One patient day at a time.

My first real QIS post.

2012-01-25T22:30:00.000-05:00

And it's not even going to be that long.

After three days of our first Quality Indicator Survey (QIS), I am enjoying it. It's much more "in the background" and feels pretty procedural - more organized. Manageable. You hear much more from me about my QIS experience in the coming weeks.

But I can't talk about it right now. I've managed a 5:40 a..m rise time three days in a row so far this week, and five straight is my goal. Oh, sweet, sweet Saturday. You cannot come soon enough.

I'll take this final moment to say, "God bless you Coach Paterno, for all you did. You will never be forgotten."

I wore the jacket all day for once.

2012-01-23T21:45:00.002-05:00

Almost forgot to mention that I was sporting some new duds this morning, at an opportune time, ya know, survey and all.

I loves me some skinny blue ties!

As a creative survey favor, I've asked the Missus to assemble my outfits for each day of this week so I can wake up early and jump into my Superman costume in speedy fashion.

Privacy Rule of Thumb

2012-01-23T20:31:00.000-05:00

It's good practice to have a "no business in the hallways" approach to resident privacy. It's difficult though - you see the social worker you've been looking for all day outside a resident's room, or you catch nurse Jackie on the way out the door, and its your duty to get them that important message.Why can't we talk about bed management in the lobby?

A lot of healthcare professionals struggle with this, particularly in and around the nurses stations and other naturally congregate areas. So while its easy to ask staff to pull their business conversations behind closed doors and to "keep all patient information confidential," it's a good rule of thumb to more specifically designate phone areas as safe communication spots. By telling staff to keep all patient or business sensitive conversation within arm's reach of a phone, it's an easy way for them to hold themselves accountable to bringing conversations back to that safety zone. By building this expectation into the culture, everyone understands to also avoid those areas when a conversation is happening, as it is likely sensitive information being shared.

Nurses stations and other public work spaces in health care come in a lot of forms nowadays, but most if not all have at least one phone stationed at their core. Teach your staff to gravitate towards offices or other phone/communication stations to avoid resident disruption and protect health information.

Good thing I made those early morning rounds

2012-01-23T13:13:00.001-05:00

My annual state survey walked in this morning, as expected. Our first Quality Indicator survey.

Don't get worked up about my post here - they're at lunch.

Things I Discovered on Early Monday Rounds

2012-01-23T08:05:00.001-05:00

Early morning rounds for the week. Sound familiar?

-Nail polish and acetone kit at nurses station;
-Dead poinsettias nobody else will throw away;
-Trash cans without bags;
-Empty (show) rooms with bare minimum furniture;
-Found out that we denied a new referral because we "didn't have any more electric beds."

Overall my campus presents amazingly, with no odors, great decor and lighting, and pleasant caring staff. That makes it all the more frustrating to go out and find these *classic* issues when rounding.

Happy Monday

Friday is Purple Day

2012-01-20T08:35:00.001-05:00

Touring a skilled nursing facility in Bluffton, IN this afternoon. Not before I:

-Choose a bathtub for the spa renovation
-Setup arrangements for a high school extern program we are hosting in April
-Editing the final draft of a new QA program for weight loss and other nutritional issues
-Creating the list of vendors to send RFPs for new campus

Yesterday I finished everything on the list expect maintenance rounds. I'm going to go fit that in right now.

Bow Ties Are Cool

2012-01-19T16:31:00.001-05:00

Bow ties are cool. Rocking the bow tie here to demonstrate part of our updated dining uniforms. They were wearing neckties, which was wonderful, but had turned into a safety and infection control issue as ties were occasionally getting into food, dishes, etc.

I'll never win a James Bond lookalike contest.

Thursday Todo List

2012-01-19T08:01:00.000-05:00

Today I'm working on:

Finalizing the renovation plans for a shower room
Meeting with activities about organizing and increasing outings
Setting up the logistics for delivery of goods for our soon-to-open skilled nursing campus
Reviewing process for tracking lost referrals
Maintenance rounds

Hopefully some resident interaction sprinkled in.

Scrabble versus our eldest resident.

2012-01-18T16:58:00.001-05:00

Yesterday she celebrated her 108th birthday. No way I was letting her lose.

Her secret? "Lots of walking."

Final score: 273-264.

Direct Supply Trip

2011-11-06T00:29:00.002-04:00

Last month I visited Direct Supply (DS) headquarters in Milwaukee, WI, traveling with an associate to evaluate furniture and equipment options for a new SNF. I delayed this trip for several months despite the encouragement from my DS reps. It turns out that I should have taken their advice sooner. The trip was 25% sales pitch but 75% quality professional education. If you have the opportunity in the future, I encourage you to take it. I learned more on this trip than most seminars and conferences I have attended.

First of all, here's what you can expect in terms of trip logistics:

-It takes two days to fully tour the DS headquarters and product lines;
-Direct Supply is the Google of the LTC industry; they have a fun work environment, awesome benefits, and an inspirational story;
-Take two items: comfortable shoes and a camera; you will walk several miles and want to remember a number of specific products you demo; you will see ten buildings and hundreds of innovative FFE offerings;
-DS paid our hotel, food and beverage; they were very hospitable;
-DS asks you to pay your own travel expenses.

More importantly, we learned about so many products. I've purchased a lot of beds, mattresses, lifts, carts, etc. in my lifetime but never really understood the differences between various products lines and models. I'm part of an independent not-for-profit, so I don't have corporate staff advising me on the latest technology and offerings. One example:

We still use the 1.5" blue mats next to resident beds to reduce injury from out-of-bed falls. Turns out those are practically obsolete. Now they offer 1/4" versions that are more effective, don't have to be moved during day, and look like floor rugs. I honestly had no idea. I've already order some replacements. Sales pitch + education is okay if it benefits your residents.

Here are some of the items we had the chance to test and learn about:
-Electric beds
-Pressure-relieving mattresses
-Clinical monitoring equipment
-Lift equipment and assistive devices
-Wheelchairs
-Floor care equipment
-Housekeeping equipment and carts for all areas
-Kitchen equipment from hoods to teaspoons
-Furniture, including living rooms, dining, and resident rooms

Direct Supply also offers several services, notably TELS. You will learn that their TELS product is a web-based maintenance tracking, life safety code scheduling, and inventory management system. TELS is designed to be the centerpiece of your facilities maintenance program, serving as both a maintenance request system as well as scheduling, tracking and documenting your annual regulatory requirements. Here are the facts:

-$97 per month, per facility for unlimited users
-Designed for all facility staff to use as maintenance request system 12-month scheduling system for LSC, PM
-Requires some Direct Supply input of information
-Has iPhone capability for easy entering and receiving of new maintenance requests (great feature)

Many large for-profit organizations use TELS and when considered as a monthly cost $97 seems reasonable. When comparing to a one-time software purchase, however, the fee may be excessive for your organization. The biggest drawback is the built in dependency for DS to scan and upload your key documents and scheduled annual tasks. We plan to trial the system for a few months and will ask our Director of Facilities to determine if this system is worth the input time and associated maintenance costs.

Overall our trip to Direct Supply was well worth the expense and time. You've seen the catalog, but it's only a small portion of what Direct Supply really offers. DS is an employer of choice in Milwaukee, an expert in long term care, and an advocate for quality and process improvement. I highly recommend you make this trip if it is offered to you and your organization. Even if you are not a direct purchaser, chances are your maintenance, environmental, and nursing departments are buying products from DS. I suggest you educate yourself on the latest products to better serve your residents and employees.

Looking for Pet Therapy Resources

2011-05-16T09:51:00.002-04:00

I'm getting ready to adopt a border collie - just six months after saying I wouldn't get another dog. I've always dreamed of being the Administrator that brought his dog in everyday for residents to enjoy, and I would love to make an attempt with my new friend.

I have no idea where to start!

If you have any policies, guidelines, stories about bringing your dog into a facility on a routine basis, would you please contact me at matthewmaupin@gmail.com? I want to make sure I do it right. Thanks!

Happy National Nursing Home Week!

2011-05-09T16:12:00.001-04:00

A man's age is something impressive, it sums up his life: maturity reached slowly and against many obstacles, illnesses cured, griefs and despairs overcome, and unconscious risks taken; maturity formed through so many desires, hopes, regrets, forgotten things, loves. A man's age represents a fine cargo of experiences and memories.

~Antoine de Saint-Exupéry, Wartime Writings 1939-1944, translated from French by Norah Purcell

New competency model will benefit long-term care industry

2011-04-13T18:29:00.002-04:00

From healthcarefinancenews.com: The Department of Labor has released a competency model for the long-term care industry that officials hope will solve long-standing issues of low wages and a high staff turnover rate.

“The models are an excellent guide to leaders at the operational level for both employee recruitment and identification of continuing education needs,” said Matthew Maupin, administrator of Lutheran Life Villages in Fort Wayne, Ind., and a blogger on the long-term care industry. “Often as leaders we focus solely on technical competencies without consideration of broader foundational principles, leading to increased training costs and ultimately employee turnover. The models support professional development programs geared towards customer service, communication and utilization of technological efficiencies, which is precisely what the long-term care workforce needs for the upcoming influx of Baby Boomers requiring care.”

See the rest of the article here.

National Volunteer Week

2011-04-12T17:08:00.004-04:00

During National Volunteer Week (April 10-16, 2011) we honor the individuals and groups that support our organizations in a multitude of ways. On our campus, volunteers run the gift shop, push residents to chapel services, repair furniture, and raise tens of thosands of dollars each year, in addition to so many other things. Our volunteers are amazing and truly improve resident quality of life.

Then why do we make it so difficult to volunteer? I had to laugh last night watching this sketch last night on Jimmy Kimmel Live. It sums up my thoughts on how we drown every good intention in regulation and risk management initiatives. Yes, I acknowledge the operational needs, but Kimmel really hit the nail on the head in a very funny way.

Employee Prayer

2011-01-04T10:51:00.002-05:00

Dear Lord,

May we be worthy of the trust that our patients and residents, our administrators, our staff, and our community place in us. May we seek Your wisdom and guidance. Bless each employee; multiply time and energy.

May each and every person here experience Your strength and joy as they complete another day in this journey.

Amen

Quality Measures to be Removed from 5-Star Updates Pending MDS 3.0 Data

2010-12-15T10:00:00.000-05:00

The individual and overall ratings for the Centers for Medicare and Medicaid Services (CMS) Nursing Home 5-Star Rating System now are based on the three domains of inspections, staffing, and quality measures. Use of all three domains will change at least temporarily while CMS analyzes the new quality measure data gleaned from the MDS 3.0, implemented on Oct. 1. The last MDS 2.0 quality measure update will be published on the Nursing Home Compare Web site in Jan. 2011. This last update will be based on the last quarter of MDS 2.0 data and it will remain posted until April, 2011. After April, CMS anticipates no public reporting of quality measures on Nursing Home Compare until spring, 2012. Effective April, 2011, the quality measures will not be included in the 5-Star calculation process and facility ratings will be based on the two remaining domains, inspections and staffing.

New Kid In Town

2010-11-24T21:42:00.004-05:00

This week I toured a new "facility" in another state. God forbid you call it a facility, because there's nothing institutional about it. It's completely out of your realm, yet so close. I've toured nearly 100 properties in the past 10 years, and this is the only one I could actually picture myself living at. And I'm 30.

Wait until a few of these pop up in every state. Don't worry, it doesn't replace your property. It doesn't even necessarily complement your property. But you aren't offering it, I'm positive. Is it a threat to your census? What isn't?

This time you should be worried.

They aren't doing short-term rehab. They don't have home health. Dementia care isn't their specialty, either. But if they are in your market, you can bet that everyone else will compare your product to theirs. It's not fair, it's not congruent, but it's reality. The new reality is a face off between your traditional facility model and a host of unique new options. Senior living is no longer need-based.

Senior living is no longer need-based.

