Cynthia Shelby worked for 15 years as a hospital nurse – including emergency rooms, ICUs, and medical/surgery – before she took a position as an Assistant Director of Nursing in a skilled nursing community in Ohio. As a hospital nurse, Shelby notes “You become a very good clinician and you have good diagnostic skills and you’re real quick on your feet.”
But skilled nursing is a different world. She adds, “Nobody just jumps into this field. It takes experience. You have to learn all the regulations and all the little pieces of the puzzle that have to get put together before someone can go home.”
For the past three years, Shelby has worked for Covia as a Regional Quality and Care Nurse, providing support to six Skilled Nursing Facilities, from Pacific Grove to Santa Rosa. She, along with other members of the Clinical Team, offers guidance on the complexities of skilled nursing, including regulatory requirements, preparing for surveys from state regulators, billing questions, staffing concerns, training, and even filling in for key roles as needed.
Covia offers skilled nursing care within its four Life Plan Communities and at Canterbury Woods, a multi-level community. Skilled nursing care “illustrates key parts of our mission,” says CEO Kevin Gerber. “It’s about the continuum of care and how the full team help residents transition through changes. Skilled nursing is also about the whole person – not just thinking about their physical needs, but all of their needs.”
Skilled nursing facilities “have always had a bad reputation and many joke it’s a death sentence,” says Connie Yuen, Healthcare Administrator at St. Paul’s Towers. “Yet, while skilled nursing care can be the final home for some who are frail and sick, it can also represent an environment to rest, strengthen and recuperate so one can continue living life and even return to a prior home. Working in skilled nursing care means that I have the privilege of providing great care to our residents during difficult times and uncertainty.”
May 10-16 is National Skilled Nursing Care Week. This year, it comes as skilled nursing facilities have become the face of the COVID-19 pandemic on top of the stereotype of the “nursing home.” Add in a few bad actors who skimp on care for profit, it is not surprising that the perception is negative.
The negative perception exists in the nursing profession itself. “I too was a nurse for years in big medical centers,” says Mary Linde, Executive Director at St. Paul’s Towers. “People thought I was nuts when I moved to long term care. But the beauty of the skilled nursing home is the relationship with the residents. Because it’s a long term relationship, the care can really be tailored to that person’s personal preferences.”
Far from causing a reduction in the care and services residents receive, the COVID-19 crisis has only encouraged new ways of serving Covia’s skilled nursing residents. “I have been astonished and amazed in the most beautiful ways at watching the staff adapt to how they do care,” says Linde. “Staff who are normally behind the medication cart are now finding ways to do one-on-one activities with residents. Because if they weren’t doing them, they may have times of isolation. They are innovating and caring in new ways, and it’s amazing to witness.”
Covia has been able to get staff the supplies they need, ordering Personal Protective Equipment (PPE) like masks in larger quantities and distributing to the different communities as needed. Shelby, as part of Covia’s COVID-19 Task Force, reports daily on the needs and concerns of the skilled nursing teams, as well as the creative solutions they are implementing – such as turning sections of the health care center into isolation areas should a COVID-19 positive resident need to be kept separate from others. During weekly Infection Prevention Zoom calls, team members share best practices, discuss concerns, and answer questions to ensure that the Covia’s health care services are prepared for what might happen next.
“We’re making history,” says Shelby. “We’re doing things we’ve never done before. We’re introducing lots of new technologies, new ways of doing things, new ways of communicating to our families. Everyone as a team comes together for that.”
“I get to work with a team of intelligent, compassionate, kind individuals that provide and coordinate care to older adults with various healthcare needs,” says Yuen. “Together, we promote healthy aging, safety, well-being, quality of life, dignity and meaning if one becomes more frail towards the end of life.”
“What happens over time is love,” says Linde. “The care is driven by that relationship and there’s not another word for it. It is love that happens there.”
In January, Webster House welcomed Mehrad “Rod” Moshiri as its new executive director. He’s spent his first month getting to know the community, both staff and residents.
“The first thing that I think I noticed about Webster House is that people care,” he says. “From the line staff to upper management, everybody cares about the residents who live here, which is great. Everything else can be learned. People caring is something you either have it or you don’t.”
After emigrating to the Bay Area from Iran in 1988 at the age of 15, Rod attended San Jose State University, getting a Bachelor’s degree in Occupational Therapy. His first job was as an Occupational Therapist in a Skilled Nursing Facility in Alameda. After that, he moved to San Francisco where he worked first as a rehabilitation manager, then became a case manager and director of case management while at the same time earning his MBA. Meanwhile, he learned of an opportunity to enter an Administrator in Training program: “I applied, I got in, and got my Masters and became an Administrator at the same time.” After getting his Administrator’s license and MBA, Rod managed Skilled Nursing Facilities for about 16 years.
Because Rod’s prior experience has mostly been as the administrator of places like Webster House Health Center, one of his first goals is to get more exposure to the Independent Living side of the community. In his short time here so far, he’s visited the dining committee, the financial study group, and presented at his first Fireside Chat – an all-community update that happens monthly – as well as getting to know individual residents.
“We have the greatest residents,” he says. “They’re very welcoming. They’re very casual. They’re more than happy to converse with people that are interested and letting them know why they’re here,” such as the fact that they can walk half a block to get to downtown Palo Alto.
His first impression of Webster House Health Center, which provides rehabilitation services and skilled nursing, is that “for the size of the health center, it’s a smooth running operation. And that’s typically not achievable unless you have competent people in place. Room for improvement? Always. But looking at it from a global perspective, it’s a smooth-running operation.”
“Because I have the background and experience in the health center side, I would confidently tell people that the care they will receive here is by far much better than 85-90 percent of the skilled nursing facilities in the area,” he says.
Rod was drawn to the position because Webster House and Covia have a good reputation as an employer in the area of senior living. The Assistant Executive Director of St. Paul’s Towers, Maggie Youssef, and Rod had worked together previously and “she spoke very highly of the company,” Rod says. “I can tell you that everyone I have met so far has been great. And I do get emails saying, ‘Everything OK? Do you need anything?’ Knowing that I’m newer to the position, knowing that I may need something, they’re taking the first step to reach out to me before I reach out to them, which is wonderful.”
Being the Executive Director of a Life Plan Community is not an easy role to fill. “You need to be able to wear multiple hats. You need to be able to think on your feet. You need to be able to put out fires right away. And you need to be able to remember that you’re dealing with people’s lives,” Rod says. “It is a tough business. Different personalities, different challenges, different situations. That’s what’s tough about it.”
At the same time, “You can make a difference in people’s lives and well-being,” Rod notes. “What I like about it is that there are no two days that are the same. It never gets boring.”
Especially with so many interesting people around. “I love and welcome conversations. I live by the fact that I have an open-door policy. I invite people to come in and say hi to me in my office. I’m enjoying every day that I’m here and I’m learning a lot.”