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Career Ladder Innovations in Assisted Living<p>​<img src="/Articles/PublishingImages/740%20x%20740/staff4.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;200px;height&#58;200px;" />Career ladders and career paths are not a new concept, but there are new and exciting innovations that come from building your own assisted living career ladder. This is exciting news and something assisted living providers should consider, especially in this time when staff development is so critical.</p><p>Career ladders and career paths don’t have to be complex, and there are resources, such as the <a href="https&#58;//educate.ahcancal.org/products/2024-ltc-workforce-webinar-series#tab-product_tab_webinar_s" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">2024 LTC Workforce Webinar Series,</a> available to help. Setting the foundation for a career ladder might include&#58; <br></p><ul><li>Defining the career ladder or the career path. </li><li>Describing the benefits and value of career ladder or career path. </li><li>Updating or identifying the organizational chart. </li><li>Defining job positions and opportunities. </li><li>Road mapping the skills needed for each position.</li><li>Identifying training needed to achieve the next level in the career ladder or career path. </li><li>Creating the training or developing the program to build skills. </li><li>Mapping the employee’s career ladder or career path based on their individual goals. </li><li>Helping the employee achieve success in advancing their career or re-evaluating what is needed next to accomplish their goals. </li></ul><h3>A Career Ladder in Action</h3><p>In an interview with Angie Mastin, a registered nurse, and licensed assisted living director (LALD), from Monarch Healthcare Management in Minnesota, Mastin provided an insider’s scoop into the organization’s career ladder program. In fact, she is a perfect example of Monarch’s career ladder program at its finest.&#160;</p><p>Mastin joined Monarch in 2016 as an LPN care coordinator. She admits that she was “very green” in the assisted living world, but “[my mentor] Leesa Gilman must have seen something in me because she guided me to be a better leader and to always want to do better,” said Mastin.&#160;</p><p>After receiving guidance and encouragement to follow a Monarch Healthcare Management career ladder, Mastin returned to school and received her RN degree. She is now the executive director of assisted living communities for Monarch.</p><p>When asked what makes the Monarch Healthcare Management career ladder program stand out, Mastin said, “Monarch promotes and encourages promotion from within the organization, recognizing early on individuals that seek that drive and passion to truly blossom and then invest in them.” Mastin recounts her mentor’s words to “build a team, set the foundation, and then get out of their way.”</p><p>When asked what has been the most successful in employee retention and growth within the organization, Mastin replied, “…learning early on about the person behind the title, truly caring about the person, and ensuring that the employee knows that we care about them. If our employees are happy, our residents are happy and thrive.” </p><h3>Evolving the Training Program</h3><p>During one of the most challenging times for health care providers, COVID-19, Monarch embraced a new training program not only for the leadership team but also every employee. Monarch 2.0 became the updated version, starting with the executive leadership team who visited each building making sure that employees felt valued, heard, and made an integral part of the innovation.</p><p>Monarch 2.0 is not about a daily core value and another acronym to remember, but rather a program by which to live and work. Mastin confirmed, “…daily, this core value is shared with all staff and then brought up again in the morning meeting and throughout the day.”</p><p>“This has changed the thought process of working a job and turned into working a career to better enrich the lives of the residents that chose to live in one of our communities,” Mastin said.</p><p>Monarch 2.0 is about the constant evolution of processes and procedures as a result of listening to its employees. Licensure changes within the state of Minnesota led facilities to prioritize the assisted living communities and legitimize them, leading to a diverse leadership role as a licensed assisted living director (LALD). Monarch seized the opportunity and identified shining team members. The organization provided training and assistance with obtaining personal licensure to these team members, along with guidance and support along the way. </p><h3>Integrating New Technology</h3><p>While Monarch may be a young company, its leadership’s mindset is focused on seeking opportunities. Monarch 2.0 was launched in early 2022 and has since evolved to enhancements of processes, including AI and robots. One such example came in the form of implementing technological systems for real time charting, which reduced the documentation strain on employees.</p><p>The Monarch team noted, “…we engage our residents in never before utilized techniques, such as activities and programs led by robots. We use AI on our Monarch website to engage prospective employees by answering questions from Morgan, the AI program, to pique the interest of potential employees who window shop.”