I won't go into detail here about yesterday's fire at a Missouri Assisted Living Facility. What I will give you is my top ten links related to fire prevention:
5. National Fire Protection Agency: Seems obvious, only problem I have with the NFPA is that they charge a ridiculous fee to access their regulations. Hopefully we can get this changed someday.
4. Fire Safety: Is Your Facility Legal? This article examines two recent facility fires in Tennessee and Connecticut, comparing State regulations to NFPA Standards.
3. Nursing Home Patient Catches Fire: I can't give enough examples of residents setting themselves on fire.
2. U.S. Considers Mandating Sprinklers in all Nursing Homes: This articles references the recent Connecticut and Tennessee fires; if your facility is not currently sprinkled, it will be soon.
1. Firesafety.gov gives great tips on general fire prevention.
Residents died today. Employees died today. There are still facilities operating without sprinkler systems. This Assisted Living was one of them. This place was reduced to nothing but ashes.
I can't bear to see this on the news again.
Nursing Home Employees: Remember Your Audience
A New York Certified Nursing Assistant has been charged with felony reckless endangerment after "jokingly" putting a pillow over the face of an Alzheimer's resident and punching the pillow where the resident's face would have been.
The worker is being charged with a misdemeanor and says the incident was made in a joking manner. His mother is a resident at the same facility.
The Nursing Home employee in question has been forbidden from the property, including visitation of his mother.
The original article on this story can be referenced here.
The worker is being charged with a misdemeanor and says the incident was made in a joking manner. His mother is a resident at the same facility.
The Nursing Home employee in question has been forbidden from the property, including visitation of his mother.
The original article on this story can be referenced here.
Five Recommended Books for Nursing Home Administrators
Because today is a slow news day, here is a list of five recommended books on my bookshelf:
1. Never Eat Alone
by Keith Ferrazi. This title focuses on making the most of your relationships without taking advantage of them. For someone who has trouble opening up to people, this is certainly a good read. Applicable especially if you are part of a "marketing heavy" corporation.
2. The Forbes Book of Business Quotations
. A good quotation is a great way to end an inspirational email, insert into a speech, or to use as a message in a thank you card to an employee or family member. Forbes delivers here with an amazing compilation, and it really goes beyond it's title of "Business Quotations." Words of wisdom for everyone here.
3. Blink: The Power of Thinking Without Thinking
by Malcolm Gladwell. This book has become very popular. How often do you wish you would have went with your gut? Gladwell insists it's the only way to go. A worthy read if you're looking for a new decision-making process.
4. Leadership, by Rudy Giulianni.
What I found most interesting about the famous NYC Mayor's recount of his tenure during 9/11 was not the descriptions of his personal and professional heroics, but rather the concept of CompStat, which I know has an application in the long term care arena.
5. Nursing Home Federal Regulations
, by James E. Allen. The same author of the Nursing Home Administration textbooks. Just published in October 2006. Make sure you have one on your bookshelf.
1. Never Eat Alone
by Keith Ferrazi. This title focuses on making the most of your relationships without taking advantage of them. For someone who has trouble opening up to people, this is certainly a good read. Applicable especially if you are part of a "marketing heavy" corporation.2. The Forbes Book of Business Quotations
. A good quotation is a great way to end an inspirational email, insert into a speech, or to use as a message in a thank you card to an employee or family member. Forbes delivers here with an amazing compilation, and it really goes beyond it's title of "Business Quotations." Words of wisdom for everyone here.3. Blink: The Power of Thinking Without Thinking
by Malcolm Gladwell. This book has become very popular. How often do you wish you would have went with your gut? Gladwell insists it's the only way to go. A worthy read if you're looking for a new decision-making process.4. Leadership, by Rudy Giulianni.
What I found most interesting about the famous NYC Mayor's recount of his tenure during 9/11 was not the descriptions of his personal and professional heroics, but rather the concept of CompStat, which I know has an application in the long term care arena.5. Nursing Home Federal Regulations
, by James E. Allen. The same author of the Nursing Home Administration textbooks. Just published in October 2006. Make sure you have one on your bookshelf.
Oklahoma Nursing Home Administrators Face Public Scrutiny
Oklahoma is certainly taking Health Facility Administrator licensing seriously by implementing a public complaint system on their Board of Examiners website. This system gives John Q. Public the opportunity to submit a complaint online by completing a seven question form.
Against the Administrator, not the facility.
From there you can search for any Administrator's name in the state and review all complaints that have been lodged against them, regardless of their merit or investigative conclusion. After searching, I had a difficult time finding an Administrator with action taken against their license. Many cases are label as "dismissed." One case even includes the comment "letter of commendation sent to Administrator."
The complaints themselves range from very broad (allegations of general unprofessionalism) to specific (Administrator misappropriated $17, 143.29 from a resident trust account) to clinical (Administrator failed to ensure that facility used proper medical equipment for certain diagnosis). There are many concerns related to abuse reporting and ill-advised hiring decisions. Most Oklahoma Administrators do not have any complaints logged on the site at the present.
As I have stated before, there are Administrators that have chosen the wrong profession, to put it nicely. I fully support mechanisms for reporting deficient practices in our facilities. But by supporting methods other than State and/or Attorney General reporting of consumer concerns, Administrators in Oklahoma are now being forced to spend more time than ever on the defensive, concerned that any single professional or personal action they take could result in a complete investigation of their practice, aptitude, and character. States such as Oklahoma should focus their consumer education on what to look for when choosing a nursing home, how to use the nursing home compare tools at www.medicare.gov, or how to contact state agencies when they feel there are seriously deficient practices occurring.
Leave it up to professional surveyors to determine who is at fault.
Against the Administrator, not the facility.
From there you can search for any Administrator's name in the state and review all complaints that have been lodged against them, regardless of their merit or investigative conclusion. After searching, I had a difficult time finding an Administrator with action taken against their license. Many cases are label as "dismissed." One case even includes the comment "letter of commendation sent to Administrator."
The complaints themselves range from very broad (allegations of general unprofessionalism) to specific (Administrator misappropriated $17, 143.29 from a resident trust account) to clinical (Administrator failed to ensure that facility used proper medical equipment for certain diagnosis). There are many concerns related to abuse reporting and ill-advised hiring decisions. Most Oklahoma Administrators do not have any complaints logged on the site at the present.
As I have stated before, there are Administrators that have chosen the wrong profession, to put it nicely. I fully support mechanisms for reporting deficient practices in our facilities. But by supporting methods other than State and/or Attorney General reporting of consumer concerns, Administrators in Oklahoma are now being forced to spend more time than ever on the defensive, concerned that any single professional or personal action they take could result in a complete investigation of their practice, aptitude, and character. States such as Oklahoma should focus their consumer education on what to look for when choosing a nursing home, how to use the nursing home compare tools at www.medicare.gov, or how to contact state agencies when they feel there are seriously deficient practices occurring.
Leave it up to professional surveyors to determine who is at fault.
CNAs Caught Photographing Dead Body
In the "Things I Hadn't Even Thought of Our Employees Doing" category, three CNAs at a Michigan Nursing Home are battling their State Licensing Agency after getting caught posing for pictures with a deceased nursing home resident.
Hopefully this isn't something I need to write a policy for.
I also stumbled across a blog post from a nurse who was concerned that the CNAs would wrap a towel around the neck of a resident who had just passed away to prevent the mortuary from breaking the neck when they moved the body. They considered this "standard practice." The nurse put an end to this in order to retain some dignity for the resident when the family came to say their final goodbyes at the facility.
I'd never heard that one either.
Does your facility have a policy and procedure for resident deaths? When was the last time you re-visited it? Has your staff become so desensitized that the death of a human being is just another event in their eight hour shift? Perhaps your staff go to the opposite extreme, removing all residents from the hallway and closing doors when the funeral home comes to pick up a body. The attendant gets sneaked in through a back door and rushed out as quickly as possible, as though our resident are not familiar with the concept of death.
Everyone deals with death in a different way, including residents and staff. It is important that you are sensitive to both extremes. At the same time you have to consider families and apparently, the deceased resident. Below is a list of tips for addressing the death of a resident while the body is still in the facility:
1. Remove the roommate. While I'm not an advocate for closing all doors and shielding our residents from a death, it is important to have consideration for anyone else living in the same room. Often there has been a large influx of family members in the room prior to the actual death, and if this is the case, hopefully you have already offered the roommate alternate accommodations. If not, give them an equal opportunity to say their goodbyes, but don't make them stay in the room.
2. Make attending the body a priority. If family was not there, they will be quickly. Do not let their lasting memory of their loved one including an IV hanging out of an arm, a bedpan within arms reach, or sweaty, matted hair. Go beyond cleaning the body. Straighten the room as much as possible, take out trash, turn off TV or music, and leave a fresh box of Kleenex.
3. Only allow assigned staff members in the room. In the situation with the photographing of the resident, five CNAs were in the room at one point. Regardless of their intentions, there is no reason to have an entire crew involved in the process. Some could argue that staff need an opportunity to grieve and say goodbyes, but this is not the time for that process. One nurse and one aide should attend to the process. This gives the nurse the opportunity to document the final note in the clinical record.
