Kacmar Reflects on Changes in Senior Care

AUSTINTOWN, Ohio -- When Don Kacmar graduated from Temple University in 1974, he returned to Uniontown, Pa., with the intention of pursuing a career in parks and recreation. He began by running a summer program for Fayette County.

Kacmar, soon to retire as executive director of Shepherd of the Valley Lutheran Retirement Services Inc., can vouch for the accuracy of John Lennon’s observation, “Life is what happens while you’re busy making other plans.”

After the summer program ended, Kacmar was hired by Lafayette Manor, a 98-bed nursing home in the town where he grew up. “After a couple of years, I got interested in administration,” he recalled.

He had taken classes on administration at Temple and saw “the principles were the same [as parks and recreation].”

Kacmar liked working with older people and was comfortable working in their behalf.

“I grew up with a grandmother living with us,” he says. Before his grandmother moved in, he and his family spent a part of each Sunday visiting both sets of his grandparents who “lived a mile from each other.”

Shepherd of the Valley was founded in Niles in 1972 by the Lutheran Church who saw the need to provide a nursing home for those no longer able to care for themselves.

Since then it has expanded its services to encompass independent living, assisted living, home health care, rehabilitation services, skilled nursing and short-term respite care as it built homes in Boardman, Poland and Howland and an administration building in Austintown where At Home With Shepherd is based.

At Home offers home health services. “Home health care is our fastest-growing segment,” Kacmar says.

Systemwide, Shepherd employs 550 full- and part-time including nearly 100 registered nurses, Kacmar says, plus licensed practical nurses, STNAs (state-tested nursing assistants) custodians and security guards who serve 240 residents in independent living, 200 in assisted living and 240 in nursing homes.

The original site at 1500 McKinley Ave. in Niles has expanded to offer condos for independent living as well as assisted living. The community in Poland Township, built on a horse pasture on W. Western Reserve Road, offers independent and assisted living. The building in Boardman, 7148 West Blvd., offers rehabilitation services, skilled nursing and short-term respite care. And at Howland, the newest site, offers independent living and assisted living.

Aware that most seniors are less than eager to leave their homes, Shepherd allows them to spend anywhere from a week to a month in independent or assisted living before making up their minds. And Shepherd allows weeklong stays so those looking after someone in need of care can have a respite.

“The type of resident we have today is different than 20 years ago,” Kacmar says. Seniors today are far more independent and most admitted to Shepherd tend to be in their 80s.

“Those in a nursing home today would have been in a hospital [20 years ago],” Kacmar reflects. “Those in assisted living used to be in a nursing home.”

The number of baby boomers has started to increase and the worn-out or wearing-out body parts, especially hips and knees, is driving enrollment in rehabilitation services along with those recovering from strokes and heart attacks.

Some things haven’t changed for those living by themselves, such as poor nutrition. “They don’t eat the right things,” Kacmar says. The Shepherd homes remedy this deficiency with “good nutrition, good meals,” the executive director says.

While Shepherd of the Valley was founded by the Lutheran community, more Catholics are residents than any other sect, Kacmar says, a reflection that Catholicism is the dominant religion in the Valley. “Residents come here more because of geography than religion,” he says. Two decades ago, the majority of residents were Lutheran.

Kacmar remarks that residents have taken better care of themselves before they move into Shepherd. There are far fewer smokers today than when he arrived in 1983. And he points to the residents in independent living who participate in the YMCA’s Silver Sneakers program, “One guy goes to the Y every morning to swim.”

The bocce ball court at Poland remains popular, he says.

Funding remains a challenge and payments from Medicare, Medicaid and private insurers remain contentious. Recruiting qualified employees – whether RNs, LPNs, STNAs or activities directors – is “going to be more challenging” as the federal and state government and private insurers strive to keep costs down.

Also hindering any retirement system’s ability to hire is finding qualified candidates who can pass drug tests and background checks. Shepherd requires candidates to pass a drug test; “15 to 20% of people don’t,” Kacmar says. Moreover, because Shepherd employees work inside the residents’ quarters, they can’t have a criminal record, especially of theft or violence.

Technology has helped keep residents in touch with their families as families move out of the area. Skype allows residents to see as well as talk to their families, Kacmar notes. And personal computers allow residents to learn the news online.

For the At Home With Shepherd program, Kacmar’s successor, Richard J. Limongi, is “researching the use of smartphones to help them manage their own health,” Limongi says. “We’re trying to help people age in place longer through home health services and by offering more service.”   

One thing that hasn’t changed -- and is unlikely to -- is the popularity of bingo. Residents suffering from dementia enjoy the game as well as the “therapeutic sing-alongs.”

The most important lesson Kacmar and Limongi have learned, as Kacmar states, “If you don’t document it, it didn’t happen. So if a nurse doesn’t record the pills she gave a resident and watched him swallow, state regulators contend she didn’t.”

Caring for seniors is one of the most heavily regulated industries in the United States, Kacmar says, and should be. “But it’s getting more and more complicated and the state is passing more and more regulations.”

Electronic medical records have made it easier to meet the regulations and not overlook care provided. “Our staff does a great job and they’ve got a tough job to do,” Kacmar says.

Pictured: Don Kacmar.

Copyright 2014 The Business Journal, Youngstown, Ohio.
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