</p><p>Monarch has found that this has quickly converted them from prospective employees to a hired employee in less than 24 business hours. “Employees are engaged because they know that we are on the forefront of technology and advancements within the long term care community.”</p><h3>Retention Is Cost Effective</h3><p>The question that immediately came to mind was “this program, Monarch 2.0, must have cost the organization a small fortune.” Turns out, this was not the case at all.</p><p>Mastin notes, “Employee retention is much cheaper than employee recruitment, and Monarch has figured that out. We hype up our current employees, and that energy creates amazing word of mouth advertising driving up our applications within our communities. When Monarch was first created, Gilman created the statement #noALleftbehind, and that is what the team of Monarch lives by every day.”</p><p>Mastin continues to demonstrate her passion for this effort, stating, “I am driven to ensure that Monarch is a household name and the first place thought of when families are looking for proper placement for their loved ones. I keep that in mind, and I realize that I am here for so much more than myself. I am here for the teams that I support and the residents that rely on them day in and day out.”</p><p>She continued, “This is what sets Monarch apart by continuing to grow and evolve daily. Our team members are driven by passion, and they know that they are a person, not a badge number. They come to work each day feeling supported and are engaged in our residents’ care. Our residents smile more and feel like they are part of the community. Take care of your team members and they will take care of your residents.”</p><p><img src="/PublishingImages/Headshots/Pam%20Truscott_2022.jpg" alt="Pam Truscott" class="ms-rtePosition-2" style="margin&#58;5px;width&#58;150px;height&#58;210px;" />This important process starts with identifying your most important customers, the ones who will care for your residents. Take care of the employees, and they will pay it forward and care for your residents. Identify the shining stars and give them the training and support that they need to make an impact on others.</p><p>Then, get out of their way so that they can continue to encourage others to do the same.<br><br><em>Pamela Truscott is the director of quality improvement with the National Center for Assisted Living (NCAL) and joined the AHCA/NCAL family in 2019. She has over 25 years of long term care experience and shares a passion for growing education and cultivating new leaders in long term care. She received a doctor of nursing practice degree with a focus on health care systems leadership and a master of science in nursing degree with a focus in nursing education. </em><br></p>2024-04-18T04:00:00Z<img alt="" src="/Articles/PublishingImages/740%20x%20740/staff4.jpg" style="BORDER&#58;0px solid;" />Assisted Living;WorkforcePamela TruscottCareer ladders and career paths are not a new concept, but there are new and exciting innovations that come from building your own assisted living career ladder.
Transporting Bariatric Residents in the Post-Acute Setting<p><img src="/Articles/PublishingImages/740%20x%20740/wheelchair.jpg" class="ms-rtePosition-1" alt="" style="margin&#58;5px;width&#58;200px;height&#58;200px;" />​When caring for bariatric residents, multiple costs factors must be considered prior to accepting the resident for admission. The facility must be able to provide reasonable care for the bariatric resident in the same manner as other residents. One of the costs to consider is transporting the resident to appointments and other off-site visits. Safe options are expensive and not always available. This is not a one-size fits all approach. Some bariatric residents may do fine in a wheelchair and the facility van. Some residents may require extensive planning and an ambulance ride for a specialist visit. </p><p>Therefore, prior to admitting this resident, the need for specialist visits and other appointments (dialysis, wound care clinic, psychiatric services, support groups, and other services) should be carefully considered. Each resident will require individualized assessment to assure the service planned will be appropriate and cost effective.</p><p>In reviewing the State Operations Manual Appendix PP - Guidance to Surveyors for Long Term Care Facilities,<sup><a href="https&#58;//www.cms.gov/files/document/appendix-pp-guidance-surveyor-long-term-care-facilities.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">1</a></sup> it should be noted there are multiple regulations from the Centers for Medicare &amp; Medicaid Services (CMS) regarding appointments and transportation. Two of the most basic requirements are&#58; F685, which indicates the facility is required to assist the resident in gaining access to vision and hearing services by arranging for transportation, and F790, which states the facility must arrange for transportation to and from dental services if necessary.</p><p>This article will review transportation options and how to evaluate cost effectiveness. </p><h3>Transport Companies</h3><p>Many communities have wheelchair transport companies that supply transportation for people with disabilities to appointments (medical or otherwise). These companies charge varying fees. Some offer an assistant that attends the appointment with the resident. Others only offer transportation to the address, and facility staff or resident families will be required to assist the resident at the appointment. The cost of these services varies widely from community to community.