Changing Aging: Most Recent Articles

Shovel it Safe....Snow of Course

Sun, 15 Nov 2009 13:54:00 -0600

We are about to embark on another winter. A few flakes have already fallen in many parts of the country. 'Tis the season for sore backs in Minnesota (or any other snowy region). It's snow time and that means shoveling!

Unless you use safe shoveling techniques, any snow covered area is a backache or injury waiting to happen. If you have any heart related condition, the first palce to start is with your Doctor.

Tips for safe snow shoveling:

Use a shovel that fits your height and strength. If the shovel itself is too heavy or too long you are asking for a problem.
Stretch, warm up by walking first or do some light exercise. Shoveling is hard work and it is easy to strain muscles.
Don't wait! Clear often and early. Packed snow and deep snow are much harder to clear.
Push whenever possible rather than lift the snow. Lift with your legs not your back.
Avoid throwing snow over your shoulder, since this is twisting and can place stress on the back.
Take breaks and drink plenty of water.

How to Handle Medical Reviews

Sun, 15 Nov 2009 13:23:00 -0600

The Office of Inspector General (OIG), oversees Medicare compliance and has increased the number of medical reviews. High overpayment rates during audits has prompted them to do so.

To avoid payment denials and flagging of the SNF for a focused medical review, you must have a plan in place to handle the request. You must act quickly, as some FIs (Fiscal Intermediaries) have started to deny claims when the requested medical records were not received within 45 days. The count startes from the date on the FI letter. This could mean that you have lost 4 days before the letter even reaches you. Holidays do count, as do any day on the calendar.

Consider the following plan:

Have some one oversee the process
Set your turn around time between 72 hours to 1 week (latest would be midnight of the 45th day)
Pull only records and data requested during the dates of service they are requesting (not asked for/do not give)
Have clinical staff review the documents to make sure there are notes to support therapy or covered services
Send all that is requested
Make a copy for the facility of all that is sent and save in case of additional requests or problems
Send the data by certified mail return receipt requested
Log all requests and outcomes
Look for trends in requests. Investigate to ensure compliance.

Remember that a medical review occurs randomly. It is only a matter of time before your number comes up.

Ecumen Consulting can help you prepare, audit, educate and put systems in place.

Nursing Home Talk Hear No Evil, See No Evil, Speak No Evil

Sun, 08 Nov 2009 14:12:00 -0600

Working in a small city run non-for-profit nursing home, has really opened my eyes, ears and voice. The fact that everyone was interconnected or inter-related was unmistakeable. The view initially, was one of home and family, but the internal dynamics soon became all too clear.

Everyone knew each other and each other's business, personally and professionally. The gossip mill was alive and thriving at the nursing home, and it bled right into the community. The morale was at an all time low and the Director of Nuring and Administrator had turned over for the third time in a year. Those employees that exercised their power (most of which were not in any position of power), were even proud of this. They knew they could make or break anyone in those positions if "they" did not meet the standards.

People lived in fear of retaliation from the "power group". No one saw the RN come in 15-30 minutes late almost daily. No one heard the LPN, in a crowed room of residents listening to daily devotions, yell across the room, "shut up back there". No one spoke up to report the LPN that injected insulin through a demented resident's clothes because she's, "not going to deal with his behaviors and I do what I need to to get done".

Until I arrived, then I watched, I listened, I heard, I investigated and I became the advocate that we are supposed to be for vulnerable adults. Discipline was issued, education provided and the chain of "untouchable power" broken. Every member of a health care team is a resident advocate. The problem is that not everyone wants the role. The role is a part of the job each and everyday as soon as you enter the door. You see it or hear it; you own it! Doing the right thing is an obligation and it feels good. Do not get trapped playing hear no evil, see no evil, speak no evil.

Let Ecumen Consulting stop your game playing and put you on the right path.

Long-Term Care Problem Solving Guidelines for Use in Conflict Management

Fri, 09 Oct 2009 09:00:00 -0500

Conflict is defined as a clash or struggle that occurs when a real or perceived threat or difference exists in the desires, thoughts, attitudes, feelings or behaviors of two or more people.