4. Make phone calls in private. Our nurses stations are generally public places, whether we admit it or not. Call the physician, funeral home, and family in a private space. Otherwise these conversations may be overhead by residents and families in the vicinity. While I believe that it is important to allow people to openly express their feelings, the nurses station is not the forum to make death announcements.
5. Never force someone to work with a deceased resident. Identify workers that are comfortable and provided them with both education on your facility policies and grief resolution outlets. If an employee says they are not comfortable preparing a deceased body, never press the issue.
Don't be afraid to ask your staff what they do when a resident dies. You may be surprised at what you find. By training staff on some basic procedures, you can help preserve both resident dignity and staff attitudes. As always, never assume that staff know what to do when it comes to something as significant as the death of a human being.
Hopefully this isn't something I need to write a policy for.
I also stumbled across a blog post from a nurse who was concerned that the CNAs would wrap a towel around the neck of a resident who had just passed away to prevent the mortuary from breaking the neck when they moved the body. They considered this "standard practice." The nurse put an end to this in order to retain some dignity for the resident when the family came to say their final goodbyes at the facility.
I'd never heard that one either.
Does your facility have a policy and procedure for resident deaths? When was the last time you re-visited it? Has your staff become so desensitized that the death of a human being is just another event in their eight hour shift? Perhaps your staff go to the opposite extreme, removing all residents from the hallway and closing doors when the funeral home comes to pick up a body. The attendant gets sneaked in through a back door and rushed out as quickly as possible, as though our resident are not familiar with the concept of death.
Everyone deals with death in a different way, including residents and staff. It is important that you are sensitive to both extremes. At the same time you have to consider families and apparently, the deceased resident. Below is a list of tips for addressing the death of a resident while the body is still in the facility:
1. Remove the roommate. While I'm not an advocate for closing all doors and shielding our residents from a death, it is important to have consideration for anyone else living in the same room. Often there has been a large influx of family members in the room prior to the actual death, and if this is the case, hopefully you have already offered the roommate alternate accommodations. If not, give them an equal opportunity to say their goodbyes, but don't make them stay in the room.
2. Make attending the body a priority. If family was not there, they will be quickly. Do not let their lasting memory of their loved one including an IV hanging out of an arm, a bedpan within arms reach, or sweaty, matted hair. Go beyond cleaning the body. Straighten the room as much as possible, take out trash, turn off TV or music, and leave a fresh box of Kleenex.
3. Only allow assigned staff members in the room. In the situation with the photographing of the resident, five CNAs were in the room at one point. Regardless of their intentions, there is no reason to have an entire crew involved in the process. Some could argue that staff need an opportunity to grieve and say goodbyes, but this is not the time for that process. One nurse and one aide should attend to the process. This gives the nurse the opportunity to document the final note in the clinical record.
4. Make phone calls in private. Our nurses stations are generally public places, whether we admit it or not. Call the physician, funeral home, and family in a private space. Otherwise these conversations may be overhead by residents and families in the vicinity. While I believe that it is important to allow people to openly express their feelings, the nurses station is not the forum to make death announcements.
5. Never force someone to work with a deceased resident. Identify workers that are comfortable and provided them with both education on your facility policies and grief resolution outlets. If an employee says they are not comfortable preparing a deceased body, never press the issue.
Don't be afraid to ask your staff what they do when a resident dies. You may be surprised at what you find. By training staff on some basic procedures, you can help preserve both resident dignity and staff attitudes. As always, never assume that staff know what to do when it comes to something as significant as the death of a human being.
Hidden Camera Investigation Leads to Arrests
New York State Attorney General Elliot Spitzer announced this week the arrest of nine nursing home employees, including six CNAs and the facility Medical Director. A hidden camera was placed in the room of a resident for a five week period, where it observed:
-Resident did not receive restorative therapy twice per day as ordered
-Resident was not turned every two hours as ordered
-Resident was not toileted every two hours as ordered
-Resident was not assisted with feeding at every meal as ordered
-Resident did not receive medications consistently as ordered
-Resident was not visited by the physician as documented
AS ORDERED. When was the last time you looked at your residents' monthly order sheets? Do you know the types of things that are being ordered? Are you comfortable with the frequency that some of these things are being ordered?
Nurses and physicians will sometimes write orders without any consideration of facility constraints. I have seen orders and careplans written to deliver some type of care "every fifteen minutes." The chances of consistently fulfilling these orders is zero. There are certainly times when an order like this is realistic and/or necessary for an acute situation. The problem is that these orders are written without a stop date or a defined time frame. As facility leaders, it is our responsibility to consistently evaluate the scope of services that we have committed to offering. A time is coming when surveyors will use their calculators as primary tools of their trade; calculating the total hours of restorative ordered per day in the facility divided by the number of restorative hours on your schedule.
Defined staffing levels are certainly a possibility in future versions of our regulations. Do you know how much care your nurses and physicians have committed you to providing?
-Resident did not receive restorative therapy twice per day as ordered
-Resident was not turned every two hours as ordered
-Resident was not toileted every two hours as ordered
-Resident was not assisted with feeding at every meal as ordered
-Resident did not receive medications consistently as ordered
-Resident was not visited by the physician as documented
AS ORDERED. When was the last time you looked at your residents' monthly order sheets? Do you know the types of things that are being ordered? Are you comfortable with the frequency that some of these things are being ordered?
Nurses and physicians will sometimes write orders without any consideration of facility constraints. I have seen orders and careplans written to deliver some type of care "every fifteen minutes." The chances of consistently fulfilling these orders is zero. There are certainly times when an order like this is realistic and/or necessary for an acute situation. The problem is that these orders are written without a stop date or a defined time frame. As facility leaders, it is our responsibility to consistently evaluate the scope of services that we have committed to offering. A time is coming when surveyors will use their calculators as primary tools of their trade; calculating the total hours of restorative ordered per day in the facility divided by the number of restorative hours on your schedule.
Defined staffing levels are certainly a possibility in future versions of our regulations. Do you know how much care your nurses and physicians have committed you to providing?
Happy Thanksgiving
I'm on call today while my boss is out of town. Hopefully I won't get any crazy calls. My least favorite on-call call:
"I know it's three am, but I've locked my keys in the medcart and I can't get ahold of the Director of Nursing."
"I know it's three am, but I've locked my keys in the medcart and I can't get ahold of the Director of Nursing."
The Best Way to Name Files
I hate it when I quickly save a file then come back to work on it again and can't recall what I named it. Did I call it the "Activities Director Performance Review", the "Perf Review for AD", or perhaps November 05 PR for AD?"
Let alone remembering what folder I stuck it in.
I now save all files using the same format, which is based on the date the file is created. This way, even files that aren't under a specific folder still sort themselves in some order regardless of what you named them. Here's how it works:
1. Always use the year as the first four digits. Otherwise, files you save this November will be mixed with files you saved last November. Then the two digit month, followed by a two digit day. Always use four digits for the year and two for the months and days to maintain consistency.
2. Don't be afraid to use big file names. Remember when a filename could only be 8 characters long? They changed that for a reason - take advantage.
3. Don't be afraid to use spaces in your file names. Follow the date heading with a space and the name of the file. I prefer to use department abbreviations followed by a document name.
EXAMPLE: 2006-11-21 AD Performance Review
This method has made it much easier to locate my files at any given time. I also sort the My Documents folder into eight major departments to mirror the organizational structure, then drill down through each department to create folders as necessary. This saves me from ending up with an "Activities Director" folder plus a "Performance Reviews" folder and eliminates confusion over where files ended up.
Let alone remembering what folder I stuck it in.
I now save all files using the same format, which is based on the date the file is created. This way, even files that aren't under a specific folder still sort themselves in some order regardless of what you named them. Here's how it works:
1. Always use the year as the first four digits. Otherwise, files you save this November will be mixed with files you saved last November. Then the two digit month, followed by a two digit day. Always use four digits for the year and two for the months and days to maintain consistency.
2. Don't be afraid to use big file names. Remember when a filename could only be 8 characters long? They changed that for a reason - take advantage.
3. Don't be afraid to use spaces in your file names. Follow the date heading with a space and the name of the file. I prefer to use department abbreviations followed by a document name.
EXAMPLE: 2006-11-21 AD Performance Review
This method has made it much easier to locate my files at any given time. I also sort the My Documents folder into eight major departments to mirror the organizational structure, then drill down through each department to create folders as necessary. This saves me from ending up with an "Activities Director" folder plus a "Performance Reviews" folder and eliminates confusion over where files ended up.
Medicaid Commission Discusses Flexibility, Electronic Records
A Federal Medicaid Commission met last week and issued a recommendations report including the following:
-Mandatory Electronic Medical Records for all Medicaid recipients by 2012
-Increased use of home health vs. skilled nursing care
-Federal tax incentives for purchase of long term care insurance
For a complete report on the commission recommendations, visit The Kaiser Network.
-Mandatory Electronic Medical Records for all Medicaid recipients by 2012
-Increased use of home health vs. skilled nursing care
-Federal tax incentives for purchase of long term care insurance
For a complete report on the commission recommendations, visit The Kaiser Network.
