Promoting Excellence : Long-Term Care Facility

Carver Living Center
Durham, North Carolina

Jennifer Gentry, RN/C, MSN, APN

Jennifer Gentry 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.”

Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying persons and their families. Visit for more resources.

Promoting Excellence logo and link to home page