Organizations recognize increased conflict for all staff as they become larger and more complex. early recognition of conflict and identifying it for what it is helps us to commit time, enegry and skills to deal with it. Failure to deal with conflict can destroy a team or organization.

Conflict provides the opportunity for creative problem solving. Many of our patterns of behavior were learned years ago as children and we have practiced them ever since. They center around our beliefs, culture, desires, attitudes, morals and ethics. Conflict can and does occur at any moment, as it is inevitable, essential and even desireable. As leaders we must be careful to deal with conflict constructively.

Problem Solving Guidelines for Use in Conflict Management:

1. Provide a private environment to begin the discussion nad limit distractions.

2. Focus on the issue or problem, not the individuals.

3. Respect the differing values and viewpoints of all parties.

4. Listen carefully.

5. Define the problem.

6. Separate fact from feeling.

7. Give each person the opportunity to state his/her views and concerns.

8. State the main issue based on common goals.

9. Find a solution which includes consensus and satisfaction for all parties

Most people don't seek conflict out as a good thing, but rather learn to see it as a neutral.

Ecumen Consulting provides training on leadership and conflict management.

10 Mistakes to Avoid When Leading the Team

Wed, 07 Oct 2009 15:00:00 -0500

Effective teamwork knows no level. It is just as important among top leaders as it is among middle managers, front line staff etc. The absence of teamwork at any level (or between levels) will limit an organizations effectiveness and can eventually destroy it.

Below are 10 common mistakes made by leaders that we should all avoid.

1. Failure to develop and maintain basic management and leadership skills.

2. Permitting poor employee selection techniques.

3. Failure to discuss expectations or establish goals which have been mutually set.

4. Inattention to training and devlopment needs of the team.

5. Failure to advocate, support and nuture team building activities.

6. Preventing the involvement of team members in any activity where they could make a contribution.

7. Failure to provide and receive feed back from the team.

8. Allowing conflict and competition to get out of control or trying to eliminate it all together.

9. Depending on someone else to recognize and reward the team and it's members.

10. Failure to send players who have not responded to coaching back to the "minor leagues".

Remember, you are only as strong as your weakest link. It is best to identify and grow the links, as the whole chain then becomes strong.

Ecumen Consulting can provide the training and/or mentorship you may need.

LTC Director of Nursing spot to fill? Do not pick the hospital nurse.

Wed, 02 Sep 2009 13:42:00 -0500

Hospital nurses wanting to coast into retirement or slow down from the pace of acute care should never pick the DON job in LTC to do it in. Clinical is clinical, yes, but there is so much more to being a DON in LTC. The mere suggestion that they take the job to "slow down" shows they have no clue of what they are about to sign up for.

Whoever said that RNs working in nursing homes are the nurses that can't cut it in the hospital are dead wrong! LTC have excellent assessment skills (they have t0, as there are no MDs or NPs in house to do it for them or oversee). Additionally, they must paint an accurate picture of the resident in their charting to capture appropriate reimbursement, for the doctor's understanding of the clinical condition of the resident, for compliance and to pass the eye of surveyors on annual state inspection. There are no IV teams to call, no lab or pharmacy in house so they must be self sufficient and resourceful.

Facility administrators are often looking to quickly fill that hard to replace spot when the DON leaves. A warm body won't do it, but neither will a hospital nurse without recent LTC experience and management background. In fact, in hiring them, we set them up for failure. They are almost on the same playing field as a new grad. The knowledge base of the survey process, MDS, Rules and Regulations are the same for both, none.

It has been said that only 2 things are more highly regulated than LTC and they are nuclear power plants and NASA. So, administrators would be better off grooming internal candidates that know LTC, but has never been a DON, then to hire the hospital nurse with no LTC experience that is relevany and current.

Ecumen Consulting can both groom new RNs in their DON role and interview and place RNs in the role.

How home-like is your nursing home?

Mon, 24 Aug 2009 14:28:00 -0500

Regulation F252 states that nursing homes are to be clean, safe , comfortable and home-like. If you or any member of the staff still refer to "my facility", chances are good that you are not fully home-like.

