Risk Management in Senior Care: the Case for e-Training

I was talking with a client of ours the other day and she shared a story that I can relate to all too well. She was asking staff for their feedback on the new e-training system that they have been using – just happened to be our system, aQuire Training Solutions.
“Believe it or not,” she said, “I kept hearing comments like this: ‘I learned so many new things’ from my staff. The most eye-opening thing for me was that this is content I’ve been teaching in inservices for years – it’s not really new!”

What Debbie was commenting on – and what I’ve experienced first hand – is that staff don’t remember. They don’t remember what you said during an inservice – or a dozen inservices. Maybe it’s because we tend to schedule inservices on pay-day, and staff could be just a little tiny bit preoccupied with how badly they need that check.

Maybe it’s because staff are either on their way out the door for the day (mentally clocked out), not really checked in yet - or not quite awake (quality training for night staff probably doesn’t happen during their regular sleeping hours).

Whatever the case, it seems like a lot of the time staff just aren’t listening. And in my experience, that’s troubling.

Troubling because training topics are things that staff really need to know. It’s not “hey – here’s a fun idea to do with your family this weekend” kind of stuff. It’s the kind of information and skill development that means the difference between quality care and just eeking by.

It is also the training that makes the difference during survey or when litigation is threatened.

Did you train staff on this? When? Where’s the documentation?

And then when someone asks the employee, “Have you had training on this specific topic?” and the employee says “No – I don’t remember ever being trained on that!”

Your sign-in for the inservice training isn’t going to carry much weight. You can say, “I know we covered that information,” but if your staff doesn’t remember it, and say they have never been trained on it, guess what – you’re in trouble.

And that’s where e-training can save the day. Not only do you have documentation of training, you have the EXACT content that the training included, a test that the employee had to pass to earn a certificate, and validation that the person was tuned in and trained on the topic.

And if you, like most companies, have a blended approach to training – some stuff you still have to cover in inservices or seminars – our newest module, the Training Tracker will let you document that training on the same page as the e-training. One click of the “Print” key and you’ll be able to document full training compliance for every employee.

And if you’re like me, one of the things that keeps you up at night is managing the balancing act of meeting increasingly rigorous licensing requirements and avoiding threatened lawsuits. Lose your balance on either one, and you’ll pay in time, money, and reputation.

Sort of makes implementing an e-training system a no-brainer.

Aging Tsunami Coming

In September a group of individuals came together for an “Aging Revolution Summit” – a look at how aging services providers will begin to address the coming changes in needs that the aging baby boomers will bring.

According to a story in the FutureAge magazine, the summit was kicked off by Wesley Enhanced Living’s president and CEO Jeff Petty, who said, “As ‘revolutionaries,’ we need not answer traditional questions, but begin questioning traditional answers.”

Keynote speaker David Walker, comptroller general of the US, shared a detailed analysis of coming costs and trends that the seismic demographic shift will bring. (See report.)

Walker notes that just the government liability for Social Security and Medicare benefits alone increased 197% between 2000 and 2006. In his presentation he notes that “GAO’s simulations show that balancing the budget in 2040 could require actions as large as 1) Cutting total federal spending by 60 percent or 2) Raising federal taxes to 2 times today's level.”

Clearly, we have not only a clue, but solid facts about what the future of this country will be with the dramatic increase in the aging population.

As senior care and services providers, our responses will need to be not just “more of the same,” but we will truly need to “question traditional answers” and explore ways to move beyond the current service and delivery method.

One traditional answer that we’ve been working hard to turn on its head is the traditional approach to training. More and more individuals will need to be trained to provide services to seniors in their homes, in assisted living and residential care settings and in skilled care settings.

Fewer and fewer resources will be available to train them. Introducing quality online training can not only increase the number of individuals that can be simultaneously trained, but it can also increase our output of trained individuals.

Once they’re trained, we need to figure out how to keep the goods ones in senior care. We know that ongoing training is a key element, but what other sorts of questions of traditional answers do we need to be asking?

