As part of our license as a Skilled Nursing Facility, which allows us to participate in the Medicare and Medicaid programs where the vast majority of our funding comes from, senior care providers agree to be regulated by a comprehensive set of highly detailed guidelines related to every aspect of our operations. To substantiate that we are in compliance of these requirements, each state is required to send in a team of surveyors for the annual survey. When I finally sit down to write about the adventures in long term care that have been accumulating in my head for well over half my life, the name of the book will be, “Oh my God, the State is here.”
Even though the process is highly subjective and uneven, as an advocate for seniors, I am generally in favor of having rigorous standards of care for providers. And while we all have plenty of survey horror stories, it is what we all agreed to when we took the job. It is the standard by which all nursing homes are all measured, and a poor survey can have severe and long lasting consequences. (There is no corresponding set of federal requirements for assisted living. Each state sets its own rules. Think what you will about government’s role in our lives, but having a uniform set of regulations that elder care providers must abide by ensures better care overall). So the annual survey is something we speak of with growing dread as the unavoidable draws closer. Some compare it to a trip to the dentist, or a colonoscopy. I like to describe it as having 4-5 people you have never met living in your underwear drawer for a week; nothing to hide really, but awkward and uncomfortable just the same.
When folks with the matching black rolling work bags finally do arrive- some new to us, some not; it is a stressful process no matter how prepared and confident you are. It seems like surveyors are everywhere for those few days and somehow something unheard of inevitably happens. Even the best employees make mistakes they would never make, or an event that seemed insignificant months ago is suddenly a focus of potential concern. Adding to the fun this year was the Mega Rule, which was the largest overhaul of Medicare requirements since 1991. This included 109 pages of additions and revisions, and over 600 pages of commentary from regulators, with emphasis in nursing, social services, and emergency preparedness.
Survey visits are by statute ‘unannounced’, meaning it is against the law for us to be notified in advance of when they will be here, but you can usually predict it within a few weeks based on past history. However, the survey teams are also learning the new rules, which just went into effect in November, so they were several weeks behind when we thought that we would be here, meaning were standing at the ready that much longer. Not to mention, our beds were full when they arrived, so everyone was as busy as could be when they finally walked in.
So, for all these reasons, I am especially proud to announce that we had the best survey we have had in many years, with just 6 low level citations, well below state and federal averages. I could not be more proud of our team. One positive byproduct of the new survey processes is that they are now relying more on resident interviews and observing interactions with staff, so we feel even better about their findings. A huge congratulations goes out to our entire care team, and a special thank you to: Lisa Hill, Heather Sunagel, Judy Kurer, Debi Taylor, Joan Harder, Randy Lawrence, and Jill Hand for their outstanding work in getting all the new pieces in place. Great job, everyone.
Of course, even with the changes, medical records and documentation are a major part of the review process, so having effective, organized record keeping is an essential part of having our entire house in order; which, thankfully, our Health Information Manager, Brenda Kiefer, had meticulously taken care of. I have been personally indebted to Brenda since my first few weeks at SSC. Prior to me starting, my predecessor had been scheduling the van transportation, and I knew that with my legendary attention to detail, that was never going to work. I asked Brenda to take it over, and she has done a great job with that, and the myriad other duties that fall onto the HIM plate. Brenda recently told me that she has a new opportunity that she wants to explore for her and her family. Please join me in wishing Brenda the very best in her future and thank you for your service to our residents and coworkers. Good luck to you.
I will close by circling back on our Passover weekend, which I mentioned last month as something I really look forward to spending each year with Rachel’s family. While it was certainly a lovely time, it was not otherwise memorable until we got to the Park and Ride in Rockford, IL, where we had left my car before we drove to St. Louis. (Rachel and her kids live in Madison.) Rachel parked outside the lot, so I walked to the car while they got our bags out and said their goodbyes from a great weekend. I pulled the car out and drive down what I thought was the right direction, but somehow missed the exit. I drove around again, but by the third time I am far less than amused because for the life of me I could not find the exit. By round number five (or was it six?) it had occurred to your fearless leader that other people have probably successfully exited the parking lot in the past, so this was clearly my problem, and that the four people who are supposed to love me and support me are wetting themselves with laughter watching me drive around the parking lot, talking to myself using language clearly not intended for a family publication. (The laughter part was confirmed by the tears running down everyone’s faces when we finally made it out.) I think the ‘Paul and the Van Galder Parking Lot’ story is one I can look forward to hearing over and over for years to come.
But it also seemed like a story too good not to share. Happy spring! -Paul