LiveWell Talk On...
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LiveWell Talk On...
268 - St. Luke's Transitional Care Center (Dr. Clete Younger)
Dr. Clete Younger, medical director of St. Luke's Transitional Care Center, joins Dr. Arnold to talk about who we serve at the TCC, our new long-term care options and how to select the right place for your loved one's healing journey.
To learn more about St. Luke's Transitional Care Center, visit https://www.unitypoint.org/locations/st-lukes-helen-g-nassif-transitional-care-center
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This is LiveWell Talk on St Luke's Transitional Care Center. I'm Dr Dustin Arnold, chief Medical Officer at Unipoint Health, st Luke's Hospital. Joining me today, or returning to the program, is Dr Klee T Younger, unipoint Clinic Family Medicine Physician and Medical Director of St Luke's Transitional Care Center, to discuss who we serve at the center, our long-term care options and what new options we have, as well as availability and how to select the right place for your loved one's healing journey. Dr Younger, welcome back.
Speaker 2:Thank you very much.
Speaker 1:Second podcast, right? No, you've done a couple, it's probably before. Yeah, yeah, You're a veteran Award-winning podcast. Sorry, I forgot to put that tagline in there.
Speaker 2:How you been. It's been good. You know we're evolving from the three years of COVID dominating healthcare and now I feel like we're getting back to where we can actually focus on other things. There was so much of all hands on deck to get past the pandemic. It's nice to be able to get back to really focusing on health and getting people healthier, as opposed to just surviving the pandemic.
Speaker 1:Well, I want to start by complimenting you and your team and the groundwork that you did early on in the pandemic to set end of life care goals for patients that wouldn't probably not have survived a hospitalization if they were admitted, and I think that was a huge impact to the community, both hospitals and I know Mercy is grateful as well, because that did allow resource management to be a little bit more flexible than perhaps it could have been. So congratulations to you and your team. I just want to recognize that. Thank you. But first of all, you're, like me, your medical director of like 7,000 things, right.
Speaker 2:Eight nursing facilities.
Speaker 1:Eight nursing facilities.
Speaker 2:Hospice, and then I work in my family medicine clinic too, right.
Speaker 1:Wow, that's amazing. And how many nurse practitioners are on your team?
Speaker 2:now we have three nurse practitioners that are full time doing post-acute care Wow.
Speaker 1:That is really, that's phenomenal.
Speaker 2:But we are very blessed in that we have they're very experienced. They all were critical care nurses before they became nurse practitioners, so they're very versed at taking care of very sick patients. So they transitioned into the post-acute role very well and we actually have a great like happy team that works really well together. We're really tight and that helps a lot because, you know, I don't think we experience any burnout working together at all, even on hard days. You know everybody gets along so well. We're just not burned out and that allows us to, you know, be really efficient and take on hard things and not have that, you know, affect what we're doing.
Speaker 1:Well, I've often said it's those hard days where you go home and go, hey, they needed me today, like if everything just goes perfect, you're like I could have really called in today and, you know, done it over the phone really Right, yeah, you know. So it's nice when they need you. But but a transitional care center out on Council Street Is that Cedar Rapids or Robbins?
Speaker 2:It is technically Cedar. Rapids, it's kind of wrapped in with Robbins and Hiawatha.
Speaker 1:Yeah so.
Speaker 2:Robbins is interesting. There I'm a.
Speaker 1:Robbins resident, so probably in a Hiawatha hometown, so very familiar with that area. When did we?
Speaker 2:when did, when was it built? So it opened in July of 2019. 2019.
Speaker 1:So pre pandemic, pre pandemic, yep, and then it has the capacity for how many? We have 46 beds, 46 beds. And now tell us about the, the, what the transition center does and what is the? What is the? Just what primary patient population is it focusing?
Speaker 2:on. So we're really looking at the patient that has had an acute hospitalization that needs a prolonged course of monitoring. So there's been a lot of push in the United States to try to shorten hospitalizations, just to use the resources we have in the hospital appropriately but then start moving people to different levels of care. Even though we have rehabilitation like physical therapy during a hospitalization, that's really not necessarily the primary goal. It's really stabilizing the medical condition and when patients move from the hospital to skilled rehab, which is what we do at the TCC, that increases the number of hours of rehab that a patient gets as far as strengthening, moving around and doing those sorts of activities, because we have a longer period of time to work with the patient. So you know our length of stay is somewhere between 12 and 14 days.