Walker closes his presentation with a statement about the “Five Leadership Attributes that are needed for these Changing and Challenging Times: Courage, Creativity, Integrity, Stewardship and Partnership.”

It is time for real leadership. And that leadership will come through partnership as we work together, creatively, to solve these challenges.

Real Caregiving

Did you hear the NPR story about the residents from an LA area nursing home that were evacuated to the Qualcomm Stadium? (Read a related story.)

The NPR reporter, who observed the care given to the residents by staff during an afternoon, shared a story about individuals who provided remarkable care for the residents, even during the most trying of circumstances.

While residents tried to rest in uncomfortable army cots, staff sang “Take me Out to the Ballgame” with them, and joked about coming to Qualcomm Stadium for this, instead of a ballgame.

When a resident’s “diapers” (the reporter’s words) needed to be changed, the staff would hold up blankets in a circle around the person, allowing him/her privacy in a very non-private situation.

I smiled as I listened to this story, thinking, “Here are folks who really get it – who understand that caring for elders is not simply making sure the right medicines are given at the right time, and that the body is well cared for.”

Caring – the right way – for seniors means using creativity and knowing that whatever the circumstances, caring for the PERSON is the most important part of the job.

That’s why when we’re training new caregivers we need to start with the basics: not bathing, dressing and grooming, but rather WHY we do what we do, and how to preserve the person’s dignity, privacy and promote independence in every single aspect of care we provide.

Those are the kinds of caregivers that I want caring for my mother – and ultimately, for me.

An Insider's View

I love a good story. I particularly love those stories that make me think, over and over, for a good, long time.

Celia Berdes, a researcher and author, reviewed the new book "Dancing with Rose" with such enthusiasm that I'm going directly to Amazon and ordering it:

Dancing with Rose: Finding Life in the Land of Alzheimer's (York: Viking, 2007), a new book by Lauren Kessler, is the best book yet written on the lives of old people in residential care and the people who care for them,

Celia writes in today's Quality Jobs/Quality Care e-newsletter.

Here's more of her review:

Dancing with Rose leads us to this inescapable conclusion: that caring aptitudes and attitudes of skilled direct care workers are the most important components of high quality care. In a call for systemic reform, Kessler asks us to think about our own aging: ''If I do need help when I get older, if it becomes impossible for me to live independently, how do I want to live? Do I want to be cared for by an overworked, underpaid woman with so many chores to accomplish on her shift that she can barely spare a minute to talk to me? The important question is whether I--whether any of us--have the gumption, foresight, creativity, fearlessness, imagination, whatever it takes to do something about eldercare before it's our turn.''

Let me echo this. My theme, and I'll repeat it every chance I get, is to simply say that this is a personal issue for all of us. Who will care for my mother - for yours - when the day comes? Who will, eventually, be caring for you and me?

That's about as personal as it gets.

Choices

Here's one advantage to our jumbled system of senior care: we have a lot more choices now. Less than 50 years ago seniors either moved in with family or moved into a nursing home. There were no other options available.

Today, in-home care is readily available in almost every community in the US. Assisted Living has added another level of care to the mix, allowing seniors to live in an independent, residential environment while accessing support services. Granted, the level and type of support varies widely - from state to state and even from building to building - but no longer does a person needing care have to move into a skilled nursing community to receive assistance.

Barbara Quirk, a geriatric nurse practitioner, writes about yet another option that boomers may well choose in the future: shared housing arrangements.

The fact is that it is not a bad idea to consider moving in together with lifelong friends and hire whom you choose for your helpers. This may be a far better option than the traditional assisted living. For starters, you would be with people you know and enjoy, rather than strangers.

My immediate response is, "Yes, but then I'd still have to cook and clean!" I like the idea of someday moving into a senior living community where I simply show up at the dining room when I wish, and leave the day-to-day worries to someone else.

My mom has been living in a cottage in a retirement village now for over 6 months. She was sharing her experience with friends who had come to visit her for the first time - and who were speechless at how friendly everyone there was to them.

"We were just walking down the sidewalk and people would stop to talk. Come to find out, we have friends in common with more than one person living here!"

