Inside Track: An advocate for change
Marywood Health Center’s Lisa McMichael sees many changes ahead in the realm of rehabilitation therapy.
Lisa McMichael has seen a lot of changes in the field of occupational therapy since she started her career two decades ago, and she expects to see more thanks to the baby boomer generation.
“Twenty years ago, you got to be 80 years old and then you would go to a nursing home, and it was a nursing home for long-term care,” she said. “Probably 80 percent of the nursing home environment was long-term care, and 20 percent were coming for rehab.”
She said today “people are coming in younger and younger, and more often therapy is being recommended for people getting those orthopedic procedures — a knee or hip replacement.”
McMichael is executive director of Marywood Health Center, a rehabilitation facility that is part of Marywood Circle, a ministry of the Dominican Sisters in Grand Rapids, which has a partnership with Porter Hills.
McMichael grew up in Grand Rapids, and at the suggestion from a mentor at her church she decided to explore the occupational therapy program at Grand Rapids Community College after she graduated from East Kentwood High School.
“What I really like about occupational therapy, in general, is you are continually looking at how to give somebody quality of life,” she said. “Not just getting them to a functional standpoint of doing their daily activities, but also how do you give them quality (of life) and tools they can improve their lives with.”
An internship at Holland Hospital helped McMichael realize she liked working with geriatric patients.
“I connected with them, and … not that everybody shouldn’t have a good quality of life, but when you get to that senior age and life changes so much, how do you keep people independent and in their home as long as possible so they can continue to have a good life well into their later years?” she said.
At that time skilled-nursing facilities with OT programs were much different than today. Rooms were typically shared, therapy wasn’t a daily event, and the environment felt much more like a hospital setting.
As an occupational therapy assistant, McMichael said she felt the facility where she was working operated like a production line.
“That drove me crazy,” she said. “My goal always has been to keep people out of a long-term nursing home.”
McMichael said she wanted to see a greater focus on customer service and patients being encouraged to be more independent. That desire led her to return to school twice, first for a bachelor’s degree in health care administration from Sienna Heights University in Adrian, Mich., and later for an MBA from Cornerstone University.
Not long after she received her bachelor’s degree, she returned to Grand Rapids to manage Luther Community, now called Maple Creek, where she was responsible for independent and assisted living.
She said she was able to start implementing changes she believed were important in helping patients have a better quality of life.
“We had a building that was licensed as assisted living and we de-licensed the building and made it independent living,” she said. “We utilized private duty home care to provide whatever services they needed. It really was promoting that independence.”
Of the experience she said, “It was perfect. I ended up being a culture change advocate.”
She said she led the facility’s transition from a nursing clinical model to a customer service-oriented model.
“It wasn’t just about going into a room and giving somebody pills and walking out. It was about building relationships,” she said. “I think I made huge progress. I was at Maple Creek for seven years and we did a whole renovation of the campus and changed to these new models, and it was awesome.”
After earning her MBA, she took on the role of managing the 60-bed Allendale Nursing and Rehab facility. She said that position was particularly important in her career, as was her management style.
“I’m not an office sitter. I’m always out on the floor trying to build relationships with the staff and the patients or residents,” she said. “People always felt comfortable coming to me if there was an issue.”
She said it’s been especially important to acknowledge her staff’s individual talents and encouraging them to “fold that into the care or services they deliver.”
McMichael said one of the biggest things for people living in a facility is making sure there are activities they enjoy. She noted as younger and younger residents join continuum of care facilities, bingo and crafts no longer cut it.
“I strongly feel people, particularly seniors, whether living in an independent situation or a nursing home situation, they need to have purpose on a daily basis,” she said. “They have to feel they have something they are waking up for. You are trying to tap into what it is they enjoy.
“I’ve had to coach people into accepting that some people aren’t going to come to all of your activities. Maybe they are content reading a book in their room, and that is OK. Sometimes people get so caught up, particularly when they are (leading) activities — ‘Well, I only had two people show up.’ Did they enjoy it? Was it worth it to them? It’s OK then.”
Today, patients want more privacy. McMichael said she’s seen facilities getting smaller in order to meet those demands. She noted Marywood Health Center has 49 private rooms and offers strong personal care, thanks to its staffing.
While many facilities have three staff shifts and different staffing levels depending on the time of day, Marywood has two 12-hour shifts, with each of its five wings staffed by a nurse and a certified nursing assistant.
Other changes she’s seen take place across the industry include weekend therapy to help people get back to full function more quickly, and technology that is changing at-home rehabilitation options.
“Our technology has changed, medical science has changed, abilities have improved,” she said. “There are people in their 70s and 80s getting knee replacements, and if they don’t have any other complications, they actually are going home with home care versus coming to a rehab center. If they do come, it’s often for a week or two now.
“Ten years ago it was typical that people would come in and get therapy Monday through Friday — no therapy on the weekend,” she said. “That was something I personally wanted to change, but then I saw the whole industry go in that direction because, to me, if you are coming to therapy, it should be seven days a week.”
McMichael said new technology is just beginning to scratch the surface and will likely explode in the next five years.
“We have a new rehab contract with a group called Functional Pathways,” she said. “Their owner has been a creator of virtual therapy. It’s like a Wii game, almost.
“We were talking about how we can use it in this environment. I could even see it being more beneficial in a home environment.”
She said the only drawback is people don’t tend to push themselves as hard when they’re doing therapy exercises on their own, which means becoming functional might take longer.
McMichael is excited for the future of Marywood Health Center.
She said she hopes to institute more real-life therapy practices, including creating a rehab apartment that would allow people to practice every day household activities. That would help staff figure out how to accommodate each patient’s unique needs before they return home.
McMichael also would like to get a pool therapy program started.
“We are working on trying to set ourselves apart in the therapy realm.”