Ten years after Inglis House set out to transform its hospital-like environment to six “neighborhoods”, leaders at the Philadelphia-based long-term care facility have had to balance staffing issues and the COVID-19 pandemic with their goal of providing person-centered care.
Inglis House provides long-term residential care for 252 adults with physical disabilities, including multiple sclerosis, cerebral palsy, spinal cord injury and stroke, among others.
Each neighborhood has all private rooms, a solarium with communal dining and a hand-painted mural selected by those who live and work in that particular wing and a ‘less obtrusive’ nursing station, all aimed to get away from a more institutional type setting.
“We’ve had to kind of keep pulling staff from neighborhood to neighborhood, which kind of gets in the way of that cohesive team,” Inglis President and CEO Dyann Roth said. “The team is not just the staff together the team is the residents and the staff together and so I would say that it’s taken a hit — the path toward that person-centeredness has taken a hit.”
Skilled Nursing News sat down with Roth last month to discuss this topic and more, including the facility’s efforts to curb the ongoing staffing crisis.
What makes Inglis House different from another skilled nursing facility?
First and foremost the age of our people. The residents here are, at this point and we’ve been aging, but I think that we’re at an average age of the late 40s, early 50s. The tenure for people, we have people who’ve been here for 46 years because they came in their 20s. So our older people are people who’ve aged here. We have a very vibrant, active, engaged community of people. Most of our residents would react negatively to Inglis House being called a skilled nursing facility. They call it a wheelchair community and they don’t understand why we need to comply with all of the nursing home regulations.
So it’s a bit of a tough dynamic at times because we are very much needing to comply with all of the nursing home regulations and we have all of the same pressures, but we staff at a higher rate — our budgeted staffing [hours of care per resident/day] PPD is 5.7. In this workforce crisis I think that makes us very similar to other facilities, it’s hard to meet our budgeted staffing ratio. We are way beyond Pennsylvania’s minimum staffing ratio but it’s still not at the level that we need for our folks with their needs.
How has Inglis House handled this ongoing staffing crisis and what ways have you tried to alleviate some of those issues?
I mean we were, I think, impacted by the growing staff crisis before the pandemic. I would say that we have done a lot to recruit, and we have increased wages, and we have done all sorts of signing bonuses and incentives for picking up extra shifts, from the monetary side [of things].
We have a very good relationship with our union. So we try to work through any kind of other needs or issues. When the pandemic hit and we had a workforce that was impacted by their kids not being in school, we converted some empty space in a campus next door in partnership with a local daycare provider to do a virtual schoolhouse for the children of our frontline employees. I mean we’ve tried to meet creatively every need that we possibly could. But it’s still very, very hard. I think a lot of people left this work during the pandemic and a lot of people are not going into this work. We were impacted by the virus just like other facilities, once it got in before we had the PPE and the testing and then the vaccines we lost people, we lost 12 residents to Covid last year and we lost one staff person.
The virus has had an impact on an already challenging workforce situation. I think at this point we’re really, again, we’re going with all of the incentives and the pay stuff, but we’re also now looking at how do we partner with our union and with other partners.
Inglis House, because of its longevity, but also it’s kind of creative, young, vibrant population, has been a magnet for a lot of schools to do internships as well as … for OTs and PTs and nursing students, it’s a really good learning environment and so we’re trying to now capitalize on that and grow our own. I don’t know what else to do except grow our own at this point.
Have you guys had to use any staffing agencies at this point?
Yeah we have… I think we have contracts with nine or 10 agencies. We pull on them all the time but they don’t have many people to offer us. We’ve even contracted for the travel nurses so that we can get our nurses just some relief. They need to take some time off, I mean I’ll tear up if I talk about how intensely they’ve worked at great personal risk and loss, so we want to get them some relief or else they’ll leave too.
How has the delta variant impacted Inglis?
We have five neighborgoods, and we have converted one empty neighborhood into our red zone. We are choosing not to open to new admissions because of the staffing pressures that we’re under, I don’t think it’s wise to add to the pressure.
All that said, we had been able to open up to visitation, to community driving, to beginning our group activities safely — I mean that’s the heart and soul of Inglis House, the vibrant connected life. All of a sudden we got one staff positive, two staff positives, and within a week and a half I think we had 12 staff positives, and four of them were vaccinated people. Then we started doing our universal testing of residents and staff and then we had four resident positives among vaccinated residents, so they’re in the red zone. All of the neighborhoods are in yellow zones, everything’s shut down again. So I think when you have hope and then it’s crashed down again it’s even more depressing.
The city of Philadelphia came out last Friday mandating vaccines for all health care workers in Philadelphia. So we’ve been responding to that mandate this week in rolling out across all of our entities in Inglis a mandate, with potential for exemptions for religious and medical reasons. We’ve been doing vaccine clinics every single week but we haven’t had droves of people among the staff so we’re hoping that the mandate has an impact on getting those numbers down again.
Where does your vaccination rate fall for residents and staff at this point?
Our residents it was 95 to 98% — our residents were like sign me up, and now they’re going to be first in line for the boosters. Our staff in Inglis as a whole is about 49% and our staff at Inglis House is about 42%, and so it’s going to be a challenge and I am concerned about further pressures on our workforce issues if people choose just to leave.
With all of the health care providers in Philadelphia needing to comply with this mandate, I think it sort of levels the playing field. But I think some people will choose to leave health care.
In 2011, Inglis formally launched a multi-year initiative to transform Inglis House into a more person-centered care home-like community. Now 10 years later what does that transition look like and where are you at now with the transition?
A lot happened in those 10 years. I wasn’t here until 2017, but part of that transition was converting traditional nursing units into neighborhoods that have their own kind of culture and flavor and consistent team of people, and the design of it is not a traditional nursing unit. We have all private rooms so everyone’s really encouraged to decorate their room the way that they want it, so very person-centered that way. When I got here we had a lot of training that included residents in the training of staff.
I would say that with staffing pressures, with regulatory pressures and more recently with this pandemic… We have not been able to do all of the continued work around the relational piece of the person centeredness that we want.
I would also say that our physical configuration is not ideal for person centeredness. It’s a big, old building — beautiful. It was built to last so it’s very hard to modify. I think the greenhouse model is probably much more conducive because they’re smaller and more home-like just by design.
I think we have some things just by the structure of Inglis House that kind of impedes our progress in person-centered design. Our goal is to just get back to stabilizing our staffing, starting with nursing, and I think that’s the core of then building up a person-centered practice.
You’ve talked a little bit about some of the constraints with the building that you currently have, could you tell me a little bit about this neighborhood idea and what it physically looks like for the residents?
Inglis House is a massive U-shaped building. When we downsized in 2015-16 we closed the center units of that U. So we have 40 to 50 private rooms on a wing, and we have a south wing and a north wing with three floors on each. The design of the neighborhood… They have a solarium, which is their communal dining area with a homemaker there. There is a nursing station in the middle of that neighborhood, but it’s been designed to be less obtrusive than a typical nursing unit and there’s murals painted that everybody participated in.
Where do you see the future of Inglis House and what are your goals?
I think the short-term is really just to stabilize staffing, and honestly to build up some of the other supports for our folks. We have a significant percentage of people with mental health needs and so one of our goals is to really beef up our ability to support people in a very holistic way. And, I think, to continue to really focus on the quality of care. Again we have very complex needs people, so we need to focus in on … not just COVID infection prevention, but also UTIs and others. So I think we’re really kind of focusing on quality, and we continue to refine our tools and process for planning discharges — healthy, safe discharges.
So we’ve got a lot of more on the qualitative side work that we’re really trying to tackle while just surviving this period.
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