A new day in nursing care

at Health and Rehab Center

By JOHN L. GUERRA

For families of elderly parents or terminally ill relatives in the former Key West Convalescent Center, the memory still haunts: the day that ambulances, vans and even taxi cabs lined up outside the facility on Stock Island in 2008 and drove off with their parents and other loved ones, bound for any available nursing home bed around the state.

The facility closed soon after Florida’s Agency for Healthcare Administration (AHCA) inspectors determined that the former convalescent center posed an “immediate threat to the health, safety and welfare of residents.” The center — which inhabited an aging building with moldy walls, occasional broken tile and other defects brought on by time — had repeatedly failed to follow patient monitoring and abuse reporting procedures, was often understaffed and had patients with bed sores and other signs of neglect.

Worse, allegations of neglect and verbal abuse against infirm residents led to the suspension of two employees. After an elderly resident who was known to fall easily took a tumble off an unsecured wheel chair and broke his nose, scratched his forehead and received stitches below the right eye, AHCA banned the convalescent center from taking on new patients.

Though staff, volunteers, and visiting family members tried to maintain a happy and healthy environment there and openly praised staff members for their dedication and hard work, the convalescent center’s owners could not make ordered improvements and in the end decided to close the facility. As residents and patients were loaded into vehicles for trips north to other facilities as far away as Tampa, healthcare workers and administrators cried and bid them goodbye, promising to bring them back as soon as possible.

Now, some five years later, that promise has been kept in many cases, said Susan DeFresne, CEO of Key West Health and Rehabilitation Center, the modern facility that replaced the old convalescent center in 2010. After a $3.5 million renovation financed by the Lower Florida Keys Hospital District, some of those former residents have indeed returned to a new facility, DeFresne said.

“There are a few we found and we brought them back,” said Defresne, who this month completed her first year as head of the rehabilitation center. “Donna Rosado, who was admissions director at the former nursing home and is our admissions director now, she knew some of those people and knew where they went and she brought them back.”

 

In the nursing home industry — the most regulated sector in America — The Key West Health and Rehabilitation Center has pulled off what even state regulators consider a rare, if not impossible feat: AHCA found no deficiencies in its most recent annual health inspection, which occurred in September 2013. “The first health inspection in 2011 had 13 deficiencies; the 2012 inspection had 11 deficiencies, and ours had zero deficiencies,” Defresne said.

This is not easy, according to Defresne, who credits her staff for keeping deficiencies to zero. “Six or seven Agency for Health Care Administration walk in through the front doors, each with a laptop. They see how clean the building looks and feels; if they don’t see anything wrong and don’t see any environmental issues such as smells, dirty spots, wires hanging — anything that begs the question what’s wrong with the picture — then they continue on.

“They’ll ask patients, president of the residents’ council, they ask family members if they like the place, is it clean, are the patients being fed appropriately, are the residents happy? If they get no complaints, they then interview the staff, asking them, ‘Are you happy working here?’ and ask them if there are any issues they feel the building has, do you like management, do they treat you with respect?”

Inspectors then reviewed patient paperwork, medication reporting, reviewed each patient’s written care plan, inspected the kitchen facilities and bathrooms, sought to discover if possible sources of infection existed — but found no health deficiencies, DeFresne said.

The inspectors were surprised when they could not come up with any health deficiencies, DeFresne said. Before she knew the results of the inspection, she assembled her staff so they could hear from inspectors where improvements were needed. “The inspectors introduced themselves and said, ‘We have found no health deficiencies,'” DeFresne said. “I thought, ‘I didn’t hear her right.’ We all stood and screamed and cried and a couple of the surveyors were crying; they had participated in the closure of the building,” DeFresne said. “Only a handful of nursing homes in the state earn that.”

John Padget, who sits on the Lower Florida Keys Hospital District Board, which leases the land on which the Lower Keys Medical Center and the rehabilitation center sit, said he and other hospital district board members are satisfied that the rehabilitation center is on track. “What is in place now in that facility is a million miles from where it was when it was closed down,” Padget said. “It’s a story the community needs to hear. There are a lot of dedicated people over there making sure local families can find long-term care locally.”

The second floor serves as home for residential patients while the first floor serves patients recovering from accidents, strokes, and other shorter-term problems. The center performs outpatient physical therapy, occupational therapy, and speech therapy, DeFresne said.

The facility isn’t without problems, however, DeFresne said. The facility needs more certified nursing assistants, a tough slot to fill in the Keys.”We need to hire six CNAs,” she said. “We’re not understaffed–we have 103 staff members and 106 residents–but we do need to fill those positions.” The jobs posted on the facility’s website, http://www.keywesthealthandrehab.com.

The administrator’s staff trains applicants, who are required to pass a written test; applicants also can call 305-296-4888 to ask about the CNA certification. The facility also relies heavily on volunteers, she said.

DeFresne, who has a law degree from University of New Hampshire Law School and has four grown children, served as administrator of a 24-hour skilled nursing facilities in Melbourne, Fla., before coming to Key West.

Key West Health and Rehabilitation is owned and operated by Senior Care Group LLC, of Tampa.

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