&#160;</p><p>The cost of this service can be as little as $95 per visit and up to $500. Insurance may reimburse some of the cost depending on the type of insurance the resident has. In some instances, the facility may be responsible for the entire cost.</p><p>Not all communities have appropriate transport companies. Many areas that are more rural may have medical transport companies, however, not all companies are capable of transporting bariatric clients. The facility must evaluate carefully the company that will be used to ensure the resident can be transported safely prior to planning the use of a company. <br><br>Items to consider&#58;<br></p><ul><li>Do the personnel have training in safely moving bariatric clients?</li><li>Is the vehicle designed to transport bariatric clients? (Doors open wide enough, ramp or lift can support the weight, there is room in the van for resident and chair, etc.)</li><li>Will the size of the vehicle accommodate a larger wheelchair or transport chair?</li><li>Are the tie-down straps for wheelchair/transport chair appropriate for larger weights?</li><li>How will the transport personnel communicate their concerns to the facility?</li><li>Will facility staff/families be expected to accompany the resident?</li><li>Is the office/clinic wheelchair accessible? Is there a larger door at the office/clinic?</li><li>Will the resident be expected to transfer from wheelchair to exam table? </li></ul><h3>Basic Ambulance Services</h3><p>Ambulance services that provide basic life support are available in most communities. The service provided and the cost for that service will vary widely depending on locale and type of provider. A review of publications regarding basic ambulance transportation reveals an ambulance ride cost of around $950.<sup><a href="https&#58;//www.acsh.org/news/2023/07/31/chasing-cost-ambulances-17221" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">2</a></sup> Some of this cost may be reimbursed by insurance. However, a recent study by the University of Michigan found that 72 percent of clients received billing that was not expected related to insurance denials.</p><p>It must be considered that not all basic services will be able to transport bariatric clients. If the services are appropriate, the cost may be higher. It would behoove the facility to develop a contract for provision of services prior to the need for transportation.&#160;</p><p>Items to consider&#58;<br></p><ul><li>Are the personnel trained in bariatric needs including transferring to and from stretcher? </li><li>Is there sufficient room in the vehicle for this resident and their equipment? (door wide enough, stretcher strong enough and wide enough, etc.) </li><li>Will facility staff or family be expected to accompany/meet the resident?</li><li>What will occur if a more pressing emergent transport need occurs? (Will the ambulance place the resident’s transportation needs at a lower priority and thus put the resident at risk of remaining at the clinic/office with no return transportation?)</li><li>How will the ambulance personnel communicate their concerns to the facility? </li></ul><h3>Family and Other Responsible Parties</h3><p>Some facilities request that, as a condition of admission, families or responsible parties transport the resident to appointments. While this may be a viable option in some cases, there are variables that must be considered including family availability and comfort in performing the transportation task, resident preference, need for staff to accompany resident, and resident safety with transportation arrangement. Again, an individualized assessment is required.</p><p>The family may be very familiar and comfortable in transporting the resident to appointments. If this is not the case or if the care team has concerns regarding safe transportation, further evaluation is indicated. The need for therapy evaluation of resident and family abilities to transfer to and from vehicle may be indicated. Having the resident/family sign out of the facility should be considered. </p><h3>Facility Van</h3><p>Many providers now have vans that are facility owned. These vans are normally equipped to accommodate wheelchairs. However, not all wheelchairs are made to travel in vans. Bariatric wheelchairs bring yet another challenge.</p><p>Items to consider&#58;<br></p><ul><li>Is the lift/ramp able to address the weight requirements?</li><li>Are tie-down straps appropriate for weight and size?</li><li>Is the door wide enough to allow access?</li><li>Will the resident be required to transfer from wheelchair to exam table?</li><li>Will extra staff be needed for safe transport?</li><li>Will the office/clinic be wheelchair accessible?</li><li>How will staff communicate their concerns?</li></ul><h3>Transport Chairs</h3><p>Transport chairs used with facility vans may be the solution to many of the issues raised. There are chairs made for the specific purpose of transporting bariatric residents. These chairs have designated weight limits, are designed for outdoor and indoor use, and may serve as a stretcher as well as a chair.