Avoid "Jumping to Z"
After a couple of days in my new position, I had noticed different members of our team refer to "Not jumping to Z" during our Processes & Initiatives meetings. New phrase for me, and fortunately, our Social Services Director, whom was also new finally asked what the heck this means. It seems obvious now. More on the concept of Processes and Initiatives some other time.
When we talk about jumping to Z, we are attempting to solve a problem by searching for the solution before we outline the boundaries of the problem. We are constantly guilty of this in long term care; perhaps you prefer to call it "putting out fires." Regardless of the terminology, I have learned that breaking ANY issue into steps always results in a longer-lasting positive outcome than brainstorming a solution and working backwards to develop steps for implementation. This process also results in creative thinking that expands beyond the topic at hand, creating opportunities for growth as an organization.
I have outlined five beginning steps to avoid jumping to Z based on my initial observances of our policy-making group. I hope to expand on this list and will appreciate any input.
1. Break the problem into manageable parts. Very few problems have one root cause. Identify each department involved, each person involved, each person affected by the problem, and any other factor that is potentially contributing. From there you can drill down each person or department into separate bullets, hopefully find a multi-layered solution rather than an all-or-nothing proposal.
2. Remember the visual people. Many people do better if they can actually see the problem in front of them. Buy an easel, a giant pad of paper, and a box of permanent markers. I hadn't worked like this prior to my latest position, but it's a simple tool that really adds to a brainstorming session. If you aren't comfortable doing the writing, find someone that is. Afterwards, we always have someone take the sheets back to their office and turn them into minutes that are quickly distributed to all involved. Save the originals for reference.
3. Don't fly solo. What's the number one way to slow a project down? Involve more than one person. I mean this in a positive sense here. Long term care folks love to use the phrase "interdisciplinary" but many don't understand the reasoning behind this approach. You always want to have a couple of people on a committee that are willing to ask "why?" Occasionally we will bring someone in that will feel no consequence of a final decision or program. Their input as an "outsider" is sometimes far more valuable than a department head with real outcomes or personal interest at stake.
4. Don't be afraid to identify threats. There is a difference between identifying negative elements and being negative. Risk can be human, operational, reputational, procedural, financial, and political, as well as other risks based on your situation. I use this approach when interviewing job candidates. It can be as simple as making a list of positives vs. negatives. There are other approaches to take, but the bottom line is never make a decision without fully understanding every negative consequence of your actions.
5. Set tangible goals and short time frames. Always approach a new program or idea with tangible benchmarks. Otherwise, success is purely subjective, and continuous quality improvement is impossible. Always revisit new organizational initiatives relatively soon after their roll out. Rare is the occasion that you roll out a new program that doesn't need some tweaking. Leaving a problem "on the workbench" until you've re-analyzed after 30-45 days ensures that there will be enough follow-up to keep things floating longer than the end of the week you introduce something to the organization.
There is a difference between making decisions and solving problems. As an Administrator, making quick decisions is certainly an important part of your daily work. But when it comes to processes and initiatives, be sure that your team has put enough thought into a project that it last longer than the time they spend dreaming it up.
When we talk about jumping to Z, we are attempting to solve a problem by searching for the solution before we outline the boundaries of the problem. We are constantly guilty of this in long term care; perhaps you prefer to call it "putting out fires." Regardless of the terminology, I have learned that breaking ANY issue into steps always results in a longer-lasting positive outcome than brainstorming a solution and working backwards to develop steps for implementation. This process also results in creative thinking that expands beyond the topic at hand, creating opportunities for growth as an organization.
I have outlined five beginning steps to avoid jumping to Z based on my initial observances of our policy-making group. I hope to expand on this list and will appreciate any input.
1. Break the problem into manageable parts. Very few problems have one root cause. Identify each department involved, each person involved, each person affected by the problem, and any other factor that is potentially contributing. From there you can drill down each person or department into separate bullets, hopefully find a multi-layered solution rather than an all-or-nothing proposal.
2. Remember the visual people. Many people do better if they can actually see the problem in front of them. Buy an easel, a giant pad of paper, and a box of permanent markers. I hadn't worked like this prior to my latest position, but it's a simple tool that really adds to a brainstorming session. If you aren't comfortable doing the writing, find someone that is. Afterwards, we always have someone take the sheets back to their office and turn them into minutes that are quickly distributed to all involved. Save the originals for reference.
3. Don't fly solo. What's the number one way to slow a project down? Involve more than one person. I mean this in a positive sense here. Long term care folks love to use the phrase "interdisciplinary" but many don't understand the reasoning behind this approach. You always want to have a couple of people on a committee that are willing to ask "why?" Occasionally we will bring someone in that will feel no consequence of a final decision or program. Their input as an "outsider" is sometimes far more valuable than a department head with real outcomes or personal interest at stake.
4. Don't be afraid to identify threats. There is a difference between identifying negative elements and being negative. Risk can be human, operational, reputational, procedural, financial, and political, as well as other risks based on your situation. I use this approach when interviewing job candidates. It can be as simple as making a list of positives vs. negatives. There are other approaches to take, but the bottom line is never make a decision without fully understanding every negative consequence of your actions.
5. Set tangible goals and short time frames. Always approach a new program or idea with tangible benchmarks. Otherwise, success is purely subjective, and continuous quality improvement is impossible. Always revisit new organizational initiatives relatively soon after their roll out. Rare is the occasion that you roll out a new program that doesn't need some tweaking. Leaving a problem "on the workbench" until you've re-analyzed after 30-45 days ensures that there will be enough follow-up to keep things floating longer than the end of the week you introduce something to the organization.
There is a difference between making decisions and solving problems. As an Administrator, making quick decisions is certainly an important part of your daily work. But when it comes to processes and initiatives, be sure that your team has put enough thought into a project that it last longer than the time they spend dreaming it up.
Seven Steps to Preventing Resident Trust Fraud
A Texas Business Office Manager was arrested this week for embezzling over $72,000 from resident trust accounts. Every company has a story like this one, just different names and different amounts. It's almost cliche to mention it, but it's always the people that you trust the most. Why? We tend to use that trust as an opportunity to let these cash functions of our business run on "autopilot." Here are ten suggestions to help you keep a finger on the flow of money in your building.1. Count the cash yourself. You probably have a $500 resident trust box and a $300 petty cash box. Take the time to count it yourself. It's a ten minutes exercise. The cash plus the receipts should always equal the total.
2. Never schedule your reconciliations. If the Business Office Manager knows that you will be counting the 15th of every month at 2pm, then they will always make that the one day that everything is in order. Be sure to put them on your calendar, though. It's an easy thing to blow off if you don't have a plan.
3. Stop letting people "get creative." Ever count the petty cash and find it ten cents short of balanced? Don't let your business office manager be so quick to grab a dime out of the desk drawer to settle up. Count again, then a third time. If this becomes a pattern, further action is warranted.
4. Require two signatures for residents that can't sign. If you start seeing more squiggly "x" marks in place of signatures, ask questions. Make the social services director one of the required signers as opposed to two business office workers.
5. Open all bank statements. Read them, too. This takes some extra time, but so does a ten year audit of your entire business office when your manager gets busted. Check statements for large transactions as well as transactions by a resident that normally doesn't withdraw money.
6. Talk to the residents. Ask your business office manager for ten recent withdrawal slips and put them in front of the resident. Let them know you are doing a routine customer service audit for their financial security. This gives you added trust with your residents.
7. Let the Business Office Manager know you are doing all these things. Let everyone know. Your goal isn't to be secretive, it's to add a layer of a accountability to the system. Any good BOM will appreciate the attention. Any bad BOM will stop in their tracks.
This is nothing but common sense, but it can be so easy to let an effective Business Office Manager operate with very little oversight. Occasionally, someone sees a window of opportunity, and once they've tasted free money, it's hard to turn back. Don't let your residents and staff suffer because you don't have time to count the cash box.
Culture Change
Most of our current facilities were built in the 1960’s and 1970’s, and our physical plants just don’t support “real-living” in long term care. We sometimes refer to traditional homes as “double-barreled-corridors” in reference to the layout of long hallways with rooms on both sides. In a nutshell: convenient for staff. And that’s the essence (convenience for us) of why culture change has been difficult for our facilities. We have spent 50 years making things as convenient as possible for our staff. Right now we are in a transition phase where we are building physical plants that cater more to the resident, but we are still creating policies, procedures, and programs with staff convenience in mind, whether we admit it or not.
There is probably nothing harder than changing staff attitudes about delivery of care. The Japanese have a culture of true respect for their elders - something that we have lost in America. Not to say that there aren’t health care workers in the US that operate under this premise; there are thousands. As a culture, though, we no longer value our seniors as we used to. Until we can change the culture (ie culture change) NOTHING will change permanently.
What an unfortunate thought that is.
Never Use Half Sheets!
Tip of the day: Sometimes we create a new form that doesn't require an entire sheet of paper. I see this situation often when creating a document that will be part of the employee file - usually something that they are signing. If a document is important enough to require a signature, you probably don't want to lose it, right?
So why put it on a half sheet of paper?
Make it a policy of your organization that all documents be printed on full sheets of paper. This rule, while not a big deal, helps you in three ways:
So why put it on a half sheet of paper?
