The Staffing Saga Continues

I tend to write about staffing when it is a problem, but I guess that's when it's on my mind the most. I really feel that nursing homes could improve the unemployment situation if people would just come to work. Right now I have a very tired and frustrated staff. I hired 4 state tested nursing assistants in August and all 4 are gone in less than 30 days. The biggest issue is over time. I have a mandation policy in place to cover scheduling problems that does not make the new person always be the one that has to stay. The reasons they left were: 1 didn't want to work the assigned unit and just left 2 hours into the shift without telling anyone, 2 due to mandation and 1 never was able to get a reason. None of these people gave any notice. Over the last few weeks I have lost employees to other facilities because they pay more. It is hard to be compeditive in a privately owned facility. On the lighter side I have recieved some very funny schedule requests. A couple of my favorites are: One was, I would like to cut back to 3 days per week with no week ends unless I am asked. Another one was I need to call off on Thursday to orient at my new job. Unfortunately in almost all health care in patient settings we are 24 hrs per day 7 days per week and everyone including managers must work weekends and holidays but I thought these were funny. If you don't laugh sometimes you would cry. I never get any remarks on this blog but if anyone has any other stories, comments or ideas to improve staffing I would love to hear from you.

Nursing Home Survey Process

Nursing homes are generally surveyed on an annual basis by the Ohio Department of Health. These surveys are unannounced and can occurr 9 months to 15 months after the last survey date, this is called the survey window. These surveys are completed by 3 to 5 surveyors and last between 4 and 5 days in general. I want to describe this process and what facilities do to maintain the standards set forth by the Ohio Department of Health and Federal regulations. Nursing homes must always be in compliance with these regulations not only during the survey window. These rules and regulations are the minimum of what a facility should do. Nursing homes must strive to do more than what is expected. Sometimes the federal rules will be more strict than the state and visa versa. What this means is the the strictest rule is what is expected during a survey. An example of this is nursing assistant staff requirements. The state requires a PPD (paid per patient day) of 2.0 and the federal rules require 1 NA's to 15 residents. The PPD is based on the total number of residents and is often more than 1 NA to 15 residents. All areas of the nursing home are surveyed during this process not just nursing. The survey team look at environment, dietary, business practices, human resources, contract services and many other aspects of the nursing home. There are other types of surveys that occur including complaint surveys, federal surveys and OSHA surveys. A complaint survey is conducted when someone calls the Ohio Department of Health with a concern or complaint. The department of health is required to look into all concerns or complaints. They do this by coming into the nursing home immediately or investigating during the annual survey. A federal survey is conducted on a much more random basis. A facility could go years without a federal survey. These are conducted in much the same way as a state survey.A Federal Survey may also be completed following an annual survey and is called a look behind. This survey is conducted to see if the same findings are determined.

National Nursing Home Week

National Nursing Home Week is celebrated every year by nursing homes across the US. It is a week to celebrate the residents in nursing homes. Over the past 23 years I have worked with nursing homes in a variety of positions.I would like to share some of the things that I have seen done and recognize the staff that pulls off these events. None of these events could happen without the hard work and dedication of the facility staff. Staff donate their time and talents to make these things happen.The following is a list of events: Balloon lift off Pic nics Bean dinners Ice cream socials Cash Cab Jeopardy Talent shows Carnivals Brunch Tea party Dog Show Car show Pet visits Sock hops Senior proms Music of all types Crazy hat contest Wheel chair races Wheel chair decorating Baby contest Cake walk Casino night Pie eating contest

Staffing The On Going Problem

It amazes me how badly people want a job yet once they have it do not seem to want to work. I use a standard interview form when I interview people. I always tell them the same things and ask the same questions. The 1 thing I make sure I tell them is that I expect them to give their employer notice if currently working and to give me 2 weeks notice when leaving. Of course every single one says that they will. I have had 41 people in just over 3 years quit without notice. These are not just nursing assistants but nurses as well.I have tried to call most of them to ask why and they will not even return phone calls. This really makes a huge impact on a facility. 1. confuses the residents, usually they have just got to know them when they are no longer there 2. leaves there co workers to pick up the hours they left opened There are many reasons people leave a job and I will be the first to congradulate them if they are bettering themselves but even then they should show enough professionalism to give a notice. I personally feel that licensed and certified nursing staff that fail to give notice should be reported to the board of nursing and nurse aide regisrty.

