long term care, training, e-learningThe juxtaposition of new federal and state laws with current reimbursement and budget cuts has created a disparity for today’s providers. Federal regulations like the Affordable Care Act of 2010 will require nursing homes to institute a facility-wide compliance program by 2013, while mandating enhanced nurse aide training and a comprehensive quality assurance and performance improvement program not long after.

State laws like the Part 1300 Nurse Practice Act in Illinois will now require licensed practical nurses, registered nurses, and all advanced practice nurses to complete dozens of hours of approved continuing education, all per each two-year license renewal cycle.

These and other regulations will call for the allocation of more resources to staff development and training over the coming years, while the Centers for Medicare & Medicaid Services reimbursement cuts and tighter budgets challenge providers financially.

Doing More With Less

Together, these forces have left administrators and human resources (HR) professionals searching for ways to do more with less, expanding their services using fewer resources.
In the fall of 2011, LeadingAge conducted a study of 65 nonprofit HR professionals with anywhere from one to 31 facilities and 50 to 650 employees. When asked about staff education, 100 percent of respondents agreed that employee training is critical to meeting compliance requirements and survey readiness. But, at the same time, almost 75 percent of the same respondents said they will either reduce or just maintain their current training budget through 2012, no doubt a direct result of this inequity.
One way to meet regulations, while cutting costs, is to create a standardized training program with consistent and targeted instruction across all shifts and employment levels. The first step in doing so is to dedicate at least one staff member exclusively to the task.
The study found that almost half of the respondents have one or two employees dedicated to executing training, including teaching, scheduling, and reporting, while the same percentage of respondents reported that this employee is typically the facility’s HR director.
With a dedicated professional or team of professionals, it will be possible to streamline training using multiple mediums of instruction. An effective training program will combine a variety of instruction methods, including in-service, written, and online courses.

Online Training Can Help

While in-service instruction has traditionally comprised the bulk of staff training for many nursing homes, online learning is growing in popularity because of its ability to provide up-to-date information in real time and be regularly updated, with the capacity to reflect even the slightest change in regulation.
About half of the respondents in the LeadingAge survey said they use online training to fulfill at least a portion of their employee education, with over 32 percent of respondents’ education courses conducted online.
“Online learning has given us the ability to more efficiently and effectively prepare for surveys and try to attack a survey or complaint issue very quickly without having to create an in-service and get everyone into the facility to receive the training,” says Carly Saltis, director of human resources for Extended Care Consulting, Evanston, Ill.
“Online learning allows us to get out of jams pretty quickly, and more courses are approved by the state and federal agencies, which helps. We don’t have to worry about missing a regulation with the online learning.”
Beyond compliance, educating staff online can save time and money by providing nursing homes with flexibility. Over 52 percent of respondents in the survey said they witnessed cost savings as a result of online training.
“Online training saves time in an environment that operates on a 24-7 basis and consists of taking care of people,” says Saltis.
Online training saves time and money at the 25 nursing facilities Saltis consults for by training first-, second-, and third-shift employees online. No longer requiring these employees to come in before their shifts start, stay after a shift, or on their days off for an in-service seminar, online training allows them the time to complete their course work during their shifts.
By allowing staff members to complete training whenever and wherever—both on the job and at their leisure, Saltis says employee satisfaction improves and the learning is more effective.
“It provides flexibility for the user and ensures that the employee is understanding the message by asking them questions throughout the training, along with a post-test to verify that they’ve truly understood and absorbed the materials,” says Saltis. “That’s important because there are times in long term care that we’ve given an in-service and when you have someone up there talking for 45 minutes, typically you lose the attention of some employees part of the time.
“If it’s at their leisure and they’re not coming in on their time off, then the employee is much more focused on the training material.” At some of Saltis’ facilities, headphones are provided to help employees focus on training modules, while minimizing noise for other staff members and patients. In some facilities, Saltis says, three or four employees may take an online course simultaneously, saving additional time and allowing for group discussion.

Federal Requirements Met

For Robert Vardaman, online training manager at Indiana-based TLC Management, the goal is to be “proactive, not reactive in our training.” This means that the employees in TLC Management’s 17 nursing homes begin their training at orientation, continuing on to fulfill additional requirements as needed, in-house, during their workday.
“The state of Indiana requires a certain amount of hours on dementia and resident’s rights, and we make sure they do those all up front,” says Vardaman. “We use it to fulfill the state requirements and then go beyond that to include care issues that we are interested in our staff learning about. Some employees will even ask if they can take courses that aren’t assigned. When they have the time, we provide the resources for them to do so.”
As always, online courses are most effective when used in combination with other mediums of learning, like in-service training sessions.
“Online learning works well when coupled with the traditional learning,” says Saltis. “We have to train them so much so you’ve got to have a good balance between online and in-person learning.”
Regardless of which type of training is used, the sign of a successful program is its ability to interact with the trainee and include a follow-up that allows administrators or HR professionals to track whether its employees understood what was presented enough to put it into practice.
Ric Henry, president of Pendulum, a risk management consulting firm based in Albuquerque, N.M., says in addition to meeting standards, training also helps nursing homes improve their consistency and effectiveness.
“Training is not just what a facility needs to do to comply; it’s a best practice,” says Henry. “It’s going to minimize the risk of liability. Best practice to us means it covers the quality and risk components.”
Tamar Abell, MA, CCC-SLP, is a third-generation nursing home owner and operator who managed 10 communities for over 15 years. In 2005, Abell founded Upstairs Solutions (www.upstairssolutions.com), now a leader in e-learning for senior care communities. Abell can be reached at: tabell@upstairssolutions.com.