Speaker 2:You can obviously do a lot different with therapy in a 12 day period of time than you could in just a 24 or 48 hour hospitalization. And that's really where we have a lot of expertise is the multiple modalities of therapy, with speech, occupational and physical therapy to work on patient strengthening. And then also there's certain medical conditions sometimes that when a patient leaves the hospital it's better than when it was what it was in the hospital, but it's still unstable and there's risk of a medical condition deteriorating, getting worse or changing, and by coming to a skilled stay we're able to continue to monitor those medical issues and fix things if they deteriorate. If a new problem develops, which is common after somebody's been hospitalized, we can address that new problem and treat it and it gives a buffer between the hospitalization and returning to home or whatever home is going to be after that for us to stabilize people.
Speaker 1:I you know I've been had this monitor my whole career, and so it was. I was a medical student and I remember reading a small study from Great Britain National Health Service and they gave so mid 90s right early 90s and they gave patients post self self address postal cards and they said they went home after hospitalization.
Speaker 1:They said you put this card in the mail every day that you don't feel like you're back to yourself and quit doing it. When you feel like you're back to yourself, and it turned out that for about every day you're in the hospital, it took three days to get your strength back at home.
Speaker 1:And I've used that kind of formula in prepping patients my whole career and it's pretty accurate really. You know, if you're in the hospital for you know five days, it's going to take you 15 days at home to finally get back. It's not going to happen quickly, you're not just going to roll out of here. Yeah, I agree and feel that you're back to normal. I don't know in your practice, have you had the opportunity to take care of any? Like old physicians, I have.
Speaker 2:That's actually one of the one of the most challenging patients I've ever taken care of was a family physician who had Parkinson's disease in a nursing facility Wow, because you could see that person that was you in them, yeah, and that actually that was one of the hardest patients I've ever taken care of.
Speaker 1:I had a patient that was in his late 90s and I took care of him. This was in Grinnell and he was a retired internal medicine doctor, but he would just fascinate me with these stories. Like you know, if you had an injury they it's particularly a heart attack they'd put you to bed rest for a month. You know that was that was the treatment. Oh, you've just had pneumonia. You need to lay in bed for a month. Yeah, it's crazy. And recover, we're the exact opposite.
Speaker 1:Yeah, you know, and so and I've always think about those, those MRIs of the astronauts when they're in a weightless environment and how their muscles atrophy. Now, it's not synonymous, but it makes you think about if you just and I say this, maybe you'll disagree or agree If you just took a healthy 90 year old and said, lay in bed for four days, they're going to be deconditioned on day five. Oh yeah, I mean you could set somebody back and they'd never recover.
Speaker 2:Yeah, Like you may have shifted somebody's baseline. Yeah, Even with that, you know so and that's if.
Speaker 1:Then now you throw a pneumonia and a bladder infection and you know, a TIA or small stroke on top of that, and it even gets worse. So, you know this. I think this, this concept of that transitional back to home, is one that, particularly as hospital medicine, we it was neglected for a long period of time, I think, since you've been in practice and your leadership certainly has put it forefront.
Speaker 2:But there's a time I don't think it was really well thought out that post-acute yeah, I mean the feedback we get quite a bit from patients like, oh my gosh, they're making me do all this stuff, because, even though there's dedicated times of therapy, people don't realize there's all the other stuff that we make people do, like you have to walk to dinner and if we want you to walk longer, we'll put you in a room farther away from the dining room in order to like. So those are therapeutic things too. Right, there's there's people they're being pushed all day to do different things, aside even just from their, their therapy interactions yeah, they sleep better at night though.
Speaker 1:Right, yeah, and then I don't like it and we talked about too.
Speaker 2:Like you know, everybody wants to be home and nobody wants to, you know, not be at home. But really we are trying to maximize every moment of time they're there because we want them to leave our facility with the most strength they've gained or the stable medical condition that we can get to. And it takes a lot of, you know, pressing and people are mentally get kind of fatigued with that, but the outcomes are better if you're able to get the most out of your time there when you're, when you're a fast and in that setting and and so what other?
Speaker 1:I mean physical therapy comes to mind, occupational therapy what other therapies and services to is a transitional care center provide?
Speaker 2:so speech therapy is a big part of it too.
