Taking Healthcare by Storm: Industry Insights with Christina Starcher

In this captivating episode of Taking Healthcare by Storm, delve into the world of expert insights as Quality Insights Medical Director Dr. Jean Storm engages in a thought-provoking and informative discussion with Christina Starcher, NHA, Senior Nursing Home Administrator at Cedar Ridge Center in West Virginia. 

If you have any topics or guests you'd like to see on future episodes, reach out to us on our website. 

This material was prepared by Quality Insights, a Quality Innovation Network-Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication number 12SOW-QI-ARPA-110824-GK

Transcript

Welcome to "Taking Healthcare by Storm: Industry Insights," the podcast that delves into the captivating intersection of innovation, science, compassion, and care. 

In each episode, Quality Insights’ Medical Director Dr. Jean Storm will have the privilege of engaging with leading experts across diverse fields, including dieticians, pharmacists, and brave patients navigating their own healthcare journeys. 

Our mission is to bring you the best healthcare insights, drawing from the expertise of professionals across West Virginia, Pennsylvania and the nation.

Subscribe now, and together, we can take healthcare by storm.

 Hello everyone and welcome to another episode of taking health care by storm I am dr Jean storm the medical director of quality insights and I am so excited To be joined by our guests today We are joined by christina starcher Nursing Home Administrator, QCP. She is currently the Nursing Home Administrator at Cedar Ridge Center, though she's also been the Administrator at Mile Tree Center in West Virginia, and probably a few more.

Maybe she probably could add those. I am so excited to be joined by Christina today. Because she has been named by the West Virginia Healthcare Association as the administrator of the year at their recent conference. And it is just what an honor and a privilege to be joined by someone who is so dedicated to doing a job.

I is with my heart is in long term care. So I am just really inspired by individuals who are dedicated and committed to doing a good job in long term care. Christina, thank you so much for joining us today. 

Oh, my goodness. Thank you so much for the warm welcome and introduction and I'm Honored that you reached out to me for this podcast.

I'm excited to speak a little bit about what we do in the long term care profession. 

Great. So let's just jump in. Tell us how you came to do what you do. 

So it was by chance. I was actually still in college, a very young 21 year old student and working at a grocery store. And there was a position that opened at the local nursing facility for a part time activities assistant.

And. I had worked in the grocery store for several years and I loved taking care of my customers and getting to meet new people. But my grandmother was actually an RN in long term care for the, from during my childhood. So I just remembered her coming home and telling us the stories about her residence and the funny anecdotes and things that she got to experience.

So when that position opened, I thought, It was time for a change, but what better way than to go in and work in that environment that she loved so much. So I thought I would give it a try. I was there for about three months and then a management position opened for the activities director.

And I accepted that and then just worked my way. Every position that I had, I love my residents. I'd love getting to make a difference. I just wanted to continue to make more of a difference. So I progressed, through, through the long term care positions. Until I became an administrator.

So I've actually done activities and then I was a marketing and admissions director and HR person, and then I became the administrator. 

I'm going to say, I think honestly, the best administrators have worked their way up through several positions in long term care, because you understand. what it takes.

Absolutely. I agree. I think that, I got the people piece of it. They're loving your residents, loving your staff from, getting to be an activities director. And then, as a scheduler, I did that in addition to being in marketing and admissions, but as a scheduler, you really do get to understand the labor piece of everything, which is such a vital component of what we do.

And then, all the way up to administration. It's just really shaped who I am as a person as well. So I've enjoyed the journey for sure. 

Yeah. So you are in West Virginia and I tell everyone on this podcast that West Virginia has a special place in my heart. So have you always lived in West Virginia?

I have not. I was actually born in Cleveland, Ohio. But I feel like I'm a West Virginian because I moved here at such a young age. I still have a lot of family in Ohio and in the Pennsylvania area, but I've lived here since I was in fourth grade. So I'm not going to give my age away, but I've been here for quite some time.

Yeah. So you are a QAPI certified professional. And for anyone who doesn't know what QAPI is, quality assurance process improvement, one of my favorite things. So that is the QCP after your name. So tell us about this certification and what role it plays in your work. 

QAPI is, probably one of the most vital components of long term care.

It's how we track and trend the ongoings in the facility and make the improvements that we need to, get, provide our residents with a higher quality of care. So we actually were as a company, I, work for Genesis Healthcare and they were so gracious to partner with the American Association of Post Acute Nursing to provide this certification to All of the administrators and directors of nursing.