</p><p>The safety of these chairs may be evaluated by the Rehabilitation Engineering &amp; Assistive Technology Society of North America (RESNA). RESNA is a professional organization dedicated to promoting the health and well-being of people with disabilities through increasing access to technological solutions. RESNA evaluates safety and makes recommendations for things such as wheelchair tie-down and occupant restraint systems for use in motor vehicles.&#160;</p><p>Items to consider&#58;<br></p><ul><li>What is the weight capacity?</li><li>What is the seat width and height?</li><li>How will the resident be transferred to the chair? Can the resident slide from the bed to the chair as with a stretcher or will a mechanical lift be required? </li><li>Is the chair appropriate for indoor and outdoor use?</li><li>Is the chair battery powered? Is there a remote feature? How is it charged? </li><li>Where will the chair be stored when not in use? Is the charging cord long enough if it is battery powered? </li><li>If the chair is not battery powered, can the staff safely move the weight of the resident in the chair? </li><li>Is the chair cushion washable? </li><li>Will this chair be used by more than one resident during the same time-period? </li></ul><p>When evaluating the cost of a transport chair, there are several considerations, such as&#58;<br></p><ul><li>Is there a warranty? If so, how long and what is covered?</li><li>How many chairs will be needed?</li><li>Will extra parts such as cushions be required?</li><li>Who will maintain the chair?</li><li>How can it be cleaned?</li><li>How much would other means of transportation cost the facility if a transport chair were not available? </li><li>Does the chair allow the resident to remain in the chair for examinations (by reclining or offering other positioning options)? If so, will this decrease the number of staff required to transport the resident to appointments? </li></ul><h3>Evaluating Cost Effectiveness</h3><p>As you evaluate the transport options for a bariatric resident, it may help to compare the cost of a service, such as a medical transport company or basic ambulance service, to the cost of using the facility vehicle. This will include determining the minimum number of visits the facility will need to transport the resident. Bear in mind that more than one resident may use the transport chair either in the same time-period or in a sequence of stays.</p><p>Here is a sample formula to use for calculating the cost&#58;<br><br><span style="text-decoration&#58;underline;">Transport Company</span><br>Transport Charges ______________ <br>+ Staff hours required to assist resident ______________ (transfer to and from chair and time spent accompanying resident to appointment) <br>= Cost of transportation</p><p><span style="text-decoration&#58;underline;">Facility Van</span><br>Mileage to and from appointment ____________ (2023 rate is $0.585/mile) <br>+ Staff hours to assist resident __________ (transfer to and from chair and time spent accompanying resident to appointment) <br>= Cost of transportation</p><p>When calculating staff hours don’t forget to review how many staff will be required to transfer the resident to wheelchair and how many staff will be required to accompany the resident to appointment to assist in clinic with transfers if required.</p><p>Also bear in mind the cost of a transport chair might be a capital expense. This then would be able to show depreciation over the life of the chair. <br><br><em><img src="/Articles/PublishingImages/2024/Sylvia-Bennett-Josephson.jpg" alt="Sylvia Bennett-Josephson" class="ms-rtePosition-2" style="margin&#58;5px;" />Sylvia Bennett-Josephson, RN, BSN, CDONA, CDP, CDDACT, IP-BC, FACDONA, CO-Q, has been a registered nurse for over 38 years and a director of nursing in long term care for over 30 years. Bennett-Josephson is a fellow of the National Association of Directors of Nursing Administration and is certified as a dementia practitioner and a certified Alzheimer’s disease and dementia care trainer by the National Council of Dementia Practitioners. She is certified as an infection preventionist and as a compliance officer. She also serves as a health care specialist with Med Net Consults and maintains an educational website, SJJ Education.</em><br><br>Refe<span class="ms-rteStyle-Normal">rences</span><br class="ms-rteStyle-Normal"><span class="ms-rteStyle-Normal">1. <a href="https&#58;//www.cms.gov/files/document/appendix-pp-guidance-surveyor-long-term-care-facilities.pdf" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">https&#58;//www.cms.gov/files/document/appendix-pp-guidance-surveyor-long-term-care-facilities.pdf</a></span><br class="ms-rteStyle-Normal"><span class="ms-rteStyle-Normal">2. </span><a href="https&#58;//www.acsh.org/news/2023/07/31/chasing-cost-ambulances-17221" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank"><span class="ms-rteStyle-Normal">https&#58;//www.acsh.org/news/2023/07/31/chasing-cost-ambulances-17221</span></a><br><br></p>2024-04-11T04:00:00Z<img alt="" src="/Articles/PublishingImages/740%20x%20740/wheelchair.jpg" style="BORDER&#58;0px solid;" />CaregivingSylvia Bennett-JosephsonNot all communities have appropriate transport companies. A facility must evaluate carefully the company that will be used to ensure the resident can be transported safely prior to planning the use of a company.