Make it a policy of your organization that all documents be printed on full sheets of paper. This rule, while not a big deal, helps you in three ways:
- Reduction in lost documents
- Easier for staff (and surveyors) to find what they are looking for
- More professional apprearance
Take my word for it (as someone who is constantly misplacing papers) that this easy tip will increase your organization and efficiency.
Changing Administrator Licensure Requirements
This link from the National Association of Boards of Examiners of Long Term Care Administrators has been up since March of this year, but you may not realize that there is a proposition by the board to change to nationally recognized accreditation of Health Facility Administrators. There's not much of a chance this would put many current HFAs out of a job. It would mean the elimination of 90-day programs for individuals without a four-year degree. As long as you've been practicing for at least two years you are be safe.
This proposal is far from going into effect. Twenty out of fifty-two state licensing boards have endorsed the proposal. Why should you support this proposal as a currently licensed HFA?
1. Endorsement would make relocation of Licensed Administrator's an easier process. Currently the process for endorsement in another state is slow and tedious, requiring fees, additional testing, and sometimes a lengthy wait for reciprocity. National Standards could potentially eliminate these short-comings.
2. Increase in median wages. There is currently a dilution of the pool of Licensed Administrators due to State Agencies offering classes for under-qualified candidates to earn there licenses in exactly six months plus 90 days. Not a dilution of talent - don't get me wrong. What I'm talking about is a gap in salary ranges that could potentially entice healthcare corporations to hire low in the low ranges and keep their fingers crossed. What is this doing to the market? Adding qualified candidates, yes, but also bringing down median salaries, which affects opportunities for salary growth in the industry.
3. Improvement in industry respect and continuing education opportunities. Frankly, I'm tired of going to conventions and learning about how many days a Medicare Part A resident has available to them after a three day qualifying hospital stay. As a healthcare professional, I try to hold myself to some minimal industry educational standards. In many organizations, most of the Department Leaders have a higher education than the facility leader. Time to take it up a notch?
It's your own licensing board sponsoring the petition. Currently many states allow anyone that can get through a 90-day course to find an AIT sponsor and ultimately run a skilled nursing facility. This unfortunately is putting our residents and facilities at jeopardy, not to mention increasing the difficulty for current Administrator's to gain reciprocity when needed the most. Support the NAB petition by contacting Randy Linder, NAB Executive Director, at rlinder@bostrom.com.
This proposal is far from going into effect. Twenty out of fifty-two state licensing boards have endorsed the proposal. Why should you support this proposal as a currently licensed HFA?
1. Endorsement would make relocation of Licensed Administrator's an easier process. Currently the process for endorsement in another state is slow and tedious, requiring fees, additional testing, and sometimes a lengthy wait for reciprocity. National Standards could potentially eliminate these short-comings.
2. Increase in median wages. There is currently a dilution of the pool of Licensed Administrators due to State Agencies offering classes for under-qualified candidates to earn there licenses in exactly six months plus 90 days. Not a dilution of talent - don't get me wrong. What I'm talking about is a gap in salary ranges that could potentially entice healthcare corporations to hire low in the low ranges and keep their fingers crossed. What is this doing to the market? Adding qualified candidates, yes, but also bringing down median salaries, which affects opportunities for salary growth in the industry.
3. Improvement in industry respect and continuing education opportunities. Frankly, I'm tired of going to conventions and learning about how many days a Medicare Part A resident has available to them after a three day qualifying hospital stay. As a healthcare professional, I try to hold myself to some minimal industry educational standards. In many organizations, most of the Department Leaders have a higher education than the facility leader. Time to take it up a notch?
It's your own licensing board sponsoring the petition. Currently many states allow anyone that can get through a 90-day course to find an AIT sponsor and ultimately run a skilled nursing facility. This unfortunately is putting our residents and facilities at jeopardy, not to mention increasing the difficulty for current Administrator's to gain reciprocity when needed the most. Support the NAB petition by contacting Randy Linder, NAB Executive Director, at rlinder@bostrom.com.
Questions Answered: What is the Baker Act?
Here's a post from a nursing home family member stating they were "Baker Acted" by the Nursing Facility where their father lives and I was curious about this obscure reference. As it turns out the Baker Act is specific to Florida, but in general the term refers to "patient dumping" at behavioral hospitals. The discharge of residents with behaviors to treatment facilities is an ongoing hot topic, as mentioned in this earlier post.
The Baker Act was passed in Florida in 1972 and has undergone a number of amendments, most significantly in 1996, when greater protections were extended to voluntary admissions as it related to transfer and discharge.
The intent of the Baker Act is to prohibit the indiscriminate long term admission of persons to an institution without just cause. Before 1972, a person could be permanently placed in a State Hospital if three people signed affidavits and received approval by a County judge. A Baker Act can be voluntary or involuntary; the emphasis is on community based evaluation and treatment.
An involuntary Baker Act is placed for a psychiatric evaluation if someone feels it is necessary; this person must be evaluated by both community professionals within 72 hours to determine appropriate placement, which must include an order from a judge.
For more information on the Florida Baker Act, click here.
The Baker Act was passed in Florida in 1972 and has undergone a number of amendments, most significantly in 1996, when greater protections were extended to voluntary admissions as it related to transfer and discharge.
The intent of the Baker Act is to prohibit the indiscriminate long term admission of persons to an institution without just cause. Before 1972, a person could be permanently placed in a State Hospital if three people signed affidavits and received approval by a County judge. A Baker Act can be voluntary or involuntary; the emphasis is on community based evaluation and treatment.
An involuntary Baker Act is placed for a psychiatric evaluation if someone feels it is necessary; this person must be evaluated by both community professionals within 72 hours to determine appropriate placement, which must include an order from a judge.
For more information on the Florida Baker Act, click here.
Survey Process: Scheduling, CMP, Immediate Jeopardy
Here is a link for the "State Operations Manual Chapter Seven." This document from CMS contains detailed information on the scheduling of the survey process as well as parameters for re-visits, civil monetary penalties, and immediate jeopardy situations. It's public knowledge, but most long term care professionals tend to confuse the details of this information when they need it the most. I will also link to these regulations under the resources heading.
Can a Nursing Facility Publicize a Suspension?
An LPN in Ocala, FL has been suspended by the nursing home that she works for due to allegedly failing to report suspected resident abuse. The alleged abuser (a housekeeping employee) has been terminated, authorities are investigating, and the resident is receiving the appropriate assessment and treatment.
But the abuse is not the only questionable act to come out of this facility.
Why is it public knowledge that this nurse has been suspended pending investigation? It has always been my practice to protect, to the best of my ability, any employee involved in an investigation that could jeopardize their professional well-being. Our judicial system is based on an innocent until proven guilty premise, and an abuse investigation should follow a similar path.
It is not always feasible to protect the identity of an employee under investigation from other employees and residents, but that should be the goal. Using names and specifics are ultimately unavoidable in an effective investigation, and confidentiality is easily compromised the second an employee leaves your office. An investigation conversation should never begin with leading questions such as "Have you ever seen John Perkins abuse a resident?" This not only immediately implicates the employee (regardless of their guilt) but also takes all objectivity away from your investigation. Remember, the goal of an investigation is to find the root cause of a problem, not to determine who is guilty.
I can't answer why this LPN's suspension hit the Ocala papers. Perhaps it was a leak, perhaps an upset family, or perhaps the facility made it public knowledge. We won't blame the facility. But the question has to be asked, "Why haven't we set standards for abuse investigations?" I guarantee that my facility measures are different from yours, and what you do to protect the resident and determine the root cause of the occurrence is different from the guy down the street. I propose that we begin to work on an industry standard for this situation. Doing so would not only formalize the procedure for long term care professionals; it would also tell the consumer exactly what our industry was doing every time that abuse was reported to Facility Administration.
Let's use this current situation as an opportunity to examine our protocols for conducting fair investigations. As often as these situations arise, it is only fair to our residents and employees to treat each situation equally, protecting identities and reputations instead of just looking for someone to blame.
But the abuse is not the only questionable act to come out of this facility.
Why is it public knowledge that this nurse has been suspended pending investigation? It has always been my practice to protect, to the best of my ability, any employee involved in an investigation that could jeopardize their professional well-being. Our judicial system is based on an innocent until proven guilty premise, and an abuse investigation should follow a similar path.
If you were issuing a written warning to an employee for a timeclock violation or smoking in the parking lot, you wouldn't post a memo in the breakroom letting everyone know that this person had been "written up." You wouldn't tell the cook and ask them to tell everyone else. Discipline is intended to be educational, not punitive. Work in this mindset and there is no value in other employees knowledge of the action.
It is not always feasible to protect the identity of an employee under investigation from other employees and residents, but that should be the goal. Using names and specifics are ultimately unavoidable in an effective investigation, and confidentiality is easily compromised the second an employee leaves your office. An investigation conversation should never begin with leading questions such as "Have you ever seen John Perkins abuse a resident?" This not only immediately implicates the employee (regardless of their guilt) but also takes all objectivity away from your investigation. Remember, the goal of an investigation is to find the root cause of a problem, not to determine who is guilty.