Speaker 2:And what's? When people hear speech they often think, oh, it's just about swallowing, it's not. Speech therapy actually encompasses a lot of cognitive testing. So our speech therapists do cognitive tests on our patients and that really helps kind of dictate what's the expectation going forward. Unfortunately, a hospitalization in a skilled state or is often a time where families start to rethink where are we going? Is it safe for mom or dad or my parents to still live in this home, for example? And so speech therapy gets involved with us because they're able to help us with that cognitive testing to correlate with the physical functioning and medical functioning so that we can help be predictive of you know where is the best place for this person to go unfortunately United States. A lot of times people choose to go from home to a higher level of care after they've broken something or got really sick.
Speaker 1:You know this. I have a saying nobody goes to rehab halfway to rock bottom, right, you don't wake up one day and say gosh, I'm halfway to rock bottom, I better go to rehab no you completely hit rock bottom and you're like whoa, I have a problem here. Same same with health care. You know you, you know mom is, is, and mom might not be agreeable to having that conversation until she breaks her hip, yeah you know, and that's, that's human nature you know, and I never get frustrated surprised at that with patients.
Speaker 1:That's just. That's just the way we are. It's a way we're wired. But you're right that those convert a lot of it.
Speaker 2:It happens late in the game yeah, we do spend a lot of time on that. You know, one of the things that's unique about our program to with our post-acute program is earners. Practitioners unlike a lot of other parts of health care, actually don't have any production part of their salary at all. They're totally salaried, and so if we need to spend two hours talking to a family, we spend two hours talking to a family. There's no 15 minutes. I got to go to this next place in the next next place. We have total flexibility and so that allows us to have a lot of hard conversations in.
Speaker 2:The MPs on our team really are focused on they want to have those discussions with families along the way, and so that's one of the ways we think that we're successful is not just the acute medical stuff, stabilizing the therapy part. They're really spending the time with patients and families in order to let's make a plan for what's gonna happen next. This hip fracture is a sentinel moment in your life to think about. Maybe living in a split-level home with three sets of stairs is not the best option. Let's talk about what else we can do and then we can compliment, you know, our discussion about somebody's medical situation with social work and then the community resources that we have access to, to be like if we can't live here, where can we live? That we still have a choice and wanting to be there yeah, that's you know.
Speaker 1:I'll be 54 coming up here and you start thinking about that. Can I live in this house when I'm 70?
Speaker 2:I built a new home five years ago and our main floor has no stairs. There's no stairs from our garage. It's completely flat, so my wife and I could live there and not have to use a single stair. Just because, in my experience, stairs are bad, because we see a lot of issues with stairs.
Speaker 1:But, yeah, you have to think about, yeah, you start wondering about that and we have some good friends that they build a home that you know they're not. They're about the same age as me and I remember, when they built it, he's like, yeah, I built flat, you know, so we could live there. And I was like, oh my gosh, I'm not even thinking about that.
Speaker 2:Yeah, you know, mm-hmm, yeah, so that's a reality, like somebody who lives in a homeless stairs, there will be a point when you cannot live there, like I mean, that is a hard stop. You know, if you have a bedroom on a different floor than your main level, that is not sustainable. Either you need a chairlift or you're gonna have to go somewhere else. I mean, nobody can live in a house with stairs forever. It's interesting, yes.
Speaker 1:That is and that's, you know, that's. Yeah, I can just hear the physical therapist talking knock out on the floors when they're like, well, they have stairs at home, you know, and that's like puts it in a whole another risk category.
Speaker 2:It does, yeah, as far as getting them back home.
Speaker 1:Now. Occupational therapy if I could go back and do it, I think I'd be an occupational therapist, because they do like a lot of clever things. I just think it's so cool. But you know, sometimes patients say, well, I don't have a job, I'm retired. No, that's they're not here to teach you how to do a job. It's not vocational therapy, it's occupational therapy. So we occupational therapy is out there as well.
Speaker 2:Yeah, yeah, we have PTOT and speech. Yeah, yeah, that's. And all those modalities are involved with every patient. So, yeah, when they come out there, they get assessed by everyone when they come.
Speaker 1:Now we were talking prior to the podcast. There's going to be a long-term care option out at the transition transitional care unit. Tell us about that. How is that coming about?