Resources

2010-11-13T08:55:00.002-05:00

I get a lot of messages from others that have placed a link to The Nursing Home Administrator on their own resource. This list below is not an endorsement from me, just an organized list (in no particular order) of some other people out there writing about care for the aging.

Get Hospice Nursing Jobs - A hospice job aggregator

The Learning Advisor - On online educational advisor

Top 50 online Resources for Families Coping with Alzheimer's disease

RetirementHomes.org - Consumer Research Site

Becoming A Life Change Artist - Wonderful book on creativity in later life

The Days are Numbered

2010-09-29T08:17:00.003-04:00

We've had great weather this year.

I was leaving work and a group of residents, as always, was sitting on the porch enjoying the sun and a nice breeze. One gentleman, sitting away from everyone else, looked especially relaxed - eyes closed, smile on his face, reclined in his chair. I know he's in renal failure and has chosen to spend his time on Earth peacefully rather than going through extensive treatments.

"Enjoying the sun?" I asked as I approached him.

"I sure am," he said without opening his eyes. "The days are numbered though."

"Oh, Mr. Baldwin, I'm sorry to hear that. You're not feeling well, huh?"

We've had a few of these deep conversations and I know that he's been to the hospital recently. He reads the obits pretty religiously and is some ways I'm sure he is counting his own days. I wasn't surprised at all to hear him comment on his own mortality.

"No, I meant the weather," he replied.

A Disappointing Response from the Governor

2010-03-22T20:10:00.003-04:00

Here is the response I received from Governor Mitch Daniel's office regarding my recent letter requesting his refusal of a bill that will now allow employees to keep guns in their cars while at work. Unfortunately this bill does not specifically exclude nursing homes or assisted living facilities and will now go into affect July 1, 2010:

Dear Mr. Maupin,

Thank you for your letter and for sharing your thoughts with the Governor. He appreciates the time you took to share your views on this subject.

House Bill 1065, various provisions concerning firearms, passed the Indiana General Assembly and was signed by Governor Daniels. This bill will go into effect on July 1, 2010.

Governor Daniels statement regarding HEA 1065:
"Considering the clear language of the Second Amendment of the U.S. Constitution, and the even stronger language of Article 1 Section Thirty-Two of the Indiana Constitution, protecting these rights as provided in HEA 1065 is appropriate. I also am compelled to give great weight to the overwhelming consensus of both Houses of the General Assembly as they passed this bipartisan statute. The law does contain ambiguities that the General Assembly may wish to refine at some future date, to avoid unnecessary litigation, but the understandable concerns raised against the bill do not suffice to justify a trespass on a fundamental right so expressly protected by our founding documents."

The 2010 Bill Watch on the governor's website has been established. We will continue to update the website as bills are received and/or action is taken by the governor. You may view this webpage at http://www.in.gov/gov/billwatch.htm.

Please be assured that Governor Daniels monitors all legislation very closely as it proceeds through the legislative process and thoroughly reviews all bills that are brought to him for approval or veto.

Thank you for your citizenship.

Sebilius Suggests Possible Changes to Five-Star Rating System

2010-03-17T09:55:00.004-04:00

"The last thing we want to do is have an arbitrary bell curve just for the sake of having a system," Sebilius was quoted this week as saying at McKnight's LTC News. The Health and Human Services Secretary was commenting on the lacklaster five-star consumer system imposed by CMS in 2008. It has received less than shining reviews from providers.

Sebilius should be aware how strongly providers feel about her statement. The fault of the system is that it forces all provides into a single pre-determined quintile, arbitrarily moving individual facility scores around during the year as other providers complete survey cycles. Rather than measuring quality improvement, it is strictly comparative, and certainly not on a real-time basis. Additionally, many facilities and organizations usie their survey as a true quality improvement process tool, and make significant improvements 3-6 months after a health survey. The system forces a single score on providers for up to 17 months at a time, quality measures component aside.

The Secretary seems to agree with providers that an improved system would include all three componets, namely better measurement and explanation of quality measures. "If everyone ends up being excellent or everyone ends up being failing, so be it,” continues Sebilius. We couldn't agree more. While CMS is unlikely to open up to most provider recommendations, we can continue hope and lobby for reform in this area. Until then, just know that a facility in another state could bump you from a three-star community to a two-star community with one good survey.

National Nursing Home Administrator's Week

2010-03-16T17:34:00.000-04:00

A lot of you landed here this week because you were Googling (or Binging, I suppose) the term, 'National Nursing Home Admininstrator Week." In case you missed it last year, I wrote briefly during the week of March 2009 on how this particulcar recognition day should not be included in your community's celebration calendar - and certainly not at your suggestion.

I can't find any proof of its existence or declaration in 2010.

So from me to you, in the most unofficial of terms, Happy Nursing Home Administrator Week!

Don't tell your staff.

Ideas for National Nursing Home Week

2010-03-15T16:18:00.000-04:00

Community Historic Trivia Contest with Silverchair online in-service

Group photograph of everyone on campus by Professional

Family photography giveaways through Professional – Have your family photo taken in the same style as the Annual Report photos (plus we could use some of the shots for advertising), we could easily do 5-10 of these packages

Banner with every employee’s name on it in front lobby

Letter of recognition to editorial of local paper, mayor’s office, state representatives, etc.

More general “Thank You for what you do” banner to employees outside on main Blvd.

Addition and dedication of new employee wellness equipment, ie. New treadmills, bikes, etc.

Special limited edition Community branded pen – one time run only of 500 for both employees at both campuses

Employee Wellness walk to raise money for Employee Assistance fund

Arrange for 2^nd shift nursing staff to work over so that we can throw a 3^rd shift party at 10:30 p.m.

Recognize National Nurses Day by purchasing a print media ad

Letter to families of employees thanking them for their support of Community

Community T-shirts…

Make a video of employees saying positive things about other employees and show at Town Hall Meeting

Daily Employee Spotlight Profiles on Facebook every day during National Nursing Home Week

Employee dog show with residents as judges

Themed dress days that will have more than 50% appeal – breast cancer (pink) day, Alzheimer’s (Purple) Awareness day, etc.

That's not a green shoot.

2010-02-21T09:02:00.002-05:00

Graph courtesy of the New York Times.

Your Employees Should be Begging to Do This

2010-02-13T16:56:00.004-05:00

This afternoon I had the pleasure of delivering an impressive Valentine's Day arrangement to a resident. She had been quietly enjoying her Saturday, which consisted mostly of sitting in her recliner watching television and waiting for dinner. Suddenly, though, I popped around the corner holding a lovely bouquet from the local florist. It was an event, and one we both enjoyed.

I work with a great Director who sometimes laments that she misses the days when she was able to work more directly with the residents. You've heard your managers voice similar concerns, reflecting on their former roles in direct care positions and supervisory roles. As a department leader or Administrator in a CCRC setting though, these daily opportunities are rarely included in your job description. You must seek them out; they probably won't just come to you. Even as a leader, as a manager, as a Director, you must connect with the residents you serve. Especially as a leader.

So I grab these flowers from the reception desk as I scoot in this morning. Sure, they probably already called down to the nurses station when the flowers arrived, and someone on the other end said they'd be down when they had a moment. I may even pass them on the way down. But c'mon, this is no chore! I'm heading that way anyways, so I'll just take those flowers, Nancy!

It's a ten-minute walk across campus as I snake through the buildings, and though I sometimes exaggerate, I'm sure no less than 15 people made some comment about these flowers. What a hit! This will definitely be a feel-good moment for Ms. R. As I finally reach her room, I hear one last person down the hall saying, "Awwwww, for me?" I knock and thrust the roses in front of the awed resident for her inspection.

For the next 15 minutes, this lovely resident tells me all about her family as I help her unpack the carefully cellophaned arrangement. I make sure to ask her permission each time I pull anything away, and I am careful not to look at the contents of the card. I don't throw anything away without her permission either, and I make sure that the flowers are left in a place that is a) sturdy, b) where she can see them, and c) in a place where other people can see them and ask her about them.

So what, you ask? Well, I find that I often miss these opportunities with both my own Grandmother and other people's Grandmothers, and now I'm reminded of the little things in life. So, if you have a Grandma, send her flowers for Valentine's Day - it really DOES make her feel good. And if you're an employee, grab the flowers when you walk past them at the reception desk.

It's your perfect opportunity to connect.

Captain Phil Harris, 1956-2010

2010-02-10T08:25:00.004-05:00

I was saddened this morning when I received word that Captain Phil Harris passed away. He suffered a stroke in January and had undergone serious treatment. Captain Phil will be missed by his fans and friends, but especially his own family:

"It is with great sadness that we say goodbye to our dad - Captain Phil Harris. Dad has always been a fighter and continued to be until the end. For us and the crew, he was someone who never backed down. We will remember and celebrate that strength. Thanks to everyone for their thoughts and prayers.

- Jake and Josh Harris

Here is Captain Phil with me and the pumpkin portrait of him that I carved in 2009. Phil befriended our staff here and was very kind to our residents the day he visited. He was a very gracious guest and geniuinely engaged during his visit.

Rest in peace, Captain.

The Relief of Annual Survey Completion

2010-02-09T20:06:00.001-05:00

Today our campus finished the re-visit to our annual survey. Fortunately our survey findings were limited this year and their follow-up took less than two days. The sense of relief that completion of the survey cycle brings is indescribable for me as an Adminsitrator. Regardless of how you feel about the survey process, knowing it's over should leave you and your staff with a sense of accomplishment and excitement.

From start to finish, you and your team will spend 2.5 months from day one of a survey to the completion of an average re-visit. Once the survey cycle is closed, find ways to continue quality assurance monitoring of survey deficiencies per your plan of correction. Remember, though, your core group has spent a lot of extra time auditing records, checking ted hose, reconciling labs, in-servicing staff, conducting return demonstrations, etc. Don't fall back from approaches that are exhibting value, but re-tool other parts that aren't working. Don't be afraid to amend your plan of correction if it becomes irrelevant.

Finally, go back through your notes from the surveyors. Those "FYI's" they give you aren't just small talk. Expect close scutiny of those very topics during your next survey. Re-organize all of the copies that you collected during the survey, type up the most relevant of your own notes, and put a cover sheet on top with the dates of the survey and any other significant information. Leave something that's easy to comprehend for the next person in your seat.

National Nursing Home Week 2010

2010-02-08T16:41:00.000-05:00

AHCA is proud to announce the 2010 National Nursing Home Week® (NNHW) theme: "Enriching Every Day." NNHW will be celebrated in nursing and rehabilitation facilities nationwide, beginning Mother’s Day, May 9, and continuing through May 15, 2010. This year’s theme was selected to honor those who are “Enriching Every Day” for others, thus adding value to life and overcoming many of the infirmities of age and disability.

I encourage you to start planning now. These events sneak up on you, and before you know it, you are throwing something together - and your staff don't feel appreciated, like they should. Watch for more posts here regarding ideas for celebrating the week with staff, families, and residents.

Medicare State Operations Manual

2010-02-06T14:36:00.003-05:00

The Internet continues to become more interactive and user-friendly. The latest online version of the Medicare State Operations Manual is one speedy PDF! It is organized in a manner that provides instant access to rules governing everything from hospitals and long term care facilities to life safety code and laboratory services.

Wondering how the swing-bed unit in your local hospital works? How about the vendors you work with? It's all included, and so easy to reference. I recommend saving the table of contents PDF and your organization's applicable guidelines to your desktop for quick reference.

101 Blog Posts Every New Nurse Should Read

2010-02-04T08:28:00.006-05:00

Nurses Practitioner Schools has a new list of "101 Blog Posts Every New Nurse Should Read." And while my post on conducting a good investigation did not make the list, their list is certainly worth perusing. Even if you don't realte to all of the posts, it is a pretty exhaustive resource to find some great health care blogs.

Additionally, the Health Herald is currently featuring it's Top 50 Hospice Care Blogs. Between the two lists, we have a pretty nice compendium of currrent "resources."

