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Director of nursing feels right at home TUESDAY, APRIL 30, 2013

A special supplement to the AUSTIN DAILY HERALD

Teresa Stewart is the director of nursing at Grand Meadow Healthcare Center, where she has worked in various roles since 1999. Matt Peterson/

Since 1999, Teresa Stewart has been a fixture at the GM Healthcare Center By Matt Peterson

Anybody who has spent time at Grand Meadow Healthcare Center has likely seen Teresa Stewart. The dedicated care professional has worked there since 1999 and within months became a certified nursing assistant. Now, she’s the director of nursing. While her increased responsibility over the years has meant more administrative work and time behind a desk, Stewart still has a passion for the one-on-one care. She needs to get out of the office and move. “I don’t wear dress clothes to work very often,” Stewart said Monday, clad in scrubs that matched her co-workers. Grand Meadow Healthcare Center primarily serves elderly residents who have been discharged from hospitals, need rehabilitation, need pain management or can no longer live at their own homes.

“Anything that is needed once they are discharged from the hospital,” Stewart said. The facility currently has 28 residents and can house 43. Stewart can’t remember anywhere near how many residents she’s seen in 14 years, but she has gotten to know plenty of them quite well. Joking and lightening the mood, discovering how each person prefers a certain routine or simply being there for someone are all parts of the job. After all, some of these residents see Stewart and the nursing staff almost every day. There needs to be a comfort level. “We know our residents probably better than I know my parents,” Stewart said. Clearly, Stewart’s supervisor saw her dedication and promoted Stewart to director of nursing. “She generally cares for the people she works for,” said Megan Kleinsasser, executive director. “She knows the facility inside and out.”

“We know our residents probably better than I know my parents.”

-Teresa Stewart




Senior Living


Machines help hospitals combat ‘superbugs’ Associated Press

NEW YORK — They sweep. They swab. They sterilize. And still the germs persist. In U.S. hospitals, an estimated 1 in 20 patients pick up infections they didn’t have when they arrived, some caused by dangerous ‘superbugs’ that are hard to treat. The rise of these superbugs, along with increased pressure from the government and insurers, is driving hospitals to try all sorts of new approaches to stop their spread: Machines that resemble “Star Wars” robots and emit ultraviolet light or hydrogen peroxide vapors. Germ-resistant copper bed rails, call buttons and IV poles. Antimicrobial linens, curtains and wall paint. While these products can help get a room clean, their true impact is still debatable. There is no widely-accepted evidence that these inventions have prevented infections or deaths. Meanwhile, insurers are pushing hospitals to do a better job and the government’s Medicare program has moved to stop paying bills for certain infections caught in the hospital. “We’re seeing a culture change” in hospitals, said Jennie Mayfield, who tracks infections at BarnesJewish Hospital in St. Louis. Those hospital infections are tied to an estimated 100,000 deaths each year and add as much as $30 billion a year in medical costs, according to the Centers for Disease Control and Prevention. The agency last month sounded an alarm about a “nightmare bacteria” resistant to one class of antibiotics. That kind is still rare but it showed up last year in at least 200 hospitals. Hospitals started paying

By the numbers


Estimated number of deaths tied to hospital infections each year.

$30 Million

Estimated annual medical cost added by hospital infections. attention to infection control in the late 1880s, when mounting evidence showed unsanitary conditions were hurting patients. Hospital hygiene has been a concern ever since, with a renewed emphasis triggered by the emergence a decade ago of a nasty strain of intestinal bug called Clostridium difficile, or C-diff. The diarrhea-causing Cdiff is now linked to 14,000 U.S. deaths annually. That’s been the catalyst for the growing focus on infection control, said Mayfield, who is also president-elect of the Association for Professionals in Infection Control and Epidemiology. C-diff is easier to treat than some other hospital superbugs, like methicillinresistant staph, or MRSA, but it’s particularly difficult to clean away. Alcoholbased hand sanitizers don’t work and C-diff can persist on hospital room surfaces for days. The CDC recommends hospital staff clean their hands rigorously with soap and water — or better yet, wear gloves. And rooms should be cleaned intensively with bleach, the CDC says. Michael Claes developed a bad case of C-diff while he was a kidney patient last fall at New York City’s Lenox Hill Hospital. He and his doctor believe he caught it at the hospital. Claes praised his overall care, but felt the hospital’s