I can't answer why this LPN's suspension hit the Ocala papers. Perhaps it was a leak, perhaps an upset family, or perhaps the facility made it public knowledge. We won't blame the facility. But the question has to be asked, "Why haven't we set standards for abuse investigations?" I guarantee that my facility measures are different from yours, and what you do to protect the resident and determine the root cause of the occurrence is different from the guy down the street. I propose that we begin to work on an industry standard for this situation. Doing so would not only formalize the procedure for long term care professionals; it would also tell the consumer exactly what our industry was doing every time that abuse was reported to Facility Administration.
Let's use this current situation as an opportunity to examine our protocols for conducting fair investigations. As often as these situations arise, it is only fair to our residents and employees to treat each situation equally, protecting identities and reputations instead of just looking for someone to blame.
Nurses and CNAs Need Resumes
People shouldn't judge a book by its cover. It's the age-old cliche. Unfortunately though, humans have a tendency to rely heavily on first impressions and gut instincts. We also live in a world of instant information, where if we don't capture our audience in the first ten seconds, they've probably moved on to something or someone else.
So why are you applying for a job without a resume?
Less than five percent of the nursing applicants that come into our facility leave a resume. Those that do have a far better chance of capturing the attention of our Director of Nursing and scheduling that first interview. A resume not only highlights your clinical skills and experience, it also shows that you are organized, you possess important technical/computer skills, and that you have a higher degree of professionalism than your competition.
Most of the professionals that do leave a resume have written a respectable document. Just having one is half the battle. But occasionally I receive a resume that is so poorly constructed it speaks more about the applicant than if they had merely filled out our five-page application and left. Misspelled words, incomplete information, poor formatting, and a disheveled presentation can be a buzz-kill on what should be a glowing advertisement of you, the healthcare professional.
Below are some beginner's tips for preparing your nursing resume. These are only beginner's tips, and there is a wealth of information on the web. There is no need to get fancy. Your goal is to organize the information in a professional manner; you are already speaking volumes about yourself just by taking the time to create this document. Good luck, and feel free to ask me directly if you would like any assistance.
1. Employers already understand your basic job duties as a Nursing Assistant or a Charge Nurse. Don't use valuable space listing daily job tasks such as passing medications, assisting with ADLs, or communicating with physicians and families. Instead, list individual accomplishments, committee participation, and newly acquired skills gained from each position you have held. Items such as "Participated in Safety Committee", "Attended CNA Day at 2005 IHCA Convention", and "Received Perfect Attendance Award Three Years in a Row" have a much larger impact than listing daily job duties. Honesty is key.
2. Don't be cute. Fancy fonts, colored paper, and other gimmicks may differentiate you from the next applicant, but remember, your goal is to be professional, not tacky. I suggest sticking to one of four fonts: Times New Roman, Tahoma, Arial, or Verdana. These fonts are easy to read and professional. Comic Sans is an attractive but extremely over-used font; I highly recommend not formatting your resume with it.
3. Provide accurate contact information. If you can't remember the name of the facility you worked at in 1988, don't include it on your resume. Nursing Facilities really do check references, and there's nothing worse than calling the names and numbers provided by an applicant only to find that the information is incorrect. If a reference is worth using, then contact them ahead of time and let them know to expect a reference call. You will get a much better reference this way than if the person is caught off-guard.
4. Follow an excepted format. Most resumes follow reverse-chronological order, meaning your most recent position is listed at the top and latter positions further down. Professional advice says keep the resume to one page; anything more won't be read anyways, and don't use staples. Here is a sample RN resume template from microsoft.com.
5. Don't make your name the largest words on the page. If you do, it speaks volumes about the type of person you are.
6. Have someone else proofread your resume. The last thing you want to do is hand me a one-page advertisement of your skills that contains spelling errors. Don't rely on spellcheck either, because it won't always catch grammatical errors. I can't tell you how important it is to have other people review your resume before you distribute it.
7. Only hand out crisp, clean copies. This may sound petty, but once again, your goal is to be professional. There is nothing professional about a resume that has been folded in half, stuffed in a coat pocket, soaked in coffee at a diner, and slobbered on by your nephew. If you hand me a mess, that's exactly what I'll think of you.
These are very basic tips for creating your CNA or Charge Nurse resume. Your resume is a living, breathing advertisement that tells the healthcare world how great you are at taking care of people. Remember, when you submit a resume, you are still required in most states to complete a formal application. Most employers will allow you to write "SEE RESUME" on the experience page if you bring one. Ask whoever takes your application to attach your resume to the TOP of the application; The great thing about your resume is that it literally stands out in a pile of 50 pre-printed facility applications, so you don't want it stapled underneath your formal app.
Good luck!
So why are you applying for a job without a resume?
Less than five percent of the nursing applicants that come into our facility leave a resume. Those that do have a far better chance of capturing the attention of our Director of Nursing and scheduling that first interview. A resume not only highlights your clinical skills and experience, it also shows that you are organized, you possess important technical/computer skills, and that you have a higher degree of professionalism than your competition.
Most of the professionals that do leave a resume have written a respectable document. Just having one is half the battle. But occasionally I receive a resume that is so poorly constructed it speaks more about the applicant than if they had merely filled out our five-page application and left. Misspelled words, incomplete information, poor formatting, and a disheveled presentation can be a buzz-kill on what should be a glowing advertisement of you, the healthcare professional.
Below are some beginner's tips for preparing your nursing resume. These are only beginner's tips, and there is a wealth of information on the web. There is no need to get fancy. Your goal is to organize the information in a professional manner; you are already speaking volumes about yourself just by taking the time to create this document. Good luck, and feel free to ask me directly if you would like any assistance.
1. Employers already understand your basic job duties as a Nursing Assistant or a Charge Nurse. Don't use valuable space listing daily job tasks such as passing medications, assisting with ADLs, or communicating with physicians and families. Instead, list individual accomplishments, committee participation, and newly acquired skills gained from each position you have held. Items such as "Participated in Safety Committee", "Attended CNA Day at 2005 IHCA Convention", and "Received Perfect Attendance Award Three Years in a Row" have a much larger impact than listing daily job duties. Honesty is key.
2. Don't be cute. Fancy fonts, colored paper, and other gimmicks may differentiate you from the next applicant, but remember, your goal is to be professional, not tacky. I suggest sticking to one of four fonts: Times New Roman, Tahoma, Arial, or Verdana. These fonts are easy to read and professional. Comic Sans is an attractive but extremely over-used font; I highly recommend not formatting your resume with it.
3. Provide accurate contact information. If you can't remember the name of the facility you worked at in 1988, don't include it on your resume. Nursing Facilities really do check references, and there's nothing worse than calling the names and numbers provided by an applicant only to find that the information is incorrect. If a reference is worth using, then contact them ahead of time and let them know to expect a reference call. You will get a much better reference this way than if the person is caught off-guard.
4. Follow an excepted format. Most resumes follow reverse-chronological order, meaning your most recent position is listed at the top and latter positions further down. Professional advice says keep the resume to one page; anything more won't be read anyways, and don't use staples. Here is a sample RN resume template from microsoft.com.
5. Don't make your name the largest words on the page. If you do, it speaks volumes about the type of person you are.
6. Have someone else proofread your resume. The last thing you want to do is hand me a one-page advertisement of your skills that contains spelling errors. Don't rely on spellcheck either, because it won't always catch grammatical errors. I can't tell you how important it is to have other people review your resume before you distribute it.
7. Only hand out crisp, clean copies. This may sound petty, but once again, your goal is to be professional. There is nothing professional about a resume that has been folded in half, stuffed in a coat pocket, soaked in coffee at a diner, and slobbered on by your nephew. If you hand me a mess, that's exactly what I'll think of you.
These are very basic tips for creating your CNA or Charge Nurse resume. Your resume is a living, breathing advertisement that tells the healthcare world how great you are at taking care of people. Remember, when you submit a resume, you are still required in most states to complete a formal application. Most employers will allow you to write "SEE RESUME" on the experience page if you bring one. Ask whoever takes your application to attach your resume to the TOP of the application; The great thing about your resume is that it literally stands out in a pile of 50 pre-printed facility applications, so you don't want it stapled underneath your formal app.
Good luck!
Freezing Panes in Excel
You receive a spreadsheet from your Regional Director. Let's say it contains ten different supply account variances for the month, and there are 45 facilities on the same spreadsheet. Your facility is near the bottom of the sheet, but when you scroll down to view your info, you lose the account headings at the top. You see you're over $850, but can't remember which account you were looking at.
Did you know that you can freeze the header columns at the top of the spreadsheet to view your information and the titles simultaneously?
By freezing panes, you select specific rows or columns that remain visible when scrolling in the worksheet. For example, you would freeze panes to keep row and column labels visible as you scroll. Here's a step by step:
1. To lock rows, select the row below where you want the split to appear. To lock columns, select the column to the right of where you want the split to appear. To lock both rows and columns, click the cell below and to the right of where you want the split to appear.
2. Under the Window menu, click Freeze Panes.
3. To unlock rows, click Unfreeze Panes on the Window menu.
Now, when you scroll down , the row you froze will stay on the screen and everything else will scroll accordingly.