Healthcare-Associated Infections (HAI)

2009-11-15T15:08:00.002-05:00

One thing everyone can agree on, no matter where they come down on the current health care debates, is that no one should get sick as a result of visiting the doctor.

Healthcare facilities are rightfully expected to protect you from infection but that's just not always the case. Sometimes people are picking up infections, from pneumonia to antibiotic-resistant staph (MRSA), while under treatment for other health problems, or even while just in the hospital having a baby. That's a situation that could, and should, be completely avoidable.

Kimberly-Clark Health Care is on the forefront of protecting patients from Healthcare-Associated Infections (HAI) and has put together a site dedicated to that prevention called HAI Watch: Not on My Watch. The site has information for both healthcare professionals and healthcare consumers.

Click on the link above to access their resource.

AAHSA Sunday: The weather, event reporting, and the shuttles

2009-11-08T19:32:00.004-05:00

Welcome to AAHSA Chicago. It was gorgeous here today, 64 degrees as I write this after dinner. I'm here this week with a group of eight and traveled today with our Director of Nursing and Director of Wellness. The great weather and our wonderful families led us to get a late start from the Fort, so I can't comment much on today's opening speakers. I spotted Mr. Minnix outside of the Marriott but did not have the opportunity to hear his comments this afternoon, which was very disappointing for me. I consider him a bit of a celeb in my world and regretted not stopping him and saying hello and thanks when I saw him tonight.

For the afternoon session I attended (85-A) "Effective Event Reporting in a Risky Environment." This session highlighted the cost benefits of successful risk management in the long term care environment. Speakers made interesting points on unavoidable statements (compare your unavoidable statement verbiage to CMS interpretive guideline language) and the legal benefits of the family notification process. They really did stress the importance of family notification at the time of an incident and talked about methods for educating families on both community policies and the aging process in general. Education in risk management techniques is encouraged now at all levels of the organization, in many different forms. By educating staff on risk management policies, caregivers should not feel as threatened by a facility's investigation procedures and their own involvement.

I hate to mention the shuttles, but coming and going may be a bit difficult this week! The city traffic and unbalanced ebb and flow of conference traffic extended some shuttle waits to 45+ minutes tonight. Fighting a disappointed Bears crowd, thousands of sunny-day bikers and runners, and a reported crowd of 9,000+ (unverified), the buses just had some difficulty pushing all of these type A personalities from McCormick to the hotels and back.

This hotel charges $14.95 a day for internet. Shameful. Good night.

Captain Phil Harris and his Pumpkin

2009-09-22T22:09:00.003-04:00

I had the pleasure of spending the day with Captain Phil Harris from Discovery Channel's "Deadliest Catch." Phil graciously visited with Lutheran Life Villages residents and was the V.I.P. at our first annual Foundation Crabfest.

As a hobby I carve portraits into pumpkins. Stupid human tricks. I carved Captain Phil into a pumpkin the night before and gave it to him. He and his agent were so pumped about it! It was on display for the Crabfest and Phil made it the screen saver on his phone.

Thanks to Captain Phil, his agent Russ, and the whole Lutheran Life Villages crew that made it possible.

Making Rounds Just Got Easier

2009-08-16T12:54:00.004-04:00

I'm a real sucker for creating a new form. For all of you form-makers out there, this is usually a bad habit and a poor use of your time. While I haven't found any great resources for long term care forms, the fact is, most of the tools you make have already been created a thousand times over - good, bad, and ugly.

You know who you are.

So last month when Apple came out with the iPhone's newest operating software, I was excited to find a new feature: Voice Memos.

Now when making rounds, there is no audit form needed. No pen, no clipboard. No sitting your materials down to intervene and then forgetting where they are. It's as easy as 1-2-3.

1. As you round, use the Voice Memos application to make notations to yourself, such as, "Peerage Room 363 needs the closet door fixed."

2. Don't push STOP, push PAUSE in between notations. By pausing, you can keep the rounds to just one file. Otherwise, you may end up with 50 separate audio files at the end of the rounds.

3. When rounds are completed, go back to your computer and transcribe your Voice Memos. Because you created a single file using pause, it is easy to stop the recording in between notations or rewind if you missed something.

The Voice Memos application works well enough that it allows the Administrator to be discreet - you can talk softly into the mic and still easily capture your thoughts. And the transcription process is where the majority of time is saved. Even if you are accustomed to just making lists during rounds, you know that communicating your observations afterward can take a lot of time. Voice Memos eliminates this.

I know that the concept of snippet voice recording is far from new. The iPhone, though, has made making rounds much easier than it was in the past. I appreciate your feedback or tips on using this and other applications to improve your efficiency.

Lutheran Life Villages Goes Live

2009-08-07T18:16:00.004-04:00

Hopefully someday I'll have more time to write about how my organization changed its name this week.

For now I'll just share our new website - Lutheran Life Villages: A Better Way of Living.

Happy CNA Week!

2009-06-17T10:43:00.002-04:00

If you are a Certified Nursing Assistant, this message is for you.

Thanks for being a caregiver. You are essential to those you care for. Their strength often comes through you, whether through physical help or emotional response. You do something that most people could not do. You have training, experience, patience, and grace. You are there for us 24 hours a day, 365 days a year.

Thanks for all you do.

Seven Residents, One Nurse Killed in Shooting

2009-03-29T14:25:00.005-04:00

On Sunday morning a young male walked into Pinelake Nursing and Rehabilitation in Carthage, North Carolina and began shooting. Seven residents and one nurse were killed. The relationship between the shooter and the community is unclear.

The New York Times article is here.

With our Emergency Preparedness plans due to the Indiana State Department of Health this week, this sure hits home. What a nightmare - something I just don't know how you would plan for.

I can't even imagine the counseling that will need to follow in order for this five-star community to rebound. My team will surely pray for the residents, families, and employees this week. If anyone reading this is aware of a broader support effort, please contact me so that I may assist.

God bless them all.

Great Housekeeping Idea

2009-03-11T15:53:00.005-04:00

During our weekly meeting today, our Director of Environmental Services told me about a wonderful cost-saving idea he implemented. Rather than issue bags to the housekeeping staff by the case (I bet your carts have a case of 6 rolls on top), the supervisor issues one roll to each housekeeper during their morning meet-up each day. The department has seen a 40% reduction in bag purchases! A bag is sufficient for one typical day's rounds, and the staff know they can come back for more if they need them.

That's what we need in this economy. It's not cheap, it's smart.

What similar ideas have your employees brought forward in the past quarter?

These People Could Be Your Family

2009-03-10T20:05:00.002-04:00

Today we opened a new 15-room Memory Care neighborhood for residents with early-stage Alzheimer’s disease. Nestled within another portion of our skilled rooms, the new Memory Care is designed to test new household concepts of care delivery. Our staff is excited to make it home for our residents (it is), and I can’t give enough thanks to all of the people that helped make it possible.

Which is what makes the next part of this story disappointing.

Last week we left the doors open for on-lookers as we moved furniture, installed fixtures, and inventoried equipment. It was late afternoon and our Director of Maintenance and I were wrapping up for the day. A family member from another area of the nursing home wandered in to look around. She had actually followed me in.

“Can I ask you something?” she said.

“Of course.” I was acquainted with this particular family member.

“You’re going to cover up the windows or these doors so we don’t have to look at these people, aren’t you?”

“Excuse me?”

“I’ve worked with these people, and we shouldn’t have to look at them. I don’t want to see these people, I know what they do.”

I know, there are a lot of things I could have said next. Reading what I wrote, it’s was more offensive than the way it reads. Anyways, I was speechless. And just to go on the record, her sentiment is exactly the opposite of how I feel, about not just long term care, but how I try to treat every person on God’s earth. Even animals and bugs, now that I think about it. Everything has a purpose, and the right to serve that purpose with dignity.

Our residents with Alzheimer’s disease have the disadvantage of memory loss. Difficulty remembering their former purpose often leads to frustration and confusion. Rather than attempt to alter this reality, we now understand that is better to direct residents down the most comfortable path than to redirect or reality-orient. We will encourage our residents to assist us with the “activities of household living ™” that will help to give them a purpose, even if it is different than the one they remembered in an earlier stage of their life.

We will not let any resident live a life without purpose. I hope that is the mission of many organizations such as ours. I believe that we do the right thing by co-habitating these residents so they may receive focused programming and well-intentioned care and attention. Looking down upon this group or any group of residents, though, is wrong, and I believe that as a resident advocate, a long term care professional, and a good Christian, that I was right in saying... Well, it doesn’t matter. I said the right thing. I received a snide remark in return, but that’s okay – we do it for the residents.

National Nursing Home Week 2009

2009-03-10T16:03:00.003-04:00

From the American Health Care Association:

AHCA is proud to announce this year's National Nursing Home Week® (NNHW) theme: "Nurturing a Love that Lasts". NNHW will be held May 10-16, 2009, beginning on Mother's Day. "Nurturing a Love that Lasts" will encourage all to think of generations of parents and grandparents nurturing future generations to carry on life and family traditions. A supportive and caring environment, such as a nursing home, nurtures and enables residents and families to continue growing, learning and teaching through various ways. Nursing home staff, residents and volunteers nurture a caring environment that values communication, relationships and partnership. Be a part of this celebration in May 2009!

Get started now and you can still be "ahead of the curve":

AHCA Planning Guide
www.baudville.com
www.positivepromotions.com
Promos on Time: "National Nursing Home Week

This is just start. Plan now so that you can also consider communications to families, recognition of nurses (National Nurses Week), and of all staff. Some communities prefer to focus on aging, wellness, or community instead of "nursing home" in order to avoid unnecessary stereotyping or generalization of residents.

Housing Market Update: Growing Impact on Senior Living Providers

2009-03-09T16:23:00.000-04:00

The housing market continues to dominate news across the nation, with words like "morbid" and "dire" applied to the topic in news bylines. The release of year-end data from multiple sources demonstrates the impact of this crucial market on move-ins to senior living communities. Particularly CCRC's such as the property I manage have seen their primary feeder, the independent living, go from several move-ins per month to zero. This will turn out to be more than a short-term problem, as our average independent living resident stays in their apartment for several years before needing a change in level of care.

The complete article is fascinating, including hard data and charts. Be sure to check it out.

Just Imagine.

2009-02-27T09:24:00.000-05:00

Running a 13-story nursing home.

Be a More Effective Traffic Cop

2009-02-17T13:15:00.003-05:00

Consider the traffic cop that pulls someone over after just 30 seconds of clocking speeds. How many drivers does the officer prevent from speeding? Not many because he is busy writing a ticket (punitive).

Now consider the traffic cop that notes some drivers exceeding the speed limit by 8-12 miles per hour, but doesn't issue tickets. Most of these drivers slow down when they see the officer as their adrenaline increases and they realize the potential harm and consequence in speeding.

Sometimes you have to be a traffic cop, and every officer has to pull over the most obvious offenders, but you have a choice.

What kind of traffic cop are you?

Stimulus Package Includes $87 Billion in Medicaid Spending

2009-02-15T18:04:00.004-05:00

AAHSA has begun breaking down the stimulus package sitting on President Obama's desk this weekend. Of relevance here it is worth noting that states will receive an additional $87 billion in Medicaid funding. Here is how much your state would receive.

Click here for more information from AAHSA.

Silver Alert System Designed to Aid in Locating Missing Seniors

2009-02-02T17:44:00.003-05:00

At least 10 states have implemented their own missing person notification system for people with some form of mental impairment, namely Alzheimer's disease and dementia. Silver Alerts are similar to Amber Alerts, which are issued by police and broadcast by media outlets and put on Web sites when a child is believed to have been abducted and is in danger.

Indiana is currently considering implementation of the Silver Alert system. Click here to read more about Silver Alert systems across the country.

Miss Indiana Crowned Miss America

2009-01-25T13:16:00.008-05:00

Congratulations to Indiana's own Katie Stam, who was crowned Miss America 2009. As an Indiana native I'm proud to give her a big shout out from her home state! Katie, email me to schedule a visit to the wonderful residents of Lutheran Home in Fort Wayne!