Blending Risk Strategies to Create Resiliency<p><img src="/Articles/PublishingImages/740%20x%20740/risk.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;230px;height&#58;230px;" />​Risk, safety, and operations managers talk about risk resiliency in terms of bouncing back from a loss but that is not “resiliency,” that is “recovery.” Resiliency is understanding your risks before they are realized and building plans to address them. It is regularly reviewing the plans as risks have a habit of mutating and innovative solutions are always being created.</p><p>There are only four risk strategies&#58; <br></p><ol><li>Risk Acceptance</li><li>Risk Avoidance</li><li>Risk Mitigation</li><li>Risk Transfer</li></ol><p>Yet, when you realize that there are only three prime colors (red, yellow, and blue), and that all the great visual art that has been created by blending these three colors, you can start to appreciate the complexity of mixing the four risk strategies.</p><h3>Risk Acceptance</h3><p>As a starting point, you have risk acceptance. When you get out of bed in the morning, you can step down, roll your ankle, and land up in the hospital. Nonetheless, we accept the risk because we realize that getting out of bed is necessary to perform our daily tasks.</p><p>In the world of assisted living, we accept thousands of risks per day, from having visitors enter the facility, to food preparation, to storing and dispensing medication, to housekeeping and providing resident activities. At a higher level of management, licensing and finances are the ultimate risks.</p><p>Accepting risk can be a stand-alone strategy, just as an artist may paint in a single hue of blue, but skilled risk managers do not rely on one strategy. Accepting the risk is based on a number of calculations. First you need to know the extent of the risk you are accepting. Once you have identified the risk, you need to determine whether there are parts of the risk that you can avoid. By example, you obviously must feed your residents; that is a risk you accept. You might decide to avoid certain risks such as ensuring that the food does not have nuts. You may look to mitigate the risk by providing training for your food staff. You may look to transfer the risk by bringing in a food service. Ultimately, the core activity is a risk you accept.</p><h3>Risk Avoidance</h3><p>The heart of your facility is providing medical care. Residents, however, have a wide array of health issues that are beyond the scope and expertise of the facility. Most facilities have physical therapy services onsite. Some facilities have x-ray equipment onsite, or in house emergency transportation services while others do not have the risk appetite for the risks associated with the additional services. Higher risk acceptance may lead to higher financial returns--or to financial loss. If your risk appetite is too limited, your market competitiveness may also be viewed as too limited. If your risk appetite is too high, you could risk financial stability. If you have ever said or heard someone else say “that is not part of our core mission,” you have witnessed risk avoidance. </p><h3>Risk Mitigation</h3><p>This is the most powerful risk management tool available. Its power is directly proportionate to the degree of understanding the risk under consideration and understanding all options for risk management. In the aftermath of September 11, risk avoidance would have dictated that airlines stopped flying. Risk acceptance would have been to say “that’s the risk associated with air travel.” Enter risk mitigation.</p><p>The airline industry and the world accepted that air travel must continue. Risk mitigation strategies were put into place including increasing pre-boarding security, enhanced luggage and package screening, and better security on cockpit doors. In the senior care industry, lifting residents is an essential activity. And it is also a leading cause of both employee and resident injuries. Mitigation strategies include an array of hydraulic and electric lifts, and transportation equipment as well as staff training. Some solutions carry large price tags. Risk mitigation includes understanding and leveraging financial opportunities and multilayered approaches. </p><h3>Risk Transfer</h3><p>Most operation managers and too many risk managers see risk transfer as a euphemism for “insurance.” Risk transfer is so much more. Transferring risk is the act of having someone else become responsible for the risk. You pay someone to do an act that you do not want to do or lack the skills to do. For example, you lack the skill to take down the old dead tree that is threatening to fall on your house, so you pay someone else to do it. You lack the skills and equipment to care for an aging family member properly, so you pay someone else to do it. The key is that you pay to transfer the risk.