Do Staffing Minimums work in LTC

As a family member, you may but are likely not aware that the Federal Government has recently passed new federal rules that dictate and mandate minimum staffing in skilled nursing home.

Here is a link to the announcement: https://www.cms.gov/newsroom/fact-sheets/medicare-and-medicaid-programs-minimum-staffing-standards-long-term-care-facilities-and-medicaid-0

The real questions facing you is: So What? Does it matter? Does it help? Will this help me and my loved one? I will attempt to answer the above questions and give a little free advise on how best to navigate the constant changing system and rules of LTC from a families perspective.

  • SO WHAT? Does it matter?

    Collectively as a nation it does matter. Some states already has minimum staffing levels that MANY are already not meeting. Many facilities struggle to recruit staff for lots of reasons from location to pay to desired population… i mean, if you want to provide nursing care to infants and mothers… LTC is not going to be a fit for you! Many facilities are highly successful but not at the current state mandated guidelines. I, myself was the administrator to a 5 star building that was deficiency free… but still not meeting the state guidelines. SO… from a families perspective, does staffing matter? The answer is no!

    Let me explain. The biggest predictor of quality of care of an INDIVIDUAL resident is the frequency of visits from the family. I would rather have a family visit 4 times a day for 15 minutes than 1 visit for an hour. It’s about frequency and routine. Example: If I am a caregiver and I have 9 residents that I need to get up. Ms. Jone’s family comes every day at 9 AM and Mr. Smith’s family rarely comes. I am here because I love my residents and I don’t want to disappoint or upset my families… so… guess who is going to be up, dressed and ready by 9 AM every day? I will get to and take care of Mr. Smith… but he will not be a priority in my sequencing of care.

  • Does it help? Will this help me and my loved ones?

  • Volume of staff or high staff to resident ratio’s are not a predictor of quality of care. You can have one care giver to one elder…. and if the caregiver is not engaged and interested…. you will still not have quality of care. Again, the best predictor of quality of care on an individual basis is frequency of family visiting and the families kind, compassionate engagement with the staff. Kindness and engagement go a long way in building the relationship between families and caregivers. The Regulators love this regulation because regulators/inspectors are able to use basic math and when has math been successful in measuring the value of human lives: both resident and care giver.

    This is a link to the AHCA/NCAL evaluation and response: https://www.ahcancal.org/Data-and-Research/Pages/Staffing-Mandate-Analysis.aspx

If you are struggling with achieving the care results that you desire for you loved one… consider giving me call and letting me assist you. I can walk beside you as an experience mentor and coach. I will help you to achieve your results. There is no need to walk alone.

Grace and Peace,

Bryan

3 Easy Tip for Hospice Success

These are tips to help you engage with your Hospice Service Provider to your best advantage.

 

1.      Establish Clear Expectation regarding the timing of services. 

 

Hospice is here to provide a service for you and your loved one.  They must first determine that your loved one qualifies for hospice and what services they will routinely provide you and your loved one.  It is at this point that you need to establish a schedule that is best for you!  Without this schedule, the hospice care provider will establish their own schedule and arrive at their convenience.  This may not be the best or most beneficial time for you and your loved one.  Therefore, you need to establish the schedule for the providers to follow. 

 

For example, my family member ALWAYS slept to nearly noon… The best time for the staff to come and provide care was in the later afternoon.  Together, it was determined that care would been provided 3 times per week but the family set an expectation that caregivers visited on Monday, Wednesday and Friday between 2:30 PM and 5:00PM.  This simple directive ensure that services provision was predictable and something that everyone can schedule around. 

 

2.     Ask for what you want and need.

 

Again, Hospice is a benefit and a service.  If you need a service or a specific piece of equipment… ask the Hospice vendor to provide it.   You are the expert in caring for your loved one and you know what is needed.  It is impossible for a Hospice provider to read your mind or guess your needs… so speak up an let them know!  If hospice cannot provide what you are desiring, they will be able to show the regulatory restriction from Medicare that prevent them from providing and or make an alternative suggestion.

 

This principle applies for nonmedical needs as well… like, emotional support.  More than one time, I asked my hospice nurse: “How are we doing?  Are we doing a good job?  Are there needs we are missing?”  In my heart and as a professional, I knew that we are doing an excellent job and we were not missing any needs… but it was reassuring to hear someone else confirm it!  