Here's the news coverage from MSNBC.

Click here to watch the You Tube video of her crowing.

Tainted Peanut Butter - Tainted Words

2009-01-23T21:34:00.004-05:00

What Not to Say When the City Newspaper Reporter Calls:

"Residents at Lutheran Home and Concord Village, 6701 S. Anthony Blvd., are not getting all their snack options these days, said administrator Matthew Maupin. Gordon Food Service, which is their food vendor, informed them of the recall. Residents have many other snacks to choose from, Maupin said."

Which is not what I said.

Extendicare and Beverly Healthcare both gave me great training on media response. But they also both had teams. If I recall correctly, I may have had a colorful laminated card with 24-hour PR response - basically, keep your mouth shut. I see that Lutheran Hospital had a "spokesperson" in this article. That's pro.

In this case, I actually explained over the phone that sure, we had received some product related to the recall, but that we were fortunate to have our great national vendor alert us immediately and assist with product replacement.

Why did I say this, even? There was no need. I did not ask to be quoted directly, which would have been responsible, even if it didn't work. I could have offered a quick written response via email, which would have been nice documentation for both parties(what if I had been quoted waaaay out of context).

I just don't gain anything giving some one-liner about peanut butter to my adoring fan base in Fort Wayne. So anyways, just some quick advice: Don't respond off-the-cuff.

If you don't buy my advice, click here for someone else's tips (a nice Powerpoint presentation) for dealing with a media call.

Tools to Connect with the Obama Administration

2009-01-19T20:15:00.005-05:00

As our first tech-savvy President is sworn in, a number of new and tradition dot-gov websites are beginning to embrace the latest, most-effective techniques to allow Americans to access to government. Bookmark this article detailing the top resources being run by the new Obama Administration so you can share with employees and residents or check them out yourself.

Are Your Employees Being Abused?

2009-01-18T11:49:00.011-05:00

Over the holidays, I purchased a cabinet from Ikea, the low-budget, lots-of-assembly-required furniture and household gadgets store. One of the largest pieces was broken, and my subsequent call to customer service only revealed that Ikea is not interested in my individual satisfaction. Like most twenty-first century, I-want-it-now Americans, I exchanged heated words with the person on the receiving end of that call. I didn't get my way, and I made sure to express my sentiments - loud and rude. Was it abusive? I didn't give this worker the chance to let me know.

You have employees who feel abused by family members and residents. And if you're a member of your community leadership team, many employees blame you for not intervening. There is not a healthcare professional reading this that cannot recall a customer sitting on the other side of their desk, or standing on the other side of the bed, or even in the hallway, vociferously expressing their anger over an actual or perceived breakdown in the delivery of care. I have been sworn at, had fingers pointed in my face, and threatened. I fully understand my responsibility as a community leader, though, and I've benefited from more customer service and crisis management training than most of our employees combined. I know that I have a responsibility to find solutions and prevention through root-cause analysis, and every concern is taken seriously.

When a direct-care employee such as a nurse or a C.N.A. is verbally reprimanded by a family member, it can be perceived as a personal attack on their intelligence, proficiency, or even race and socioeconomic status. The linked article above, from a great C.N.A. forum, describes the frustration felt by many nursing staff members first-hand. I admit experiencing the same feelings as an Administrator, and the helplessness that can accompany them. Patti's article along with the subsequent reader comments, calls for a policy shift in retirement communities that holds customers accountable for their own behvior.

The topic has forced me to examine my own views and approach to conflict resolution, and I agree that families do not have the right to verbally accost employees, regardless of the situation. While difficult to craft an umbrella policy that does not discriminate against residents or breach resident rights, I recommend reviewing your process for prioritizing family and resident concerns. This process must be transparent, accessible to families, and objective. I believe that most communities have some version of this in place, but I also know how uncomfortable the worst of these situations be.

What is alarming about the conversation is that some direct-care employees are searching for their own methods to deal with situations because they feel a lack of support from their Administration. Several commenters promote calling 911 when they have been verbally (even physically) attacked by a family member. Their presumption is that communities pander to families in order to maximize revenue:

"We must stand up for ourselves if the DON won’t. If we lose the job, so what. The job wasn’t worth US. Getting hurt at work isn’t worth it. The management CAN draw the line but usually won’t cause it’s all about money- the paying customer. Mind you, I question if the payment equals the worker comp bills.

When it is family who is abusing staff, that is different. They should be banned from the facility until they are made to take an anger management course. And then they must apologize to the staff. It’s one thing to yell and hoot and scream. It’s quite another to shake and rattle and otherwise manhandle the staff. Limits must be set. Just like with kids."

So how are you going to effectively convey the right message to both employees and customers? No Administrator or Director of Nursing enjoys asking a family member to examine their own actions, but allowing your customers to act out against employees certainly sets the tone for your community. Feelings of resentment will build and employee morale will suffer greatly if leadership fails to address each individual circumstance swiftly. While I still have some introspection to conduct on the topic, I offer three tips to begin your own journey:

1. Include "Addressing Angry Customers" as part of your Abuse Prevention and Reporting In-Service. The resentment created by an angry family member can turn into retaliation - against the resident.

2. Take ownership of the concern process. I receive all written concerns in order to ensure timely, objective follow-up, and review all concerns from the previous 7 days with our Concerns Committee. The Director of Nursing and I take time each week to sit down and call several families that have expressed concern or frustration.

3. Educate employees on involuntary discharge. The average employee believes that a nursing home resident can be "kicked out" at the whim of management. Involuntary relocation is an extremely cumbersome process, and rarely executed. Why? Because forced discharges are almost never to the benefit of the resident.

OH, the resident! We almost forgot about the resident. And that is what concerns me the most about this conversation. When employees become embroiled in family onflict, the resident almost always loses. By dealing quickly and honestly with family outbursts, leadership can minimize resident stress and undue harm. Focus difficult family conversations on how actions are impacting the resident's best interests, rather than scolding or threatening discharge. A successful Administrator or Director of Nursing can advocate for both residents and employees simultaneously - and should do so every time.

I look forward to hearing from you on this topic.

Healthcare or Business Internship Opportunity

2009-01-16T16:25:00.004-05:00

I am hosting a summer internship for a qualified Business Administration or Health Policy & Administration student. While I do not have an available Administrator-In-Training position open at this time, the opportunity to complete a Bachelor's degree internship experience with a large retirement community will be vital to graduating students hoping to earn their licenses post-graduation.

Lutheran Home is the largest not-for-profit retirement community in Fort Wayne, Indiana. Also the headquarters for Lutheran Homes, Inc., our well-established community takes a different approach to delivery of care, focusing heavily on holistic wellness programming and empowerment of all community residents. Considered home to more than 350 Fort Wayne residents, Lutheran Home offers many levels of care and endless learning opportunities for students.

Interested, qualified students should forward their resumes, in Word or PDF format, to matthewmaupin@gmail.com by March 31, 2009.

ABC News Highlights C-Diff Prevalence in Healthcare

2008-11-11T20:24:00.002-05:00

Tonight ABC News ran a feature on the prevalence and impact of C-Diff on hospitals and nursing homes. While the focus was more on hospitals, the most interesting segment featured a clinical study on the effectiveness of bleach decontamination in the post-sub-acute setting.

Bottom Line: Consumers demand and deserve your respect, rightfully so, regarding the prevention of this infectious disease. Here are several tools for you to use when communicating to employees, residents, and families:

Mayo Clinic Guidelines on Hand Washing

Center for Disease Control (CDC) Facts on Seasonal Flu

Blogging Live from AAHSA

2008-10-13T23:37:00.002-04:00

I'm here at my first AAHSA Annual Convention in Philadelphia, PA. It's Monday night and the crowd has filed out of the Dana Carvey show and into any number of downtown Philly joints. Of course you've already enjoyed a Philly cheese steak off the street and a good night at the Fieldhouse, and no matter where you are staying there's some historic sight of epic proportion within walking distance - we've got city hall out the window and the liberty bell within walking distance. On Saturday night I literally ran into Chris Matthews outside the Loew's hotel. A trio of high class weddings and an international media dinner drew the best-of-the-best to our part of town this convention weekend.

Dana Carvey was sub-par, an equal but disappointing replacement for the absent Aretha Franklin. Anybody that respects music would have preferred Aretha, but overall the crowd seemed to enjoy the impressions that were either Carvey circa 1994 (Swartzenager, Bush Senior, Church lady, Ross Perot) or Carvey circa 2008, which is an "impression" of every current political newsmaker, half of which require a serious stretch of the imagination.

The attendance is estimated at over 6,000, though I don't see quite that many people - as a first timer I'm still very impressed. The current presidential race and economic crisis are an intrinsic theme of the whole show, whether presented by a comedian or a nun. The audience here is the type that was abuzz today over the 900+ day the Dow had - you could feel the value of everyone's accounts rise as Monday passed. I wasn't the only one staring at my Blackberryhalf the day.

Great sessions, at least for me at this point. The speakers are experienced presenters, which is one key difference from smaller conventions. It's one thing to be a success or an expert - it's another thing to be able to tell your story really well. The educational sessions that I have attended all included multiple, related speakers. Fortunately, I chose presentations that will really help me pull some projects together, with best practice ideas presented that neither my team nor I had thought of. I am not 100% sure that all presentation materials are accessible online, but you can tell that AAHSA is at least on the way to being a green organization. You should've heard the audience clap at the opening address when it was announced that this was the last year they would be distributing tote bags.

I chose to sleep in for the John Glenn talk, but I can say that Whoopi Goldberg was decent. Her message was a bit of a stretch, and she was one up'd by Larry Minnix, AAHSA President. Minnex's discussion on the impending leadership void and the state of our government and economy was right on point and was also in line with the convention theme of "One Voice." The nun stole the show from both when she confessed to being a sinner by embracing Goldberg during the end of the opening session.

Overall, I'm excited to discover such a large, high quality convention dedicated to our profession. The polish that this convention has trulyturns the cost of sending your leadership into an investment in your organization's success.

Info from a Nursing Home & Hospital Surveyor

2008-08-06T20:07:00.003-04:00

Finally! Check out a newer blog from "Info from a Nursing Home & Hospital Surveyor." Glad to see another perspective out there.

On Hiatus...For Awhile

2008-07-28T18:54:00.003-04:00

It's so pleasing to see the number of great resources available for professionals in long term care to turn to online. As much as I enjoy being a part of that family, I am again planning to go "on hiatus" in an attempt to simplify both my work and personal life. I prefer to keep my blood pressure at healthy levels.

Please feel free to send me an email message, but please understand if I do not respond timely.

Thanks for reading.

Welcome Peabody Retirement Community!

2008-07-21T08:20:00.003-04:00

I kept getting visitors from the internal website that I set up for Peabody Retirement Community last year...So I visited the page (which is being kept up to date!) and there's a link back to "The Nursing Home Administrator."

So, if you're from Peabody, thanks for visiting! Please leave a message in the comments section - It will be great to hear from you.

Administrator-In-Training

2008-07-20T11:30:00.003-04:00

Occasionally I am contacted by a professional that is searching for an Administrator-In-Training position. While I am not in a position to host an AIT at the present time, I felt compelled to post the resume of Phil Eccles. Below is a brief bio on Mr. Eccles, and if you are interested, his resume can be downloaded by following the link at the bottom.

Please contact Mr. Eccles directly to arrange an interview.
...

Thank you for your consideration in looking at my bio and resume. As I anticipate my final career transition, it is one that is taking me onto the track that I nearly took when completing graduate school – administration of residential care of the infirm and elderly. I am in search of a seasoned administrator as an AIT preceptor who is in excellent standing with their corporation, also has an incessant curiosity and desire to improve operations and financials, is willing to be a true mentor beyond an AIT program, provides leadership in the industry in some capacity (writes articles, provides seminar sessions, serves on committees, serves as an officer, or is a regular AIT preceptor), is able to pay a stipend, and can assure me that their corporation will have a place for me upon completion of the program in good standing. I currently reside in Plainfield, IN, and would like to find a preceptor within a forty-five minute driving radius from here so that a temporary move would not be necessary until full-time placement.