</p><p>When you have a vendor replace the roof or a toilet at your facility, who is responsible if the roofer falls off the roof or drops something that hits someone? Who is responsible if the roofer fails to do the job well causing the roof to leak or damages the building while doing the work? What happens if the plumber does a poor job and the new toilet on the second floor leaks causing the ceiling on the first floor to collapse or the water soaks into the walls creating a mold situation? Yes, you assume the vendor is responsible, but are they? It depends on the language in the contract. What if the plumber who charged you $500 to replace the toilet has language in the estimate that says damages are limited to the amount of the job?</p><p>Risk transfer starts with the contract. As an attorney, I learned that lawyers and risk managers see contracts differently. It is critical to review contracts, including purchase orders, to ensure that you are certain as to how much risk you are accepting and how much you are transferring.</p><p>Finally, we get to the issue of insurance. Who will obtain the insurance to make sure that the medical waste is handled and disposed of properly? Do you need to be named on the vendor’s insurance policy as an Additional Insured? And what is the correct insurance policy for the removal and disposal of medical waste? Is it commercial general liability (CGL)? Environmental waste? Errors &amp; Omissions?</p><p>Insurance is the last consideration because it is supposed to be a safety net. Unfortunately, the insurance industry has convinced too many attorneys, operations managers, and risk managers to see insurance as a hammock. There has even been a spate of insurance commercials that use a hammock to communicate the message. Insurance is supposed to be for those risks that you either cannot anticipate or that you cannot afford to address any other way.&#160;</p><p>For most people, insurance brings to mind auto insurance and health insurance. Both are consumer products that are heavily regulated by the state. Your car insurance may have 10 decisions such as the amount of coverage, a deductible, whether you want collision coverage or not, replacement value versus present value and not too much more. Your health insurance is equally as easy. And yet, many of us labor over those simple options.&#160;</p><p><span><span><span><img src="/Articles/PublishingImages/2024/risk.jpg" class="ms-rtePosition-1" alt="" style="margin&#58;5px;width&#58;345px;height&#58;258px;" /></span></span></span>Business insurance is far more complicated. Consider a fire that destroys your kitchen facility. Unless you negotiated your property damage coverage properly, you may only receive the depreciated value of that six-year-old oven even though you have to buy a new one. How will you feed the residents until the kitchen is back up and running? That is not part of a standard property insurance policy. You need business interruption coverage. As for the business interruption policy, there are interesting deductibles associated with them. The policy may not cover the first 10 days of interruption. How do you pay for the food service during that time? What are the limits on an interruption period? Does business interruption coverage apply to the loss of computer damage caused by the fire? How about a cyberattack? And beyond all this, if the officers and directors get sued due to allegations that the fire was caused by their poor decisions regarding building maintenance or that a resident was harmed by a medical malpractice issue, does the Errors &amp; Omissions policy protect the directors and officers or do they need a separate Directors &amp; Officers policy?</p><p><span><span></span></span>Insurance is the last consideration because insurance companies set your rates on your loss experience (the frequency and severity of your losses), and your processes and procedures. The safer your operation, the better your rates.&#160;</p><p><img src="/Articles/PublishingImages/2024/Jeff-Marshall.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;135px;height&#58;167px;" />Risk resiliency is partially the ability to recover from a loss, but if that is the limit of your interest, that is called “loss recovery.” An Errors &amp; Omissions carrier may talk about risk resiliency, but it may be solely focused on patient treatment. A workers’ compensation risk manager, unaware of federal and state medical provider regulations, may recommend increasing worker safety by (unlawfully) increasing patient medication or restraints without understanding risk resiliency’s interconnectivity to all aspects of the business operation.</p><p>Risk resiliency can be a powerful tool for management, especially if the resiliency is formulated using the four risk strategies in a blend to meet the needs of your facility. </p><p><em>Jeff Marshall is a risk and claims management consultant focusing on nursing homes and assisted living facilities. He can be reached at <a href="mailto&#58;IManageRisk4U@gmail.com" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">IManageRisk4U@gmail.com</a>.</em><br></p>2024-04-09T04:00:00Z<img alt="" src="/Articles/PublishingImages/740%20x%20740/risk.jpg" style="BORDER&#58;0px solid;" />ManagementJeff MarshallResiliency is understanding your risks before they are realized and building plans to address them. It is regularly reviewing the plans as risks have a habit of mutating and innovative solutions are always being created.