Take a look at what "institutions" do:

Overhead page and have music piped in throughout the building

Meal service in a dining hall using trays

Institutional signange labeling workrooms, closets, etc.

Medication or work carts in use

Audible and widespread alarms

Mass-purchased furniture, drapes and bedspreads that all look alike

Large centrally located (nursing) workstations

Did this describe your nursing home or the federal prison system? A scary comparison and yet look at the similarities! We must all strive to de-emphasize the institutional character of our buildings. A "home-like environment" must be felt using all of ones senses to get it right. It is not purely the physical environment. It is the smell of cookies or bread baking as you enter, the sound of laughter or singing, that warm feeling you get because you were recognize for something you did no matter how small and knowing you have meaningful relationships with people you see everyday.

Let Ecumen Consulting help you create home.

I want to be an MDS Coordinator

Fri, 21 Aug 2009 14:41:00 -0500

The MDS Nurse Coordinator role is very important in LTC as it drives reimbursement and is used by surveyors to navigate around the nursing home clinical issues during survey.

The top 6 things to consider when choosing to be or employ an MDS Nurse Coordinator are:

1. The Nurse must like to meet deadlines. the entire RAI process is time line driven. Timing errors can lead to lost revenues. Late assessments are billed at the default rate which is substantially lower than the catual RUG rate.

2. The Nurse must like completing paperwork, be highly organized and detailed oriented. Although MDS Nurses do not at first see it, one of their primary job duties is record keeping. They must complete or see to the completion of assessments, documetation to support medical necessity, collateral documentation, certifications, order completion, care conference schedules and much more.

3. The Nurse mut be computer-literate. The day of handwritten completion is no longer for the MDS and LTC is moving toward the EHR (Electronic Health Record). Someone who does not want to touch a computer or hates to use it will not be a good fit for the position.

4. The Nurse must be comfortable to hang the "Do Not Disturb" sign. The MDS must be accurate. The Nurse must be able to say "no". focus on details, and limit interruptions. Loss of focus on the ADL section that should have ADL score of 16 but comes up ADL of 15 can loose $53.58 per day or almost $20,000 a year.

5. The Nurse must like the business side as well as the clinical aspect. The MDS is tied to reimbursement. Understanding that choosing the correct ARD (Assessment Reference Date) as well as encoding things properly can mean revenue and is critical for success. Developing systems to track, capture and document while realizing the financial impact decisions will have is a major responsibility.

6. The Nurse must enjoy being a team player and interacting with all interdisciplinary team members. At other times, the Nurse must be the police officer keeping things in compliance and on time. Communication to and from the team in verbal and written form is vital to successful completion and identification of significat chnages and errors.

With these top six things to consider, are you ready? Still unsure? Ecumen Nurse Consultants are available to assist you .

Is RN Co-Signing Appropriate?

Wed, 12 Aug 2009 15:23:00 -0500

There are times when it is appropriate for nurses to co-sign, such as when narcotics are discarded by a licensed nurse with an RN observing for the record. In this case you are observing the activity, and fulfilling a leagl policy for double checking.

Co-signing is generally identified as a student/instructor relationship. It implies that the instructor has approved the care given, has personal knowledge of it, and assumes responsibility for it. When co-signing is demanded of employees in the workplace it may be because the activities the LPNs are being required to perform are not within their legal scope of practice. requiring RNs to co-sign for LPN work does not make it legal. It also implies that the RN has approved the care given, has personal knowledge of it, and assumes responsibility for it.

What do you do if an employer orders you to co-sign? Educate that then that it is not necessary to co-sign. When the RN or LPN performed the care, they should sign for the care and assume responsibility for what they have done. Politely refer then to the MN Board of Nursing Laws. However, be aware that there are those employers that will pull rank and threaten discipline due to "insubordination". In this situation, protect yourself. Ask that the request be put in writing. This may be enough to make the employer stop and think. You have the right and duty to refuse to perform illegal or unethical acts. In order to show you were coerced into signing for work you did not partake in, or observe, you may want to add a disclaimer statement such as: "I am signing this at the direct order of my employer. I did not observe or give this care."

