Gateway Senior Living
Lincoln, NE
A little bit about Gateway
• The first retirement community in the city of Lincoln,
built in 1963
• Independently owned by Russell V. Peterson
• Dual licensed: Duplex unit, 54 ALF apartments & 18 SNF beds
• Amy Fish hired in 2007, with 22 years of healthcare
administrative experience, licensed preceptor for the state
• 80 staff members: nursing, therapy, dietary, activities,
social services, administration, & environmental services
• Participates in the Medicare, Medicaid, and Medicaid
waiver programs
• Current occupancy is 98%
Goals of Mission Retention
Improved orientation to the campus
Improved training systems
Enforcement of personnel policies
Better management of staff & resident needs
More involvement of direct care staff
Routine measurement & evaluation of our
Day-to-Day Applications of
Mission Retention
FISH philosophy
Employee Booster Committee
Other committees: safety, QA, RSP
Dish with Fish
“Are We Meeting Your Expectations”
“Caught ya Caring” cards & program
Communication tools: newsletter, caretracker, etc.
Training programs on teamwork & customer service
Enforcement of the attendance policy
Interviewing & Hiring practices
Impromptu moments & celebrations
Balanced Scorecard Measurements:
Turnover statistics
Staff Satisfaction Survey questions:
Overall Satisfaction
Quality of Teamwork
Quality of Inservice Education
Recommendation for job
Recommendation for care
Staff to Staff Communication
Safety in the Workplace
Staff Satisfaction Survey return rate:
At the End of the Day
It’s Really Very Simple…….
and doesn’t cost a lot!
Maintaining Higher Occupancy A joint program to increase resident's
length of stay by managing difficult
Kathy Pietrocola
Executive Director
The Chelsea at East Brunswick
Mission Possible: Changing Culture,
Changing Practice, Changing Care.
A joint venture with NJ Geriatric Education
Center, the NJ Division of Mental Health
Services and the Department of Health and
Senior Services
Purpose of program
to enhance overall capacity to better serve those in
our care
to develop a site specific behavioral management plan
to increase resident length of stay
Our initial interest in the University
Behavioral Health Program:
We have two programs that we felt could
benefit from an innovative team approach.
The Country Cottage – Dementia Program
The Crossings Program – unique to assisted
living designed for residents with a psychiatric
Goals for our involvement:
to maintain higher occupancy and length of stay by creating
unique approaches to challenging care needs
to try new approaches for challenging behaviors rather than
medication alone
to decrease instigating triggers
to provide individualized care by increasing staff awareness
to create alternative responses to resistant behavior
to foster a staff “buy in” to the concept that some behaviors can
be changed/avoided with proper early interventions and
Team approach
We attended the meeting as a team:
Exec Dir, RN, Cottage Dir, Certified
Medication Aides and CNAs
 Met as a group during our training to decide
what our focus would be and we decided our
dementia program would be our starting
Know your resident
The Cottage Director took photos of each cottage
resident and put them in a photo album.
She then created a “getting to know you” sheet
about each person.
These sheets were then placed on the opposite side
of the resident’s picture in the photo album.
All staff was required to read over the information
and get to know the residents in a new way.
Selecting our first residents
As a group, we selected residents we felt had
specific behaviors we could address.
Resident #1 had lived in our AL community for
years and had been transferred to the Cottage.
Resident #2 was new to our community and was
directly admitted to our Cottage.
Resident #1
Targeted behaviors–
unstable wandering
touching (and often ripping) anything within her
limited focus
Targeted approaches –
sensory table with sensory videos
sensory boxes
staff awareness
Resident #2
Targeted behaviors–
exiting the secured area
extremely difficult to redirect
very limited verbal skills
Targeted approaches –
creation of the “Walking club”
Walking Club
Our results after two weeks
Resident #1
– was calmer
– had periods of engagement with the sensory
– increased staff interactions
Resident #2
– responded well to the walks
– less exit seeking behavior
Resident #1 and #2 today
Resident #1 just recently moved to a nursing home
with overall physical decline and a need for 24 hour
nursing supervision. We were able to keep her in
our community six months longer using the new
techniques and methods.
Resident #2 is doing well. Continues to participate in
the walking club and is overall, more content. There
is no longer a discussion of not being able to care for
him in our community.
Ongoing efforts
As with any new program, change is constant
so we continue to adapt our plan using new
What works this week may not next week.
We currently have two new residents who
are sundowning with extreme agitation, and
we are now looking at options to avoid the
triggers for them.
Looking to the future . . .
