Lydia Cristobal – Evidence-Based Practice Design in Long Term Care & Tailoring to the Geriatric Population

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Dr. Lydia Alicia Cristobal DNP, LNHA, RN-BC, NEA-BC
Dr. Lydia Alicia Cristobal DNP, LNHA, RN-BC, NEA-BC

Dr. Lydia Cristobal DNP, LNHA, RN-BC, NEA-BC is a healthcare executive who has worked in various health care settings and specializes in post-acute and geriatric care.  She earned her undergraduate and graduate degrees in nursing administration from New York University and Doctor of Nursing practice from Yale University.  Her credentials are licensed nursing home administrator, board certified in gerontology, and board certified in advanced nurse executive practice.  A Veteran of Operation Enduring Freedom, she continues to serve in the U.S. Army Reserve as a Major in the Nurse Corps at Picatinny Arsenal in New Jersey.  She is currently the administrator of a hospital-based skilled nursing facility in Hudson County, New Jersey.
Topics Discussed:

  • Organizational stewardship
  • High turnover rates in nursing home leadership
  • Changing the way geriatric care is delivered
  • Evidence-based practice

Lydia’s Links:


Hanh: 0:58
Dr. Lydia Cristobal is today’s guest. She’s a healthcare executive who has worked in many healthcare settings with a special focus and post acute and geriatric care with two degrees in nursing administration. She’s currently is the administrator for the hospital-based skilled nursing facility. So I’m excited to learn about her journey in caring for the older adults in post acute in geriatric care. Lydia, thank you so much for being here on Boomer Living to share some of what you’ve learned throughout your career and welcome.

Lydia: 1:31
Thank you. It’s a pleasure to be here.

Hanh: 1:33
All right. So could we start with you sharing a little bit about yourself, where you’re from your work experience and what are you working on right now?

Lydia: 1:42
Well I was born and raised in the Philippines and my family and I immigrated here in the us when I was 18. So I started being a licensed practical nurse. And that was when my first job in the nursing home happened. and I grew up in long-term care. and it was in those experiences that I realized that , um, I’ve seen the rise and fall of leaders. I’ve seen challenges, situations and I was fearful. I was fearful for my career. I was fearful for the way that our patients were treated in the nursing home. And that’s when I told myself that when I become a leader, then I will make that change and that will make things better for our geriatric population. I will be their voice. And hence I am this journey being an administrator myself and slowly and keeping that promise and changing the way that care is delivered for a geriatric population.

Hanh: 2:40
Congratulations on the impact that you’re making. So can you tell us a bit about the problem with high turnover in the nursing home?

Lydia: 2:50
Yes. So what my empirical evidence I’ve seen this all the time in every nursing home that I’ve been to. And it’s a known fact that administrators don’t get to stay in their jobs easily. It’s like a year or two because of the. The need to fill up the beds. Pretty much administrator’s job is to fill up the beds regardless of how that happens. And if the administrator is unable to fill up the beds, that’s a topic and possibly lose her job. Same thing with the director of nursing, and because if there’s no match, a good partnership between the director of nursing and the administrator, that’s when the high turnover happens. And as much as, don’t get me wrong, there are really good administrators, director of nursing’s out there, but the thing is they’re not supported. And so what happens is that when they try to start an initiative to the staff, Oh, I’m the new administrator or, Hey, I’m the new director of nursing. Let’s do this project, we going to make it, and just when they started, that’s when they leave the job, and here is the staff being affected by that high turnover. Like, Oh, here’s the same story again, right? Here’s a new person. They’re going to start put some initiative and then what for, and so we need to figure out something and how we can take care of our leaders for providing mentorship. But providing support for them. And I think it’s easy to say, but very difficult to do. So that’s when the organizational’s stewardship all falls into to action. How are we really taking care of our leaders? Because if you take care of our leaders, and, because most of the nursing homes are family owned, and it’s a business. We have to make the money to be a sustainable business, but we also have to consider that for an organization to be successful we have to take care of them because once we take care of our staff, then they will take care of our patients, and magical things happens as a result. If we really care about our geriatric population, we will take care of our leaders because once we take care of the leaders and staff, the results will come out as they provide the best care for our geriatric population.

Hanh: 5:15
Very true. Very true. That was my next question is What the role of organizational stewardship in providing an excellent patient experience?

Lydia: 5:25
So, one thing is, one, and it’s easy to do, mentorship. But it’s hard to do because what happens in long-term care is that short of staff, that’s a lot of short staff and we don’t put emphasis on having a simple as having a nurse practice council. That’s one of the things that contributes to organizational stewardship by taking care of the staff. So if I’m a good person, if I’m a good nurse, I want to care. I came into the long-term care because I want to take care of old people. And if I’m not supported by thoughts of innovation, thoughts of improving my practice, as a nurse, then what’s the point. Everything will just get task oriented. and yeah. That’s a sad reality. And that’s when it’s important that we practice organizational leadership by promoting how we can advance into our practice. And I know that it costs money in terms of having to allocate staff, to attend nurse council to attend further education, to improve what they do for for the nurses. But if we actually invest on them, we will get the return thereafter it’s as restorative investment. And again, it’s easy to say, but it’s not usually practiced, and it’s not, it’s not usually being done in our long-term care settings.

