Getting staff to adjust to patients coming from hospitals “sicker and quicker” can be a challenge. Facilities have to ensure that they have the knowledge, training, and resources to care for these patients. They also need to ensure that staff aren’t overburdened or overwhelmed to the point of burnout. “We don’t throw away DONs [directors of nursing] and team leaders, but we need to help them get over this hump,” says Clint Maun, senior partner and president of Maun-Lemke Speaking and Consulting in Nebraska. Everyone needs to realize, he says, that this is the new normal. 

Instead of hoping for healthier patients, Mark McKenzie, chief executive officer of Focused Post-Acute Care Partners in Texas, suggests implementing efforts such as developing wellness programs to help sicker people compensate and give them choices. This can have a powerful impact on late loss activities of daily living scores.

“We bring these pieces to the table to give our teams confidence. If you aren’t looking at this as a complete team approach—involving rehab, activities, social work, etc.—you are missing the entirety of the boat,” he says. 

Elsewhere, McKenzie stresses the importance of frequent education, especially when there is turnover and new staff need to be brought up to speed. “Whatever issue we are looking at, we start at the nursing level, then involve the ancillary players such as social workers,” he says.

Not all staff may have the desire or the ability to care for higher-acuity residents. Based on turnover, he says, the provider keeps education going as frequently as possible. Training is specific to patient needs. However, he suggests ongoing education and frequent updates on general issues related to higher acuity, such as intravenous care and maintenance, wound management, cardiopulmonary resuscitation, and pain management. 

“We try to make it an honor to have the opportunity to work with these patients,” says McKenzie. “It’s not necessarily a promotion track, but in some instances, there are financial incentives. If a team member isn’t comfortable, we should find out what his or her issues are and what barriers we might be able to overcome. If there isn’t a compelling reason, we need to deal with it.” 

And the staff, he says, must be leaders in their own right. Personal development plans for administrators and DONs are a must, and it’s important for the organization to invest in the team to cultivate leadership amid the changing times. “If you are a clinical leader and you say you will never be comfortable with this changing patient demographic, you probably need to find another care setting or industry,” McKenzie says.