I am finding that in service oriented businesses there are those who care and will go the extra mile, and then there are those that have room for improvement on their evals.

Make it a good one

Right in the middle of my new adventure and venture I stopped and opened my own personal care company. It took about 6 weeks to get up and running and that was a truly a miracle! I knew it was the right thing to do. Of course, Medicaid is our primary payer source. Medicaid’s volumes of rules and regulations are what I call a joke because they do not enforce all the rules and regulations, however, the admin costs are outrageous. Medicaid stated that they would perform an audit 60 days after we received our first client. We have not seen them yet and it is a year later.

The goal of personal care is to keep the elderly and disabled OUT of the long term care facilities. So many people do not know that personal care is available. It is much better to keep folks in their own homes with their loved ones and in familiar surroundings. Personal care is not the answer for everyone, but in many cases is feasible. I believe that educating the public regarding the availability of personal care services in the home could eliminate the dread of possible nursing home placement. Some of our clients have to make copayments, but it is still more economical then nursing home placement and much nicer. We also care for people with long term care insurance.

Oh by the way, if it had not been for you, Vickie, convincing me that a nurse can do anything, I would not have been able to start my own personal care business. Thank you. I am now ready to get back to my CLNC^® business. I’m looking forward to seeing you in San Antonio in March.

http://www.medicare.gov/HHCompare/

This is based on their OASIS information (the assessment form that is done at each admission and every recertification q62 days.)

The government, who puts the “stars” on these homes, is the one who pays less than $100 per day for the Medicaid residents in most states, and requires the same level of care as if they were actually paying for their care. Try providing housekeeping staff and products, laundry staff and products, maintenance staff and products, dietary staff and food, social service staff, activity staff and supplies, nursing professionals and supplies, pharmacy supplies, business office staff and supplies, medical record staff and supplies, therapy staff and supplies…not to mention staff development, human resources, MDS, Admissions, Administrator, and Marketing all for around $100/day. This is the only business I know of where the government requires that you provide service at a loss. Do you really think all of this can be provided, even at the most cost-effective rate, for $100/day?

I have worked for both for-profit homes and not-for-profit homes. The staff are generally the same—very caring and concerned. It’s just that they’re supplied with different tools because the owners are re-imbursed at different rates. Those doing the Medicaid work are the ones who truly care—they’re willing to go out there and TRY to do good work for these seniors, even though they know that every day of their working life they will be beat up by the system, by the families who are in poverty–thus locked into this system, and by the government who created this system. I enjoy sewing in my spare time: When I was using a $100 Singer sewing machine, I sewed a straight line and my products looked ok. When I graduated to a $1,000 Viking sewing machine, I still sewed a straight line and my products looked ok—but better than ok, my products had stitches that were all uniform in size and never had more tension in one than in another, etc. It wasn’t the person sewing…it was the tool that made the difference.

We have a HUGE problem in our society, and you are right to say we need to pay attention. However, it is important to realize that the difference in quality of care has nothing to do with the for-profit/not-for profit other than the tools that can be purchased.

OK…you got me on a soapbox and I’m jumping off now. Always stay balanced when you think long-term care: One of the reasons it’s so hard is that no one wants to get old, go to a nursing home, or die. And no one in long-term care wants you to go to a nursing home either…unless you need it. Nursing homes are for when there is absolutely no other way to care for someone…after you’ve exhausted all other avenues. THEN the nursing home is there to help with what is an impossible task. This does not mean that they will be perfect, but rather that they will be able to help with tasks that would have been impossible without them.

The American Nurses Association reported that charges against New York’s Sentosa nurses were dismissed. These nurses recognized patient endangerment and deplorable working conditions at a nursing facility. A visit to a nursing home is always best practice in order to talk to the staff and residents.

However, the current system that was used by CMS to rate the facilities is not the way to do it.
Data used for these ratings is very old data in most cases and probably does not show an accurate picture of the current facility.