room cleaning and infection control was less than perfect. “I would use the word ‘perfunctory,’” he said. Lenox Hill spokeswoman Ann Silverman disputed that characterization, noting hospital workers are making efforts that patients often can’t see, like using hand cleansers dispensers in hallways. She ticked off a list of measure used to prevent the spread of germs, ranging from educating patients’ family members to isolation and other protective steps with each C-diff patient. The hospital’s C-diff infection rate is lower than the state average, she said. Westchester Medical Center, a 643-bed hospital in the suburbs of New York City has also been hit by cases of C-diff and the other superbugs. Complicating matters is the fact that larger proportions of hospital patients today are sicker and more susceptible to the ravages of infections, said Dr. Marisa Montecalvo, a contagious diseases specialist at Westchester. There’s a growing recognition that it’s not only surgical knives and operating rooms that need a thorough cleaning but also spots like bed rails and even television remote controls, she said. Now there’s more attention to making sure “that all the nooks and crannies are clean, and that it’s done in as perfect a manner as can be done,” Montecalvo said. Enter companies like Xenex Healthcare Services, a San Antonio company that makes a portable, $125,000 machine that’s rolled into rooms to zap Cdiff and other bacteria and viruses dead with ultraviolet light. Xenex has sold or leased devices to more than 100 U.S. hospitals, including Westchester Medical Center.

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Senior Living

A special supplement to the AUSTIN DAILY HERALD



Stewart: ‘It feels like a huge family’ From Page 1 Stewart has continuously advanced her career since the day she started. She attended Riverland Community College, became a CNA, got her Assisted Living Facilities certification, became an LPN, an RN and most recently director of nursing in 2011. Over time, she has become a problem solver, whether that means training, coming to work while on call or learning the needs of new residents. Yet Stewart and her co-workers are always

looking for ways to make their facility more efficient, so residents can receive more services where in some cases they’d have to go back to a hospital. One recent change included switching from paper logbooks to touchscreen computers. “The goal is to catch things before they get out of control,” Stewart said. Of course, with any career, challenges arise. Stewart is used to that. “The first week, that’s where you see the challenging parts of learning them or what they like,”

Teresa Stewart works at her desk Monday morning at the Grand Meadow Healthcare Center, where she does a little bit of everything. Stewart said about serving newcomers.

Still, things work themselves out. Soon

enough, everybody feels at home.

“It feels like a huge family,” Stewart said.

Nursing home week begins May 12 and runs through May 18. Grand Meadow Healthcare Center will host a list of activities with local support during that time.

VA withholds disability claims executives’ bonuses Associated Press

WASHINGTON — The Department of Veterans Affairs is withholding bonuses for senior officials who oversee disability claims, citing a failure to meet performance goals for reducing a sizable backlog in claims processing. The backlog has increased dramatically over the past three years, and the department has come under intense criticism from veterans groups and members of Congress who have asked President Barack Obama to try to speed the process. VA spokesman Josh Taylor said Monday the savings would be used to help reduce the backlog. He didn’t provide specifics,

nor could he say how many people would be affected or how much the savings would be. The withholdings apply only to executives of the Veterans Benefits Administration, which is part of the VA. “We remain confident that VBA senior executives are dedicated to our nation’s veterans, and they will continue to lead our drive toward VA’s goal: eliminating the claims backlog in 2015,” Taylor said. In all, records show the VA paid its senior executives a total of $2.8 million in bonuses in fiscal year 2011. Among the VBA bonuses, three staff members received the top payment of $23,091 each. The amount of the

bonuses was first reported by the Center for Investigative Reporting. The number of disability claims pending for longer than 125 days jumped from less than 200,000 to nearly 500,000 in fiscal 2011. “How does the department expect to turn things around when it is rewarding employees and managers for falling behind?” said Rep. Jeff Miller, the Republican chairman of the House Committee on Veterans’ Affairs. The VA and other federal departments routinely give bonuses to Senior Executive Service workers and other nonpolitical employees.