 

3.     Learn to say ‘No thanks!”.

 

Decline services or visits that you do not want or need.  Just because a service is offered does not mean you have to accept it! 

 

My family member was secured in her faith and the family was unified in our election of hospice.   For my family member, strangers created stress and anxiety… so we declined Chaplin visits or visits from the social workers.  If you family member changes and you think they might benefit for a visit… then call the hospice agency and request the service. Remember, you can always change your mind. 

 

If you have other questions or I can help in anyway…. I’m here for you!

 

Grace and Peace,

 

Bryan

Three Quick TIPs for SNF Success

Three Quick TIPs you can do PRIOR to placement to ensure a successful relationship with a SNF

 

There are many “experts” giving advice and writing articles about how to choose a nursing home.  These articles have lots of good generic information and a few good tips.  While I appreciate their efforts, this is akin to writing an article on how to choose a good spouse and never addressing the relationship that occurs after the choice.   We all know that choosing a good spouse is important but it doesn’t negate all the hard work in developing the relationship that happens after the “choice”.  Additionally, many of the people giving this advice work for companies that make money by selling referrals. 

This is not an article about choosing a nursing home or home health or hospice… this is an article about how to START the relationship in a way that set you up for a better experience and outcomes!

I have broken it down into 3 easy steps… they are only starting points but will get you on your way to a successful family/ provider relationship.  First of all, you are the expert on your family member!  You know them better than anyone else…You should, you have been in relationship with them for decades and we want to leverage that knowledge in a way that will make care provider thankful to care for you and your loved one.  These are three easy tasks that you can do that will set you and your loved one up for better care.

 

1.     Write out a detailed social history.  (Prior to Placement)

Tell their life story.  Everyone has a unique story and if I am a caregiver, I am looking to bond with this person so that they feel safe and will trust me.   This job is made so much easier if I have a “Cliff Notes” of my patient’s life!  A social history should be a story about how they began the journey and important experiences along the way that help form who they were, what they did and accomplished!  You are a combination of both positive and negative experience… so don’t be afraid to tell the whole truth.   It is helpful for providers to know of past traumas or difficulties so that we do not inadvertently hurt or offend our clients.  The Legacy Project has a tool that you may want to use… or just use it as a prompt to help you tell the story of your loved ones live.  https://www.legacyproject.org/activities/lifestory.pdf

 

2.     Create a detailed food preference. (Prior to Placement)

If the provider is going to be serving your loved one meals… it is helpful to know what they like and dislike.  In this situation, details matter!  Especially with food item like “fish”.  What is the exact preference or dislike?  Is there a preferred style?  Some likes fried fish but not baked fish?  Do they dislike all fish?  White fish, Salmon, Salmon Cakes?  What about shrimp and crab?  If you just report they don’t like fish… the provider will eliminate ALL Fish!  Maybe include a couple of their favorite recipes to help staff to know their style of food.  How do they like their vegetables cooked?  Attached is a link to an industry standard form.  Feel free to print and fill it out!  Just remember to PERSONALIZE IT!  Details matter!  https://www.briggshealthcare.com/assets/itemdownloads/1184P.pdf

 

3.     Provide a list of activities or meaningful tasks. (Prior to Placement)

Answer these questions?… What activities, events, tasks, jobs or duties give your loved one value and enjoyment?  What gives them joy?  How do they prefer to occupy their time?  Visiting friends and going for coffee?  Reading and knitting?  Watching TV?  What kind of book, what shows, what do they like in their coffee?  Again… you are the expert and what you share will make all the difference in the world.  Did you know your family member could help do “job” at the facility?  If they volunteer and it gives them joy… the options are limited only by ones imagination and willingness to think outside the box!

Attached is an example to help get you juices flowing but remember to personalize it!  https://www.pdffiller.com/jsfiller-desk14/?requestHash=0ebb86b6baa19a546bbfc8c57b54f7480a961e14901458a5f6b4d52fc7442c79&projectId=1376637446&loader=tips&MEDIUM_PDFJS=true&PAGE_REARRANGE_V2_MVP=true&richTextFormatting=true&isPageRearrangeV2MVP=true&jsf-page-rearrange-v2=true&jsf-new-header=false&routeId=45f9462f8d01d952dbb1b2e6d10bd871&mode=force_choice#f2221efece9941e7bef9e5ef1be7a5ad

 

Investing the time upfront so that you can present these documents to the facility upon entering will honestly make the job of staff so much easier.  You will have provided them a path to get to know your loved one and to bond with them quickly and with confidence.  You will see a payoff for your efforts!