Did you know that you can freeze the header columns at the top of the spreadsheet to view your information and the titles simultaneously?
By freezing panes, you select specific rows or columns that remain visible when scrolling in the worksheet. For example, you would freeze panes to keep row and column labels visible as you scroll. Here's a step by step:
1. To lock rows, select the row below where you want the split to appear. To lock columns, select the column to the right of where you want the split to appear. To lock both rows and columns, click the cell below and to the right of where you want the split to appear.
2. Under the Window menu, click Freeze Panes.
3. To unlock rows, click Unfreeze Panes on the Window menu.
Now, when you scroll down , the row you froze will stay on the screen and everything else will scroll accordingly.
Administrator's Salaries
This Administrator's Salary Survey was published at the beginning of 2006, but I thought I would share while I am compiling so much information. If you've ever spent any time looking for similar information on sites such as monster.com or salary.com, you've noticed that "Healthcare Administrator" is never an option.
The most interesting fact from the survey is probably the fact that although 33% of Administrators have clinical credentials (RN, PT, etc), these professionals make on average $4000 less annually than those without clinical credentials.
The most interesting fact from the survey is probably the fact that although 33% of Administrators have clinical credentials (RN, PT, etc), these professionals make on average $4000 less annually than those without clinical credentials.
Restraint and Alarm Elimination
Today I heard Diana Waugh RN speak on Restraint and Alarms Elimination. Diana's approach is mildly abrasive and humorous, screaming at DONs in the back of the hall getting up to go to the bathroom. I've seen this approach before, but just as an attention getter. She uses it to effectively illustrate how we treat our own residents in an effort to prevent falls, racing towards people and making them feel as though getting up after a meal to use the restroom is a punishable action.
Here's what I took away from her presentation, which I hope to elaborate on soon:
1. No level of pain is acceptable for our residents. Falling out of a low bed 18 inches to the ground still hurts, so why do we lower a bed and call it an intervention?
2. We ask to be surveyed. You don't have to accept payment from the government. We have equal access to the regulations and the guidelines just like the surveyors. I sat in a room of 200 professionals today and less than five percent could say that they had read the new guidelines published this year. This makes it hard to be refute a citation or use the guidelines to improve care delivery.
3. We are allowed treat our residents in ways that the CIA is no longer allowed to treat terrorists. If a prisoner is put in restraints, he has a person monitoring him 24 hours a day. Why? Restraints are dangerous. they kill people. We put demented residents with alarms that blare up to 80 decibels when they try to scratch their ankles, but sleep deprivation is now considered a war crime. Siderail deaths have been tracked by CMS since 1995 for a reason. Posey puts a warning on their restraint guidelines telling users that their devices are only for cognitively aware residents. When was the last time you restrained a resident per their request?
Thanks to Diana Waugh for an eye-opening day. I highly recommend that you see her speak if you have a chance and are willing to open up your mind to some pretty basic concepts that many of us ignore as healthcare professionals. Just don't get up to go to the bathroom.
Here's what I took away from her presentation, which I hope to elaborate on soon:
1. No level of pain is acceptable for our residents. Falling out of a low bed 18 inches to the ground still hurts, so why do we lower a bed and call it an intervention?
2. We ask to be surveyed. You don't have to accept payment from the government. We have equal access to the regulations and the guidelines just like the surveyors. I sat in a room of 200 professionals today and less than five percent could say that they had read the new guidelines published this year. This makes it hard to be refute a citation or use the guidelines to improve care delivery.
3. We are allowed treat our residents in ways that the CIA is no longer allowed to treat terrorists. If a prisoner is put in restraints, he has a person monitoring him 24 hours a day. Why? Restraints are dangerous. they kill people. We put demented residents with alarms that blare up to 80 decibels when they try to scratch their ankles, but sleep deprivation is now considered a war crime. Siderail deaths have been tracked by CMS since 1995 for a reason. Posey puts a warning on their restraint guidelines telling users that their devices are only for cognitively aware residents. When was the last time you restrained a resident per their request?
Thanks to Diana Waugh for an eye-opening day. I highly recommend that you see her speak if you have a chance and are willing to open up your mind to some pretty basic concepts that many of us ignore as healthcare professionals. Just don't get up to go to the bathroom.
Kindred Healthcare Sells 7 Unprofitable Homes
Kindred Healthcare today announced the $78 million sale of 7 unprofitable facilities. This will reduce Kindred's total beds by 1,754.
Unreported Med Errors in the Nursing Home
This report states that only 5% of med errors in the nursing home are reported to Facility Administration despite the fact that "staffers know about virtually all errors that occur." Nurses blame their own supervisors for the non-reporting, claiming that managers would prefer not to know about the errors.
There have been two recent medication administration focuses in our state recently. One involved the deaths of several infants at Methodist Hospital in Indianapolis; the other a news expose on discarding prescription information containing confidential PHI. Our management team has developed a point system for tracking individual nurse medication errors, but this does not solve the problem of non-reporting. I will appreciate any information that others can share about creating a culture of trust in reporting these important med errors. More to come...
There have been two recent medication administration focuses in our state recently. One involved the deaths of several infants at Methodist Hospital in Indianapolis; the other a news expose on discarding prescription information containing confidential PHI. Our management team has developed a point system for tracking individual nurse medication errors, but this does not solve the problem of non-reporting. I will appreciate any information that others can share about creating a culture of trust in reporting these important med errors. More to come...
Creating an Eye-Catching Memo
There are two schools of thought when it comes to written communications for a large audience. The first one says that you follow a standard, professional format. This provides the organization with clear, specific parameters for how critical information is disseminated. These are the communications that actually say "MEMO" at the top and are always written in ten-point Times New Roman.
The other school of thought, which I have adopted, suggests that it may be more effective to capture some one's attention and find a way to help them remember the information by employing a more creative technique. Some would find this mildly unprofessional, but in today's world, information flows so quickly that we are truly competing for the attention of our workers at every moment.
Several suggestions for creative written communications:
1. My number one trick, particularly when posting a mandatory inservice, is to put a random, colorful picture at the top. I learned this lesson unforgettably one day when a staff member told me, "I don't usually read your notes, but I had to see why there was a photograph of a camel hanging in the breakroom."
2. Take advantage of your word processor program! Microsoft clipart now has THOUSANDS of pictures, photos, drawings, outlines, and even videos! I searched for banana and came up with more than 100 choices! Many people are visual, and using pictures can help them remember the information after they walk away from the bulletin board.
3. Use fonts and colors! Once again, Microsoft makes it inexcusable for you to create a document that isn't appealing to the eye. Beware using fonts that are too specialized or hard to read. Comic Sans has been used to death. Tahoma, Lucida Sans Writing, and Eras Light are three fonts that I consider "friendlier fonts."
4. Keep it Simple! Remember, you have a person's attention for ten seconds - if they aren't actively seeking out the information, they aren't going to search for it amidst a mess of dialogue. Space things out as much as possible, maximize your font sizes, and only capitalize and bold what is necessary. Nobody likes an all CAPS guy.
Good luck! You can be a creative communicator and still be professional. There is definitely many a time and place for professionally drafted documents, but when it comes to "advertising information" you've got to compete to stay ahead.
Fine Dining in Detroit
The National Institute on Aging has published a two-part article entitled: Promoting Successful Eating in Long-Term Care: Relationships with Residents are Key. The premise is that individualizing diets and providing choice can increase resident intake and hydration. Broad concepts here, I'll be interested to see Part Two.
Here's a nice example of an establishment in Michigan that has found cost effective ways to improve resident dining. Here are several myths that keep many facilities from improving their dining program:
Here's a nice example of an establishment in Michigan that has found cost effective ways to improve resident dining. Here are several myths that keep many facilities from improving their dining program:
- Our food costs will skyrocket if we give our residents more choices
- We can't put condiments on the tables because residents with special diets will be jeopardized
- Staff will be unable to manage the number of options
- We can't eliminate seating arrangements because residents will be confused
- We can't have a buffet or family style service because of infection control concerns
- Food temperatures will be difficult to maintain in an open dining environment
Facilities are overcoming all of these obstacles. Surveyors are beginning to accept these culture changes, but until these concepts are the norm, there will be struggles. But I have been seeing with my own eyes the value of a restaurant-style dining program. We have a lot to learn and change, but our residents greatly benefit from the concepts of choice and variety. In the future I will elaborate on some of these concepts, but until then I invite you to share some of the things that your facility is doing to enhance dining services.
Consumer Questions...
I am already noticing a trend on the website "Yahoo Answers..."
This website lets anyone in the world pose a problem that they are having (with a nursing community) and leave it open for discussion on their forum. I have taken several opportunities this week to respond to consumers and guide them back to Facility Administration. There is rarely a reason not to. The main reasons that consumers are turning to the Internet:
This website lets anyone in the world pose a problem that they are having (with a nursing community) and leave it open for discussion on their forum. I have taken several opportunities this week to respond to consumers and guide them back to Facility Administration. There is rarely a reason not to. The main reasons that consumers are turning to the Internet:
- Facility guidelines are not explained in detail. Take, for instance, the decision to change a diet to mechanical soft or puree. If a family leaves the facility upset about this baseline initiative, we have missed the boat.