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Senior Living


A special supplement to the AUSTIN DAILY HERALD

Health care’s ‘dirty little secret’: No one may be coordinating care By Roni Caryn Rabin Kaiser Health News

Betsy Gabay saw a rotating cast of at least 14 doctors when she was hospitalized at New York Hospital Queens for almost four weeks last year for a flare-up of ulcerative colitis. But the person she credits with saving her life is a spry, persistent 75-year-old with a vested interest — her mother. Alarmed by her daughter’s rapid deterioration and then by her abrupt discharge from the hospital, Gabay’s mother contacted a physician friend who got her daughter admitted to Mount Sinai Medical Center in Manhattan. By then, Gabay, 50, had a blood clot in her lung and a serious bacterial infection, C. difficile. She also needed to have her diseased colon removed, according to the doctors at Mount Sinai. Had the problems been left unaddressed, any one of them might have killed her. Coordinated care is touted as the key to better and more cost-effective care, and is being encouraged with financial rewards and penalties under the 2010 federal health care overhaul, as well as by private insurers. But experts say the communication failures that landed Gabay in a rehab center, rather than in surgery, remain dis-

turbingly common. “Nobody is responsible for coordinating care,” said Dr. Lucian Leape, a Harvard health policy analyst and a nationally recognized patient safety leader. “That’s the dirty little secret about health care.” Advocates for hospital patients and their families say confusion about who is managing a patient’s care — and lack of coordination among those caregivers — are endemic, contributing to the estimated 44,000 to 98,000 deaths from medical errors each year. A landmark report by the Institute of Medicine in 1999 cited the fragmented health-care system and patients’ reliance on multiple providers as a leading cause of medical mistakes. Leape, who helped author that report, says there have been improvements since, but “we have not done enough.” Subsequent studies suggest the toll may be even higher than the Institute of Medicine estimated. A 2010 federal report projected that 15,000 Medicare patients every month suffered such serious harm in the hospital that it contributed to their deaths. Gabay experienced such shortcomings firsthand. During her 26 days in the Queens hospital, she


said doctors would do rounds and “I couldn’t tell one name from the next. I didn’t know whether it was the gastroenterologist, or the nutritionist, or the physical therapist.” When she was discharged to a rehab center, she was suffering from acute abdominal pain and bloody diarrhea, and was too weak to get out of bed. “I thought I was being sent there to die,” said Gabay, who made a complete recovery once she was treated at Mount Sinai for the infection and blood clot and her colon was removed. Officials at New York Hospital Queens numerous declined requests for comment, citing patient confidentiality.

orchestra conductor pulling it all together,” said Robert M. Wachter, chief of hospital service at UCSF Medical Center in San Francisco, who coined the term “hospitalist” in 1996. “I may only spend a few minutes in the [patient’s] room, but the other subspecialists are communicating to me, and I’ll integrate it so we give the patient one uniform message.” But that system is vulnerable to breakdowns. Patients and family members meet hospitalists, along with many other medical specialists, when they’re in crisis. Even when hospitalists explain

their role, patients may be too overwhelmed – or ill, medicated, or disoriented — to absorb the information. As a result, they often don’t distinguish the hospitalist from the dozens of other caregivers they see. “Unless the patient has

written it down, they will say, ‘Someone was here, but I don’t remember what they said,’” said Ilene founder of Corina, PULSE, a nonprofit organization in New York that works to improve patient safety.

A new set of doctors Patients such as Gabay are often surprised to discover that the primarycare physician with whom they have an ongoing relationship isn’t the doctor overseeing their hospital care and is unlikely to be informed about their progress. Instead, hospitals have staff doctors called hospitalists who are supposed to manage a patient’s care, coordinating the various specialists, managing medications and then overseeing the transition back home. “I see my job as an



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