As a brief bio, I have a background in sales, consultation, customer relations, and work within the healthcare industry. I completed my graduate studies at Indiana University in Health Administration, including coursework in nursing home administration. My adjunct professor was the administrator for Hooverwood in Indianapolis. The majority of my career has been in patient financial services.

My skills and achievements include:

Ability to quickly garner trust and rapport.
Experience working closely with medical providers, insurance carriers, and healthcare business offices.
Knowledge of the continuum of elder care available.
Coaching and personal development
Interdepartmental communications and teamwork building
Process flow analysis and recommendations, and implementation of subsequent policies and procedures
Management by direct observation and talking with/helping employees
Financial analysis, flexible budget determination, expense reduction, and price setting to obtain net profit goal

Thank you for reviewing my biography and attached resume. Please contact me with any questions, or to simply discuss your thoughts in directions that I may take. Even if you do not have a place for me now, I enjoy meeting people and building relationships, so I would enjoy hearing from you.

Sincerely,

Philip A. Eccles

PhilipAEccles@aol.com

Click here to download the resume.

Senate Fails to Pass Medicare Bill; Therapy Caps to Go Into Effect

2008-06-30T11:35:00.000-04:00

Last Thursday, the Senate failed to act on HR 6331, the Medicare bill that passed overwhelmingly in the House. This Medicare bill would stave off a 10.6% rate cut for physicians beginning on July 1st. This cut was part of a 1997 balanced budget deal to trim the money going to Medicare, but physicians have been able to regularly postpone the cuts. The 1997 bill also included the Medicare Part B therapy caps that have also been either postponed or have been rendered harmless through an exceptions process. The caps would also go into effect on July 1st without this legislation.

HR 6331 would “pay” for the postponement of the physician rate cut by cutting the subsidy given to the private Medicare Advantage plans. President Bush has threatened to veto the bill if it includes this cut to the insurance plans. The administration would pay for the postponed physician rate cut by cutting other provider group reimbursement, such as eliminating the market basket rate adjustment for skilled nursing facilities and home care agencies.

The original Senate vote was 59-39 (Sen. Ted Kennedy and Sen. John McCain absent). Sen. Harry Reid changed his vote to No (final vote 58-40) so that he can bring the bill up again when the Senate returns on July 7th. Both the Senate and House are now on 4th of July recess (known as “District Work Period”).

The Bush administration gave a reprieve to the physician rate cut on Sunday. The Department of Health and Human Services will essentially freeze the current pricing system until Congress returns. Congressional aides said the freeze could last 10 days. If the legislative dispute lasts beyond the new deadline, HHS Secretary Leavitt said he hopes to retroactively pay doctors once the dispute is resolved.

The therapy caps were not included in this reprieve and will go into effect on July 1st. Congress is expected back on July 7 and it is anticipated that a vote will be taken that week.

Residents with Alzheimers Benefit from Volunteering

2008-06-12T08:34:00.003-04:00

As Alzheimer's disease begins to wear away the memory and cognitive functioning of an older adult, caregivers are sometimes so distracted by the disease process that they fail to recognize the inner struggle of the resident. One key aspect of this struggle is the loss of contribution to society, represented as the occupational component of the six dimensions of wellness. Residents who once defined themselves by their service to their country, their community, and their family recognize their inability to perform in these roles and subsequent depression sets in.

This morning National Public Radio aired an intriguing, at least reassuring, story on a study that was pairing these residents with intergenerational volunteer opportunities. The story highlighted several assisted living residents, including a woman (with Alzheimer's disease) that was such a great volunteer that last year she won her city's volunteer of the year award - and didn't know why.

This story is a wonderful way to illustrate to caregivers the inner turmoil faced by those they love and take care of - and poses at least one solution to improving their lives, even if it's forgotten five minutes later.

National Administrative Professionals Week

2008-04-21T21:29:00.004-04:00

Yes, it IS National Administrative Professionals Week. No, it is not National Nursing Home Administrators Week (as a few of you have Googled).

Here's the information you're looking for regarding what started as "National Secretaries Week."

Here's my brief aside on National Nursing Home Administrator's Week.

If you're looking for ideas (Wednesday is the "Day"), consider taking in something that the entire office may share. You always run the risk of leaving someone out that felt they were classified as an Administrative Professional.

Hey, these things happen all the time.

I'm going with "Business Office Donuts" plus individual thank you cards for the key Administrative staff. If I had an assistant I would go flowers, not roses, lunch sometime during the week.

But, I don't have an assistant (and wouldn't know what to do if I did).

One hundred fifteen. Don't you forget it.

2008-04-18T20:43:00.005-04:00

I would be remiss in my duties if I did not highlight Ms. Edna Parker, from Shelbyville, Indiana, who turns 115 on Sunday. There are only 75 people alive — 64 women and 11 men — that are 110 or older.

At 115, Ms. Parker is the officially the oldest, according to Guinness.

Boomers to Flood Medical Care System

2008-04-14T19:48:00.003-04:00

From today's MSNBC Article:

There aren’t enough specialists in geriatric medicine.
Insufficient training is available.
The specialists that do exist are underpaid.
Medicare fails to provide for team care that many elderly patients need.

Everybody start running around and screaming.

The Star Program

2008-04-13T13:40:00.003-04:00

Goal: To create and sustain a culture that actively shares positive feedback within the organization.

Method:

Make asking for positive feedback regarding other employees a part of day-to-day conversation. Find this information by talking with managers, direct care staff, residents, families, and even vendors.

Award a small gold star pin to employees that are recognized. Include a thank you note quoting the positive feedback you received about them.

Start by handing out pins and thank-yous privately versus at a public forum. eventually, enough staff will receive pins that employees will realize the meaning.

Begin awarding some pins at monthly employee meetings. Tell a small story about the employee and make a small to-do in front of other employees.

Buy more pins.

Reminders:

Keep it simple. Don’t make a tracking system, don’t trend anything, don’t MAKE anybody do it. It’s just a fun employee morale exercise.

Keep it up. If you do it for six weeks and then stop doing it, you’re being one of those guys.

Keep it interesting. Simple doesn’t mean you can’t be creative. Occasionally pass one out with a random gathering of employees, attach an additional gift card for really great efforts, etc. again, just don’t get bogged down with it or you’ll stop doing it.

A Good Investigation

2008-04-12T14:15:00.007-04:00

When confronted with an off-color situation between a staff member and a resident, the effort that a manager puts into investigating the facts is more than just a good customer service gesture. The community must ensure that there is immediate action around the occurrence and that it is addressed systemically for the future. The charge nurse can play a very effective role in collecting facts and minimizing exposure.

Recently, a weekend nurse debriefed me on an abuse allegation that had been made just several hours earlier in the morning. The nurse had immediately assessed the resident situation and systematically clicked off a number of key facts regarding the incident:

The assessment and status of the resident
The immediate actions taken, including meeting with and immediately suspending an employee
The staff involved, including other employees secondary to the incident
Brief history and status of the resident and family
Brief history and status of the employee
Documentation, including witness statements, from above mentioned employees
Educated conclusion to the allegation
Action steps still needed

In addition to her consideration of these key steps, this licensed nurse minimized the disruption of employees and residents not directly involved. This maintained privacy for the resident and staff involved, and will hopefully enable leadership to conduct root cause analysis that can in the future identify abuse before it happens.

Successful communities will be those that have an outwardly positive culture. By consistently reinforcing not just positive outcomes but also positive behaviors, employees begin to find job satisfaction and success in just being happy. Employees who fail to embrace this culture standout more quickly and can be evaluated prior to an abuse situation.

Good investigation techniques often translate into good assessment skills, and similar strategies should be encouraged when dealing with other problems or diagnoses in the community. Leadership must build constructive questioning into daily processes. Nurses that use their senses to answer the questions of who, where , why, and how eliminate negative outcomes by considering the root cause of an issue. This includes an assessment of staffing, environment, emotions and morale. Often something happens in the course of a day or even week that sets off a chain of events, and employees should be able to identify when those situations are escalating.

Items Needed to Re-Furnish a Resident Room – 2008

2008-04-11T21:58:00.005-04:00

Electric Hospital Bed Frame, Faux Wood Finish, Footboard controls - $1200.00

Pressure-Relieving Mattress with Heel Slope - $225

Bed-Side Cabinet - $350

Four-Drawer Dresser - $450

One Sitting Chair for resident (Avoid recliners) - $550

One Matching Guest Chair - $350

One 22” LCD Television with Mount - $450

Estimated Total - $3575

*Prices are estimations based on vendor catalogs

Items to consider: Carpet, Draperies, Lighting, Phone

Siderail Measurement

2008-04-02T10:57:00.005-04:00

Today we have a surveyor in our building measuring siderails. ISDH's latest initiative, coming to a building near you! There are guided to refer Administrators to the FDA website, and I gleaned some basic information at: http://www.fda.gov/cdrh/beds/guidance/1537.html

Here is a handy one page PDF summarizing the information. Feel free to download and use as an inservice with your maintenance staff and/or safety committee.

Items Needed on the First Day

2008-03-27T20:30:00.004-04:00

List of New Admissions in the Past 30 days

Schedule of Routine Meetings (Leadership, Dept, all staff)

Facility Floor Plan

Breakdown of Total Licensed beds by Level of Care

Copies of Current Schedules For All Departments

Two Weeks of Staffing Sheets for the Nursing Department

Labor Budget 2008

List of Key Personnel and their locations/contact information

Name of Resident Council President and meeting times

Schedule of Meal Times for each dining room

Schedule of Medication Administration times

Previous Quality Assurance Committee Meeting Minutes

Latest Quality Indicator Report based on 3-month data

List of Residents with In-House Acquired Pressure Areas

List of Residents with Restraints

Chart of Accounts

Last Annual Survey with Plan of Correction

List of Door Codes/Access Requirements

Current Marketing Plan

List of Reportables since January 1^st, 2008

Why You Can't Tell Your Staff It's National Administrators Week

2008-03-19T13:27:00.003-04:00

Usually by the middle of this week it's tempting to mention, nonchalantly, of course, that it's National Long Term Care Administrator's Week. After not receiving flowers, a new name plaque, or some other "Things Remembered" type of gift, you may find yourself at morning meeting on Wednesday saying, "Somebody told me it was National Administrator's Week. Isn't Housekeeping Week coming up soon?"

How very sly you are.

Not that you feel that you deserve any extra recognition. Not that you feel you deserve any recognition at all. But darn it, you signed off on that $60 Chase's Calendar of Events book, and you just want the staff to make good use of it. We celebrated National Bubble Wrap day, so why not this holiday?

If you're feeling THAT forlorn, then let your family know, not your staff. There's really no need to lay down the guilt trip so you can have an extra fifteen minutes of fame. Lord knows you already get the biggest gift card at Christmas, and from a store you actually like. And if you need more recognition then take a look at your last paycheck. You make more than they do (If you work at a responsible facility, the D.O.N. may earn more than you do).

Don't you dare be the one to point out this "Holiday."

If you are a staff member here looking for an idea for your Administrator (on your own free will, that is) then here are a few ideas:

Make a donation to the Alzheimer's Association in their name
Buy them a sustainable plant for their office
Buy them Good to Great: Why Some Companies Make the Leap... and Others Don't or some other book that will positively affect your entire team
Just give them a nice card that says "Thanks." Better yet, have it signed by residents

Care to share? Use the comments button below to let everyone know how you approach this "Holiday."

My Job Announcement

2008-03-19T10:57:00.002-04:00

To the residents and employees of Peabody,

Last week I met with our Vice President of Operations and Health Administration to discuss my departure from Peabody. I am excited to announce that I have accepted the position of Administrator for Lutheran Home in Fort Wayne, IN. Tentatively, my last day at Peabody will be Thursday, March 27^th.