 

Grace and Peace

 

Bryan

The Leadership of Change

Leadership during times of change or transition is a common topic in leadership development circles and something that LTC is always facing! 

In the United States, we are the most regulated industry and constantly facing regulatory changes.  The ever-changing expectations of our customers and provider partners create additional challenges.  As an Administrator, I was constantly working to set expectations and manage the expectations of healthcare providers up and down the continuum of care chain.  All of this is in addition to leading of team of care givers and all the dynamics that come from being the Administrator or Director of Nursing.

The question is: How do you as a leader guide your team out of the chaos and into stability?  Leaders amidst the chaos of change need a guiding concept or principle on which to base their actions, decisions, and reactions.  There must be a strategy to avoid being in a constant cycle of reactionary leadership, emergent crisis management and ultimately, allowing CHAOS TO REIGN! 

 

My guiding principle is simple:  LEAD FROM A POSITION OF TRUTH… not power. 

 

LEAD FROM A POSITION OF TRUTH… not power

From the beginning of time, literature and history are rich with example of leaders who have used TRUTH or HONESTY as their primary tool in leading their team. 

Winston Churchill was brutally honesty with the British public regarding the difficulties facing them as they declared war on Germany.  Because of his careful, integrous honesty and engagement with difficult facts, his words of encouragement had even greater impact.  When he reminded the British Commonwealth that they had “…nothing to fear but fear itself”, it had greater impact and was not perceived as being trite or dismissive but an honest statement.  It was his honesty regarding the difficult times ahead that allowed his words of hope and change validity. 

Sybil Ludington is a revolutionary war hero.  The daughter of a Colonel in the Colonial Militia, Ms. Ludington took a similar ride as Paul Revere to rally the militia forces in response to British military actions in Danbury, Connecticut.  She was effective in sharing the details necessary to rally a response.  She was not an officer in the military.  She was not an imposing figure but a young teen girl tasked with sharing difficult/bad news and issuing a call to arms that needed to be effective. 

 

TRUTH is the ONLY MEANS to guide and ensure impactful change.  This kind of honesty is not reactionary or based in anger but requires you to be purposeful and careful in your word selection.  This kind of honesty requires you to be self-aware and intentional.  This kind of honesty calls out to employees, co-workers, and leaders. It offers people an opportunity to engage with truth and to choose to align with it and create the path forward.  This engagement and interaction with truth in meaningful ways will result in decisive engagement and change individually and as a group.  It follows the logic that if a leader is willing to be careful, purposeful, and brutally honest about the negative or hard truths, then he/she must be being honest about the positive statements of truth as well.  Your words of hope, your belief that change can happen or is happening, your statements of encouragement are believable because of your complete honesty. 

Regardless of your role, as an leader, it will not be a title or relationship with the owner/CEO that will get people to follow your leadership or my consulting guidelines.  They do not remain in their leadership positions amid chaos because we are engaging or look like a “great leader”.  People remain because they have observed careful, purposeful and complete honesty of the leader.  It is not about power… it is about honesty.  This undergirding reality has the power to create strength in both the leader as well as their teams, it enables cohesiveness as the teams gather around the facts and begin to envision a different path forward, and it gives people a sense of hope that in seeing their true location in a story that is happening in their lives that in the end, they will reach a new and better place both individually and together in their team/community. 

Grace and Peace… Bryan

Covid and LTC Tips

I like a good roller coaster as much as the next guy and most of us can remember that visceral sensation of thrill and fear combined as the clicking of the coaster on the track started our thrilling ride! In fact, researchers on the subject say that there is “clear evidence that people enjoy the sensations that accompany the fight or flight response within a non-threatening environment.” But the key words here are, however, the words “NON_THREATENING”.

When Covid began to spread from country to country, from one state to the next into our communities, homes and medical facilities, real fear began to rise. This deadly virus demanded response - and both fight and flight were brought to bear in both organized and governmental response and in our personal responses to what was clearly a growing crisis. What followed has been a roller coaster ride - but not one of the good ones!

