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Long Term Care/Skilled Nursing – a service nightmare for everyone

The business of providing 24-hour nursing and personal care is a difficult service for everyone.  Patient/residents are at their most vulnerable: physically, mentally, emotionally challenged, have trouble with communications, perception of time and social control.  Families are scared, exhausted, emotionally battered, anxious, intimidated – totally fried.  Management deals with challenges of reimbursement, family emotions, regulations, inspections, complaints, staff coverage, training, attitudes and morale, aging physical plants.  Staff are engaged with serving heart breaking patients every day, performing difficult, highly personal services, handling complex nutrition, medication, therapies and demands that are unrelenting.  Often staff coverage is stretched as pay can be low, turnover high, and the burden of doing the work heavy.

By any analysis, this is a tough service to deliver and do so with any degree of satisfaction from patients or family.  It is particularly tough to deal with expectations of staff responsiveness and attention to care.

As with most round the clock services, supervision is strongest on “first shift” from 7AM to 6PM during the week.  These are the easier shifts to staff.  Therapies, assessments, treatment plan meetings, physician interactions and other medical services happen on this shift.  The amount, competence, and activity of staffing is at highest levels.  All this tends to mean that service levels are at peak performance when management is most present.

After 6 PM and on weekends the pace and nature of activity changes.  From 6 to 10 or 11, family members may be present.  Staff on second shift have access to less supervision and little or no management support, but they are often the primary customer service “face” of the facility.  Third shift is even more quiet, although the condition of resident/patients means that calls for service can be frequent.

There is often no systematic monitoring of responsiveness, request volume, outcomes or performance, individually or collectively by unit.  Feedback often comes from patients through family members, who may have let reports of poor service response, cleanliness, food service and others accumulate before sharing concerns.  Management sees first shift and may assume that other shift services are consistently sound, so may discount or deflect feedback.  Some of the feedback may well be inaccurate or unfair.  Family may be reluctant to challenge or report performance issues for fear of retribution or resentment from first line care givers. All this can fuel a toxic service, customer perception and work environment that makes difficult work even more challenging.

What might be done?  Software vendors to this segment can help by adding data integration of service call tools with patient charting, RFID or barcode scanning of patients and care givers to track requests, response, and actions taken.  This data can be shared proactively with family members for each patient to help them understand the demands their loved one is making, the timeliness and nature of care/service delivered.  This objective, credible patient service support card can help family members appreciate the level of need their loved one is experiencing, and the quality of care facility staff are providing.  Families know that management and staff are fully and immediately aware of individual and team performance around the clock.

Staff are reassured that management have a clear, objective understanding of the challenges they are facing with unreasonably demanding patients, particularly heave service requirements or poor teammate performance.

Management can be truly confident of quality of care and service based on objective, detailed performance data.

Taking initiative to complain about care in a 24-hour facility is not something done lightly.  Better to not rely on patients and families for feedback necessary to assure sound operations for critical services provided to our most vulnerable citizens.

Investing in post-acute services?  Striving to compete and grow?  Engage BrightWork Advisory, LLC to help.

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