New Model a Wave of the Future

With the launch of Carrington Senior Health Services in Hermitage, Middle Tennessee now enjoys a model unlike any other in the area for the care of older citizens. Carrington offers adult day care on the campus of Summit Medical Center.

“For years now, we have not been able to embrace this model, but we’ve seen it be very successful in different parts of the country and as close as our neighboring state of Kentucky,” explained Carrie Ermshar, Carrington’s principal owner and partner.

That this care-delivery system is available today is the result of the Long Term Care Community Choices Act of 2008, which the Tennessee General Assembly unanimously adopted. Thanks to the legislation, the Centers for Medicare & Medicaid Services OK’d an amendment to the state’s TennCare waiver, thus green-lighting a wider spectrum of senior care choices. One of the most welcome changes was the expanded option for home and community-based programming.

“With that new law came the opportunity for Medicaid reimbursement for adult day services. That has certainly opened up the opportunities to a wide spectrum of folks who typically would not have been able to receive it before,” Ermshar said, adding, “With that door opening also comes a lot of attention from private pay, insurance and even Veterans Administration benefits. They are realizing the value of having that therapeutic day, and then the individual can still go home at night.”

And that is just what Carrington provides. Open 7:30 a.m. to 6 p.m. Monday through Friday, Carrington is staffed by nurses. That’s why Ermshar calls her firm’s service “a therapeutic day program.” Located on the fourth floor of the hospital’s medical office building, Carrington provides an atmosphere more akin to a condominium environment than an institutional one.

Ermshar calls her daytime denizens “guests,” and each is afforded a personalized care plan based on his or her needs. For some, that therapeutic care may mean meeting social needs “to prevent some of the isolation that so often occurs with older adults who are home alone during the day or just don’t have the social interaction that they need to keep their attention span and their personal emotional needs met,” she explained. The care plan also may include clinical oversight such as medication monitoring, blood pressure checks or working to ensure recommendations are followed from home health organizations or physicians. While Carrington doesn’t offer physical therapy, nurses do work with guests on restorative therapy using onsite fitness equipment. More importantly, they ensure guests are delivered to and picked up from their outpatient therapy appointments at Summit.

“We don’t provide skilled care, but we can certainly work with skilled care partners,” Ermshar said.

While bingo, crafts and other recreational pursuits are enjoyable for the guests, they are integral to the care plan, too, especially for those with Parkinson’s, dementia and Alzheimer’s. “While they’re playing a game, we’re able to clinically monitor their ability to remember those numbers or their tactical ability to pick up the squares,” Ermshar said. Guests also enjoy snacks and a hot lunch through the medical center’s food services.

There’s also another group of people served by the daytime model – the caregivers. “The Carrington program is not only bringing quality to the individual guests but also giving quality time to those caregivers who are really exhausted and trying to keep their life together at home,” Ermshar said. For one guest, his wife brings him by each Thursday so she can run errands and see friends. Other guests are there each weekday while the caregiver is at work. Carrington requires a minimum stay of four hours.

Generally, Carrington accepts guests 55 years of age or older. Yet, Ermshar said she recognizes there might be a daytime care need for someone younger, and that’s a possibility.

Ermshar is a senior care pro. Before she launched Carrington, she was the CEO of the Tennessee Association of Homes and Services for the Aging. “Through the advocacy role with the association, I decided there just has to be a different model to deliver services,” she recalled. During discussions with Jeff Whitehorn, CEO of Summit Medical Center, the germ of the Carrington idea grew. Whitehorn wanted to know how to better position the hospital to be of service to seniors, and Ermshar was considering a location for a new venture. Thus, the partnership was born.
“As valuable as long-term care communities are, people need to go to services where they have a comfort level with safety, security and their sense of community,” Ermshar said. And for some people, that isn’t changing where they live.

Capacity at the Carrington facility at Summit is 15, and the number of regular guests in mid-October was at eight. “We keep it that small for a purpose,” Ermshar said. “Our goal and intent is to open these in a variety of community hospital settings throughout Middle Tennessee, but we want to keep it small so we can follow these individuals and their families carefully with a focused, individual care plan.” She predicted the next location would be in conjunction with Skyline Medical Center in Madison, and she’s looking outside Davidson County, particularly Murfreesboro and Dickson, for additional sites.

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