Changing Perspective Part 2: My Day as a Post-Acute Care Resident<p><img src="/Articles/PublishingImages/740%20x%20740/nurse_patient.jpg" class="ms-rtePosition-2" alt="" style="margin&#58;5px;width&#58;200px;height&#58;200px;" />In <a href="/Articles/Pages/Changing-Perspective-Part-1-My-Day-as-a-Post-Acute-Care-Resident.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">part 1 </a>of this article series, I described my experience living a day in the life of a resident to understand the experience better. I was given a fictitious diagnosis that included rehab for a post hip fracture, macular degeneration, and use of a wheelchair.</p><p>In this part, I dive more into the people I encountered in the process and the take-aways I learned from my experience. </p><h3>The People</h3><p>The intake process, the resident agreement, the physical and mental evaluation. Transition management, life enrichment, social work, plans of care, therapy plan. All incredibly important and in this case, all clearly explained and laid out for me to understand. And yet, the people are what made all the difference in my stay, and the people are the all-important piece that make this profession successful. I thought I knew that, but my stay showed me some specific examples.</p><p><em><strong>Boniface, my nurse&#58;</strong></em> I asked him why he chose nursing and long-term care. He had cared for his grandmother when she was sick, and he fell in love with the nurses that were also caring for his grandmother. At that point he made the decision to leave his studies in computer science and begin studying nursing. He told me that as he began nursing, he loved the long-term care demographic. He feels that this is when people need the most from others, as they are losing independence and grappling with physical limitations. He feels a personal benefit in learning from the life experiences of the residents he treats and appreciates their life advice.</p><p>I asked him what the biggest challenge was in his work. His answer was a single word&#58; Burnout. He read an article saying that pre-pandemic, burnout for nurses occurred between 10-15 years into nursing, but now post-pandemic that number dropped to 8-10 years. Combined with the number of people who left the profession in the last few years, he is most concerned with an increasingly quick burnout cycle and a lack of replacement nurses. He worries about the impact for patients and residents.</p><p><em><strong>Sarah, my CNA&#58; </strong></em>Sarah was a bartender before she became a CNA. Her mother was a social worker, so she was around senior care her whole life. She knew she wanted to be a part of the profession. She’s a mother of three so the flexibility in long-term care was a draw. She says she is hooked for good, and her plans include becoming an LPN or RN and continuing to take on more responsibility in long term care.</p><p><strong><em>Sylvie, my CNA&#58;</em></strong> I don’t think Silvie is capable of NOT smiling. She had a smile on her face every time I interacted with her, right through her shift ending. Sylvie has been a CNA for almost two years and says she loves it. She came to the United States from Benin in West Africa in 2016. In Benin she was a secretary, a profession that she studied in college. When she got to the U.S., she went to work in Denver-area hotels, but when the pandemic hit, opportunities in hospitality dried up. She decided to make the leap to health care. Though her native language is French, she went to Emily Griffith Technical College and earned her CNA while still learning the English language.&#160;</p><p>When I ask how she got interested in senior care, she tells me that when she was in Africa she was a volunteer caregiver at a local hospital. She cares about people and loves taking care of them. She tells me stories about touching a resident’s hand or rubbing their shoulders, and I can see what it means to her to be a part of their lives. The hardest part of her job is when a resident passes away. She wipes away a tear after she gives me that answer.&#160;</p><p>I was in awe of her story. Learning a new profession, in a new country, speaking a new language, all in the midst of a global pandemic. She dismisses how hard that was and tells me that in life we should be looking for new challenges and opportunities. I am inspired by Sylvie.</p><p><strong><em>Tiphany, my transition care manager&#58;</em></strong> How and why did Tiphany get into senior care? At age 12 she took care of her grandmother until she passed. She came from a large family and had to work part-time jobs growing up, and her mother encouraged her to look at long term care. She found that the field was good for access to part-time jobs that offered flexibility. She also cared for her father for four years before his passing. She is clearly hooked on what she does for a living and for whom she does it.&#160;</p><p><strong><em>Jackie, the life enrichment manager&#58;</em></strong> Jackie was a hairdresser before she injured herself and wasn’t able to keep working in that capacity. She turned that injury into an opportunity to return to college. Upon entering college, she met a future mentor who told her that she was going to pursue senior care and said that geriatrics just “clicked.” She said that the majority of her clientele as a hairdresser were elderly and that she missed them when she went to college. She started as an intern at Clermont Park and moved into her current job. I asked her what it took to do her job well, and she said it’s a combination of being outgoing and being patient.