Person Centered Care Update

Person centered care has made a positive impact on the faciltiy I work at. The following are some examples: 1. Residents that ate alone in their room are now coming out to the dinning room at lunch time to eat 2. One resident that was having pain at meal time is now being layed down even if it is meal time and meal is served later when she is feeling betted and she is eating better and we have actually discontinued one of her narcotics and her pain has not increased. Before person centered care we were encouraging her to stay up untill after the meal and she just didn't eat well.We were more focused on the meal than the resident. 3. Residents that were refusing showers are now taking them because they don't have to worry about it being done on a day or time they don't prefer 4. The biggest impact is the reduction in falls. I did not expect this and I am not sure why it has happened but the number of falls has actually improved. Over the last 2 years our goal has been to have 5 or fewer falls per month. We have not met that goal until the first quarter this year. Last year there was a total of 7.6 falls per month on average and the first quarter this year we had 5 each month for April we only had 1 fall. I will need to do some further study to try and determine why but the one thing that stands out is that we started Person Centered Care on January 1 this year.

Person Centered Care Part 2

Step Four:
Determined goals to work on
1. make lunch time dining restaurant style
2. provide bathing time based on the residents choice
3. minimal over head paging
4. reduce over time
5. increase staff retention
6. STNA's to attend care conferences
7. provide medications and treatments based on resident choice
8. set up an activity closet where residents can go and get items to read, work on or games to play by themselves

Restaurant style dining

We started this the first Monday in February. The following are some of the thins that were put into place
a. list of restaurants to sit in each dining room
b. named the dining rooms and placed signs over doors
c. developed menu's to be filled out daily with options for food choices
d. developed policy and procedure for staff to follow
e. got input from staff, residents and responsible parties
d. linen table cloths and napkins
e. drinks served when given menu
f. new dishes obtained
g. dining rooms organized, cleaned and new paper, paint ect.

Person Centered Care

We are beginning the journey to impliment person centered care in our facility. I plan to document our progress. This project is anticipated to take 6 months to complete. There are several reasons for doing this in long term care:
1. improve resident and responsible party satisfaction
2. improve satff satisfaction and retention
3. improve the facilities bottom line through a better Medicaid rate

The definition of person centered care is basically providing care and services to a nursing home resident in a maner that takes into consideration their values and choices.

Nursing homes currently practice a medical model that is based on routines and treatments and a plan develoiped by the facility for what is best for the resident.

As well as the Person Centered Care the Centers for Medicare and Medicaid have expanded the quality program to include 20 areas that are for the most part the same as the Person Cenetered care goals. Facilities Medicaid rate will be increased by over $16.00 for achieving 5 of these goals.

The Area Agency on Aging has chosen 10 facilities in Sounthern Ohio to be a part of their Person Centered Care program. They are providing education and assigning an ombudsman to the facility for support.

Step One:
Some of the members of our team leadrs went to a Person Centered care Meeting at the Portsmouth Area Agency on Aging office and recieved the beginning education and were assigned our Ombudsman leader. We were given the assignment to choose 2 goals and read a book they passed out on Person Centered Care.

Step Two:
The entire team was educated on what Person Centered Care is and given the list of goals and asked to choose the top 5 they would like to impliment.We decided to call the department managers the team leaders and to have captains from each department to be a part of the development team for Person Centered Care.

Step Three:
Reviewed the definition and goals of Person Centered Care with all staff and asked them to choose the top 5 areas theywould like to work on. Team captains were choosen as well. We chose one person from each department and additional nursing staff from each shift.