Pre­dictable sched­ul­ing

Nurs­ing homes can boost qual­ity, bot­tom line with ‘con­sis­tent as­sign­ment’

Modern Healthcare - - Opinions Commentary - Mary Jane Koren

An aide notices an un­touched cup of cof­fee sit­ting on the bed­side ta­ble near an el­derly res­i­dent I will call Mrs. Jones. This break in the rou­tine trou­bles the nurs­ing home aide, who has been car­ing for Mrs. Jones for three years. She knows, for ex­am­ple, that this res­i­dent loves her morn­ing cof­fee. So she of­fers to bring her a hot cup.

But Mrs. Jones just shakes her head and says she doesn’t feel up to it.

As it turns out, Mrs. Jones is in the early stage of a heart at­tack and the un­touched cof­fee, as in­signif­i­cant as it seems, has alerted the nurse that some­thing is wrong. She pages the doc­tor and Mrs. Jones gets prompt—and pos­si­bly life-sav­ing—med­i­cal care.

Sim­i­lar sit­u­a­tions play out again and again in nurs­ing homes that as­sign an aide or a nurse to reg­u­larly care for an el­derly, frail res­i­dent. The prac­tice is called “con­sis­tent as­sign­ment,” and it is one key tar­get iden­ti­fied by Ad­vanc­ing Ex­cel­lence in Amer­ica’s Nurs­ing Homes, a 3-year-old na­tional cam­paign aimed at im­prov­ing the qual­ity of nurs­ing home care.

To date, 42% of the nation’s nurs­ing homes have joined the cam­paign, which is the largest vol­un­tary ef­fort of its kind in the in­dus­try. But ad­min­is­tra­tors of all 16,000 nurs­ing homes in the U.S. should sign up to­day and pledge to make qual­ity care a top pri­or­ity.

Nurs­ing homes that join the cam­paign set qual­ity tar­gets, and they can monitor their per­for­mance. The cam­paign works to help nurs­ing homes im­prove by giv­ing them im­por­tant tools to mea­sure their progress and achieve goals. The cam­paign of­fers free we­bi­nars, best-prac­tice guide­lines and ad­di­tional re­sources to help staff feel more sat­is­fied with their work and pro­vide bet­ter care to res­i­dents.

Data col­lected over the course of the cam­paign shows that nurs­ing homes can make sig­nif­i­cant strides in im­prov­ing qual­ity out­comes: They’ve de­creased the use of phys­i­cal re­straints, im­proved pain treat­ment and shown a re­duc­tion in the devel­op­ment of pres­sure ul­cers. Those are all in­di­ca­tors of a higher stan­dard of care. They’re of­ten found in fa­cil­i­ties with low staff turnover and homes that rely on con­sis­tent as­sign­ment.

For ex­am­ple, a de­crease in the use of phys­i­cal re­straints might be re­lated to a care­giver who has come to rec­og­nize the causes of agi-

Al­though there are startup costs, nurs­ing homes with con­sis­tent as­sign­ment save on turnover and treat­ment costs.

tation in a res­i­dent. For ex­am­ple, peo­ple with Alzheimer’s dis­ease can be­come ag­i­tated when they are in pain or can’t ask for some­thing they need. A reg­u­lar care­giver knows what to do to calm an up­set res­i­dent quickly, get them back on sched­ule—and pre­vent a sit­u­a­tion that might oth­er­wise be han­dled with phys­i­cal re­straints.

Nurs­ing home res­i­dents al­ways rate re­la­tion­ships with care­givers as ex­tremely im­por­tant to them. There­fore, nurs­ing homes that adopt con­sis­tent as­sign­ments of­ten gain a com­pet­i­tive edge in a tough mar­ket—one that’s filled with other op­tions.

Con­sumers to­day have choices when they need long-term care. Many go to as­sisted-liv­ing fa­cil­i­ties or will com­par­i­son shop be­fore they pick a nurs­ing fa­cil­ity. The CMS col­lects data on nurs­ing home out­come mea­sures, and in­creas­ingly con­sumers will check the pub­licly avail­able rat­ings be­fore choos­ing a fa­cil­ity.

Nurs­ing homes that be­gin us­ing con­sis­tent as­sign­ments might have to change the way they man­age staffers but, af­ter the ini­tial startup, they of­ten find the new way is a bet­ter way: They of­ten catch med­i­cal prob­lems in the early, treat­able stages.

For ex­am­ple, a nurse who’s as­signed to Mrs. Jones might no­tice a slightly pink patch of skin, the first sign of a de­vel­op­ing bed­sore. That nurse could im­me­di­ately be­gin treat­ment to pre­vent the skin from break­ing down. If that pro-ac­tive ap­proach works, the nurs­ing home can end up with a bet­ter bot­tom line be­cause once a bed­sore forms and be­comes ad­vanced, it can cost $19,000 to treat. In many cases, not all of that ex­pense can be passed on, and the ex­tra cost ends up hurt­ing the fa­cil­ity’s bot­tom line.

Nurs­ing homes that rely on short-term em­ploy­ees or tem­po­rary staffing might not in­vest in com­pet­i­tive salaries, ben­e­fits and other fac­tors that keep staff sat­is­fied and on the job for the long run. The turnover rate for many nurs­ing homes ex­ceeds 50% per year. In con­trast, some nurs­ing homes have made changes that keep turnover rates in the sin­gle dig­its. High turnover can lead to de­mor­al­ized em­ploy­ees, and in many cases, qual­ity prob­lems.

For ex­am­ple, if Mrs. Jones saw a string of dif­fer­ent aides ev­ery day, they might not know her his­tory, her med­i­ca­tion re­quire­ments, her health risks, her name or what she en­joys.

Higher turnover means higher costs for find­ing and train­ing new aides and nurses— re­plac­ing a sin­gle aide can cost $3,000.

The re­volv­ing door of staffers also leads to low job sat­is­fac­tion for the work­ers left be­hind. But the real cost of this poor man­age­ment style is a hu­man one: nurs­ing home res­i­dents such as Mrs. Jones can’t de­velop a bond with the tem­po­rary worker of the day. The temp might not know Mrs. Jones at all and will prob­a­bly dis­miss her re­fusal to en­joy her cup of cof­fee as noth­ing sig­nif­i­cant.

In the end, nurs­ing homes that adopt con­sis­tent as­sign­ment re­duce staff turnover and that work to im­prove other qual­ity mea­sures gain some­thing price­less: They’ll have a fa­cil­ity that fosters strong re­la­tion­ships be­tween care­givers and res­i­dents, and of­fers the high­est stan­dard of care.

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