Ten years after Inglis House set out to transform its hospital environment into six “wards,” executives at the Philadelphia-based long-term care facility have had to balance staffing issues and the COVID-19 pandemic with their aim to provide people. centered care.
Inglis House provides long-term residential care to 252 adults with physical disabilities including multiple sclerosis, cerebral palsy, spinal cord injury and stroke, among others.
Each ward has all private rooms, a solarium with shared dining and a hand-painted mural selected by those who live and work in that particular wing and a ‘less intrusive’ nursing station, the everything aimed at moving away from a more institutional framework.
“We had to keep pulling staff from one neighborhood to another, which hinders the cohesion of this team,” said Inglis President and CEO Dyann Roth. “The team isn’t just the staff together, the team is the residents and staff together so I would say it took a hit – the path to this person-centered approach has taken a hit.”
Skilled Nursing News spoke with Roth last month to discuss this topic and more, including the facility’s efforts to curb the ongoing staffing crisis.
What makes Inglis House different from another qualified nursing facility?
First and foremost the age of our people. The residents here are, at this point, and we’re getting older, but I think we’re in a middle age of our late forties, early fifties. The mandate for the people, we have people who have been here for 46 years because they are in their twenties. Our elderly people are therefore people who have aged here. We have a very dynamic, active and engaged community. Most of our residents would react negatively to Inglis House being labeled as a qualified nursing facility. They call it a wheelchair community and they don’t understand why we have to comply with all nursing home regulations.
So sometimes it’s a little bit difficult dynamic, because we absolutely have to comply with all nursing home regulations and we are all under the same pressures, but we employ a higher rate – our budgeted staff. [hours of care per resident/day] The PPD is 5.7. In this workforce crisis, I think it makes us very similar to other facilities, it is difficult to meet our budgeted staff ratio. We’re way beyond Pennsylvania’s minimum staffing ratio, but it’s still not at the level we need for our people with their needs.
How has Inglis House handled this ongoing staffing crisis and in what ways have you tried to alleviate some of these issues?
I mean we were, I think, affected by the growing personnel crisis before the pandemic. I would say we’ve done a lot to recruit, and we’ve raised the salaries, and we’ve done all kinds of signing bonuses and incentives to take extra shifts, on the cash side. [of things].
We have a very good relationship with our union. So we try to solve any kind of other needs or problems. When the pandemic hit and we had a workforce affected by their children not attending school, we converted an empty space at a nearby campus in partnership with a local daycare to create a virtual school for the children of our frontline workers. I mean we have tried to creatively meet every possible need. But it’s still very, very hard. I think a lot of people left this job during the pandemic and a lot of people are not going into this job. We were affected by the virus just like other facilities, once it got in before we had the PPE and the tests and then the vaccines, we lost people, we lost 12 residents because of Covid last year and we lost a staff member.
The virus has had an impact on an already difficult workforce situation. I think at this point we’re really, again, we’re going with all the incentives and compensation elements, but we’re also now looking at how to partner with our union and with other partners.
Inglis House, because of its longevity, but also its creative, young and dynamic population, has attracted many schools to do internships as well as… for occupational therapists and physiotherapists and nursing students, it is a very good learning environment and therefore we are now trying to capitalize on that and develop our own. I don’t know what else to do other than cultivate ours at this point.
Have you used recruiting agencies at this stage?
Yes, we have … I think we have contracts with nine or 10 agencies. We shoot them all the time but they don’t have a lot of people to offer us. We even signed a contract with the traveling nurses in order to be able to relieve them a little. They need to take time, I mean I’m going to cry if I talk about how hard they have worked risking their lives and their losses, then we want to give them some relief, otherwise they will leave too.
What was the impact of the delta variant on Inglis?
We have five neighbors and we have converted an empty neighborhood into a red zone. We choose not to open for new admissions due to staff pressures we are under, I don’t think it’s wise to add to the pressure.
That said, we were able to open up to sightseeing, community driving, starting our group activities in a safe way – I mean that’s the heart and soul of Inglis House, vibrant connected living. All of a sudden we had one positive staff member, two positive staff members, and in a week and a half I think we had 12 positive staff members, and four of them were vaccinated people . Then we started doing our universal tests on residents and staff, and then we had four positive residents among the vaccinated residents, so they’re in the red zone. All the districts are in yellow zones, everything is closed again. So I think when you have hope and it crumbles again, it’s even more depressing.
Last Friday, the city of Philadelphia made vaccines mandatory for all healthcare workers in Philadelphia. We have therefore responded to this mandate this week by deploying a mandate in all our entities in Inglis, with the potential for exemptions for religious and medical reasons. We’ve had immunization clinics every week, but we haven’t had a lot of staff on staff, so hopefully the mandate will have an impact on reducing those numbers.
Where is your vaccination rate for residents and staff at this stage?
Our residents it was 95 to 98% – our residents were like signing up, and now they’re going to be the first in line for reminders. Our staff at Inglis as a whole is around 49% and our staff at Inglis House is around 42%.
With all of the health care providers in Philadelphia having to comply with this mandate, I think it kind of level the playing field. But I think some people will choose to leave health care.
In 2011, Inglis officially launched a multi-year initiative to transform Inglis House into a more person-centered nursing home community. Now, 10 years later, what does that transition look like and where are you now with the transition?
A lot has happened in these 10 years. I wasn’t here until 2017, but part of that transition was converting the traditional care units into neighborhoods that have their own kind of culture and flavor and a cohesive team of people, and the design of this n is not a traditional care unit. We all have private rooms so everyone is really encouraged to decorate their room however they want, so very person-centered that way. When I got here we had a lot of training that included the residents in the staff training.
I would say with the staffing pressures, with the regulatory pressures and more recently with this pandemic… We haven’t been able to do all of the ongoing work around the relational part of the person centered that we want.
I would also say that our physical setup is not ideal for being person-centered. It’s a big, old building, beautiful. It was built to last, so it’s very difficult to modify. I think the greenhouse model is probably a lot more suitable as they are smaller and more like home just by design.
I think we have some things just by the structure of Inglis House that kind of hamper our progress in person-centered design. Our goal is just to get back to stabilizing our staff, starting with nursing, and I think that’s the heart of building a person-centered practice.
You talked a bit about some of the constraints with the building that you currently have, can you tell me a bit about this neighborhood idea and what it looks like physically for the residents?
Inglis House is a huge U-shaped building. When we downsized in 2015-2016, we closed the central units in that U. So we have 40-50 private rooms in one wing, and we have a south wing. and a north wing with three floors each. The design of the neighborhood… They have a solarium, which is their common dining room with a housewife. There is a nursing station in the middle of this neighborhood, but it was designed to be less intrusive than a typical nursing unit and there are painted murals that everyone participated in.
Where do you see the future of Inglis House and what are your goals?
I think the short term is really just to stabilize the staff and, honestly, to strengthen some of the other supports for our people. We have a significant percentage of people with mental health needs, so one of our goals is to really strengthen our ability to support people in a very holistic way. And, I think, to continue to really focus on the quality of care. Again, we have very complex needs, so we need to focus on… not only preventing COVID infections, but UTIs and the like as well. So I think we’re really focusing on quality and continuing to refine our release planning tools and processes – healthy and safe releases.
So we have a lot more qualitative work that we’re really trying to tackle while still surviving this period.