&#160;</p><p><strong><em>Bobbie, the social worker&#58;</em></strong> How did Bobbie come to LTC as a social worker? Her aunt was a nursing assistant at a nursing center. Bobbie was studying psychology as an undergraduate and decided to choose social work as a focus area. She started out working in a residential care center for people with dementia, but life changes meant that overnight hours would no longer work for her family. She went to work in a long term care center where she learned about mental health, case management, and LTC social work. She loves working in long term care because it’s homey and she has a sense of real connection with the residents. She says that it’s the only health care setting where the culture is just right for what she wants to contribute.</p><h3>Reflections</h3><p><strong>A person who moves into a nursing home is bombarded with important decisions when they arrive.</strong> When you arrive, you are faced with a long contract and deciding what kind of life-saving measures you do or do not want. You give a deep dive into your life with a great number of strangers. What are your health conditions, personal challenges, food preferences, family history? Are you coming from an abusive environment, a poverty-stricken environment, do you have enough mental capacity to make your own decisions? A gnawing sense that you might somehow be judged by your answers. I know that moving to a new home for an unknown period of time is incredibly stressful. Telling and re-telling your life story, your conditions, delineating all of your wants and needs, and making life decisions in a period of a few hours can be overwhelming.&#160;</p><p><strong>It’s hard living without full sight.</strong> Spending energy to see and craning my neck to look at things straight-on instead of out of the corner of my eye was frustrating and a little exhausting. If I wasn’t wearing a pair of glasses to simulate a sight deficiency, nobody would know about my challenges. This drove home the point that having all of my caregivers understand my conditions is critical to their ability to take good care of me.&#160;</p><p><strong>It’s hard being in a position to rely on other people for all of your needs</strong>. Everyone around me exhibited an interest in helping me any time I needed it, but I still felt guilty about asking for their time. Though I wasn’t a real resident, I can see how I would be hesitant to ask for help. I would assume someone else needed their help more than I did.&#160;</p><p><strong>The regulatory environment HAS TO CHANGE to meet modern day realities.</strong> Some of the rush of information upon move-in is done to make sure the resident receives all that they need. Another part of that mad rush is dictated by regulation. There has to be a way to ease some of that initial stress for residents and their caregivers. A resident is supposed to have choice, and their environment is supposed to be home-like. At the same time, caregivers are harshly judged when they accommodate those wishes and the outcomes don’t meet a regulator’s expectations for safety and security. The providers are equally harshly judged when a resident chooses not to comply with the caregiver’s recommendations.&#160;</p><p>My trip to the restroom drove that point home. I was told that I should not get out of my wheelchair without assistance. I decided I was fine and was going to go on my own. When I stood up without locking the wheels on my chair, I nearly fell over. If I had been an actual resident, that could have resulted in a meaningful deficiency and harm tag, an immediate jeopardy, a fine. There has to be a less formulaic way to ensure that quality care is being delivered. These caregivers want nothing more than to give the best possible life to their residents. We need to find a way to convince the regulators to work on fixing providers that aren’t trying to do it right and focus less on those who go out of their way to do it right. Even when the outcomes aren’t perfect.&#160;</p><p><strong>It’s all about the people.</strong> So many people surround you at a care center&#58; people checking on your vitals, preparing your meals, planning your care, cleaning your room, and more. My interactions with these people were great. I don’t know what it takes for them to come to work and be happy and patient and committed every day, but it’s critical to the quality of care they deliver. Since I started my job at the Colorado Health Care Association, I have told policymakers that our staffing challenges go beyond a shortage of workers. The real challenge is that we need people that are cut out for taking care of others. We need people with the right attitudes and temperaments to care for vulnerable people, which limits the pool meaningfully. The importance of that became very clear to me during my stay.&#160;</p><p><img src="/Articles/PublishingImages/2024/Doug-Farmer.jpg" class="ms-rtePosition-2" alt="Doug Farmer" style="margin&#58;5px;width&#58;200px;height&#58;200px;" />The good people working in this profession are truly inspirational. They could probably make more money in another line of work. They stay because they love their fellow humans. They stay because they gain something more than money by knowing that they give of themselves to help others.&#160;</p><p>I hope to get by as long as possible without needing anyone else’s help. If I do need the help of others at some point in my life, I hope I’ll be able to receive the kind of care and attention that I did during my short stay at Clermont Park.<br><br><em>Doug Farmer is president and CEO of the Colorado Health Care Association.​</em></p>2024-04-04T04:00:00Z<img alt="" src="/Articles/PublishingImages/740%20x%20740/nurse_patient.jpg" style="BORDER&#58;0px solid;" />CaregivingDoug FarmerThe people are what made all the difference in my stay, and the people are the all-important piece that make this profession successful.

 

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