Hanh: 6:59
So what would you say the biggest lesson that your facility has learned as a result of COVID-19?

Lydia: 7:05
This is where, this is a time where we can find ways to use technology to connect. This is a time where we can bring people closer, understanding them, um, because of the COVID, then their visit, visitation restrictions are in effect. And so how do we allow our patients to connect with family and friends? And it’s a good thing that we have technology that we can, we can use for, as a matter of fact, we had a patient who had his 90th birthday and we allowed the family to bring in his cake and balloons, and we had a really good celebration by using FaceTime, and video conference and to celebrate with the family. We can think of ways to change, to prevent isolation. Um, and it’s very tough, even the nurses are also overwhelmed, in terms of staff, but with the events of the COVID and what it brought us, it made us realize too, that if we’re working as a team, it brings us closer together because the challenges that we face, we only have each other. And, and it’s a great thing. And this is when we actually had the time to stop and smell the roses that wow we have a great team and we’re able to get through it together.

Hanh: 8:29
Very true, team usually wins. So that’s a great philosophy. Now, as far as the biggest thing that you learned personally, in your own life from working through this pandemic, do you have any lessons learned?

Lydia: 8:42
Well, prior to the pandemic I was already looking into telehealth because I know that boomers, we know that boomers want their independence. And so the way that traditional nursing homes are set up is pretty much not where you want to be. As a matter of fact, statistics show that 6 in 10 Americans would rather die than be in nursing homes. And there’s a stigma related to that. So then the question is how are we going to change the kind of care that we deliver? I personally do not believe in traditional nursing homes anymore, because that’s where the stigma comes in. I believe in Greenhouse Project, I believe in a different care model. And, and so what can we do to change it, the way that the care is delivered? But we have to ask the right questions first. And, for me, I was armed with education to practice evidence-based practice. So, are we really doing that? Are we asking the right question to change the kind of care that we do? (Even if it’s just in small steps.) So, for instance, in my current job right now in CarePoint, one of the things that the evidence-based project that we had, as simple as music therapy is a complimentary treatment where we can, where the patient’s pain is going to, pain management will be effective rather with the use of music therapy in adjuvant to pain medications. And another one that we have today as well is the horticultural therapy. To improve the quality of life, and improve activities of daily living. So when we do projects like that, we have to disseminate, we have to tell the world that it works, and then we have to do something about it to change the care model that we provide. And it’s very important in our profession to always ask the questions and how we can change. Now, sadly for long-term care, again, everything is task-oriented, let’s just get through the day, we give the patients that are medications, that they do, their activities. Everything is like all over again. But I think that there’s a need and I’m calling out to all post acute care leaders out there that we should use this opportunity to leverage collaboration with entrepreneurs and high-tech industries. How can we change the way that care is delivered through innovation? For example, if I would want my father, in other words, my father has dementia, and he lives alone. What are the ways that we can use technology for him to be safely at home? There are the cameras at home, or motion detectors, when they move around the house. By us collaborating with entrepreneurs, enables us to think about what technology can be created to allow our boomers to stay at home safely. Because that’s what they want to do, they want to stay home. They want to have their independence and there are technology out there, but we just have to tap into that.

Hanh: 11:54
Yeah, I think there are a lot of technologies perhaps operating in separate entities. I think it needs to be more of a coordinated orchestration of all of these segregated technologies to work in our harmonious fashion. Do you agree?

Lydia: 12:10
Yes, totally.

Hanh: 12:12
Yeah. I, I’ve had a couple folks as guests on this show and they’ve shared some great innovation technologies. And I think that absolutely they exist and there’s going to be more that, will be flourishing and years to come as a result of the pandemic. But I think more importantly, how do we orchestrate all of these technologies into one that’s very robust into a smart home, let’s say. These are very good points. So let me ask you, so what do you think geriatric care will be in five years?

Lydia: 12:42
It will be really be home-based, and that’s the thing of the future because. And we’ve seen a lot of nursing homes bed capacity shrinks because nobody wants to be the nursing home. If we have this smart home, and we can leverage that, then I think that’s the future. And we can see that from other countries where they are putting emphasis, as well for home care. And the mere fact that a lot of providers are now able to go to the patient home to give the care, or use technology, and to use telehealth for that matter.

Hanh: 13:19
I think I’m out of this pandemic. tele-health, telemedicine televisits, however, um, is being used. Uh, has exponentially grown and I think it will continue to do so. Um, the serving the aging population. So let’s say in the longterm, 50 years or so, what big changes will you see to geriatric care? What do we need to do to get there?