Similar to Peabody, Lutheran Home is a faith-based, non-profit retirement community. With more than 400 total beds across their skilled nursing, residential, and independent living campus, it is a rare opportunity that few healthcare professionals would pass up if given the chance. I am taking on the challenge of implementing person-centered care, much like Peabody, in a setting that is still considered very “traditional.”

I have learned many great things at Peabody, and have met many remarkable employees and residents. It is a pleasure to be able to part ways on such a positive note, as the Peabody organization and its employees have made me a much better Administrator, leader, and person. It is with great regret that I choose to move on.

My wife, Jodi, and I would like to thank you for this amazing opportunity. We will always keep you in our minds and in our prayers.

It has been a pleasure serving you.

Matt Maupin

National Nursing Home Week 2008

2008-02-18T17:57:00.003-05:00

National Nursing Home Week is Sunday, May 11th through Sunday, May 18th. The theme (which is set by the American Health Care Association) is Love is Ageless. Also place these related dates on your calendar:

Sunday, May 11th is Mother's Day (Tea, anyone?)
May 6th-12th is National Nurses Week
June 12th-19th is National Nursing Assistant's Week

Past experience says start planning now! Decide if you want to roll Nursing appreciation events into the National nursing Home Week concept or keep them separate. Begin scheduling activities, purchasing supplies and recognition items, and communicate early.

More on this topic to come.

Does Lipitor Cause Memory Loss?

2008-02-13T07:41:00.002-05:00

"I don't want to be the person in the nursing home with the lowest cholesterol."

This is the statement from one Lipitor user who reported confusion and memory loss that dissipated only after discontinuing the drug. While evidence is only anecdotal at this time, both users and prescribers of the statin drug are thinking twice about this drug of choice.

Dr. Timothy Johnson commented, "In general people should not worry, but if they're having a problem, they should talk to their doctors about switching the drug they are on."

As a nursing home professional it is important that you regularly monitor these media-driven medication scares - but not because you should plan on a facility wide d/c order. Administrators, Medical Directors, and Licensed Nurses are most likely to field concerns from family members who have a loved one taking the medication - not to mention themselves.

Hopefully this news on Lipitor will turn out to be urban medical legend. But until it's disproved, keep these possibilities in the back of your mind.

Special Focus Facility List Updated by CMS

2008-02-12T15:40:00.000-05:00

Like a condensed version of Santa's naughty list, providers and consumers can now easily identify those facilities with the worst recent survey performance.

The Center for Medicare and Medicaid Services (CMS) has issued their updated list of "Special Focus Facilities." This updated list now includes not only the "worst of the worst" but also identifies those facilities previously identified that have either shown improvements through two surveys (graduated) or have failed to show improvements. There is also a category for those in-process but not yet up-to-par.

Click here for the February 12, 2008 list (PDF).

The SFF initiative was created by CMS in 1998 in response to the number of facilities that were consistently providing poor quality of care. Those facilities were periodically instituting enough improvement so that they would pass one survey, only to fail the next (for many of the same problems as before). Facilities with this compliance history rarely addressed underlying systemic problems that were giving rise to repeated cycles of serious deficiencies.

Serious deficiencies include such things as failing to give residents their medications in the correct dose at the correct time, taking steps to prevent abuse or neglect, inappropriate use of restraints and failure to prevent or properly treat bed sores.

Kerry Weems, CMS acting administrator commented on the CMS site, “This is the latest in a series of steps we will be taking to improve quality and oversight in nursing homes. We are issuing more information on special focus facilities to better equip beneficiaries, their families, and caregivers to make informed decisions and stimulate robust improvements in nursing homes having not improved their quality of care.”

I bet you just checked the list to make sure you weren't on it.

Nursing Home Arbitration Agreement Upheld

2008-02-03T10:39:00.000-05:00

Does your organization include an Arbitration Agreement as part of the admission packet? This document is continually up for debate amongst industry professionals. It is rarely upheld in court and fiercely contested by consumers who claim they did not understand what they were signing at the time of admission.

Regardless of your opinion on the matter, the Supreme Court has upheld an arbitration case in Massachusetts (Miller vs. Cotter), denying the Power of Attorney the right to litigation.

Reinsurance Focus.com reports: "A former Air Force intelligence officer with a bachelor’s degree in English and 27 years of experience as a claims examiner and manager for an insurance company, pursuant to a power of attorney and health care directive, signed papers admitting his 91-year old father to a nursing home. The arbitration provision was presented as a separate document, was not a requirement for admission and was discussed prior to its execution."

One key factor in this case was that the Arbitration Agreement was presented as a separate document, not attached to the Admission Agreement or contract. And as a facility operator, it is increasingly important that your Admissions personnel understand not just how to present the arbitration clause, but also what it really means.

FMLA News - National Defense Authorization Act

2008-01-30T17:02:00.000-05:00

On Monday, January 28, 2008, the President signed into law (P.L # - not yet available) the first expansion of the Family and Medical Leave Act (FMLA). The National Defense Authorization Act (H.R. 4986) provides additional FMLA leave for military families. Specifically, Section 585 of the bill adds two new FMLA-qualifying events, expanding FMLA to include employees caring for an injured service member as well as family members who have a family member called to active duty.

Under the new law, FMLA-eligible employees will now be entitled to the following:

Family Leave Due to a Call to Active Duty—This benefit provides 12 weeks of FMLA leave due to a spouse, son, daughter or parent being on active duty or having been notified of an impending call or order to active duty in the Armed Forces. Leave may be used for any “qualifying exigency” arising out of the service member’s current tour of active duty or because the service member is notified of an impending call to duty in support of a contingency operation.

Caregiver Leave for an Injured Service member—This benefit provides 26 weeks of FMLA leave during a single 12-month period for a spouse, son, daughter, parent, or nearest blood relative caring for a recovering service member. A recovering service member is defined as a member of the Armed Forces who suffered an injury or illness while on active-duty that may render the person unable to perform the duties of the member’s office, grade, rank or rating.

Ten Things to Do for a Nursing Home Resident

2008-01-26T13:08:00.001-05:00

When planning our trips to see Grandma Shuey, my wife and I found it progressively more difficult to decide what to take (Grandmas love gifts), what to talk about, and what we could do for Grandma, if anything, to make her life better.

It would seem that as a nursing home professional these trips would be old hat. Really, though, it practically froze me at times as I opened the door to a reality that is easy to forget in the front office: Spending 30-45 minutes with someone, even someone you love very much, can be difficult when the person is hard of hearing and sight, requires more assistance with daily activities than the last time you saw them, and has a generally gloomy outlook on their situation.

But at the end of every visit, we had brightened Grandma’s day. Probably her week, since the average nursing home resident does not get many visitors. So what can you do for a resident that you are visiting at the nursing home? Just visiting is half the task, but there are certainly small things that you can do to truly enhance lives.

1. Let them know you’re coming. Don’t you hate the pop-in? Nothing worse than your friends and family stopping by while you are watching a movie, eating dinner, or having a party they weren’t invited to. Don’t assume your loved one appreciates such surprises. It may leave them with that same distressed feeling you have when the pop-in happens.

2. Bring leftovers. Lasagna always tastes better the second day, right? A nursing home resident doesn’t have the same luxury – and I’m not talking about the macaroni soup the kitchen made from yesterday’s entrée. There’s no shame in sharing your extras – they won’t be seen as leftovers, just good old home cooking.

3. Blow up the news. While many residents still enjoy reading the newspaper, the fine print leaves me squinting at times. Technology has made it so easy to find any article of any size – and manipulate it to fit our needs. If your loved one enjoys the Chicago Cubs, search for recent articles at usatoday.com or your local periodical. Cut and paste the best articles into Word and adjust them to a size 18 font, double-spaced and printed on white copy paper. This makes articles easier to read and also eliminates the overwhelming glut of articles found in a full newspaper.

4. Bring toilet paper. This sounds corny, but even the best healthcare facilities still purchase commercial toiletries. A couple of super soft rolls of Angel Soft can go a long way. Insert the same sentiment for other bathroom products. Not extravagant, just personal.

5. Don’t forget the roommate. We’re still living in facilities built in the 1960’s, which means most residents have a roommate. Bring two pieces of lasagna instead of one and you’ve made two peoples’ day.

6. And the employees? I’ve always preached “enough for everybody” to employees and residents. If you are the cooking/baking type, making cookies for the unit staff says a lot. Better yet, give them to your loved one and let them give the baked goods to the staff. This pay it forward gesture brightens everyone’s day, including the resident. Go with the cookies versus the toilet paper for staff.

7. Change out pictures frequently. Don’t forget to bring new pictures of the kids. That prom picture from 6 years ago is cute, but don’t you owe it to Grandma to exchange it for a college graduation photo? If there is no bulletin board in the room, a $15 investment will get you a nice 2’ x 3’ board and a couple of screws. Ask staff if you can hang it – they won’t say no.

8. Sexy calendar. My mom bought Grandma Shuey a “Sexy Firefighters” calendar every year for nearly ten years. Grandma got a kick out of it for sure, but more importantly it gave her and the employees a nice conversation piece. Staff appreciated the ice-breaker quality that something like this can bring, because many younger employees have a difficult time finding things to talk to the resident about. Make sure it’s appropriate of course.

9. Advocate kindly. One truly kind gesture you can give is to check wheelchair cleanliness. This is an area that is frequently neglected by well-intentioned staff. If it just needs a brush-up, perhaps you can take 30 seconds to help out yourself. If the chair needs more attention, be kind about it, asking politely for some attention will always get a better response than anger. Also, asking for staff to assist with things like this tells them that the resident has friends and family that are looking out for him or her. This perception can make a difference.

10. Make things tradition. To Grandma Shuey, the firefighter calendar wasn’t about the hunks in suspenders; it was about the anticipation of receiving the calendar each Christmas, laughing hysterically over the mildly embarrassing nature, and the ceremonial act of hanging it up and changing the pictures each month with staff. Whether it’s bringing pizza, the newest Ann Landers segment, or a sexy calendar, these traditions mean so much to the nursing home resident.

Grandma Shuey passed away last year, but I’ll never forget our visits. I can look back and say that while we did a lot of these things, we could have done more. If you haven’t visited your loved one in the nursing home for some time, what are you waiting for?

I just saw that sexy firefighter calendar for 75% off at the local bookstore.

I Know What You're Googling

2008-01-26T10:31:00.000-05:00

One of the more interesting points of maintaining this blog is researching the items people search for. Right now we have 20-30 readers per day, most of which come from a Google search of some sort.

Thanks to the hundreds of readers we experienced last week based on searches for "Activity Professionals Week" and the like. I apologize to those readers who were hoping to find a comprehensive list of things to do in honor of your activities staff. If you weren't searching until last Wednesday, it was too late anyways. Trust me, I've been there.

ADMISSION OF GUILT: I was so busy last week that I have really nice Activities Professionals picture frames that I didn't get to hand out (Our organization has around 12 activities professionals not including volunteers). I've had the frames ready for over a month.

Back to the point: You are Googling for really important topics that need covering. There's a true lack of reflective information out there on non-clinical nursing home topics.

So, over the next month I plan on writing on some of the very topics you are searching for. While a few will be consumer based ("What To Do For a Person in A Nursing Home") most will be geared towards the nursing home professional and the student hoping to become one.

I hope you enjoy.

We're Catching On!

2008-01-21T19:50:00.000-05:00

There's a great new nursing home related blog out there called "Setting the Nursing Home on Fire." It's a very similar format to this site, with a slightly heavier focus on culture change in long term care. It is authored by a Nursing Home Consultant in Tennessee, Matt Sevier, and I appreciate his linking to this site. It's important that we all share our resources.

Without further adieu...

