The Type of Referral You Should Think Twice About!

On May 7, 2010, In Administration, Employees & HR, Management, Marketing, Admissions, and Census, By Mark

One of the mistakes that many of us make when our facility is census-challenged is to begin taking and admitting whatever referrals we can get.  This can create tons of problems in your facility.  Obviously, a good rule of thumb is to ensure that clinically you can take of the patient, that financially they have a payor source, and you’re not going to lose money on them.  However, there are other factors to consider.  Namely, is this a good admit?  Will this person be good for us?  Will taking this resident cause more problems for my facility?  Could I lose any staff by taking this resident?

I’d like to discuss one particular type of referral that I believe you should always think twice about before admitting.  I’m not saying don’t admit.  I’m saying you should carefully consider the consequences.  The type of referral is this:  The family member of a current employee.

“What?!” you say!  These are the best kind, right?  I mean, the employee already knows what to expect.  They won’t have unrealistic expectations, right?  Not so fast.  Actually, many times the employee may assume that the other staff will do an even better job because it’s their mom or dad.  What happens when the employee (who is a good employee, by the way) becomes dissatisfied with the care their loved one is receiving?  This can happen with any family member, right?  What happens is the employee can begin to lose faith in the facility, the staff, and the management.  They become resentful.  They are afraid if they speak up too much they’ll lose their job but if they don’t say anything, their loved one will suffer.  Sometimes, they even begin to call complaints in to the State themselves when they can’t get the results they expect at the facility level.

You can handle all those things you say?  Ok, what happens if the employee isn’t such a good employee and they have to be disciplined for their job performance?  At this point is when you start receiving care complaints on their family member.  That’s pretty much guaranteed.  Even worse, what if you have allegations of abuse against the employee?  What if you substantiate the allegations?  You still have their family member there as a resident.  What are you going to do when they want to visit the resident?

On the flip side, many times, you can have a great experience with the referrals generated from your employees and can reinforce their trust in you if you do a good job with their family member.  Employees are definitely a source for referrals, I just want you to carefully consider each one before agreeing to admit. 

Thanks for reading today!

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The BASICS MEMO: The Most Important Memo Your Staff Will Ever Receive

On March 31, 2010, In Administration, Best Practices, Employees & HR, Management, By Mark

For the past few years, everytime I took over a new facility, one of the first things I did was to distribute my BASICS MEMO to each and every employee and go through it with them in my first inservice.  Then, every new hire orientation had time set aside for me to personally sit down with new team members and go over the basics with them, too.  

The BASICS MEMO was compiled after having to troubleshoot many facilities and seeing the same common issues cropping up or the same survey deficiencies being cited over the same problems.  It all boiled down to not following the basic standards of long term care.

The BASICS MEMO (which is most likely the longest memo you’ll ever receive with 115 clearly communicated standards of expectation outlined) clearly identifies exactly what I expect from my staff members on a daily basis – the minimum requirements.  I wrote it in an easy-to-understand form so that there’s no miscommunication.  I would go so far as to say that taking the basic standards that I want to see in place everyday, putting them in a format the staff can understand, and making every staff member knowledgeable and accountable for them is the most important element of my success in the past 10 years.  It is absolutely critical that you communicate to your staff what is expected of them and back it up in writing.

The contents of the BASICS MEMO are not new concepts.  These are the basics that should have been in place since Day 1.  Oddly enough, most of these basics are not usually found in your facility’s policy and procedure manuals.  They’re not usually found on job descriptions.  These are things we expect our staff to know, but we hardly ever teach.  I remedied that.  I no longer just assume that my staff know the basics.  I ensure they do.

I’ve used the BASICS MEMO in turnaround situations with facilities suffering from disastrous surveys, to facilities with years of mismanagement, to facilities that ran smoothly and just needed someone to hang their Administrator license.  It doesn’t matter.  It works for all nursing homes and has information every employee needs to hear.  I typically make copies for everyone and then put a copy by the timeclock for good measure.  If I walk into a room and see double-padding on a bed, I simply ask the CNA and nurse if they read my BASICS MEMO.  Knowing they did as this was my first assignment to my staff, there really is no excuse they can give me for being noncompliant. It takes away the excuses.  ”I didn’t know…” no longer applies.

