Interview with Camas Lenz

Camas Lenz, Resident Council President of Riverview Lutheran Care Center in Spokane, Washington

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amas Lenz came to Riverview Lutheran Care Center in Spokane, Washington, as a resident several years ago and brought with him an abundance of leadership experience. He was the mayor of his hometown for over 20 years and also worked as a postmaster. Three generations of his family lived at Riverview, so he was very familiar with the organization. In his leadership role, he feels it is his responsibility to welcome every new resident and staff member. Camas runs a "tight ship," so he conducts meetings according to standard procedure. When a job needs done, Camas is the first to jump in with both feet and help out. As Resident Council President in an Eden Alternative Home, there are always people to meet, opportunities to help out, and new things happening every day.

       What is the size of your home?
       Camas: Riverview Lutheran Care Center is considered a small community. We have 75 elders who live here. The home is divided into two "neighborhoods." Neighbors include elders and staff who live and work in the neighborhood. Neighbors meet on a regular basis to make decisions about how the home is run.
       There are 120 employees whom we consider part of our family, and more than 200 families are welcome on a 24-hour basis. Children love our community and visit regularly from St. Aloysius School, Gonzaga Preparatory School, and many local day cares. Our care providers are encouraged to bring their children to work during the summer. Those kids keep this place hopping.
       There are not only human habitants in our home but also two greyhounds, five cats, 19 fish, and more than 100 birds of several varieties. No one here has to complain about not having opportunities for companionship.

Hazel Bryan, Agnes Johnson, and staff's children discussing the care of dogs.

       How is your home managed and by whom?
       Camas: Riverview Lutheran Care Center is a not-for-profit organization affiliated with The Lutheran Church. We are located on the campus of a Continuing Care Retirement Community. Riverview is an independent corporation that is governed by a board of directors. The board is guided by input from the people who live and work at Riverview and also by area churches.

       Does your home have a wound care team?
       Camas: Because Riverview has a dedicated wound care team, we seldom have problems with elders' fragile skin. The team includes the therapy and rehab director, the dietitian, the director of nursing services, the assistant director of nursing services, and primary care nurses. The focus of the team is on preventative treatment. The team meets on a weekly basis and performs what they call "skin rounds." During these rounds, they review each elder with skin problems, and the team recommends treatment modalities. If a skin condition does not respond to treatment, we refer to our local wound clinic, which will recommend further care options.

       What are some of the new equipment, devices, and products introduced at your home lately?
       Camas: We recently purchased a NuStep TRS 4000. It is a state-of-the-art exercise machine, which our elders are able to use in their physical therapy. The NuStep is used to increase both upper- and lower-body strength. One of our most active residents, Joyce Mason, enjoys using the NuStep with her friend Sammy, a deep gray cockatiel. They exercise together every day.

This is Joyce Mason on the Nu-Step with her best riding partner.

       Do you use particular software? How do you handle physician timelines?
       Camas: We use Continuex software for all of our procedures, such as admitting, discharging, and keeping records up to date. Our medical record director keeps a schedule of physician visits, which is updated weekly. If a physician is late for a visit the physician is sent a "late visit letter." The director of nursing services then makes a telephone contact. If this is not effective, the medical director will fill in for the late physician and will also call the physician to request a follow-up visit.

       How is inventory managed in your home? Who handles purchasing equipment and supplies?
       Camas: Two nursing assistants manage our inventory. They purchase 95 percent of our equipment and supplies. To inventory items, we use a labeling system on each item stocked. When an item is used, the labels are torn off the item and placed in a notebook with pages specific for each resident. The information is used to reorder new supplies and for billing purposes.

       Has your home recently expanded in size and elder census?
       Camas: In 1999, Riverview expanded in size. We continue to serve 75 elders.
The remodeling process allowed us to grow from a home with only five private rooms to a home with 27 private rooms. We added two additional dining rooms, a recreation area, and a resident kitchen. A living room, reception area, and fully equipped therapy gym were also added. For elders reaching the end of their lives, we designed a "Hospice Room," which is a two-bedroom suite in which family members spend the night when an elder is close to passing. The expansion has greatly improved our elder's satisfaction with their living environment.

       What measures has your home implemented in order to cut costs and improve efficiency?
       Camas: Washington State is like many states in the United States who are looking for ways to reduce the cost of healthcare while continuing to provide quality services to their elders. Riverview has felt the forces of the economy and had to reduce spending. In our organization, our largest expenditure is staffing. To meet the recent budgetary requirements, we cut several staff positions. All of the managers were in agreement that we could not compromise elder care. Our decision was to cut management positions instead of front-line staff. We have done this successfully, eliminating most of the impact on our elders. We have found that by moving decisions normally made by our administrator or board to our management team we have positive results.

       Does your facility have an outpatient program?
       Camas: Riverview has an outpatient therapy program that serves the elders in our retirement community. The advantage of this program is continuity of care. When an elder returns to his or her home after a stay here, the same physical, occupational, and speech therapists will continue to work with him or her in the home or apartment setting.