It's a course that you do. It was about, I think it was, I want to say 15 hours worth of training. And then you do a certification exam at the end. But basically it just really is bringing your knowledge to that next step so that you continuously grow and sustain that performance that you've improved upon.

It, it teaches you really how to motivate your entire interdisciplinary team. And, create action plans and things that will minimize risk for, possible adverse effects of things that happen in the nursing home and improve all of your resident outcomes. So it's something that we learn as administrators, but this training just took it to the next step of.

With the certification and being able to really attest to making sure that our residents are getting the best care by utilizing the data and turning it into information that we can use to drive performance improvement. Absolutely. QAPI is very important in long term care, as is. Understanding mental illness very important and you are a cares serious mental illness certified professional.

So tell us how you achieved this certification and what role it plays in your work. Sure. I alluded to an adverse effects. And unfortunately, I think in all health care settings, we do have those from time to time. So we actually, I had an experience at a previous facility and we sometimes will take.

a younger population than what, we did 10, 15, 20 years ago. This is not just long term care. This is short term rehabilitation as well. And the population that we serve is We used to recruit, I'm sorry, we used to receive training, on dementia. We still do. And that was really the biggest training that the most beneficial training that we needed to work in long term care was that dementia and Alzheimer's training.

But with the younger population, we have found that, they're not suffering from dementia. They may be suffering from. Substance use disorders or these serious mental illnesses. And so sometimes when you have these adverse effects, it really makes you look at your resident population and take a deeper dive.

So how can I better meet these people's needs? During this training, I learned that about 10 percent of residents and long term care suffer from serious mental illnesses. But at the time of the adverse event in my center, I had 69 percent of my residents that had a diagnosis of a serious mental illness.

So that's, major depression, bipolar, schizophrenia. And I just felt like there was an opportunity to really train myself, train my staff, so that we could better meet the needs of the people that were already in our building. And it didn't happen overnight. This was, just taking the people that needed our care.

And this is the population of residents that we ended up serving. So that training just really taught us out, a way to be more sensitive to the serious mental illnesses, a way to notice any signs or symptoms of substance use disorder that could cause an adverse effect. And a lot of times the residents that have the substance use disorders turn to those substances because of a serious mental illness.

So it just really brought our whole care spectrum together to be able to provide that training to my staff and myself as well. 

Most definitely. So I know you are currently at Cedar Ridge Center. But my, I was going to ask you about what you're most proud of achieving at Miletree Center, but why don't we just, why don't you share with us what is your most proud achievement at any facility where you've been an administrator?

So I think first I'm horrible at saying special things about myself, but I look at it more of a way is what have I done to improve our residents lives? Because that's what I'm here for. I think. That's what you have to be here for if you're working in long term care. Definitely retention.

That's a huge focus for me because the staffing challenges that we've had pre and post COVID have just really made it difficult to retain staff. At my previous facility, We were able to decrease turnover by 113%. So I think when I got there, it was 150 percent turnover for all staff.

And by the time I left, we were down to 37. And you're going to have some people that leave. So I definitely think that the way that I connect with people, whether it's my residents or my families or my staff, it does make a difference. And that is a good reason to be proud because the more consistent caregivers we have, the better care your residents receive.

Absolutely. Better staff, a stable staff translates to better quality of life for residents. Absolutely. So what advice would you give someone who is thinking about becoming a nursing home administrator? 

So it's not for the faint of heart. I think you really have to be doing it for the right reasons.

Essentially we're running a business. We are, Taking care of people, but we also have to make sure that we're profitable. And it's just, in order to do that, you really have to have somebody who has that business mindset, but also the heart to put in the long hours and realize what your residents need and take the time to get to know your staff.

The the advice that I would give somebody is just really be prepared to dedicate yourself to this position, not to say that you can't have it. Healthy work and home life balance. I certainly do. But you have to build those relationships and really get to know all aspects of the business and be able to have the answers that your staff and your families need.

And some of that takes experience. So you just, you really have to, like I said, dedicate yourself and be willing to go that extra mile to get the results that you need. For your people. 

Absolutely. I think to myself sometimes, what is a harder job being a director of nursing or a nursing home administrator?

And 

so 

in your opinion, what makes an exemplary nursing home administrator? 

