The 5 C’s of Long Term Care

Decisions, decisions!  Nursing home administrators are faced with the task of making decisions multiple times each day.  Many times there really isn’t a clear right answer for the decision to be made.  So, how does one know what to do?  Over my years as an administrator, I have developed a simple test to help me make the right decision.  I test the potential outcomes of my decision against the priorities I have set for my facility.  I call these priorities the 5 C’s of long term care:

  1. Care
  2. Compliance
  3. Census
  4. Cash Management
  5. Customer Service

Care always goes to the top of the list.  The other 4 may shift positions with one another depending on the situation, but never should any of them take a higher priority of care.  Care means that we’re going to do everything in our power to ensure the resident is taken care of.  If they have wounds, they’ll get an air mattress.  If they need negative pressure, they’ll get a wound vac.  If they need a Scoot chair, they’ll get one. We won’t skimp on care to save money.

Compliance is a priority because we have to stay in compliance with our regulations in order to keep our Medicare and Medicaid provider agreements and our license.  We have to keep our doors open.

Census is what you usually hear the most about from corporate.  After all, heads in beds is what makes our world go round, so it is tracked the most of anything in long term care.  If you’re going to spend 5 hours a week on census conference calls, you might as well make census a priority.

Cash management isn’t just making revenue.  We have to collect that revenue.  We also have to ensure our expenses are in line with budgeted ppds.  And, labor has to be in line as well as controlling overtime.  These all affect cash.  It has to be managed effectively for your facility to be successful.

Customer service is the forgotten C.  Most facilities don’t put a lot of time or effort into making the customer’s experience and satisfaction a priority.

The 5 C’s are really all related.  If you have to make a decision, you can bet that it affects more than 1 C.  Let’s say that you have an employee that doesn’t do well with customer service.  As a result, one of the residents who has been offended by this employee decides to leave.  It’s your job to stop that from happening.  How you handle this situation will dictate your success or failure.  The customer service problem has to be remedied.  If not, your census is automatically hit with a loss.  The resident’s word-of-mouth in the community can also hurt your business significantly.  This, in turn, pulls down your revenue. With reduced revenues, your ppd expense budgets total dollar amount decreases meaning you get to buy less supplies.  You’d also run less staff as a response to declines in census.  Even worse, the dissatisfied resident who leaves may be just angry enough with your employee to call the STATE.  That could definitely affect your compliance due to the fact that there is not a nursing home in the world that is truly deficiency-free.  If the STATE is in your building long enough, they will stumble across something that you can get a tag over.

The 5 C’s need serious consideration when making a decision or taking actions in your facility.  It’s how I make decisions and it’s worked for me.  I have actually seen a couple of nursing home companies that have something similar in their mottos and mission statements, but, oddly enough, not a single one that I’ve come across put care first.  I guess it shows where their priorities are.

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