My mom is happy, has tons of new friends, and says she truly feels like this is now "home" for her.

My friend, on the other hand, receives calls daily from her mom who, recently widowed, is alone and lonely on her countryside home.

“I lied to my mom for the first time yesterday when I told her I was busy and couldn’t go with her on an errand,” she said. “I was simply worn out from daily calls for help – but mostly for companionship.”

Caregiver stress and the medical ramifications are well documented today. This stress affects families who are trying to balance it all, as well as paid caregivers who don’t have access to the training or support that they need to do a demanding, often thankless job.

I like what Barbara Quirk says in her comments about shared housing and other options we have now:

With all of the housing options available today, plus a few that haven't even been thought of, it pays to at least consider what would be acceptable to you.

And, perhaps even more importantly, consider – and discuss - what would be acceptable to your loved ones. Giving that some attention now may take some of the stress off all of us when needs arise in the future.

No shortage of workers IF ONLY...

Today's email brought this e-newsletter from a great organization, "Quality Jobs/Quality Care":
"If some people are fashion-conscious, I guess you'd have to call me fashion-unconscious, but this issue's New from Health Care for Health Care Workers box includes evidence of the kind of trend that gets me excited: Over the last month or so, two states have voted to extend health care to thousands of home care workers. Both Montana and New York are covering many -- though not all -- of the workers in their states who are currently uninsured or in danger of becoming uninsured very shortly. And both states are doing it by increasing their reimbursement to providers and requiring that the extra funds be spent on health insurance coverage for employees. iPhone, schmiPhone. Now this is a bandwagon worth hopping onto. "
(Thanks, Elise Nakhnikian, editor)

I SO agree with this! Anything we can do to support caregivers and keep the best in this work is worth everyone's support - everyone in the broadest sense of the word meaning us - taxes - government. Also noted in this e-newsletter is the testimoney of Steven L. Dawson, president of the Paraprofessional Healthcare Institute, before the Institute of Medicine (IOM) Committee on the Future Health Care Workforce for Older Americans:

"There is no mystery here: If tomorrow we paid these individuals a livable income, offered them health insurance, trained them better, supervised and supported them--listened to them--we would solve this unnecessary 'workforce crisis' in a matter of months."

Those providing care genuinely do CARE; as a society we need to find systematic ways to support them. I applaud the initiatives that Montana and New York have begun. It's up to all of us to continue to support and promote system-wide changes so that we all will see the benefit when it's our turn - or our loved ones' turn - to need care.

Online Training: One Solution for Quality Careby Sharon Brothers, MSW

Assisted Living has been in the spotlight lately in both positive and negative lights. While most individual residents and families are happy with their assisted living communities, legislators and senior citizen activists across the country continue to raise concerns regarding the lack of national standards for assisted living quality.

While on the surface national standards sound like a good idea, the reality can be somewhat different. Look what national standards have done for the quality of nursing home care, for example. Scandals hit newspapers daily with stories of resident abuse, neglect, and other violations.

Perhaps better than national standards is the approach of some within the profession: the concept of self-regulation. But while self-regulation makes logical sense, any approach to improving the quality of care must make financial sense as well.

Take the matter of training: Inadequacy of training for caregiving staff is frequently cited as one of the key problems within all areas of senior care. In this area, regulations vary dramatically from state to state. Some states have detailed requirements for staff training; other states have no requirements at all. It’s challenging for operators to make financial sense out of offering a service that is not required, while they struggle to meet all the other regulatory requirements.

One solution that is getting increased attention is online training – using computers so that employees can get up-to-the-minute training during working hours without adding other layers of costs, such as overtime or instructor wages.

“Faced with retraining 50 million American workers, corporate America is using distance learning, both internally and externally, for all aspects of training. Many major corporations save millions of dollars each year using distance learning to train employees more effectively and more efficiently than with conventional methods,” reports the United States Distance Learning Association.

In Canada, continuing education for caregivers can cost as much as $9,000 per year, according to the Canadian Union of Public Employees. Compare that to the cost of online training – less than $150 per caregiver – and the financial logic of online training is clear.

