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Matching Residents to Facility Resources

Published August 29, 2008 10:41 AM by Brian Garavaglia

It is no surprise to anyone who works in health care that census is always a critical issue for long-term care facilities. This especially is an important focus for many skilled nursing care facilities. As more assisted living facilities are now taking many residents that at one time was the purview of nursing facilities, many nursing facilities today are in competition for residents that are being more difficult to get to help bolster their census numbers. However, because census is such a driving force for nursing facilities, and since many facilities are in competition with many other nursing care facilities for the same residents, a common error often happens: Many facilities attempt to take anyone they can obtain in the referral process. This is a critical error than can come back to haunt the nursing facility. 

A few principles need to be adhered to regardless of whether the facility is a for-profit or a not-for-profit facility. First, the facility must remember that they are there to service the resident to the best of their ability. The ethical principle of beneficence has to be always followed here. Although census is a key driving force for the sustenance of the facility, so to is following this important ethical principle of doing no harm to help further the resident and their health status. Taking residents that you cannot support with the skill level of your facility is unethical and inappropriate.

Another major principle that follows from this is that the administrator and other administrative personnel such as the director of nursing, have to know their staff, the knowledge capital that is found in their facility, and the supplies and other supportive factors that will enhance their ability to provide the appropriate level of care. For instance, if a person comes in with a significant level of wound care that is needed as well as a wound vac, and your facility fails to have a sound wound care personnel that can address this issue, your facility can face great liability in this area. When you admit a resident it is implied understanding that you have reviewed the case and feel comfortable with the ability to care for the resident's needs.    

Revenue is very important on the business or administrative level in long-term care. However, this often is at variance with sound clinical judgment on taking a resident. Another important principle that needs to exist is never let your bottom line business mentality become so myopic that it clouds your ability to see the larger context of the resident care environment. Many individuals will often try to close the sale of a resident, similar to that of a car sales person. A sales or marketing plan in long-term care is always dealing with human beings and not inanimate widgets. 

Making sure the proper people, skills, accoutrements and such are in place all need to be considered.  Admissions decisions are too often driven from a purely business point of view-how can we increase our census and with it, our revenue. Administrators and other nursing home administrative personnel who manage on this level often fail to understand that management happens within a larger context, both internal to the facility and external to the facility, and both factors have to be considered in the larger context of appropriate resident to facility fit.   

Quality care and resident population stability is driven by making sure that the resident to facility fit is appropriate and conducive for not only the resident, but also the staff. If the resident has care issues that exceed the facilities resources it can be quite problematic. On one level it may actually be so expensive to care for such residents that the bed that they are occupying, nevertheless, is causing the facility to incur a tremendous financial hardship. Furthermore, the clinical complexity of the resident may actually outstrip the knowledge capital and resources in the facility. 

However, more often than not, the staff feels the pressure and stresses of not having the appropriate skills to care for residents that are not a proper fit with the skill level of the facility. Take for instance a nursing facility that chooses to admit more residents with psychiatric issues that many nurses, or physicians, may not feel comfortable with in treating since they have not worked with this type of clientele before, or very sparingly.  Can nurses and certified nurse assistants be trained to address the unique concerns that some of these residents have? Yes, but remember there is a learning curve. Is it fair to say to improve our census we will take more individuals with behavior problems even though our staff is not comfortably trained with this type of resident. Definitely not!  Not only is it not serving the resident well, but having staff work in apprehension because they know their skills are not appropriate to care for these types of residents on a wider scale will often lead to errors and poorer levels of care. 

Furthermore, it is a hardship for many residents. They need to feel comfortable with the facility and skill level of those that take care of them. Residents and family members often become cognizant of a facility and staff that lack the skills to appropriately address the resident care issues. Not only does this taint the reputation of the facility, but the legal liability that exists here can be quite costly. 

A final principle that needs to be stated is that quality is the driving force for nursing care facilities. Although everyone is looking for a quick fix to their census problems, quality drives census in a number of areas.  Understanding your facility's capabilities shapes quality. Tailoring your residents to the fit of your facility shapes quality. These in turn lead to a facility having a strong reputation in the community.  The reputation of the facility leads to census development. However, the leaders of the facility have to be realistic about what their capabilities are and where their strengths lie. Exploiting the strengths of the facility will lead to better quality of care, which subsequently leads to a strong reputation and better census growth and stability. Conversely, one has to also understand their weaknesses. All facilities have weaknesses,  yet attempting to enhance their census be admitting residents that fall into these areas of weakness is a recipe for disaster.

It is a categorical imperative that nursing care facilities understand the importance of matching residents to the facility's strengths and therefore proper facility fit. If you find yourself saying that "I think we can take care of this resident," this often is a sign of attempting to place a round block in a square peg. If the fit fails to exist and you are not able to knowingly and adequately address the resident's needs, then you need to be conscious of this and let that resident be admitted to a facility that is more able to do so. Just because many skilled nursing home are called ‘skilled," does not mean the same skill level exists in all facilities.  Skill is not a constant, but is a variable that has to be closely monitored to provide appropriate and quality resident care. Continuing to view census myopically, viewing just the numbers and failing to understand the larger qualitative context of the resident to facility fit is often a major error that is learned by many the hard way.                      


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About this Blog

    Brian Garavaglia, PhD
    Occupation: Long-term care administrator
    Setting: Sterling Heights, Mich.
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