- We have not given a family the choice to "opt out" of a clinical initiative. Just because our industry has proven that a directive is the standard does not mean that it is best for the individual. Let's leave some of the decision making in the hands of the family and the resident to encourage autonomy and choice.
- Long Term Care Facilities have not represented themselves sufficiently. That stings, doesn't it? When examining why consumers exhibit discontent, I continue to return to the fact that the overall sentiment is based on the opinions of Plaintiffs Attorneys, disenfranchised consumers, and government lobbyists. It's no secret why the industry has been painted in a negative light. Until Long Term Care Professionals step froward and represent the industry as it stands today, we will continue to cower under the shadow of consumer image.
Behavioral Health
"She is a screamer.
"That is all she does.
"She is not a walkie-talkie.
"She is not a danger to herself or others.
"And we know, in the back of our minds, that the first weekend the nursing home gets to enjoy the unending screaming, she will be right back here. For management."
Always interesting to hear the thoughts from the other side of the fence post. Really makes me think back to all those occasions where I have authorized sending out a resident with behaviors on a Friday afternoon. The scramble to call all four behavior units and convince someone to admit. Writing the letter promising that we will take the resident back (that letter means nothing). I'm sure that someone has done a trend-study on Friday afternoon behavioral health admissions from nursing homes. Would be interesting to see, although I bet I can guess what the trend would be.
"That is all she does.
"She is not a walkie-talkie.
"She is not a danger to herself or others.
"And we know, in the back of our minds, that the first weekend the nursing home gets to enjoy the unending screaming, she will be right back here. For management."
Always interesting to hear the thoughts from the other side of the fence post. Really makes me think back to all those occasions where I have authorized sending out a resident with behaviors on a Friday afternoon. The scramble to call all four behavior units and convince someone to admit. Writing the letter promising that we will take the resident back (that letter means nothing). I'm sure that someone has done a trend-study on Friday afternoon behavioral health admissions from nursing homes. Would be interesting to see, although I bet I can guess what the trend would be.
Microsoft Word vs. Publisher
It seems as thought the majority of the business world (at least my world) uses Microsoft Word as their primary editor for most documents. I do see people using the clip art function sparingly, and an occasional template for a card, resume, or an important marketing piece. But I still don't see many people using Microsoft Publisher. It's an easy to use tool with drop and drop editing, an endless array of templates from everything from business cards to postcards to flyers for your dog's batmitzvah.Crabby Office Lady has posted a good article on when it is more beneficial to use each of the programs. If you aren't familiar with the Crabby Office Lady, she is a Microsoft Office guru that always has good advice. You will probably see me refer to her often. Enjoy!
Medicare Part A Co-Payments for 2007
The daily coinsurance for the 21st through 100th day in a skilled nursing facility will be $124 in 2007, up from $119 in 2006.
Bingo!
I had to laugh this morning as I was walking to stand-up. I passed two ladies coming back from breakfast and overheard one say to the other, "Who would have thought we would actually be playing bingo when we got old?"
(Another) New Blood Glucose Reg
CMS issued a new fee schedule on Thursday which included a provision affecting the administration of finger sticks on diabetic residents. The new provision requires that every finger stick on a Medicare beneficiary is ordered and certified by the physician.
In case you've have trouble keeping up with blood glucose reimbursement, you aren't the only one. Many privately owned organizations have not even had the resources to attempt the complicated billing for these services. Large corporations have put their best foot forward in the recent past but have constantly changed their billing procedures based on changing interpretations.
The new bl odd glucose rule puts the patient at risk by more directly associating frequency with reimbursement. This provision “puts paperwork ahead of quality patient care,” said Bruce Yarwood, President and CEO of the American Health Care Association.
In case you've have trouble keeping up with blood glucose reimbursement, you aren't the only one. Many privately owned organizations have not even had the resources to attempt the complicated billing for these services. Large corporations have put their best foot forward in the recent past but have constantly changed their billing procedures based on changing interpretations.
The new bl odd glucose rule puts the patient at risk by more directly associating frequency with reimbursement. This provision “puts paperwork ahead of quality patient care,” said Bruce Yarwood, President and CEO of the American Health Care Association.
Avoid Criticizing Other Professionals
I spent some time this weekend studying "Risk Prevention Skills" by Tennenhouse and Kasher. I'll be working on a complete inservice on the topic as it relates to documentation and behavior in the long term care setting, but thought I would begin by writing several summaries as I review the information. As I research this topic, I will organize these thoughts into a complete presentation.
We've all been in a situation where a comment is made in front of a resident or family member that undermines another healthcare professional. Perhaps the comment is made inadvertently, a slip of the tongue, or perhaps the intention is meant as a quasi-apology ("We're so sorry the bedrails weren't up, this is Nurse Sally's first week here"). Many human beings get an ego-boost from other people's short-comings. Regardless of the reasoning behind questioning some one's judgement publicly, it undermines the professionalism of an organization and creates a feeling of unease for the resident and family member.
Tennenhouse and Kasher list four basic rules to prevent criticism of the healthcare team in the resident's presence:
We've all been in a situation where a comment is made in front of a resident or family member that undermines another healthcare professional. Perhaps the comment is made inadvertently, a slip of the tongue, or perhaps the intention is meant as a quasi-apology ("We're so sorry the bedrails weren't up, this is Nurse Sally's first week here"). Many human beings get an ego-boost from other people's short-comings. Regardless of the reasoning behind questioning some one's judgement publicly, it undermines the professionalism of an organization and creates a feeling of unease for the resident and family member.
Tennenhouse and Kasher list four basic rules to prevent criticism of the healthcare team in the resident's presence:
- Avoid Conveying a Negative Opinion About Another Healthcare Professional to the Resident: Never convey negative feelings about technique or competence of an associate in front of the resident or family member. Avoid making comments that imply an associate is lacking in experience or qualifications. In direct-care teaching situations avoid negative outcomes by assisting directly if necessary, and always wait until you are in a private space away from the resident to highlight areas of concern.
- Do not make unsolicited suggestions to another member of the team in front of the resident or family member: Unless in emergency situations, avoid suggestions for further treatment that may leave the resident wondering why they were not considered in the first place. Questions such as "Shouldn't this resident's bed be at a 45 degree elevation?" are better asked outside of the resident's hearing.
- Never assume that an associate has made a mistake based only on statements made by the resident or family. Often when someone comes to us with a concern about a specific associate, we are quick to answer "That is against our policy! I will speak with her supervisor and make sure this does not happen again." While it is important to let our residents know that we take followup seriously, it is better to let them know that you will " Check into the matter and let you know what I find out."
- Never criticize another healthcare organization for policies or problems encountered during care. As professionals we are often quick to identify issues with other organizations. When those issues affect our own facility, it is easier to share in the frustration with a resident than to address the issue on a professional level. When one of your long term residents spends two weeks in an acute care setting and returns with a new pressure area, resist the temptation to make comments to the family and physician such as "Everyone that goes to XYZ Hospital comes back a mess." Definitely address the issue with the proper hospital professionals, but act as a part of the Healthcare Community rather than a competitor eager to slander your competition.
These four rules seem like common sense but can sometimes, in a moment of frustration, be difficult to put into practice. To the resident or family member, undermining comments and moments of unprofessionalism will stick in their minds far longer than positive outcomes. Don't leave your residents with a lack of confidence in you, your fellow associates, or your organization.
Even Your Heroes Need Rehab
Penn State Football Icon Joe Paterno broke his left leg and damaged a knee ligament Sunday when a Wisconsin player rammed his helmet into JoePa's leg during the third quarter. Reportedly, JoePa is considering surgery vs. letting the injury heal naturally, but has no plans to let the injury sideline him.
Considering that Paterno turns 80 next month, it's hard for the press to avoid the obvious cliches. If you've seen JoePa working the sidelines in person or on TV, though, you know that Joe's doing better than most people half his age. I just hope that JoePa can make a quick recovery and shut up all the naysayers.
Considering that Paterno turns 80 next month, it's hard for the press to avoid the obvious cliches. If you've seen JoePa working the sidelines in person or on TV, though, you know that Joe's doing better than most people half his age. I just hope that JoePa can make a quick recovery and shut up all the naysayers.
Humor
A family took their frail, elderly mother to a nursing home and left her, hoping she would be well cared for. The next morning, the nurses bathed her, fed her a tasty breakfast, and set her in a chair at a window overlooking a lovely flower garden. She seemed okay, but after a while she slowly started to tilt sideways in her chair. Two attentive nurses immediately rushed up to catch her and straighten her up.
Again she seemed okay, but after a while she slowly started to tilt over to her other side. The nurses rushed back and once more brought her back upright. This went on all morning. Later, the family arrived to see how the old woman was adjusting to her new home. "So Ma, how is it here? Are they treating you all right?"
"It's pretty nice," she replied.
"Except they won't let me fart."
Again she seemed okay, but after a while she slowly started to tilt over to her other side. The nurses rushed back and once more brought her back upright. This went on all morning. Later, the family arrived to see how the old woman was adjusting to her new home. "So Ma, how is it here? Are they treating you all right?"