National standards may be one answer to the rapidly growing problem of care for the next generation of elderly, but a better solution may be found at the touch of a keyboard, through online training for caregiving staff.

When It Comes to Training, Invest Wisely, Not Cheaplyby Ed Hansen, MBA

When it comes to training, it pays to spend. Companies that invest in training reap the benefits of increased employee satisfaction, competence, and confidence, happier residents and families, increased census and reduced turnover, and mitigation of risks of all types. Some studies indicate that when training funds are spent wisely, more is better. For example, the Pennsylvania’s Frontline Long Term Care Workers report, published in 2001 by the Polisher Research Institute at the Philadelphia Geriatric Center, found that companies in the top 25% of training spenders reported fewer problems with turnover.

You may wonder, then, what constitutes a significant investment in training. The American Society of Training and Development (ASTD) 2005 State of the Industry Report notes that in 2004, mid-size companies – averaging 8,000 employees – spent an average of $955 annually per employee for training. This represents an increase of 16% over the previous two years. In the sample of large organizations – averaging 58,000 employees – spending on training was even higher, at an annual rate of approximately $1,368 per employee. Finally, in a sample of what ASTD ranks as the “Best of Breed” learning companies, spending per employee averaged $1,554 per year.

More recent data is available through Bersin & Associates Corporate Learning Factbook 2007. Bersin & Associates found that healthcare organizations spent, on average, $948 per employee on training. The biggest spender – the technology sector – came in at $2,763 per employee. The lowest spending was in the retail sector at $519 per employee.

Approaching training expenditures from a slightly different angle, several studies have uncovered average training costs in the senior care industry. The Polisher Research Institute report found that average annual training costs per nurse aide, were as follows:

Government Nursing Homes - $1,604
Private Nursing Homes - $1,066
Licensed, Certified Home Health Agencies - $955
Large Personal Care Homes - $455
Unlicensed, Non-Certified Home Health Agencies - $442

Another report, The Role of Training in Improving the Recruitment and Retention of Direct-Care Workers in Long Term Care relied on an informal questionnaire sent to AHCA affiliates. This questionnaire uncovered costs ranging from $150 to $2000 per trainee, with a majority of states reporting costs ranging from $500 to $1000 per trainee.

So, how much should you spend on training the most visible, highest customer contact employees in your organization? I can only speak for myself, but when I am finally dependent on others to care for me, I would prefer that they receive more training than the person who rings up my groceries.

Links:
View the 2005 Executive Summary at http://www.astd.org/NR/rdonlyres/A314C9A6-D2F1-42C7-AD72-F2F3EA0D688F/11196/2006SOIRExecsum.pdf

Order the Corporate Learning Factbook 2007 at http://store.bersinassociates.com/factbook.html

View Pennsylvanian’s Frontline Workers in Long Term Care at http://www.abramsoncenter.org/PRI/documents/PA_LTC_workforce_report.pdf

View the Workforce Strategies report at
http://www.directcareclearinghouse.org/download/WorkforceStrategies3.pdf

The Sandwich Generation: Good enough isn’t good enough anymore

For the past 20 years, I have taught about, written about, and thought I understood the Sandwich Generation experience: the adult children, still caring for children of their own, and also caring for aging parents.

Now, however, I do more than understand – I am living the role. Last night, standing in the checkout line at Target with all the essentials needed to set my mom up in her new retirement apartment, I realized that I had done the exact same thing just a few months ago with my eldest daughter, who was moving into her first apartment.

I had the same exact cart contents, too: shower curtain, laundry soap, kitchen essentials, sheets and towels.

As I rushed from unloading my mother’s purchases to pick up my youngest daughter at dance class – 15 minutes late . . . again – I thought, “I am living the Sandwich experience.”

I, and nearly every one of my friends and acquaintances.

Melanie has been sitting at her dying mother’s side for the past two weeks, leaving only to attend her high school daughter’s performances. She’s learned more about hospice, caregiving, and end of life choices in the past two weeks than I have in the past two decades.