Honestly the dedication, like I said earlier, it's, somebody who's able to pour your heart into what you do. And you just have, if you're not there for the right reason, it becomes very evident in your outcomes with your residents and even your success as a business.

Just, being the best person that you can be and making sure that you truly care about all the aspects of long term care. 

Absolutely. So how do you engage staff to make them feel part of the team from the D. O. N. to a C. N. A. to a housekeeper? 

I think you're just, you have to have your feet on the floor.

I'm really, that, that's how I'm sorry. That's really how I engage my staff is to just be a presence for them. Be out on the floor, make sure that I'm checking on them every day asking them if they need anything we involve them with any type of employee relations activities that we do I just I feel like when you Show them that you care That they do a better job when they know that you're here for the same reasons that they are they want to succeed So that we all succeed together one of the things that Genesis just recently started was a leading with heart campaign.

And I just, I really think that it has motivated our staff even more. We pick somebody every week who has, gone above and beyond and their job duties to really stand out to The residents and their co workers and my leadership team. And I just, I love that program and I love that campaign because it, they're not competing for a title.

They're encouraging each other to lead with heart. So it's really been a beautiful addition to our already robust employee relations program. 

Oh, that's just sounds fantastic that meeting with heart. And I will say just to somebody who's been in many long term care facilities. And sometimes I feel like as a medical director, you're not really part of things as you're a contractor, and I've heard people. Comment on different administrators. And usually the administrators that are most effective are those that are on the floor. And, when the administrator, they're like, Oh, they just stay in their office. And so it's a different environment. So I would definitely agree with you.

I had some wonderful mentor administrators and, you learn something different from everybody that trains you when you take a position such as this. But I really learned a lot from one administrator on the way that you treat people. But I also had another administrator who was, he had a broom in his office behind the door.

And so when he did his rounds, he took his broom with him. And if there was any trash on the floor or pill bubbles laying down, he always cleaned them up. And, but to me, at that point I was Admissions director. And I'm like, if that administrator cares so much about the way this building looks and he carries a broom around, it's not going to hurt me to bend over and pick up trash either.

So it sets the tone and the culture in the building when everybody's willing to jump in and do what they need to do to take care of our people. 

Yes. I agree. So what has been the biggest challenging in combating staffing challenges that we're faced with? And how do you overcome that?

I don't know if overcoming them has been achieved anywhere yet. Truthfully, Dr Storm, there's going to be challenges in staffing everywhere. I just think, in this setting, it really has to be about The way that, that they're treated. There's so many options for our staff that, they could go anywhere to work and, this place pays this much.

So what are we doing to make it the best place to work? And again, it's just about building that relationship and that trust and wanting to be on a team where you can make each other proud and. Make sure that your residents when you have happy residents, it makes all of our jobs easier. I just, my focus is really on, obviously we want to recruit the best people for the positions in long term care, but then I want to keep them and make sure that they're happy because they're going to take the best care of the residents in that way.

As far as combating the staffing challenges, I. I think we're always going to have some sort of staffing challenge. There's always going to be, greener grass somewhere else for our staff. So it's really just about making them feel valued and showing them how we lead with heart so that they want to do the same and make that difference.

It's very intrinsically rewarding. Long term care is it's, on the days I'm having my worst days, that's when I probably spend the most time with my residents because they remind me of my why. 

Absolutely. Yes. And we talk a lot about there's been a lot of research on in staff empowerment and we know that it empowered staff are more likely to stay in a facility.

So how do you empower staff? to be active participants in the culture of the facility. 

Culture change, it doesn't happen overnight. And it really just has to be promising and following through on that open door policy and creating that safe place for your staff to come and share with you their challenges and their troubles.

What they feel like we can improve to make their lives easier in our residents quality of care better. So that's really, what I've done in all the buildings I have gone into is just really build those relationships, build that trust and let them know that they are vital.

Like any staff member in this building from the CNA to the housekeeper are vital and everything that we do, they are Our feet on the floor and there are eyes and ears and it's just amazing How dedicated that people become when you appreciate the things that they bring to the table? 

Oh, absolutely.

I agree. Yes you know the pandemic was very rough especially You know in the long term care community and You know everybody I think You And I would say in the outside world. So anybody who's not in long term care has moved on and really wants to forget about the pandemic.

