By Sarah Johnson

Missourian Staff Writer

Cedarcrest Manor nursing home in Washington has been chosen as one of the 145 nursing facilities in seven states to participate in an initiative to reduce avoidable hospitalizations of its residents.

“It’s a huge deal,” said Dana Bailey, Cedarcrest admininistrator.

The program is being funded by a $14.8 million four-year grant awarded to the University of Missouri Sinclair School of Nursing from the U. S. Department of Health and Human Services Centers for Medicare and Medicaid Services (CMS).

It is the largest research grant ever awarded to the university.

Under the grant, Cedarcrest was able to employ the services of Ginny Mezei, an advanced practice registered nurse (APRN), who has specialized knowledge of INTERACT II, a quality improvement program that improves the recognition, assessment and management of conditions that are common causes of hospitalizations for aging adults.

According to CMS, nearly two-thirds of nursing facility residents are enrolled in Medicaid, and also are enrolled in Medicare. Research has found that approximately 45 percent of hospitalizations involving Medicaid-Medicare enrollees in nursing facilities is avoidable.

Total costs for these patients in 2011 has been estimated between $7 billion and $8 billion.

Recognize Signs

Although one of the outcomes of the program is to save Medicaid and Medicare money, Bailey said the program will guard the well-being of nursing home residents.

Hospitalization can be a traumatic experience for residents, she said, because they don’t adapt well to a sudden changes in their environment.

“When they look at residents who go to the hospital and come back, they come back a different person because they’ve been in a different environment,” she said. “Because they have been sick, they are not up and active so they may come back more debilitated and in a different mental state.”

Bailey said that residents exhibit small behavior changes about 10 days prior to an acute illness that could require hospitalization. Through the program, Mezei will teach staff at Cedarcrest and even residents’ family members how to recognize those changes.

“For example, someone in dietary may notice that Mrs. X, who usually cleans her plate, hasn’t been eating as much,” Bailey said. “Or someone in housekeeping might notice another resident doesn’t want the blinds open and is not as cheerful as they are normally.”

Certified nursing assistants also are learning to recognize symptoms of different illnesses.

Angie Reising, director of nursing at Cedarcrest, said aids who notice something amiss about a resident can pick up a “stop and watch” form that will alert nurses of a potential problem.

“The aides are learning things like how to recognize a (urinary tract infection), like what urine would look like, things like that,” she said.


Mezei said the program also is geared toward developing better communication with hospital staff. By the end of this month, a Caremail system will be in place that will allow Cedarcrest to send patient information in an encrypted email to physicians without violating HIPAA laws.

“This will allow us to send information to the hospital before residents get there so they won’t have repeat information or tests and we can give them a better history,” she said.

The communication also will allow physicians to relay treatment information back to Cedarcrest.

“We will know what they did there so when they come back we’re not doubling up on X-rays or blood work, which will increase costs,” Reising said.

Bailey said she thinks the program could set a standard for all nursing homes nationwide.

“I think once they’ve proven that the INTERACT tools provide a better quality of life for residents by keeping them in their home environment that they will want all facilities to use them,” she said. “It’s a big thing for Washington and for Cedarcrest.”