Staffing as mentioned also played a very high role in these scores, which should definitely enter into the scoring procedure but facilities such as LTACs who are required to staff with full time RNs around the clock score superbly while smaller facilities who may only have one RN on staff (which meets the requirements set forth by CMS) score poorly in this area.

Also if a facility has an annual survey and does not score highly, though these might be very minimal deficiencies, it also affects the scores.

I do not believe the current ratings system is accurate and for those looking for a good nursing facility for placement of a loved one or a great place to work I would recommend they not use this as a guide.

As Vickie points out, visit the facility, several times and during several times of the day. Ask tons of questions, observe meal times and food service, response by the staff to residents and number of staff available at these different times. Talk to other family members if possible to get their feedback on the care provided. Look at the facility’s annual survey results in the facility as well as the staffing patterns which they are required by law to have posted.

Please don’t rely on the government to make these choices for you. There are some great facilities out there that provide very caring service to their residents.

Healthy care has become increasingly more “big business” over the past several years. Profit and not for profit are misnomers. Everyone and every company is all about the bottom dollar. They have to be in order to remain a business. (Sad but true). However the quality of your service should be the driving force to back a business. My husband is in business he has his MBA from Notre Dame, i can’t recall a single time he has visited the hospital, patient or otherwise, that he wasn’t just appalled.
He always gets on his soap box about business ethics. He Say’s if healthcare was any other kind of “business” it would have been out of business long ago. Unfortunately we are just not there yet, but I am holding out hope, that someday healthcare will face the same or more rigorous scrutiny when it comes to customer satisfaction and relations.

Again I stress, as in my previous blog comments, we can only control a small part of the industry-OURSELVES. Yes we are all put out by time constraints, lack of staff, incompetent staff, and general lack of regard to our profession. So what can we do, we can demand more staff, threaten to quit, complain to the administration and everyone else that will listen, but what will that accomplish? Instead of complaining about the situation, discover some solutions. Nurse retention programs, patient staff ratio’s, how to make healthcare more cost effective and managed better. Which ever environment you work in, you and you alone can make it better. How much better? I challenge you to find out. I have changed nearly every environment I have worked in.(In some form or fashion). For example I worked in a busy ED that was always over crowded, understaffed and just a mecca for complaints from patients and staff alike. So I looked at the “flow” of the department and decided that was the route cause. With that I went to my director and ask if I could pilot a quick care(QC) program for the ED. She was a new director so she was eager to improve our department and her image. (opportunity) I created a QC department that took care of the non urgent cases which in turn freed up the main ED rooms and staff. One RN and one DR stayed in the QC and seen patients with minor injuries or complaints. The patients seen there were still charged the same but were triaged separately and subsequently seen, treated and released usually with in an hour or less. I also created customer satisfaction surveys for the QC and the results were so astounding that the CEO of the hospital wrote me a personal letter and sent it to my home address thanking me for my efforts.

I worked at a large prestigious hospital (cancer center) and it bothered me so much that I had to send my “sick and tired” patients out (across the street to another facility) for any cardiac issues or procedures. So I went to administration and got permission to open up a cardiac unit so my patients would not have to travel to get cardiac care.

My point being, it is still our responsibility as nurses and professionals to make changes on the front lines until we are able to make them common place with government.

“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes up short again and again, because there is no error without shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the end best knows in the end the triumph of high achievement, and who at worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.” T.R.

Having worked in SNF/LTC facilities for the past 11 years, I know all too well what “corporate priorities” are nowadays for these facilities. Caring staff have to struggle each and every day in order to provide even the most basic care to their residents. There is Never Enough…Never Enough time to give care the way you want to, and know these folks deserve…Never Enough supplies to give the care even if you had the time…and Never Enough staff to give the care, even if you had the supplies and the time! I wholeheartedly support a rating system for nursing homes. Maybe one day, if enough people pay heed to nursing home ratings, corporate healthcare will finally get the message!