"It's pretty nice," she replied.
"Except they won't let me fart."
Getting Workers to Punish Other Workers
After another failed round of safety bingo, it's becoming difficult to justify "safety incentive programs" in the nursing home setting. Perhaps it's the implementation (pulling and posting a bingo number everyday), keeping workers focused on the goal of the program (and avoiding employee-discovered loopholes in the game), or perhaps they really don't work. You're more apt to find resources discouraging these programs than promoting them.
What's the problem? These programs often discourage workers from reporting minor injuries and accidents that can later lead to nagging problems. Workers in this frame of mind are less likely to report facility issues that could later lead to serious harm if not addressed timely. Consider a dietary employee that cuts their hand on a utensil hanging on a poorly placed knife rack. If this employee reports their minor cut, they will lose their opportunity at the "safety incentive prize" or perhaps even jeopardize everyone from earning the incentive. So they don't report this problem. This increases the likelihood that someone else will now injure themself, perhaps more seriously, as a result of your safety program.
I have several suggestions for alternatives to these "blame the worker" programs.
What's the problem? These programs often discourage workers from reporting minor injuries and accidents that can later lead to nagging problems. Workers in this frame of mind are less likely to report facility issues that could later lead to serious harm if not addressed timely. Consider a dietary employee that cuts their hand on a utensil hanging on a poorly placed knife rack. If this employee reports their minor cut, they will lose their opportunity at the "safety incentive prize" or perhaps even jeopardize everyone from earning the incentive. So they don't report this problem. This increases the likelihood that someone else will now injure themself, perhaps more seriously, as a result of your safety program.
I have several suggestions for alternatives to these "blame the worker" programs.
The Legal World vs. Nursing Home Administrators
I came across a commentary on a legal blog today with the heading "LET’S PUT MORE NURSING HOME ADMINISTRATORS AND OWNERS IN JAIL." For some reason I have a difficult time swallowing a blanket statement such as this one. Several recent convictions in Montana, Missouri, and Pennsylvania have re-kindled the consumer sentiment that our industry puts profits first and care last. Many plantiff's attorneys across the country are fueling this fire rapidly.
If this is the kind of information that interested consumers are entering our facilities with, how will we ever get ahead? Talk about sitting behind the eight ball. Are there criminals running healthcare organizations? Obviously, and anyone who steals one red cent from our residents in any form SHOULD be punished, and never allowed to work in healthcare again. If we consistently highlight only the negativity in the industry, we will find ourselves on the defensive so often that progress will be impossible.
So thanks for being a healthcare professional. Thanks for giving it everything you've got, smiling when you are sad, giving when you are broke, and for promoting respect and kindness for our elder generation. We are making a difference.
If this is the kind of information that interested consumers are entering our facilities with, how will we ever get ahead? Talk about sitting behind the eight ball. Are there criminals running healthcare organizations? Obviously, and anyone who steals one red cent from our residents in any form SHOULD be punished, and never allowed to work in healthcare again. If we consistently highlight only the negativity in the industry, we will find ourselves on the defensive so often that progress will be impossible.
So thanks for being a healthcare professional. Thanks for giving it everything you've got, smiling when you are sad, giving when you are broke, and for promoting respect and kindness for our elder generation. We are making a difference.
Holiday Gifts for Staff to Share
When it comes to infection control, the dirtiest thing in your facility during the Holiday Season has to be the three-flavored popcorn tin behind every nurses station. You've spent the past ten months throwing away half-finished Diet Cokes, leaving hot memos on the Nutrition Pantry fridge about personal food, and scolding nurses for eating yogurt at the med cart.
But even you're a sucker for the cheese popcorn.
It's a simple gesture - families, vendors, and other staff want to take the opportunity to say "thanks" with food. It's what our moms taught us. And as early as the middle of November the goodies will start filtering in. Cookies, candies, pretzels...The community popcorn.
Our staff understand the concept of not accepting gifts. Our families understand our requests that they bring something that everyone may enjoy. Unfortunately, items like the community popcorn tin truly do undermine our efforts in infection control, environmental integrity, and professionalism. Extendicare Health Services has published a nice consumer information sheet highlighting several creative alternatives for showing appreciation during the Holidays.
Here are a few of my suggestions:
But even you're a sucker for the cheese popcorn.
It's a simple gesture - families, vendors, and other staff want to take the opportunity to say "thanks" with food. It's what our moms taught us. And as early as the middle of November the goodies will start filtering in. Cookies, candies, pretzels...The community popcorn.
Our staff understand the concept of not accepting gifts. Our families understand our requests that they bring something that everyone may enjoy. Unfortunately, items like the community popcorn tin truly do undermine our efforts in infection control, environmental integrity, and professionalism. Extendicare Health Services has published a nice consumer information sheet highlighting several creative alternatives for showing appreciation during the Holidays.
Here are a few of my suggestions:
- Collect holiday food items and donate them to a food bank weekly through the Holidays; Communicate this initiative to staff and form a committee to assist with deliveries
- Have a poinsetta tree for staff- Families pick a staff member off the tree to sponsor a Holiday flower, delivered around December 15th - just be ready to cover the remaining number of staff that are not sponsored by a family
- Hold a staff Holiday appreciation party catered and hosted and served by willing families and residents
- Hold a daily or weekly silent auction for all donated goodies and let staff select a local charity to donate the money
There are lots of great things that you can do with Holiday gifts from families. What is most important is that you communicate early on to both staff and families. This way you can avoid confusion, hurt feelings, or a broken policy - and truly enjoy the Holiday Season!
Cost of Labor Statistics
The Department of Labor runs a very useful website for the Bureau of Labor Statistics. I have found this site helpful when considering the creation of a new position in the organization, responding to wage discrepancy concerns raised by employees, and even recruitment and retention projects. They publish up-to-date statistics for everything from average wages to cost of living and benefits analyses; stats are broken up by state, industry, etc. I will add the link to the resources column for easy future access.
Happy Halloween!
There's a real reward that comes when you see residents and employees having a great time together. Yesterday we had our Halloween costume contest; nearly 50 staff members dressed up for the day, including my boss (pictured here). Our residents served as the costume judges, clapping for their favorite costumes as we paraded around the rotunda. Grand prize, which was a five-pound Hershey bar, went to a very creative dining services duo that dressed as "deviled eggs."
While we sometimes fall short on planning and execution of these events, it's nice to be reminded that it's all about the positive outcomes; seeing eveyone have a good time just leaves you excited to come back the next day.
Thank You's
We've been having a conversation in our recruitment and retention meeting about how we show our appreciation. I know from personal experience that a handwritten note of praise is a very genuine way to show our employees how much we appreciate their efforts. Our dinig services manager forwarded this message from Linda Talley's Success Newsletter that addressed bad handwriting:
"I talk about sending hand written notes all the time and people still come up with all kinds of excuses not to send them. I was talking to a friend of mine a while back, and he said he didn't send them because he had terrible hand writing. I told him to join the crowd because I have had people whom I have sent hand written notes call me up to decipher my note for them and then tell me that even though it was tough reading it, they enjoyed it and thank me. Bad hand writing is not an excuse. No time is not an excuse-that's called setting a priority and writing a note is not at the top! Bottom line, that's it!
"I tell people, if you want the competitive edge, send hand written notes and they still don't do it. Not because they don't want to get ahead but because they are too lazy! Again, some people call it being lazy, I say it's about priorities! If your customers are not a priority, then don't write a thank you note. Let those business people who see their customers as a priority write the notes and they will have the competitive advantage.
"The handwritten note has become about as rare as the dinosaur so when people get one, they are really excited about it. I cherish the hand written notes I receive because I know it took time and thought to construct and write the note. And I am always impressed when someone does that for me!
"By the way, Christmas is coming up. You can start practicing when you send someone a thank you note for the cool gift; or to a staff member that worked overtime to get that gift box out; or to a vendor that made a special delivery to you; or that customer/client that has been a loyal advocate! "
"I talk about sending hand written notes all the time and people still come up with all kinds of excuses not to send them. I was talking to a friend of mine a while back, and he said he didn't send them because he had terrible hand writing. I told him to join the crowd because I have had people whom I have sent hand written notes call me up to decipher my note for them and then tell me that even though it was tough reading it, they enjoyed it and thank me. Bad hand writing is not an excuse. No time is not an excuse-that's called setting a priority and writing a note is not at the top! Bottom line, that's it!
"I tell people, if you want the competitive edge, send hand written notes and they still don't do it. Not because they don't want to get ahead but because they are too lazy! Again, some people call it being lazy, I say it's about priorities! If your customers are not a priority, then don't write a thank you note. Let those business people who see their customers as a priority write the notes and they will have the competitive advantage.
"The handwritten note has become about as rare as the dinosaur so when people get one, they are really excited about it. I cherish the hand written notes I receive because I know it took time and thought to construct and write the note. And I am always impressed when someone does that for me!
"By the way, Christmas is coming up. You can start practicing when you send someone a thank you note for the cool gift; or to a staff member that worked overtime to get that gift box out; or to a vendor that made a special delivery to you; or that customer/client that has been a loyal advocate! "
Subscribe to:
Posts (Atom)