Carver Living Center
Durham, North Carolina
Jennifer Gentry, RN/C, MSN, APN
Jennifer Gentry uses her nurse practitioner
training and specialization in palliative care to
provide medical care for the residents of Carver
Living Center (CLC), a 272-bed long-term care
facility in Durham, North Carolina. One of the
largest nursing homes in the state, CLC offers
short-term rehabilitation, long-term care and
hospice care. “Our motto is function and
comfort,” Gentry explains. “In everything we do,
we ask how it will benefit the patient— and how
it will make the patient more comfortable or
more functional.”
As a nurse practitioner in North Carolina, Gentry is able to act independently as an on-site primary care provider for facility residents. Rather than waiting for a patient’s doctor to visit or for a clinic appointment, Gentry can evaluate and treat a CLC patient with minimal delay. Often, problems that might have required emergency treatment and hospitalization are averted.
CLC’s progressive medical director, William F. Uthe, MD, has worked closely with Gentry to integrate palliative care into the normal flow of clinical care at the nursing home. Rarely does a week go by without a family meeting to discuss issues of palliative care and to determine what steps should be taken to ensure a resident’s comfort and continuing excellent care.
Careful Case Management
Case management begins the moment patients
are admitted to the CLC. For new patients,
Gentry performs the admission, takes the
patient’s medical history, and writes orders for
lab tests and for an initial plan of care. For
existing patients, she examines, diagnoses and
treats whatever medical problems occur. Part of
her routine includes discussing patient preferences
for care and advanced directives, either at
the time of admission or shortly thereafter.
People are admitted to CLC from the hospital, from home and from hospice. At times, it is clear that the patient being admitted has only a short time to live. In these cases, Gentry convenes a meeting with the physician and family. “I sit down with family and review the patient’s advanced directive,” she explains. “We talk about what to expect. Everyone is different, and taking individual differences into consideration is one of the secrets to success.”
Financial Viability
Carver Living Center bills Medicare, Medicaid,
private insurance and patients for Gentry’s acute
care services. Her salary is covered by reimbursement,
thus allowing the facility to recoup the
expense of a full-time care provider. Gentry has
collected data showing that CLC nursing home
residents make significantly fewer trips to the
hospital emergency room than average, resulting
in lower patient costs and a less stressful atmosphere
in the facility. In addition, hospice referrals
have tripled since Gentry joined the facility.
Collaboration at Work
The philosophy of palliative care is implemented
at CLC through the day-to-day, hands-on care
given by attending physicians, a second nurse
practitioner, a physician assistant and a social
worker. In addition, Gentry has worked hard to
develop collaborative relationships with area
medical specialists to improve access to services
for CLC residents. For instance, a local neurologist
now holds a clinic at the facility six times a year.
Gentry frequently consults with the CLC nurses at the bedside. “I validate their nursing skills and teach them techniques of palliative assessment and care,” she explains. She also conducts in-service training for staff, teaches nurse practitioners and resident physicians, and serves as a mentor for nurse practitioner students from University of North Carolina–Chapel Hill and from Duke University.
Personal Reflection
CLC’s success story is traveling by word of
mouth. “Several times a year I get a phone call
from a nursing home administrator who wants to
learn how we improve people’s lives,” Gentry
says. “Our model is self-sustaining and relatively
easy to implement with the right kind of
leadership and support.”
