a ten year old, and she’s still very attached to him. Now Major says she’s encouraged by the recent changes at the center. “I think [the new] management is trying to do the right thing,” she says. “Everyone’s working on communicating better. And in the end, we’re all here for the same reason-to help the people we care for.”
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Northampton Rehabilitation and Nursing Center,737 Bridge Rd, Northampton, MA 01060 |
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