Setting the Nursing Home on Fire

Activity Professionals Week

2008-01-21T17:45:00.000-05:00

Heads up! This week is National Activity Professionals Week. Whether you have one Activities Director or several, this is an excellent opportunity to recognize a key department in your organization. Activity Directors do more than just bingo nowadays. Is your Director:

Participating in falls committee? We have found that focused recreation at certain times is a better fall prevention technique than any device.
Making environmental rounds? They should be. Nail polish, knitting needles, and popcorn machines are all routine issues when it comes to "accident hazards."
Marketing? The Activities Director is probably one of the most creative people on your team. Buy them a Chases's Book of Important Dates and let them in on the fun.

Just remember: Now that you've recognized your activities directors in January, you've set the bar. Don't forget other departments the rest of the year!

Check out Positive Promotions for a good start on those other dates.

Fire Safety Tip

2008-01-18T08:26:00.000-05:00

Today I am hosting the local fire department to our campus for an in-depth fire tour. This will give them an opportunity to:

Review facility layout for familiarity (Could you navigate your facility if it was filled with smoke?)
Introduce new first responders to the facility
Discuss problems that have arisen during previous calls
Suggest improvements to the physical plant related to safety

On the tour we will point out unused corridors, attic accesses, fire panels, locked doors, etc. We will review what accesses the department has (they keep keys and proxy cards on their trucks for instant access) and point out areas of recent deficiency (faulty sprinkler heads, parking issues).

Afterwards we are treating the entire department to a fire-alarm chili lunch. Because we are located in a small community, some members of the department already have relationships with our maintenance and environmental staff. Whether the meal conversation turns to fire safety or community politics, firefighters love to eat!

As any Administrator knows, there nothing better than killing two birds with one stone. Not only is this a great proactive safety measure for both parties; it's also a fabulous marketing event. If you've never done this, now is the time. If it's been a long time, now is still the time.

Ten Ways To Exercise At Work

2008-01-14T11:39:00.000-05:00

I bought a YMCA membership. It’s on the “nice” part of town, it’s always fully staffed, the people are nice. I get what I need when I’m there. But is still takes 90 minutes of my day. And I can’t figure out where to fit it in.

As often as I can, I fit it in while I’m working.

Now, bear in mind, I work on a 33-acre campus. Making rounds can mean walking nearly two miles a day if I’ve got the energy. And that’s the key to all these tips: Make the most of your active day and take advantage of energy whenever you find yourself “in the zone.”

Deliver a heavy package to a resident. Perhaps your Activities Director would usually do this. Next time the mail comes, grab that special delivery. Carrying a 25 pound package across your facility is good exercise, and it’s an extra opportunity for you to touch base with a resident on social circumstances.
Participate in a high-octane employee activity. You always hear about the facilities that hold the “Wheelchair Olympics.” Take on an employee-retention activity that involves some physical activity and a little friendly competition – and get involved.
Shovel the snow. We had a facility crisis this winter that I would classify as “all-hands-on-deck.” Amongst the things that needed done with nobody to volunteer was clearing major walks until snowplows could get our direction. Perhaps you are most valuable moving dressers or dumping water. There’s nothing wrong with grabbing a shovel – once other key players are involved.
Sort wheelchair equipment. This was the first true “manual labor” I ever witnessed my first preceptor performing (and certainly not the last). It’s always struck me as something valuable that I could do. Needs done and nobody wants to do it. Don’t do this one too often. Use this one good workout to develop a better system for equipment tracking.
Park and take the deposit inside. Maybe you make the twice-weekly bank runs yourself. Instead of going through the drive-through, park at the far end of the parking lot and walk it in. You probably will find that you don’t lose any time.
Make daily outdoor rounds part of your schedule. An examination of utility devices, structural integrity, safety, and curbside appeal are worth a daily 15-minute walk around the perimeter.
Serve a resident meal from start-to-finish. Prep the coffee, fill the condiments, straighten the silverware. Take orders and serve five to a table. Work for those tips (compliments from wonderful old ladies) and sweat it out for 30 minutes. Clear the plates and help push chairs in. Don’t brag about it, just do it.
Do a one-on-one inservice with every employee – yourself. You have those important topics: A Plan of Correction reminder, an impromptu meeting, a time-sensitive announcement. Hit the pavement, talk it up, and burn some calories connecting with every employee on multiple shifts.
Bounce around the room. If you’re having a high-energy afternoon but really need to stay behind the desk to get organized, do it standing. I find that keeping up in the office helps me stay energized, limber and moving around. Calories in, calories out.
Hit the kitchen. Not for a snack. There are so many places in a kitchen that are “underneath.” Get down on all fours and check important places: behind refrigerators, under stoves, back corners of lower shelves, and the backs of deeply-filled janitor’s closets. This is a worthy task. Pest control requires vigilant sanitation in even the best kitchens.

Be conscious about the amount of time you spend on physical activities at work. Make a point to use your energy when you have it. You can be useful without being “too hands on” and meet resident and employee needs at the same time. Picking up just a couple of these tips can help you burn an extra 200-300 calories per day, which is the equivalent of walking 2-3 miles.

Feel free to share other tips in the comments section.

Speechless.

2007-11-07T21:13:00.001-05:00

Giving to Staff

2007-10-30T21:37:00.000-04:00

I started my career as a Nursing Home Administrator with Extendicare. It was a great experience and I met a lot of people. I miss my Director team and think about them often.

Several of you have recently Googled "Gifts for Staff" that led you here. I encourage you to read this letter to families from Extendicare that highlights team building and community in the context of customer-driven giving.

Please check this out and remember to educate your staff as well.

I Love My Job

2007-10-30T15:38:00.000-04:00

Today I gave a really good employee a five thousand dollar raise. Much deserved and probably overdue. She wasn't expecting it. As a matter of fact, when I called her to meet with me I think she may have been expecting something bad.

I continually reflect on the opportunities that I am given every day to serve not just our residents but also our employees.

Even on the most stressful of days, I still feel pretty lucky.

Meeting With State Officials

2007-10-23T20:15:00.001-04:00

Today I had a unique opportunity to meet with the Director of Long Term Care for our State Department of Health. While there for a specific reason, she did afford me nearly 30 minutes of general discussion on how the Department of Health operates, our own Long Term Care division in particular. I was honest in telling her that I found our meeting a rare opportunity for insight into a person and Department that is often not understood by the very people that it holds accountable.

She answered questions about the survey process, licensure, current industry and state trends in regards to falls, pressure area reduction, and restraint use. She shared with me that our state is going to begin issuing preferred pressure relieving devices directly to facilities in an effort to facilitate better wound prevention. I was impressed to hear this.

She was interested to learn about some of the programming at our campus, particularly the 10 Dakim mPower devices which I have been overseeing for nearly one year now. There is a possibility that the Director will conduct a day trip to our buildings sometime soon to trial these devices, with hopes of educating her own staff.

It is true that many of the facets of our regulatory agencies seem to be shrouded in mystery, subject to individual and organizational interpretations. Survey mechanisms, quality reports, and alternate codes such as Life Safety and HIPAA are densely based on anecdote and assumption, miscellaneous versions of "policies and procedures" passed from other generations of workers.

Thanks to the Director for taking time to share some of the inner-workings of the Department.

MRSA News Running Rampant in Media

2007-10-21T20:12:00.000-04:00

From McKnight's Long Term Care News:

Drug-resistant staph infection rates are highest among the elderly, according to a new study by researchers at the Centers for Disease Control and Prevention. The infections also are more common among the general population than experts previously believed. Click here for more.

The least you can do Monday morning is get out your infection control manual. Find your policy for isolation, laundering of MRSA infected linens (do you have one?). Who has to go into a private room? How many times does a person have to test negative for C-Diff isolation to be released per your policy?

Questions that people might ask you. Prepare ahead of time with the answers.

Holiday Gifts for Staff to Share

2007-10-21T20:08:00.000-04:00

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:

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 poinsettia 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!

Welcome Indiana Wesleyan MBA Students

2007-10-07T15:41:00.000-04:00

If you were directed here via an Indiana Wesleyan University Master's course, than please leave a comment with your name and feedback!

This fall I started my MBA program at IWU. It's a once per week class non-stop for two years. I am excited to introduce this class to one of my creations. I hope everyone has a chance to enjoy the collaboration between my work, my class, and this online project.

Cheers!

New F323 Accidents Interpretive Guidelines

2007-09-15T13:31:00.000-04:00

Because it can be difficult to find the most up-to-date regulatory information, I feel it is important that I surface it whenever possible. Below is the link to the new F323, which combines the former 323 and 324 Fall Tags. The new guidelines are extremely thorough and surveyors are running with it.

Click here for the new F323 Guidelines. F324 no longer exists.

On Hiatus

2007-08-08T23:27:00.000-04:00

I have to take this project on hiatus. I find too many that just fade away, and that's certainly not my intention. I just think it's best that I let you know that posts may be far and few between, if any, in the coming months.

You know how it goes, the ebb and flow. Things are just moving really fast right now at our place, and I need to give my time to that. If you're curious, here are some of the things I'm spending my time on currently:

Internal blog: Trying to turn this into our primary communication outlet on campus
Food ordering: I am learning this process first hand and making my first-ever attempt at changing menu cycles
Incident Reporting: Refining my processes for better documentation and investigation.
Survey Preparation: I'm halfway into my window...To that point where every moment and detail counts
Preceptor Training: I just got my Preceptor Certification and have taken over Leadership Training for our Organization

Amazing how much time some of these things can take. Please continue to email at mgm0014@comcast.net and I will be happy to dialog with you.

Thanks for your support. Search around, there is some decent information here.

Bathing Without A Battle

2007-07-08T09:42:00.000-04:00

Do you remember receiving the "Bathing Without A Battle" materials several years ago in the mail? You didn't order them, and they came randomly addressed to the nursing leadership at your organization. Quite honestly, they looked a little suspect. I remember them collecting dust, still in their protective wrapping, on an ADON bookshelf somewhere.

It turns out they were part of a study by some University of North Carolina Researchers. They had developed bathing strategies for older adults but also decided to measure the effectiveness of their national campaign to distribute their programs via cdrom and video.

So if you've been waiting years to find out, the videos are free. You may keep them. Turns out they may actually be useful.

Did your organization use these videos? We would love to hear your input.

On Having a Blog

2007-07-04T22:38:00.000-04:00

I am a Nursing Home Administrator and I have a blog. I think I'm still the only one. Please speak up if I am wrong. I've been licensed for nearly five years and have been in the industry for almost ten in Dining Services, Nursing, and a solid stint in the for-profit world with two different corps.

I also carry on an internal blog at my home location. I keep it all business. I haven't heard of anyone else trying this either. So far we are getting about 60 hits per day, with 310 employees. Decent, but definitely something to work with. This site is private and not shared at this time.

This blog gets attention from a great Certified Nursing Assistant blog. About once a quarter we have a lively discussion that gives front line staff a chance to sound off vs. Nursing Home Administration. As a matter of fact, perhaps we should set up those arguments. That's how we learn, right? I wish that I wasn't hearing so many comments that sounded like "this is just a job." It wouldn't hurt so much if so many caregivers weren't simultaneously saying "I want to help people."

This blog also is getting some significant recent attention from Nursing Link on their weekly post/rant Change of Shift. Thanks, Nursing Link. I think you're cool too.

Happiness is a Choice

2007-07-03T16:51:00.000-04:00

A 92-year-old, small-framed, well-poised and proud man, who is fully dressed each morning by eight o’clock, with his hair fashionably coifed and shaved perfectly, even though he is legally blind, moved to a nursing home today. His wife of 70 years recently passed away, making the move necessary. After many hours of waiting patiently in the lobby of the nursing home, he smiled sweetly when told his room was ready.

As he maneuvered his walker to the elevator, I provided a visual description of his tiny room, including the eyelet sheets that had been hung on his window.

“I love it,” he stated with the enthusiasm of an eight-year-old having just been presented with a new puppy.

“Mr. Jones, you haven’t seen the room; just wait.”

“That doesn’t have anything to do with it,” he replied.