For more information on scope of practice, check out Ecumen Consulting's 2 part series on LPN Empowerment coming in September. If you are unable to join us at one of the sessions, Ecumen Consulting will conduct training at your site.

Long-Term Care - 8 Rules for Customer Service

Wed, 12 Aug 2009 14:53:00 -0500

Good customer service is all about sending the customer away happy, knowing they will come back and that they will tell others of their good experience. Thus, opening the door to new customers. Sounds simple! How do we do it?

1. Answer the phone.

People want to talk to a live person when they have health issues or are checking on the staus of a loved one's health. They assume if you do not care enough to pick up the phone you certainly do not care about them. Worse still, they believe you are as understaffed as you have heard the staff mention on more than one occasion and now you know care is lacking!

2. Never make promises unless you know you can keep them.

Trust and reliability is everything when serving seniors. If you "promise to be back in 15 minutes", you had better set an alarm or something and get there. You are being timed and somehow they know when it is 17 minutes rather than 15 minutes.

3. Listen

No one likes to be blown off or worse have to repeat themselves many times over. Show that you are listening by giving appropriate responses, ask for clarification when needed or recap what has been said.

4. Deal with complaints.

Pleasing customers is our business. No one likes to hear complaints but use them constructively. never shrug it off with the attitude, "you can't please everyone". We are employed to try to please.

5. Be helpful - even when there is nothing in it for you

The other day I broke the clasp on my necklace. I went into the jewlery store and the clerk said, "no problem, I have one in the back just like it." It took him only seconds to repair and to my surprise he said there was no charge. Where do you think I will go for my next jewlery purchase?

6. Train staff to be helpful, courteous and knowledgeable

Make customer service a part of orientation and annual training. Empathy training is a powerful tool when caring for people. It feels very different to walk in the customers shoes.

7. Take extra steps

When your resident says, "where is my sweater?" Do not just reply, "over there" ; get up and provide them with the sweater.

8. Throw in something extra.

A small thing can be so meaningful and important. It is many small things over time that are remembered as acts of kindness and generosity. You told me yesterday how much you love DQ cones so I stopped and brought you one.

If you apply these 8 steps you'll be on track for good customet service. Ecumen Consulting can help with your educational needs and provide empathy training.

Dignifying America's Nursing Homes

Wed, 12 Aug 2009 13:56:00 -0500

CMS and the Pioneer Network held a national symposium back in April 2008 on "Creating Home". As a result, changes have been made to the interpretive guidelines and changes to regulations may follow.

F241 Dignity - Nursing homes still have many undignified practices and old habits can be hard to break. CMS examples regarding this include:

Eliminating the use of bibs which we have all been trained to refer to as clothing protectors. Infants use bibs not adults. The dignified approach is to use and offer cloth napkins instead.

Having staff sit rather than stand when helping residents to eat. A move toward family dining is dignified were staff eat with the residents. This is much more home- like and non-threatening. Conversation should be directed at those dining not yelling across the room to co-workers. Staff interact and converse with their residents not each other.

Speak to residents respectfully; avoiding use of lables such as "feedes" the "new admit" or the "wanderers:".

How undignified to refuse a resident's request for toileting assistance during mealtimes and then restricting them from use of common areas open to the public such as lobbies and restrooms. It is dehumanizing to restrict residents from using restrooms, closer to where they dine, which are open to the public.

Think about what is dignified for us. It is no different for the elders we serve. If we would not want it neither would they.

If you need help with culture change, Ecumen Consulting can lead you through a successful transition.

LPN Empowerment Seminar- New Dates

Wed, 12 Aug 2009 08:00:00 -0500

In these hard economic times, the Long Term Care industry is using LPN's in more diverse roles and hiring less RN's. These seminars will not only support the LPN's survival but enhance their knowledge of professional roles and responsibilities, regulations and the ability to lead a team.

Part 1 is recommended, prior to registering for Part 2.