Covid has made Long Term Care an ever changing and unpredictable roller coaster. Nursing homes are working to meet guidance that can change daily based upon which regulator decides to update guidelines and when. There have been times in the past year that the Centers for Medicaid and Medicare Services (CMS) and the Centers for Disease Control (CDC) have issued conflicting guidelines for care provision… and nursing facilities were left trying to figure out which to follow. Due to these ever changing and often conflicting guidelines for “infection control and care provision”, Skilled Nursing Facilities have been left in a difficult situation with patients and families - and in a place of tension between following all the regulations required by governing bodies while still deeply concerned for the patients and families who are struggling with how and when visits can occur, how the mental and emotional health of these fragile ones and their families is affected and how to best serve the WHOLE patient while making sure all the safety measures are served.

And it’s been a roller coaster for most - but with no end in sight to the ride… and it has been a roller coaster that no one got on voluntarily!

The instability remains, the waves of new variants remain, the mental and emotional roller coaster effect remains and we all want OFF the roller coaster but it does not look as if we will be allowed to get off the ride anytime soon. How I wish this was not the case but in working with the truth as it stands, here are a few thing a family member can know that may be helpful as we all sit tight on this ride:

  1. Understand that the SNF is doing it’s best to communicate with you but has many families that are in the same position as you… so MAKE A FRIEND or TWO within the staff! Most will be happy to help answer question or accommodate a special request as they are able!

  2. Call before you visit so that you know what is allowed at that time. This can help set expectations and create a smoother and more fulfilling visit for you and your loved one.

  3. Be positive! We all feed off each other’s energy! Kindness always goes a long way - especially in situations such as we are all facing. Your kindness can go a long way with staff and helps everyone to want to go the extra miles for you and your loved one!

  4. Ask the Administrator or Director of Nursing for their cellphone. Yes, Most of them will give it to you and would like very much to establish a relationship of mutual respect and care! (Remember, they certainly didn’t get into this field for the money and they truly care deeply about the work they do.) Send them a text with concerns that may arise and give them some time to check into it for you! They want you loved one to have all they need and they will do their best to address your questions and concerns!

It is difficult enough to walk the necessary but unfamiliar path of LTC but Covid has made it MUCH more difficult for the patients, the families and the caregivers within long term care…We know this!

We can be a light, a help or guide to assist you navigate this roller coaster ride and ensure quality care for your loved one. There are ways that we can help ensure that you are creating a thriving relationship with your loved one’s placement or if you have any concerns, please don’t hesitate to give us a call!

Caring together,

Bryan

© 2021 The Hatton Group. All Rights Reserved

Copying and Distribution is Prohibited Without Written Permission of the Author

Long Term Care During the Storms of Covid

If you took a poll among people who work in long-term care, I’d bet the ranch that you would not find anyone who said, “I do this job for the money.” But you would, in fact, find MANY who would tell you that long-term care work is a calling, a tug at their souls and an honor. Most people who work in nursing homes have a compelling story about how they came to do this important work. But to be honest, it’s a hard job on the best of days.

It’s hard because it’s heavy. It’s hard because we see people in pain and grief. It’s hard because we give aid and care to people who don’t want to need it - let’s face it, no one ever says, “I can’t wait to have to move to a nursing home”! It’s hard because we care for more than just the patients - we try to care for their families too. And it’s hard because, with the exception of the nuclear power industry, no other industry in America has more rules and guidelines to follow.

Despite the challenges, as I said, most of those who work in Long Term Care do so out of a sense of calling and a desire to make a difference for the most vulnerable among us. It’s important, hard, beautiful work when there isn’t a pandemic raging. But when there is a pandemic raging?…it takes the challenge to a whole new level never seen before in our times!

So how exactly has Covid impacted Long Term Care?

During Covid, Skilled Nursing Homes have seen:

  • Increased unpredictability

  • Increased staffing instability

  • Increased regulatory oversight and expectation

Obviously, this is not an exhaustive list, but in the coming weeks I will be addressing each of these topics in some depth as each has impacted the industry and created new challenges for both Skilled Nursing Facilities and for patients and families. These challenges are likely to remain with us for the foreseeable future and both staff as well as those with a loved one in skilled nursing care have certainly already felt the painful impact. As I cover each, I want to provide suggestions for your use in obtaining the best level of care possible for your loved one!

Caring together,

Bryan

© 2021 The Hatton Group All Rights Reserved

Copying and Distribution Prohibited Without Written Permission of the Author