February 8, 2023 —In a presentation given by Director of Clinical Services Danielle Mohler and Resident Services Coordinator Brittany Camden Smith on November 29, 2022, residents in Independent Living got an important refresher on the continuum of care provided at Kendal at Lexington.
Aging in Place
Referred to as “aging in place,” a mainstay of life at Kendal, continuing care allows residents to remain on the Kendal at Lexington campus if and when their care needs change throughout the entirety of their lives.
“The purpose of the presentation was to cover all the bases on how moving through the continuum works,” said Marketing Associate Katie Hall. Residents’ main questions and concerns revolved around who will support them in a move to a different level of care and who makes those decisions.
A review of the presentation addresses those concerns and other key points.
Three Living Options
Independent Living is exactly what it sounds like – residents can live independently without help with activities of daily living (ADLs) or any other personal functions.
The Webster Center Assisted Living is staffed by Certified Nursing Assistants (CNAs), Registered Medication Aides (RMAs), and Licensed and Registered Nurse Managers. Webster provides assistance with ADLs, medication administration, temporary respite following rehab or illness, and long-term and end-of-life care.
The Borden Health Care Center provides the highest level of care and is staffed by CNAs, Licensed and Registered Nurses 24/7, and other health professionals. The Borden Center offers short-term skilled care, respite, and long-term and end-of-life care.
Which Living Option Is Best, and How Is That Determined?
Before admission, Kendal staff completes a Resident Functional Screen (RFS) of each resident to determine their baseline for ADLs (bathing, dressing, toileting, eating, etc.) and Independent Activities of Daily Living (IADLs), such as cooking, cleaning, writing checks, and making appointments.
Other assessment tools include mini-mental and depression screens, a fall assessment, and sequencing quizzes. Staff may request an updated RFS from time to time to compare any changes against the initial baseline.
Residents’ RFS scores help ascertain their most appropriate level of care; however, a decision to move under any circumstance is a collaborative effort among residents, staff, their physicians, family and/or representatives, and the Resident Care Committee (RCC).
Led by the director of clinical services, the RCC identifies concerns and possible solutions, promotes safety and aging in place, and helps determine when a transition may be necessary. The committee meets regularly to review the needs of residents in Independent and Assisted Living, drawing upon input from team members across the continuum of care.
When Is It Time to Transition, and How Is That Decision Made?
When an individual can no longer live safely and successfully in independent residential living, planning begins to transition to another option. Reasons might include the inability to care for oneself or lack of in-home support, multiple hospitalizations and/or falls with injury, cognitive decline, and other safety concerns.
It bears repeating that a determination by the Resident Care Committee (RCC) to make a transition is done in consultation with residents, their family and/or representatives, and their physicians.
Per the Residence and Care Agreement, a permanent transfer to the Webster Assisted Living Center, or Borden Health Center may be necessary and required for health and other conditions requiring the level of care offered.
There are also need-based services within each of the three living options, such as clinical care services, home health, companion support, respite or hospice care, or an internal move closer to main amenities, among others.
In the Webster Center, a staff member guides residents through the process; their primary care physician completes a history, physical and tuberculosis screening, and paperwork (sometimes time-sensitive) is completed.
In the Borden Center, the process is the same, with the addition of nurses’ review of medical documentation and interdisciplinary care planning to determine the next steps. Borden can complete an emergency admission if the situation warrants immediate care.
Admissions to either Webster or Borden are coordinated through the admissions coordinator in collaboration with the RCC or the interdisciplinary team for the level of care.
A certain number of days are allocated for vacating each current residence. These timelines can be adjusted according to individual circumstances, if necessary.
The contract type and level of care determine fees and payments.
- How will you know if I need services? The role of the RCC is to monitor and advise; your physician may contact us; family or friends may express concern; signs of decline may be present (they will be discussed with you).
- What are the reasons I may need to leave Webster and move to Borden? Regulatory restrictions, significant risk of wandering, clinical needs, and needs beyond what staff can provide.
- Can I graduate to a lesser level of care? Yes, depending on your recovery.
- What about my medications? You may bring your medications to Webster and Borden until you have used them all, after which we encourage you to use the KaLex pharmacy. You may self-administer your medications, but you must be assessed for safety and comply with the policy for self-administration and medication.
- What if Webster or Borden is full? You will receive services in Borden using Webster contract days if Webster is full. In the never-happened-before case that Borden is full, your contract covers a stay in another community until a room becomes available.
- I worry about a friend and wonder why RCC isn’t doing more. If you are concerned, please see Brittany Camden Smith or Danielle Mohler. Keep in mind that work may be happening behind the scenes (confidentiality is a factor), or your friend may not be ready or accepting of approaches.