New ideas we feel may be successful–
Creating a “Sensory Aide” position.
responsibilities will include:
ensuring that the sensory plans are carried out each day
– maintaining the equipment for the program
– training new aides
Expand program to The Crossings
Create interventions for:
social isolation
– anxiety
– lethargy
Creating real life-changing
for nursing home residents and staff
since 1994
What is Wellspring
A quality improvement program that:
 fosters culture change (e.g., resident-
directed care, staff empowerment, a
homelike environment)
 assists participating senior care
organizations through ongoing education
and support
Wellspring History
 Launched in 1994 in Wisconsin as the
Wellspring Innovative Solutions for
Integrated Health Care
 Was one of the first efforts to affect
culture change
 Has assisted nursing homes throughout
the country in advancing excellence in
their settings
 Now part of The Beacon Institute
Core Principles
 Care decisions need to take place at the
level closest to the resident
 A substantial knowledge base is required
by all staff to equip them to participate in
decision making
 An empowered workforce increases
resident and employee satisfaction and
reduces staff turnover
Why Wellspring?
Customized Programming
Recognizing that every nursing home is
different in terms of its staff, resident
population, physical plant, resources, and
other factors, Wellspring tailors
implementation strategies to enable a nursing
home to participate in Wellspring regardless
of where they are on their journey of culture
Why Wellspring?
There is no need to make expensive changes
to the physical environment or invest large
sums of money. There are options to
participate in Wellspring for every budget.
Wellspring Achieves Results
Research has demonstrated that Wellspring:
 improves the quality of care, resident satisfaction,
employee satisfaction
 helps to reduce pressure ulcers, falls, incontinence,
weight loss, restraint usage, immobility, and
psychotropic drug use in residents
 increases resident and staff satisfaction
Wellspring Education
Workshops address Best Practices and timely topics:
Culture Change 101
Culture Change Nurse Coordinato Preparation
Leading Culture Change
Leadership for Frontline Staff
Observing and Understanding the Older Adult
Best Practices in Elimination and Incontinence Care
Nutritional Needs from a Holistic Perspective
Restorative Care for Falls Prevention
Best Practices in Pressure Ulcer Prevention, Identification, and
Best Practices in Caring for Persons with Dementias
Holistic Palliative Care
Best Practices in Infection Control
Wellspring Education
But dynamic classroom instruction isn’t
Wellspring has developed strategies to
assist with the most challenging aspect of
education: real life implementation
Wellspring Program Options
There are a variety of ways that a nursing
home can participate in the Wellspring
Program based on their unique
characteristics, budget, and progress
on their culture change journey
Wellspring Program Options
Culture Change Launch Program
Consists of:
 Onsite presentation of three full day educational programs:
 Culture Change 101
 Culture Change Nurse Coordinator Preparation
 Developing Best Practice Teams
 The nursing home is responsible for proving the site for the
program, participant food, an LCD projector, and reproduction of
handout materials.
 Nurse consultation via email for one year
 The monthly Wellspring e-letter and updates for one year
Wellspring Program Options
Alliance Member
An Alliance consists of 8-10 nursing homes that are located within
several hours’ driving distance of each other. The Alliance
members contract to be part of the Alliance and:
 Participate in the same Wellspring educational modules
 Receive nursing consultation by the same nurse consultant(s)
 Each have a staff person designated as their Wellspring
Coordinator who networks and participates in meetings with
other Alliance Coordinators
 Input monthly data using My InnerView which is compared
among Alliance members
 Receive the monthly Wellspring e-letter and updates
Wellspring Program Options
Individual Wellspring Workshops
and Consultation Services
 An individual nursing home can purchase educational
programs and consultation based on individual needs
without committing to the full implementation of the
Wellspring model.
The Business Case for Wellspring
Wellspring is an investment which leads to
increased efficiencies resulting in cost
savings and enhanced revenue.
Research shows that among Wellspring’s
benefits are reductions in resident falls,
pressure ulcers, incontinence, and staff
The Business Case for Wellspring
Consider the following costs:
 $4,000+ Turnover cost for one nursing assistant
 $15,000+ Turnover cost for one nurse
 $5,300+
Nursing home added expense related to a fall
 $11,000
Treatment of facility acquired pressure ulcer
 $4,000
Annual cost for incontinence care per resident
 $2,000
One day consultant visit to address a problem
Just one occurrence of each of the above could cost $41,300, in
addition to the nonfinancial costs that result (reputation, morale,
poor ratings, etc).
This is several times what it would cost to implement the full
Wellspring Program.
Invest in Your Future!
Join the leaders who improved the
quality of care & life for residents,
and the quality of work for employees
by implementing
The Wellspring Program
Sandy Douglass, CEO/Administrator
The Methodist Home of DC
[email protected]
For more information…
Isabella Firth
Beacon Institute President
[email protected]
Charlotte Eliopoulos
Wellspring Executive Director
[email protected]
Wellspring web site:

Gateway Senior Living Lincoln, NE