Lydia: 13:43
I, again, as I mentioned, I love the concept of the Greenhouse model, and I’m sure it’s going to be well-known and it’s going to grow, but, yes, to answer your question about 50 years from now, I just think that by that time we have already thought of ways to change the way to react to care is delivered, not in an, as an institution, but more of a Greener house. And one of the things that I advocate for is evidence based practice design, and sadly, a lot of the long-term care industry, or the PR or the senior living industry, they continue to build models of home by construction, and because it’s aesthetically pleasing, but not using evidence-based practice that really tailors to the geriatric population. For instance, as simple as color, as simple as how the architecture of the environment is designed; it’s as simple as that. And I can envision a future where we will practice evidence-based practices designed where it is, the environment is conducive to a holistic model of care. And that’s what we need and, again, it’s being in an institution is a thing of the past. And I think that we should put all our efforts to change that care, and to do that we should also have our voices heard. So we he knows something that is not working, then we should do as leaders, to participate in getting our voices heard to, for cms, for our, um for a state-based makes the decision for policy change, because sometimes a lot of these care as much as we want the best innovation for our geriatric population, sometimes it’s cost prohibited. And it’s it, it’s a sad reality, but I’m sure again, by collaborating with the best minds in the industry, we can figure out a solution to change the model of care that will benefit everyone. It’s all about research, right? So, we really have to emphasize data and research to improve the care that we provide.

Hanh: 16:00
What I hear in our conversation is that independence, purpose, contribution, wellness, and vibrancy, all of that promotes living. Right? And I think that’s, that’s what we all want to be. Whether we are fifties, seventies, or nineties. And what’s your thought on that? Because I feel like everything that you’re talking about, yes, we do need to provide better care, geriatric care, and promote wellness, vibrancy, engagement, overall living. And because I think that’s what you and I want. And as humanity, we all want that.

Lydia: 16:36
Correct. And that’s how we have to practice, and this is our opportunity to change, this is our opportunity to have our voices heard, because if we do not convey that, then nothing is going to change. For other generations, they work their life to contribute to the society. And nobody wants to like, Oh, okay, I’m going to work hard so I can be in a nursing home. Nobody wants, but we want to know enjoy. We want to age in a very in a very beautiful way where, um, life is beautiful and we live a very holistic healthy life. It’s something that we, I know it’s very easy to say that pretty much difficult to do, but, in small steps, I’m sure sometime in the future I am hopeful that we can change it. We just have to gather together and collaborate as leaders to make it better for our geriatric population.

Hanh: 17:38
Yeah, I agree. I think now it’s the best time ever because of COVID it has uncovered the importance of this, right? It’s in the media, in all the good of the Healthline front care providers and workers. I think mostly it uncovers the the shortcomings, and this is when we can take on those shortcomings and improve, and make it stronger for many decades to come because we have 10,000 folks turning 65 plus every day for the next several decades.

Lydia: 18:10
Yeah, we really have to position ourselves. and it’s the first time that I heard about, um, China and Italy, where there are more of older people and you only have a few of the younger and generations to care for them. So, what is our solution to tackle that problem? So, it’s just a matter of what kind of culturally competent care can we provide that is also efficient as well? That will Provide the best outcome for our patients.

Hanh: 18:44
And I hope by having these conversations, people that are voicing the concerns, asking the questions, the folks that really want to make an impact as opposed to just sitting back and just accepting the problem. So, I’m glad that we had this conversation and I’m hopeful that people will listen and there will be a stronger voice, and eventually come folks coming together with some action items that are truly executable solutions.

Lydia: 19:13

Hanh: 19:14
So, that is the driving force behind the senior living, the the podcast that I’m doing, because I think it’s very important. It isn’t just one sector, it’s all encompassing and it has to be a coordinated effort.

Lydia: 19:28
I agree. And thank you for this platform. And this is one of the things that can disseminate ideas, and that I encourage leaders to, to publish. Sometimes those good news stories they just need to be heard. What are those little things that we have done in our profession to improve our geriatric care? We need to disseminate those, those important stories and simple as that, can probably inspire other people. So it’s just a matter of publishing, and again, it’s the dissemination is of utmost importance for us to move forward.

Hanh: 20:05
Very good. Now, do you have any other thoughts that you would like to share?

Lydia: 20:09
I pretty much would like to have a wishing message to our leaders out there that I know with the COVID pandemic that happened, it’s very tough just living day to day, but if, again, we come together as leaders and in long-term care or the senior living industry, we can make things better in the future by supporting each other. And that the simple, the simple action of supporting each other having, use leveraging social media to support each other. Sometimes it’s all we need to get through the day, because it is tough. It is tough if we all, I’ve known a lot of administrators who quit their job because they said I’ve had it. I’m done, but sometimes it’s those challenges that makes us stronger. And if you really are passionate in the work that we do, we will overcome that and it will make us stronger eventually.

Hanh: 21:16
It’s such an honor. And what a blessing to be, a, it’s very difficult, but to be in the industry that we get to serve the aging population, because you know what, I believe it sets the direction, how we’re going to be cared for, because we’re all going in the same direction. And, as professionals in the industry, we got to step it up, because everything that we’re doing for our parents and grandparents, we’re setting the stage for ourselves.

Lydia: 21:41
I agree. I agree.

Hanh: 21:43
Yeah. I appreciate your time.

Lydia: 21:46
Okay. Great. Thank you so much for this opportunity. I really appreciate it. And enjoy this wonderful time with you.

Hanh: 21:52
All right. Thank you.

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