So do you feel that the culture in long term care facilities has returned to baseline since the public health emergency ended? 

I think that the baseline has just shifted since COVID, we have such a hyper, hyper awareness for this illness that could come d I think tha a lot more cautious with that we do.

But I do Like you said, COVID was so detrimental to long term care. Imagine these residents were in their rooms and there were no communal activities or dining, and they lost that socialization. Like I said, then being happy is a big part of our building being successful.

And so I have seen that, I have seen that camaraderie come back and the residents getting out, they're attending the activities, they're able to do all those communal activities and outings and. Participate in all these fun events now. And I think that seeing that side of things is what also helps to build that culture up for your staff as well.

So I do feel like they've returned to baseline in that aspect. But it, but the staffing patterns and the, a lot of, we lost a lot of staff, during COVID because like you said, they left the industry and they don't even want to return. And we have new staff. I think a lot of buildings have a lot of new staff.

So right now, the challenge is just making sure that we're training them appropriately and that they understand the old school way of doing things to make sure that our residents are getting the best care. 

Yes. And I think, I always like to tell myself that with challenges lessons that are important to learn.

So do you feel like. feel that infection control is still a challenge after everything that was learned during the pandemic? 

I really do. And I think it's not that it's challenging in a way that we can't be compliant, but It's so much more of a focus now than it ever was. I think COVID really opened everybody in the healthcare industry's eyes to just how particular we probably should have been for a long time as far as, the spread of infection and safety is concerned.

I think that we're more aware of, these superbugs and these respiratory illnesses and these different diseases and how we need to prevent the spread of that and how quickly if it gets under out of control that it can really affect our residents health. So I definitely think it's still a challenge, but I also think that's because it is still such a big focus.

Yes, absolutely. So what have you learned are the most important things for residents and also for families in the long term care arena currently? 

Definitely the, Building the trust, and being able to, there are going to be issues, nobody's perfect, but I think the way that we respond to those issues in the building, the trust and the promises that we make with our residents and their loved ones, that we're doing our best and we're going to continue to grow and we're going to continue to educate and until we can be the best versions of ourselves, like I said, nobody is perfect, but I think in this environment Those relationships are so important and I feel so blessed, how many people get to say that they go to work every day and that their biggest job is just to love people because that's what I do.

And that's what I expect for my staff to do. Like The bigger that your heart is, and the more that you're pouring into your job, the more it's going to transcend into the customer satisfaction and the high quality outcomes and the quality measures being higher. And so I just, I feel taking the best care of our residents that we can, and then when something doesn't go as planned, responding in such a way that they, the residents and families know they can trust us and that we're going to do our very best to make their stay as pleasant as possible.

And I would agree with you. I think it is such a meaningful thing to be able to listen to someone's preferences and wishes and then respect and abide by those preferences and wishes. It's a wonderful job, right? It's wonderful work. 

Yes, it is. Honestly, it's just like I said, intrinsically rewarding and to know that, your residents or their families are just in this place where, maybe there's a misunderstanding or they don't quite grasp what, what has happened and they come to you and you're able to make it make sense for them and to show them your heart.

And I think that goes such a long way. 

Yeah, 

absolutely. 

So last question I ask just about everyone that comes on the podcast. If you were in charge of health care in the United States, what is the first thing that you would do? 

Oh, my goodness. I honestly, honestly, I just I feel I would.

Every healthcare entity has its challenges and, I, I just, I would hope that, if I were in charge of healthcare, that the biggest focus would just be about providing the highest quality resident care that you can or patient care. 

That's so wonderful. So wonderful in common sense. 

Yeah.

Christina Starcher. Thank you so much for being with us today. I feel better about the world knowing that people like you are in it to improve the care of nursing homes. That's, as far as I'm concerned, that's one of the most important jobs that anyone can do. So I am happy knowing that people like you are doing it.

Thank you for joining us today. 

Thank you so much for having me. I enjoyed my time with you.

Thank you for tuning in to Taking Healthcare by Storm: Industry Insights with Quality Insights Medical Director Dr. Jean Storm. We hope that you enjoyed this episode. If you found value in what you heard, please consider subscribing to our podcast on your favorite platform.

If you have any topics or guests you'd like to see on future episodes, you can reach out to us on our website. We would love to hear from you.

So, until next time, stay curious, stay compassionate, and keep taking healthcare by storm.