One Skilled Nursing Facility’s Turnaround from Two Stars to 97% Full

Five years ago, the Harlem Center for Nursing and Rehabilitation had rooms filled with used and abandoned building materials. Wires were hanging from the ceilings, and some of the showers in patient bathrooms weren’t working.

That’s according to Melissa Powell, chief operating officer of the Allure Group, which took over the facility in 2012 and manages six skilled nursing facilities in the New York City area.

In 2013, the facility had 83% occupancy, a 31% rehospitalization rate, and a two-star rating on the Centers for Medicare & Medicaid Services (CMS) Nursing Home Compare tool. Despite this, it had potential when Allure took it over, particularly in its strong staff, Powell told Skilled Nursing News.


“It had all the makings of being a great facility,” she said “But it was missing maybe some strong leadership and investments.”

Care and staff

Those investments have totaled in the millions, Powell said, though she did not have a specific number that Allure invested. The first step in any nursing home Allure enters is speaking to staff about their needs and what they’d have on their wish list for a facility, according to Powell.


“The initial investment, dollar-wise, is always around safety, regulation and staff and patient needs,” she said. “You can’t do a good job if you don’t have it.”

At the Harlem Center, the initial investments included fixing patient bathrooms, significantly improving the wander-guard system, installing pressure-relieving devices for beds, and adding to the monitoring systems.

Then came investment into staff education and program development, after an assessment of what the community needs and what it does well, Powell said. That’s also, if needed, when Allure starts bringing in equipment needed to boost clinical capabilities, since the company caters to more clinically complex cases than just long-term care (LTC), according to Powell.

“The very first thing I look at is what we’re not doing well and strengthening the clinical, because the only way I can build census is keep the patients in house,” she explained.

Investing in patient care is always a priority, however, and to deal with more complex patients, having the right staff is essential — which is why Powell stresses the need to invest in staff hiring and education first and foremost. Harlem Center had an additional 99 staff members brought in since 2012 at all levels, she said.

Working with hospitals

When it came to addressing readmissions, one of the first steps involved examining the patient population in a neighborhood as part of market research, according to Powell.

“We go in to the hospitalist and literally ask them that question: What do you need from Harlem Center that we weren’t doing before?” she said.

There was a need for help with cardiac, diabetic, and tracheotomy patients, which Allure wasn’t accepting at the time. Powell had respiratory therapy brought in to deal with trach patients, and deployed education and resources to provide high-level cardiac care. Staff also played a role here, as adding the more complex patients necessitated an increase in staff, she said.

She did acknowledge the staffing issues notoriously plaguing senior care and nursing homes, especially with registered nurses. But Allure puts a particular focus on hiring and has centralized its systems to make the process organized, Powell said.

“We’re not doing anything different, but I think there’s a focus on [hiring],” she told SNN. “I also preach to people that we don’t panic-hire.”

The focus on both staffing and care appears to have paid off for Harlem Center. The facility’s rehospitalization rate was 14% in 2017, compared with 31% in 2013. Occupancy currently sits at 97% with an overall rating of four stars from CMS, and the facility recently received the Eli Pick Facility Leadership Award.

But with all the improvements to the facility — which include a complete rehab gym, dining room, and activity area — Powell stressed the importance of care in improving quality.

“You can make the building look beautiful and you can put in fancy rehab equipment, but unless the care matches, it doesn’t matter,” she told SNN.

Written by Maggie Flynn

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