       What quality control measures are practiced in your home?
       Camas: In recent years, we have chosen the Eden Alternative philosophies as the basis for our quality control programs. Our mission is to enhance the quality of the lives of elders in our care. All of our policies and procedures are based on this. If we are having a meeting to discuss the installation of a dog door or the decrease of psychotropic drugs, our mission is always in the forefront. By doing this, everything we do allows us to improve the quality of the care provided.

This plaque shows the 10 Principles of the Eden Alternative, which we follow.

       On a monthly basis, we meet with our medical director to discuss the work we are doing. During these gatherings, we focus on new projects or areas that need special attention.

       How are your employees oriented and trained at your home?
       Camas: Employee orientation is done through several days of job shadowing. During the orientation process, employees are required to watch a series of training videos. They also are invited to an eight-hour introduction to the Eden Alternative philosophy to better understand how Riverview embraces the Edenizing process.
       Elders interview some employees before they are hired. During one such interview, a potential employee discovered that the elder she was talking with was once her second grade teacher. Needless to say, she got the job!

       What are your strategies for retaining and motivating staff?
       Camas: It is evident at Riverview that we value our elders and employees as our greatest assets. We look for ways to make each and every day a special one. We celebrate everything with gatherings that include both elders and staff. Front-line caregivers and elders are asked to make decisions in the daily running of the home. We acknowledge their decision-making ability and do not penalize them for decisions that don't work out. We allow employees and elders to learn from mistakes and move on to make more decisions in the future.

       What continuing education opportunities are provided to staff members?
       Camas: We train nursing assistants at our home in a five-week training session.
       These classes are made available to all non-nursing staff. All staff members are provided the opportunity to attend regular inservices on our campus on specific healthcare issues. We also provide opportunities for our staff to attend workshops in the Spokane community and in the Seattle area.
       The Riverview board of directors offers a scholarship program for any staff member who wishes to work toward a degree as a licensed practical nurse or registered nurse. Staff members also have the opportunity for flexible schedules that will accommodate school classes.
       As a special project, the elders at Riverview are raising money to send a staff person to an International Conference on the Eden Alternative this fall.

       How is staff competency evaluated?
       Camas: Competency evaluations are done on an ongoing basis and routinely with a staff member's yearly evaluation. A staff person's immediate supervisor completes evaluations. Part of the evaluation includes the staff person's participation in the community we have built at Riverview.

       Does your home utilize alternative therapies?
       Camas: At Riverview, we have a massage therapist who provides massages to our elders three days per week. She also provides massages for staff and family members when her schedule allows.
       Aroma therapy has been a part of our plan of care for the past two years. We use aromas to help calm and relax anxious elders and to stimulate appetite.
       Because our campus has a swimming pool, some of our elders attend pool aerobic exercise classes with our occupational therapy assistant. Our recreational therapist offers individual therapy sessions in the pool as part of our recreation programming.
       Animals are also very important at Riverview. Instead of an animal therapy program, we have opted to have pets live in our home. The pets are always available around the clock, seven days a week.

"When I grow old I am going to wear purple...with a red hat..." Ruth Harvey is proudly displaying her favorite poem.

       What is unique about your dining process?
       Camas: Our dining process is unique because we serve our meals restaurant style. Elders have many choices at each meal. All elders are included in the dining experience, even those few who choose room trays.
       Dietary aides go door to door to get elders' orders. Even those elders who eat a puree diet have choices in their meals.
       Meals are served over an hour and a half time span. This allows elders to choose when they want to come down and be served. They don't feel rushed. If an elder chooses to sleep in, a room tray is sent. A salad bar is available every evening. Meals are leisurely, and service is excellent. Choices of beverages are offered, and wine is available at dinner for those who would like it.
       Riverview has such a great reputation for its wonderful food that family members come to eat at every meal, making the experience even better. Recently, an elder donated $25,000 to remodel the eating area because he was so pleased.

       What trends do you see emerging?
       Camas: Elder and staff satisfaction is high. We see trends in decreased staff turnover as compared to other homes in our state. Our census remains above 72 at all times. While some facilities are looking for residents, our home has a waiting list of elders who want to live here. Families are proud to tell others about us. Quality of care has continued to improve. Our most recent state survey was citation free.

       What makes your home unique?
       Camas: Those who visit our facility see a place full of life. Plants are growing, animals are playing, and elders are involved in a meaningful life. Visitors report, "This place is unlike any nursing facility I have been in." We reply, "It is not a nursing facility--it is a human habitat where people come to live and to grow."

ECPN will spotlight an administrator or director of nursing from a long-term care facility, acute care facility, or home care agency in every issue. Please contact Renee Olszewski by phone at (800) 237-7285, extension 209, or by e-mail at rolszewski@hmpcommunications.com for a questionnaire.