Speaker 2:So when we first so in the in Iowa, if you were to go across the state, most skilled rehab is done in long-term nursing facilities. So most facilities have a population of patients that live there for a period of time and then they also will see post-hospital patients for a skilled stay.
Speaker 2:When we first kind of had the idea, and Peg Bradkey and her you know kind of vision when she did this back in 2017 and 18 before we built it was to try to create a facility where it was skilled patients only, and that was unique. It's the only facility that really ever did that in the state of Iowa. We, of course, opened in July of 2019 and the whole healthcare world got turned upside down in 2020. And so that's had to kind of make us think about like that model of care and how our population has changed and what the expectations from families are. So, instead of having an all skilled facility, we actually try to create some sort of long-term component to our facility, because one, we're not using the beds that we have and that's not good. You know. We have, like we have our nurse practitioner team based in the facility. It's branded under unity point Like we should actually try to serve as many patients as possible.
Speaker 2:And if the use of skilled care in the United States has changed because of the pandemic and managed care you know those are two big reasons. They've changed how we do skilled rehab then we should really then try to maximize the beds we have in this high quality facility to take care of patients long-term too. So where we weren't really open to that, you know several years ago now, we're gonna try to have a consistent population of patients that are there for long-term care so that we can maximize, you know, that experience at the TCC. We'll still have lots of skilled patients coming through, but we will have, you know, a subset of the building that's dedicated to long-term care as well, and we do that in every other building. So the other seven buildings that I work at with my nurse practitioner team, all of those buildings have long-term and short-term patients. So it's something we're experienced in. We're just kind of expanding that to the TCC so that it can do both as well.
Speaker 1:What makes sense. It allows greater degree of flexibility.
Speaker 2:And a lot of patients come to the TCC and want to stay. You know we would kind of do that on a one-off basis over the last four years, but now we're gonna, you know, try to like, maybe market that a little bit more, like you've had a good experience here with your skilled stay.
Speaker 1:Yeah, it's a beautiful facility. You need a higher level of care. It's a beautiful facility, you know, beautiful facility. Let's talk about the nurse practitioners. I hired Julie Shaw to work at Manor Care in the 2006, 2007. And so then she was just based. We had a nurse practitioner working there and that was to complement the hospital's program. But now you've taken it to the whole next level. Tell us about your team. You have three.
Speaker 2:Yeah, so three nurse practitioners. They all worked in high-level health care.
Speaker 1:That's what you said.
Speaker 2:Two of them were critical care and then they both got their geriatric nurse practitioner degree. Our other nurse practitioner she worked in Mercy Hospice for 14 years and then got her a nurse practitioner degree. So all of them had a lot of nursing experience, which is actually really good in a skilled nursing facility, because I'm not a nurse and there's a lot of stuff I don't know about nursing and about how to care for patients. There's all sorts of how to move a patient the right way, how you do things with different parts of people's bodies that nurses do that I don't know. So having these nurse practitioners is so good because they have the medical knowledge like a doctor, but that they have the experience of a nurse and it's great to combine them together.
Speaker 1:That's so funny because I'm a nice guy, right, and so what I'm making rounds in, my patient needs to be moved. I'm like or they're transitioning a patient, I'm not just going to stand there, I'm going to help. And so often the nurses on the floor are like just get the hell out of the way. You are in the way, you don't know what you're doing.
Speaker 2:And I don't Right because we don't have the experience.
Speaker 1:They're just like you know, and they make it look so easy.
Speaker 2:Yeah, so I love having their nursing back, because I'll ask them questions and be like how do you guys do this? Or like, why is this not working? I don't understand, and they're able to kind of describe that. And so having that nursing experience first is fantastic. And now they've all been in practice in our post-acute program all day, every day, for a minimum of three years and some up to eight years. So just having that volume of that subset of patient population, the experience is unbelievable. And we have a shared kind of space where we have an office and there's nothing like that, Because if you have an odd situation, the best thing to be able to do as a physician is turn to your colleague and be like this is what's going on. What do you think about this?
Speaker 1:Yeah, especially early in your career.
Speaker 2:Yeah, to be able to bounce stuff off people, our users, experience, so we're actually the bigger the team gets. Now there's four of us working together, even the better, because we have all this knowledge base together and I've seen that exact thing. This is what you should do. This is what my outcome was, so it's been so helpful as it's grown. So, now that we are in eight facilities with my medical directorship, but we actually see patients in like 11 or 12 different facilities, we're able to combine all that knowledge together and we know a lot of the staff in other facilities now and we can collaborate with them, and that's made it easier too. They know what to expect from us when we're seeing patients, and so that's made it a lot more efficient and just really great people that we've been able to work with too.
