Providing Wellbeing through Care Coordination

As a part of Blakeford’s continuing mission to be the premier provider of senior living options, we have dedicated new resources to navigating health systems and making sure all our residents receive all the care and services they need in order to thrive. We believe that care coordination is key to good health and wellbeing. In 2014 Blakeford added a full-time role to provide care coordination to all our residents. Our Community Care Coordinator, Pat Hudsmith, works alongside each of our residents beginning when they are “prospective” residents to the community and continuing throughout their life at Blakeford.

Pat took some time to answer a few questions regarding her role and its impact on the community. Pat Hudsmith

What is your professional background?
I have been a registered nurse for 30 years. I started my nursing practice in neonatal/ pediatric intensive care. Then, I worked as a case manager, taught nursing education, and worked for a physician in private practice. When I started working for Blakeford, I was a medication management nurse and caregiver educator with Blakeford At Home, before moving into the role of Community Care Coordinator.

What was it about the job of Community Care Coordinator that appealed to you?
The role of Community Care Coordinator allows me to combine all of my nursing experience for the benefit of our residents. I have clinical expertise, as well as strong teaching and care management skills.

What are your primary functions in your role?
My role here isn’t as a clinical nurse, although that is my background, so I can’t diagnose or treat. I can listen to symptoms and decide if a resident needs to visit their doctor. I review the medical histories of new residents and meet with them before they move in, helping them assimilate into resident life. Regularly, I meet with a resident’s doctor to get information for preoperative and postoperative care. I also meet with families a lot. If residents have a life change, need a caregiver in their home, or need a different level of care, I’ll walk people through those transitions.

I’ve gone through bags of medications with people and have done a lot of teaching – my favorite work – explaining how to manage a new diagnosis, providing advice on nutrition, or when to take medicine. I will visit residents at the hospital if they are there for more than a short in and out, and will help them develop a plan for returning home. For all our residents who must move to another level of care, whether permanently or temporarily for physical therapy, I will continue to work with them as necessary.

I really consider myself an advocate for our residents. Many residents refer to me as a professional daughter that happens to be a nurse!

Is there a typical day for you?
There’s definitely not a typical day! Each day provides a wide variety of opportunities and I am always finding different needs and ways to help our residents. I spend very little time in my office but, when I am there, residents stop by to chat or ask specific questions related to their health.

What are the benefits to residents? To families?
The main benefit for residents and families is increased communication and proactively addressing health issues and concerns. I have also found that interacting with physicians has promoted a big change in making a long term plan of care.

Why is it important for Independent Living residents to have access to a Community Care Coordinator?
The Community Care Coordinator works to build relationships with residents. This trusting relationship allows for open communication which is so important if an independent living resident does have to move on to another level of care.

What are your goals for this position?
In the future, I would like to provide more educational opportunities for our residents and team members that will promote health and wellness.