Upcoming Dates/Cities:

Part 1& 2 - September 9-10, 2009 - LaCrosse, WI

Part 1 & 2 - September 29-30, 2009 - Thief River Falls, MN

Part 1 Only - September 9, 2009 - LaCrosse, WI

Part 1 Only - September 29, 2009 - Thief River Falls, MN

Part 2 Only - September 10, 2009 - LaCrosse, WI

Part 2 Only - September 14, 2009 - Mankato, MN

Part 2 Only - September 16, 2009 - Duluth, MN

Part 2 Only - September 17, 2009 - Bigfork, MN

Part 2 Only - September 30, 2009 - Thief River Falls, MN

To register contact: Stephanie Gibson at stephaniegibson@ecumen.org or call 651-766-4393.

Welcome to Ecumen's Nursing Home Help Desk Blog for Long-Term Care Professionals

Mon, 10 Aug 2009 11:37:00 -0500

Hello, My name is Mary Leber, RN-BC, RA-C, and I direct Ecumen's long-term care consulting services. We provide nursing and clinical consulting services for nursing homes, assisted living, Continuing Care Retirement Communities (CCRCs) and home care and community-based services. From mock surveys to reimbursement optimization and from nursing training to operational analysis, we help nursing homes, CCRCs and assisted living providers improve, innovate and enhance services for the people and communities they serve.

I have more than 25 years of experience in nursing and clinical consulting, serving in a variety of long-term care settings, improving operational and financial performance. As a director of nursing, I oversaw a community ranked in the top 10% nationally by Consumer Reports Magazine. Before joining Ecumen I led regulatory training for one of the country’s largest continuing care retirement center (CCRC) operators. I am board certified in Gerontology and MDS-RAI certified.

Although, I call my blog, "The Nursing Home Help Desk," you'll find information here that extends beyond the nursing home. In the coming weeks and months I'm gonig to share with you insights, tips, experience and other information designed to educate and empower professionals in the clinical side of long-term care. It's an extremely exciting time to be in our profession, and I look forward to talking with you about this rapidly changing world. Let the fun, learning and information sharing begin.

Tips for Effective RN Delegation in Long-Term Care

Wed, 10 Jun 2009 18:04:00 -0500

By Mary Leber, Director, Ecumen Consulting Services

Effective delegation is important to every profession, but it’s especially important in nursing. Some RNs – due to heavy workloads and limited staff – may be tempted to delegate responsibility to LPNs and nursing assistants before they’re ready for certain tasks. RNs, however, need to adhere to delegation guidelines found in many state’s laws.

Click to download Whitepaper PDF

Overcoming Mistakes on Section G of the MDS: The Most Miscoded Section

Wed, 10 Jun 2009 18:01:00 -0500

By Mary Leber, Director, Ecumen Consulting Services

The Centers for Medicare and Medicaid’s (CMS) Section G of the “Minimum Data Set” is an important assessment tool for reimbursement. The 10 to12 page document requires nurses to spend, on average, four hours per resident assessment, correctly encoding the collected data and observations gathered over a period of days and weeks and then submitting the results to CMS for reimbursements.

Click to download Whitepaper PDF

Ecumen Publishes QIS Whitepaper

Mon, 23 Mar 2009 12:48:00 -0500

Ecumen Whitepaper discusses 10 key tips to help nursing homes prepare for the QIS from the Centers for Medicare and Medicaid Services.

Click to download Whitepaper PDF

10 Questions to Ask When Selecting a Senior Housing Management Company

Mon, 23 Mar 2009 12:43:00 -0500

The professions of senior housing and aging services are customer-service intensive. Customers vote with their feet. As you search for a senior housing, nursing home or a continuing care retirement community (CCRC) management company, ask yourself these 10 questions to help ensure that you find the right
management partner for your customers and you..

Click to download Whitepaper PDF

Tips for Reducing Common Medicare Billing Errors

Mon, 02 Mar 2009 12:28:00 -0600

By Mary Leber, Director, Ecumen Consulting Services

Many in our profession find Medicare to be a Rubik’s cube of regulation and complexity. Combine that with busy employees, large workloads, a lack of a minimum data set coordinator (MDS), and a care center can quickly find that it’s not filing Medicare claims in an accurate, timely manner.

Click to download Whitepaper PDF