Speaker 1:Yeah, I think I've said this about inpatient medicine and applies to skill. I mean nursing home medicine as well. It's nurse driven, physician guided where your clinic is the other way around. It's physician driven, nurse guided you know that patient doesn't move through clinic till they touch you. Yeah, and it's two different problem solving skills, it's you gotta think about it differently and it's interesting that you've had that same experience in your career. Well, Dr Junger, you know we've talked about all positive things.
Speaker 1:You know, but there's a real sort of kind of dread of going to a nursing home or being sent to a nursing home. That it's. But talk about that, how people approach that and how you guide people to making that decision, to have that, whether it's extended care, skilled care, intermediate care. Tell us about how does that? What's been your experience in talking to patients about moving to a nursing home?
Speaker 2:The one of the things that's interesting is that as we've lived longer people, then we can stabilize medical problems longer, but then your functional decline still occurs, associated with aging. So the reality is is that people just lose function to a point where they need more assistance, and that can occur in assisted living or sometimes people need, you know, long-term nursing care. Then it's about how can we make that the best experience possible for them, you know. So I think understanding that you know a patient individually sometimes will feel like I'm being sent there. But really the people around you like you know, our nurses, our team, like we're just trying to make the best experience right. We don't want people to suffer. We want people to have the best experience they can. I think that that is a core tenant of anybody who works in long-term care. You know as it's intimidating to go to a nursing home right away. The longer you're in there, you really see that like everybody is there who's compassionate about let's make this person's life, what they have at this point, the best that it can be.
Speaker 2:And one thing that's interesting about you know hospital nurses versus long-term care nurses the relationships are an important thing.
Speaker 2:You know, as a long-term care nurse. If you work 40 hours or 50 hours in a nursing facility every week, your home is in that facility, right, and you will see long-term care nurses really appreciate that, those relationships and it's, and they appreciate knowing a patient, seeing the same person every day, having those consistent relationships. And that's different than what you see in the hospital where things are turning over every two days and you have new people all the time and there's definitely personality types where that works very well for them. But a long-term care nurse, they want a relationship long-term, they want to know somebody for a long time because that's basically their home. They spend as much time at that facility taking care of those residents than they do at home with their own family and their own kids. So you will see those personality types get there and I think until you've really had a lot of experience in long-term nursing you don't understand that, like this person who is the nurse for my dad actually probably cares about them almost as much as I do oh yeah.
Speaker 2:Because they've gone there with the idea this is a home-like environment. So I think, approaching as a family, approaching that idea of long-term nursing, I think approaching it that this is different than the hospital and these people are here because they like long-term relationships and they want to take care of my loved ones and they want to make the best experience possible for them and it's going to be different than what you see in the hospital. But that's the whole point of that and really trying to get to know the staff, because they're your family too now, because they're with you, and going at it from that perspective of now we have a new family. We just have to adapt to this a little bit. Let's make it the best that we can.
Speaker 1:Yeah, and as a physician, when you get my experience, when I get a phone call from a nursing home nurse that sees that patient all day, every day, and they say the patient doesn't look right or doesn't feel well, I'm like, yeah, they don't. You know, I mean, it's you really. Yeah, you do get a sense of ownership and community. You really get a sense of community.
Speaker 2:Yeah, people are very prideful for where they work. They want their place to be the best because that's their home.
Speaker 1:Yeah, absolutely, that's interesting. Well, thanks for joining me again today, and once again, dr Klee Younger, who is with Unipoint Family Medicine, physician at the Medical District. Is that, what is it the?
Speaker 2:Medical District Family Medicine Medical District. Family Medicine, medical District.
Speaker 1:And also Medical Director of just about everything, but including St Luke's Transitional Care Center. For more information on short-term rehabilitation, as well as long-term nursing services provided at the center, call 319-366-8701. Thank you for listening and live well. Talk on. If you enjoyed this episode, don't forget to subscribe. And if you want to spread the word, please give us a five-star review and tell your family, friends, neighbors, strangers about our podcast. We're available on Apple Podcasts, Spotify, Pandora or wherever you get your podcast. Until next time, be well.