Carol, a professional with a thriving private practice, has gradually reduced her work week to three days as her kids have completed college. Last week, Carol started working five days a week again to help cover the costs of two parents in need of high-level assisted living care.

My husband is taking tomorrow off work to accompany his parents to the doctor to learn how his 87 year old mother’s recently diagnosed cancer will be treated, and to support his 93 year old father in handling the news.

Clearly, we’re not alone. Both CBS and NBC are currently airing segments during their evening news broadcast that focus on this exact challenge which is facing millions of Americans today.

Many of our parents need care in assisted living communities, nursing homes and retirement centers. And you can bet your last dollar that every one of us will be picky, annoying, and demanding. We’ve grown up demanding more, and we’re accustomed to getting it.

A promotional announcement for the upcoming Assisted Living Federation of America conference featured a Disney University past executive speaking on the topic of “Learning from Disney, Where It's Not About Satisfaction.”

While Disney seeks loyalty by offering the best vacation experience imaginable, we in senior care have felt smugly successful if our clients are merely “satisfied”.

As my generation of self-centered Baby Boomers enters the long term care system – as advocates for our parents or as consumers ourselves – beware: We’ll be looking for an experience that far surpasses simply “satisfactory.”

Yesterday I interviewed a young woman for an office position. She told me of an earlier job she’d had in a care setting where she had been excited to help, but left after just three months.

“I was thrown right into the work with no training at all – just another employee to get me started,” she said. “I would have loved the job, but I couldn’t do it without training.”

No wonder our turnover rate is so high – over 70% annually, according to the most recent survey by the American Health Care Association (AHCA), as reported by the National Clearinghouse on the Direct Care Workforce.

This one thing I know: As a profession of senior care providers, we are not going to be ready to meet the high demands of my generation if we don’t aim higher.

Higher in our training of frontline staff.

Higher in our own expectations of happy customers.

Because for me – and for millions like me – it is no longer just a job; it’s personal.


Links:
ALFA: http://www.ALFA.org

ALFA Conference (May 15-17 in Dallas, TX): http://www.alfaconferenceandexpo.com/whoattend.shtml

Fred Lee, author of If Disney Ran Your Hospital (Amazon link) http://www.amazon.com/Disney-Ran-Your-Hospital-Differently/dp/0974386014/sr=1-1/qid=1172180888/ref=pd_bbs_sr_1/103-7876113-5071805?ie=UTF8&s=books
AHCA: http://ahca.org/

Direct Care Turnover Statistics: http://www.directcareclearinghouse.org/s_state_det.jsp?action=view&res_id=52

Who Will Care for Your Mom?

Even though I’ve been in the business of senior care for the past 20 years, it all took a personal turn for me recently.

Last fall, my parents were in an auto accident that left my mother severely injured. After several weeks in the hospital, she was ready to be discharged. With oxygen, IV medications and a three-person transfer requirement, we had no option but to find the best skilled nursing center available to her.

We had a choice of three nursing homes that had contracts with her insurance provider. Having been in the business of long term care for two decades, I called a few of my contacts and picked the best option – I thought.

Over the next two months, I realized on a personal level what I’ve known on a professional level for years: Good training of staff is NOT optional if you want good care – it’s a requirement.

This week, NBC Nightly News is airing a special series on “Trading Places: When kids care for aging parents” (http://www.msnbc.msn.com/id/17121113/). Clearly, I am not alone in realizing that training – of the people caring for MY loved one – is a very personal matter. Over 36 million Americans over age 65 feel this need personally, as do the families of some 5 million Americans over age 85. By the year 2020, over 10 million disabled seniors will present the largest disabled group in the history of this country.

As America’s Baby Boomers age, the system of care will be taxed beyond what we can currently conceive. How will we adequately staff these care settings, let alone train and retain qualified workers?

Who will care for YOUR mom – and mine?

Developing systems that train, motivate, engage and excite the people providing this care will no longer be optional, it will be essential.

We have begun a journey to help create this system; more importantly, we have begun our journey as individuals – and as a company – to work to improve the lot of caregivers throughout this system of care.

Join us. (http://www.aQuireTraining.com)