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By Dr. Gordon DeFriese

In 2007, the North Carolina Health Care Facilities Association, the trade association for skilled nursing care facilities in the state, saw the need for a new research and education initiative that would focus on efforts to address the many issues affecting the quality and performance of the nursing home industry, with an emphasis on innovative approaches to long-standing issues in both medical/nursing care as well as in residential quality of life. The decision to form a new nonprofit 501(c)(3) public corporation, with its own independent board of trustees, would make it possible to attract to North Carolina support from a variety of private philanthropies and governmental agencies so that these efforts could focus on all types of facilities providing skilled nursing care.

The wisdom of this initiative, taken under the leadership of J. Craig Souza, the President of the North Carolina Health Care Facilities Association, was almost immediately successful in attracting nearly $300,000 in private financing from The Duke Endowment for the support of an innovative (perhaps even unique) approach to in-service education for nursing home nursing personnel at every level (NAs, LPNs, and RNs). Through this project, directed by Polly Godwin Welsh, RN-C, FutureCareNC was able to purchase a $75,000 patient care simulator (mannequin) that would make it possible to simulate almost any bodily function. And with the aid of a dedicated nurse educator, Mandy Richards, RN, MSN, who travels with the mannequin, FutureCareNC was able to offer on-site simulated practice in the recognition of critical clinical symptoms and medication reactions, and to enable all nursing teams in each of 40 participating facilities not only to gain experience in both the recognition of such clinical signs and symptoms, but to also learn how to intervene appropriately, including to practice communication skills associated with reporting among nursing team members and with physicians and families.

This has proven to be one of the most exciting and highly acclaimed approaches to in-service nursing education offered in skilled nursing care facilities in our state. The project is so successful that it is now proposed that this same approach be made to a series of medication-related errors that are most common in the management of skilled nursing patients. Moreover, several companies operating nursing facilities in our state have made it known that they are interested in providing patient care simulators for regular in-service education program use in their facilities, and FutureCareNC is offering to train-the-trainers in the use of these new approaches to nursing skill development.

Beyond this initial project, FutureCareNC is also facilitating an innovative new demonstration in multiple facilities whereby a nurse aide is being trained in the provision of simple oral health care (brushing patients' teeth) for those who are unable to do this for themselves. This project, first attempted in a New England state, is already receiving rave reviews from those facilities within which it has been initially introduced. Once the demonstration project is fully implemented, a DVD will be prepared so that its results can be more widely disseminated among all skilled nursing facilities in the state. This project is expected to have many dental as well as medical/nursing benefits, e.g., a reduction in the incidence of aspiration pneumonia and the enhancement of personal self-esteem and nutrition associated with the experience of good oral hygiene for those residents who will benefit from this innovation.

FutureCareNC staff are also working to bring together all important stakeholders with an interest in the use of nurse practitioners in long-term care. Building on the excellent results obtained from the early demonstration of the utility of nurse practitioners in skilled nursing care in Wilkes Senior Village in North Wilkesboro, FutureCareNC expects that many other North Carolina skilled facilities will want to realize the potential benefit in terms of lowered rehospitalization and lowered rates of medication errors as nurse practitioners become part of the nursing care team in these facilities.

These are only some of the projects FutureCareNC has either under way or in the planning stages. We hope you'll take the opportunity to learn more about FutureCare at upcoming association events and FutureCare events, and to get involved in this exciting foundation. It is the intent of FutureCareNC to begin to systematically address issues for which carefully constructed demonstrations can be undertaken in a few skilled nursing facilities and the results then implemented more widely in others, as North Carolina's nursing home industry moves forward in its aspiration to achieve recognition as the national best.

The FutureCare board of directors consists of leaders from the long term care industry, hospital industry, insurance industry, and academia. The Foundation's president is Dr. Gordon DeFriese, former president of the N.C. Institute of Medicine and the board of directors is chaired by Ken Burgess of Poyner Spruill.

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