Long-term healthcare facilities

If a poll was conducted regarding the most challenging workplace setting to manage, there is little doubt that the consensus would be healthcare, and in particular, a long-term care facility. For organizations involved in healthcare, COVID-19 was an inflection point of epic proportions. The speed with which it spread added an enormous amount of stress to the already difficult task of maintaining the health of residents and staff in the face of the pandemic.

While technological advances helped employees in some industries work remotely, long-term care still requires a hands-on approach because its primary workers provide varying degrees of skilled, custodial and personal care for the chronically ill or elderly who cannot manage the activities of daily living.

Since the pandemic, the rate of unemployment for healthcare and social assistance has not risen above 2.9%, among the lowest in the nation. But that is accompanied by a worker shortage of crisis proportions, and nowhere is that crisis greater than in long-term care, where there are fewer workers today than in the last 15 years, even as the population needing care continues to increase. To complicate matters, although healthcare salaries in general have increased with worker demand, the worker who is most in the trenches of providing long-term health care ― the certified nursing assistant (CNA)  ― earns a starting annual salary of $22,750, which tops out for most experienced CNAs at less than $37,000 per year. CNA turnover rate is unsurprisingly high and still increasing in 2022.

Against this backdrop, there is a very aggressive, unempathetic personal injury plaintiff industry that is spending record levels on advertising.

More than ever, long-term care facilities need to have a solid operational approach. To that end, what are five loss prevention measures that long-term care facilities should embrace?

  1. Expectations management. At the onset of admission there should be discussions with the stakeholders ― the incoming facility resident, relatives, friends and others ― regarding clear and realistic expectations of the resident’s care. While it is reasonable for stakeholders to expect the facility to provide a caring environment, the reality is that issues will arise with residents. That is why the facility should avoid creating an impression that preventative measures will avoid mishaps. To do so provides a false sense of security that cannot realistically be attained.
  2. Fall management. Given the propensity for falls among the elderly, it should be discussed that falls do occur despite reasonable efforts. However, it can be stressed that in the event of a fall, there is a coordinated plan of care that the physician recommends based on the resident’s situation. As the treatments continue, regular updates should be provided to all stakeholders on the person’s progress.
  3. Service recovery. As can be expected in a long-term care facility, health issues will arise. For example, “pressure injuries,” notably bed sores, result when prolonged pressure causes localized damage to underlying skin and soft tissue. Dealing with these types of issues requires pro-actively managing a resident’s “service recovery.” Stakeholders must be notified promptly to avoid the situation that could arise when family visit and then are told ― or worse observe ― an injury to their loved one. Prompt and proper communication by staff can sometimes be a challenge. Many CNAs and other long-term-care workers speak English as a second language. Having a staff person who can communicate with stakeholders in a clear manner and provide updates is imperative.
  4. Focus on documentation. The facility must capture ongoing care information in a timely basis, and particularly as situations develop. Thorough and clear documentation can be helpful to the defense of claims. Rather than notating simply, for example, “Resident Jones did not go to his class,” be sure also to document what progress Resident Jones is making and any other relevant information. Plaintiff attorneys will seize on documentation gaps to presume that malfeasance was involved in how care was provided (or not provided).
  5. Staffing matters. There is no easy solution for the largest challenge: staffing. More than ever, long-term care facilities are grappling with ways to recruit and retain staff. Given the practical budgetary limitations for wages, creating a culture of empathy for staff is vitally important. Make celebrating the facility’s achievements a norm. Sharing positive family and community recognition helps maintain staff morale. Encouraging staff to advocate and recruit for the facility ― and providing incentives to do so ― are steps that can help with staffing shortages.

It is not easy being the steward of a long-term care facility. Yet for those dedicated to the mission of helping people who need ongoing skilled and custodial care, it can be very rewarding. A consistent mindset and commitment to loss prevention measures is critical to maintaining the facility’s long-term viability.

Please visit Connected Risk Solutions for suggested insurance coverage solutions for healthcare facilities or contact Pendulum Risk Management Services.