I encourage you to do the same – take away the excuses.  Give your staff a tool that lets them know plainly in black and white exactly what you want to see everyday on your halls.  If your staff members follow the BASICS MEMO, if they put the BASICS in place – you’ll have a great survey!

How To Get Your Free Copy:

To claim your free copy of the BASICS Memo, simply register in the GET YOUR FREE BASICS MEMO HERE Box in the right sidebar.  This is the same document I use daily in my facilities.  Feel free to edit and customize it for use in your facility as well.

Once implemented, I’d love to hear how well it helped you!

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Guest Post: Common Difficulties That Occur During Caregiver Training

On March 17, 2010, In Employees & HR, Guest Posts, By Mark

Today, we have a guest post from our friend Daniel over at Cherry Hill Adult Family Home.  The point of view is from an assisted living perspective, but we can find many similarities in the NH industry.  You can see Daniel’s Assisted Living Blog HERE.

You’ve done your background checks, screenings, and interview and have selected a new caregiver to start training in your assisted living facility. Although you’ve done everything in your power to setup a good training program and select a good caregiver candidate, there are 4 common problems that can come up and bring havoc to the caregiver’s training. These four problems include: Information overload, lack of a mentor, an area a caregiver just can get right, and lack of information reiteration.

The first problem we commonly see come up during training is information overload. Caregivers have a lot of responsibilities. Often times, they cook, clean, run errands, and provide social activities for residents. When a caregiver first arrives at your assisted living facility for training, they can become bogged down with too much information. This often leads to them forgetting simple tasks that need to be done, and their training not being as complete as it should be. The simply solution for this is to spread your caregiver’s training out over the course of a long period of time. Each day is set a side for a new skill or process the caregiver must learn.

The second problem we often see is the lack of a mentor. Anybody in a new job position needs a mentor, someone who has been there longer and knows the ropes. Not having a mentor leads to them making mistakes that could easily have been avoided. The simple solution for this is to allow your new caregiver a day or two to “job shadow” an experienced caregiver.

The third issue is that we often get a new caregiver who just can’t quite get one area of their job right. As we already mentioned, caregivers have a lot of tasks that are expected of them. There might be one or two they are not proficient at. The way around this is to devote extra time for their training in that area, and have them train with one of your staff who are very good in the area.

The final common problem is lack of information reiteration. It is said that humans need to hear something at least 10 times til they understand it. If that is the case, then caregivers must be showed something multiple times. The best way to do this is ask them multiple questions on the same topic throughout their training.

Caregiver training can be a tough process. To get more tips on elderly care, be sure to visit Adult Family Home.

Thanks,

Daniel

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Don’t Change Systems for Personnel Problems

On March 3, 2010, In Administration, Employees & HR, Management, By Mark

I recently encountered an issue with the way employees are being paid in one facility.  It seems that at one point, the Nurse Administration team members other than the DON - ADON, RN supervisors, MDS, support staff, etc. were all paid hourly. 

That’s fine.  They simply need to manage their hours to avoid unnecessary and unapproved overtime.  However, one of the Nurse Admin team members ended up having to work the floor in a charge nurse slot to fill a hole in the schedule.  She ran into 2 hours overtime due to this. 

The administrator lost it!  Not having any emotional control, he decided to change the whole pay system for all of these people.  It created chaos and  upset a lot of individuals.  All the Nurse Administration team went to salaried exempt positions that did not receive overtime compensation.  He neglected to write new policies on what happens to the their benefits, i.e. paid days off which is different for salaried than it is for hourly.  He neglected to check with the labor board for clarification on several issues which leads to me having to clean it up.

Actually, I see this a lot.  I see entire companies change the way they’re doing things, change systems, due to employee problems.  Why not just address the root issue?  If the employee is at fault, don’t change the system, address the employee.  If there is a scheduling snafu, don’t change the system as a first response.  Look and see what happened.  Otherwise, you could be creating more problems for yourself.

Knee-jerk reactions like the one described above usually do little to fix the actual problem and often create other problems to boot.  As a leader and decsion-maker, we must get our emotions in check, manage issues as they arrise, and think about the best possible solution that addresses the root cause of the problem.  The answer is not always to tear down a system.  It’s more often to do the uncomfortable and address someone that needs to be talked to or shown a different way of doing their job.

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