“Happiness is something you decide on ahead of time. Whether I like my room or not doesn’t depend on how the furniture is arranged…it’s how I arrange my mind. I already decided to love it. “It’s a decision I make every morning when I wake up. I have a choice; I can spend the day in bed recounting the difficulty I have with the parts of my body that no longer work, or get out of bed and be thankful for the ones that do.

Each day is a gift, and as long as my eyes open, I’ll focus on the new day and all the happy memories I’ve stored away. Just for this time in my life.

Article on Being an Administrator-In-Training

2007-06-26T21:26:00.000-04:00

I stumbled across this timeless article from 1995 written by an Administrator-In-Training (AIT) during his experience. Basic summaries of each department. It's a good primer for someone that asks the question, "What's an AIT program like?"

The Article

One CNA Captures My Sentiments Well...

2007-06-24T23:28:00.000-04:00

"I have been a Nurse Aide for 4 years now at the same facility. I can’t imagine working as a Nurse Aide anywhere else. This is in part because I don’t plan on being a career CNA, and in part because I don’t think there is another place with the dedication to excellence in care and improving our processes anywhere in the state of Wisconsin. I have a lot of respect for Aides that work prn, it’s something I couldn’t do and we really need the help sometimes. However, I don’t understand how Aides can go from facility to facility year after year. I’ve been taking care of the same residents for years as well as many, many acute care patients. I work as an aide as a service to others. I feel that public service is my duty, my purpose. Without a certain level of dedication and direction I feel that some aides should not be here or anywhere at all. If you’re looking for a paycheck, go somewhere else. If you’re looking to make a difference in the lives of many people, be a CNA, and stick with your facility. If things are bad, they won’t get better by your quitting and going somewhere else."

Five Things to Do Before Someone Videotapes Your Facility

2007-06-24T21:53:00.000-04:00

Last week PBS came to film a new 30-second sponsorship spot on campus. The end result will be a montage of 1-2 second clips that we spent all day filming. Looking back, here are five things I could have done to make this type of experience go easier...

1. Decide who will be on camera and get waivers signed. The day before! Don't wait until the day of the shoot to alert staff to find some residents. Schedule this time in advance with both the resident and staff, and be sure to get a facility photo consent signed ahead of time. In some cases, the person filming will also have a waiver; don't bet on it, though.

2. Setup shots and cleanup. Decide where you will be shooting and schedule Environmental Services for some specific upkeep of the area. Again, don't scramble at the last minute.

3. Get to know the camera person. They may come with an agenda and specific shots in mind. If you have your own vision of the project, key into this person quickly and don't be afraid to speak up. Especially if you are paying for the end product.

4. Sell staff on being on camera. You know who your in-house stars are, but that doesn't mean they want to be immortalized on camera. Give everyone at least a 24 hour heads-up to get pretty and primed for the spotlight. Even if it's just a "cameo."

5. Acknowledge those who helped. What it's over, go back and say thanks in person to those who gave their time to the project. You will need their help again next time!

The Important Things: I Threw Your Drink Away

2007-06-20T19:49:00.000-04:00

I'm a heavy drinker at worker. Coffee, Diet Coke, water, all day. I'm more likely to have a tasty beverage with me than my phone. It's a pretty big part of our culture - just look around. Everybody's filling a big gulp, standing in line at Starbucks, or slinging a twenty ounce Mountain Dew around.

Today I threw yours away.

I make rounds everyday so I can give feedback to department leaders. Today I was out on your neighborhood and I opened the refrigerator in the resident lounge. I was checking for the thermometer, items that weren't dated or were more than three days old, and general sanitation. I was also looking for your drink.

It's hot. You're working your butt off. You've spent your hard-earned cash on a drink (and you're ticked that the pop machine prices just went up). I'm on a crusade, though. A crusade to...

GETCHA!

I open the fridge and there it is: Your [Insert Tasty Beverage Here]. It's unlabeled, half-full (or half-empty) and has "rule-breaker" written all over it. Victory is mine.

You know we have a rule here about keeping employee drinks in the resident refrigerators. Or at the nurses station. Or really anywhere really, besides the breakroom (that you think is gross). Maybe you don't know. Did that hit the "General Orientation" list? Probably not. Maybe you picked it up in your training. Obviously it's not consistently enforced, because there were three just like yours already in the fridge when you opened it. Whatever, you say...

And so I toss it.

I take your drink, which you paid for, which is not touching or harming any other item in the refridgerator, and I put it in the trash. Even though I am about to go back to my office and finish my coffee, I pitch your drink. Goes to show what a nice guy I am, huh. What a morale booster I must be.

Before we go further, the above narrative does not represent my real-life actions...

I've never solved this one. Bring on the comments please...

1. Has your facility solved the employee beverages on the job puzzle?
2. What is your solution?
3. Do you have a different way of eliminating the issue (besides throwing drinks away)?
4. Do you know why we discourage food and beverage around residential common spaces?

I appreciate the discussion.

Being a CNA is Very Hard Work Indeed

2007-06-14T17:09:00.000-04:00

Here is one uplifting comment from a CNA that responded to my musings from yesterday...

Wow! After reading all the other comments, I must say that I must be really lucky. I know this does not exactly answer your question but I wanted to comment anyway.

I have been at the same nursing facility for several years; along with most of my co-workers. We do not see a lot of jumping around from job to job where I work. (It does happen but not that much.) We have a very dedicated team of people all the way from department heads to the laundry to nursing to the kitchen, activities, housekeeping and activities, ect. ect. It is not rare to see departments other than nursing to answer call lights. It is not rare at all to see the DON out about in the hall helping out when she can. I have found that the administrator is there and willing to help also. Both doors are always OPEN. As GNA's we are told and reminded often that we are very important. We work together for the most part, like a big family, residents and guest included. I feel very appreciated at my work place.

Being a CNA is very hard work, but seeing a smile on a resident's face or hearing a thank you from a family member is priceless. Rule one: To be a good CNA you must like the job, if you do not you can NOT BE SUCCESSFUL in doing so. I used to work for an agency who sent me from facility to facility and I will say it's the same job everywhere you go, you have to want to do it.

Good Luck and God Bless!

Sherry

Protect Resident Dignity by Staying Put

2007-06-13T22:16:00.000-04:00

Today my barber told me that it was his last day – he was quitting the shop. This guy has been cutting my hair for almost a year, and he’s someone I trust. There aren’t many people that I let come around my head with scissors. A haircut is a personal thing, and it’s nice to have that familiarity with the people that take care of you. One thing that my barber mentioned, somewhat apologetically, was that while leaving the shop itself was easy, having to deliver this news and essentially “quit” with each of his regular customers was very difficult.

Now you be the barber and your customers are the residents. Do you go out of your way to make your residents comfortable? Not nice, but comfortable. It’s your job to build that relationship with each resident so they can focus on living rather than the discomforts of requiring assistance from others. And we aren’t just cutting hair. We’re inserting catheters, doing 5am bladder scans, inspecting the skin of grown adults in the shower, naked and vulnerable – and often assuming that their comfort level is equal to ours. You can be a professional caregiver, but there are no professional residents. Nobody should have to “get used to” going to the bathroom in front of a stranger.

So you do everything that you can to build that comfort. You have wonderful respect for privacy of the residents and you even go out of your way to withhold that integrity when working with less-caring co-workers. I see these positive actions every day, and I have nothing but respect for those who put their hearts and minds on the line every day to help others.

Why then, caregivers, do you continue to move from job to job, facility to facility? If you truly believe in resident privacy, comfort, and dignity, why don’t you want that continuity for your residents? Are you a caregiver for yourself or for others? When faced with a difficult situation on the job, do you find yourself thinking about how it will affect you or your residents? How many issues that people quit over could be resolved if ours goals were better aligned?

My barber essentially quit…me. Sure, the barber shop will hire another guy, but it’s going to take me awhile to get used to him. He’ll probably screw up a little bit the first or second time, and I may be too timid to say anything. Just remember, please that once you’ve built those trust relationships with the residents, you aren’t quitting the organization as much as you are quitting the residents.

One Family Deals with Alzheimer's Disease

2007-06-11T11:30:00.001-04:00

"A man is sitting next to her. She knows his name is Frank, but that is all she knows. She doesn't remember that when they met, she was head cheerleader and he was considered the best-looking guy in town. She doesn't remember that they've been married nearly 63 years and have raised two daughters, Michel Webb, 55, and Melinda Proza, 46. She doesn't know that her daughters and Frank, 85, try to watch her constantly because they're terrified she will wander off. She doesn't even know her own name. It is Helen Erskine. She is 81 years old and she has Alzheimer's disease—a devastating diagnosis..."

Read the full Newsweek summary here.

Nursing Homes Can Rob Elderly of Self-Worth

2007-05-31T09:09:00.000-04:00

I'm so glad to see this sort of article hitting the mainstream. It highlights alternative nursing homes as well as "Greenhouses" which are smaller, commune-like homes for 5-10 residents who assist each other in daily needs with the help of universal staff members. This is one direction we're going that is going to continue to pick up momentum.

By Atul Gawande
New Yorker
Published on: 05/29/07

Printed in the Atlanta Journal – Constitution 5/29/07

At some point in life, you can't live on your own anymore. We don't like thinking about it, but after retirement age, about half of us eventually move into a nursing home, usually around age 80. It will be your most-likely final address outside of a hospital.

To the extent that there is much public discussion about this phase of life, it's about getting more control over our deaths (with living wills and the like). But we don't much talk about getting more control over our lives in such places. It's as if we've given up on the idea. And that's a problem.

This week, I visited a woman who just moved into a nursing home. She is 89 years old with congestive heart failure, disabling arthritis, and after a series of falls, little choice but to leave her condominium. Usually, it's the children who push for a change, but in this case, she was the one who did. "I fell twice in one week, and I told my daughter I don't belong at home anymore," she said.

She moved in a month ago. She picked the facility herself. It has excellent ratings, friendly staff, and her daughter lives nearby. She's glad to be in a safe place —- if there's anything a decent nursing home is built for, it is safety. But she is struggling.

The trouble is —- and it's a possibility we've mostly ignored for the very old —- she expects more from life than safety. "I know I can't do what I used to," she said, "but this feels like a hospital, not a home." And that is in fact the near-universal reality.

Nursing home priorities are matters like avoiding bedsores and maintaining weight —- important goals, but they are means, not ends. She left an airy apartment she furnished herself for a small beige hospital-like room with a stranger for a roommate. Her belongings were stripped down to what she could fit into the one cupboard and shelf they gave her.

Basic matters, like when she goes to bed, wakes up, dresses and eats were put under the rigid schedule of institutional life. Her main activities have become bingo, movies and other forms of group entertainment. Is it any wonder most people dread nursing homes?

Surveys of nursing home residents reveal chronic boredom, loneliness and lack of meaning —- results not fundamentally different from prisoners, actually.

Certainly, nursing homes have come a long way from the fire-trap warehouses they used to be. But we've settled on a belief that a life of worth and engagement is not possible once you lose independence.

However, a small band of renegades disagree. They've created alternatives with names like the Green House Project, the Pioneer Network and the Eden Alternative —- all aiming to replace institutions for the disabled elderly with genuine homes.

Dr. Bill Thomas, for example, is a geriatrician who calls himself a "nursing home abolitionist" and built the first Green Houses in Tupelo, Miss. These are houses for no more than 10 residents, equipped with a kitchen and living room at its center, not a nurse's station, and personal furnishings. The bedrooms are private. Residents help one another with cooking and other work as they are able. Staff members provide not just nursing care but also mentoring for engaging in daily life, even for Alzheimer's patients. And the homes meet all federal safety guidelines and work within state-reimbursement levels.

They have been a great success. Thomas is now building Green Houses in every state in the country with funds from the Robert Wood Johnson Foundation. Such experiments, however, represent only a tiny fraction of the 18,000 nursing homes nationwide.

"The No. 1 problem I see," Thomas told me, "is that people believe what we have in old age is as good as we can expect." As a result, families don't press nursing homes with hard questions like, "How do you plan to change in the next year?" But we should, if we want to hope for something more than safety in our old age.