O

ur exposure to ever-increasing liability claims are a societal problem that has great effects on us, how well we sleep at night, and the bottom line of any company. This is evident in the number of lawsuits that pervade our society. It is also evident that the real risk is not in the event but in the cover up—just ask Martha Stewart or Richard Nixon. So what can we do and how do we minimize it?
       One basic fact we have to remember is that when family members put their parent in an assisted-living facility or nursing home, they have a huge amount of guilt; a “good kid” would have mom or dad at home to take care of. Of course that is not possible for many people, but the underlying expectation is there, hence the guilt. How does this guilt manifest itself in a family member’s relationship with the facility in which their parent resides? This guilt means that the worst possible outcome will be assumed. How can a facility make family members feel good about the decision and turn them from hyper-vigilant to allies and friends? Family members need to reassure themselves that their parent is getting the best care possible. As long-term care administrators, it is our job to do that and to relieve them of the knot in their stomachs they get every time they leave their parent. The family members want a warm fuzzy feeling that mom or dad is okay. We are partners in this process. Most long-term care professionals have this attitude, but what can you do to make the residents’ children your partners rather than adversaries?
       Transparency is a key word. When family members have easy access to information on how and what their mom or dad is doing, they will get a great guilt relief. They no longer assume the worst but go from caregiver to friend when they talk to or visit their parent. The Elite Care Technology Family Portal (Elite Care, Milwaukie, Ore)—pictured to the left—provides family members access to automatically collected information through the Internet. This is only available if the resident gives permission, of course. Access is via a secure log-in code and password. There are 2 screens; 1 gives them a live view of where their parent is at the moment, how long he or she has been there, who is in the room with him or her, and whether there are any alerts pending. The second screen gives them 6 graphs. It covers alerts, activities participated in, movement, socialization, weight, and sleep for any time period. When you click a bar in each graph, it provides various details, including:
       • Alerts: Shows how many and what types of alerts, how long it took the caregiver to respond, how much time the caregiver spent with the parent, etc.
       • Activities: The type of activity, how long it was, who else participated, what staff was involved, etc.
       • Movement: Shows details of where the parent spent the day by room and how long he or she was there
       • Socialization: Shows what percentage of waking time the parent spent alone, with a caregiver in his or her room, out in common area, etc.
       • Weight: Shows how much time the resident spent in bed, how often he or she got up at night, how well he or she slept, and whether there were any weight changes
       • Sleep: This gives details of how much time the parent spent in bed and includes alerts and who was in his or her room and for how long.
       This kind of information is extremely comforting and powerful for family members. They feel they know more about their parent’s day. They can talk to the parent about activities. How many times does a resident say to their family member, “I am bored, I never get to do anything”? With short-term memory loss, the resident may not remember that he or she went on a great outing yesterday. The Family Portal information, however, shows what happened, and the family member knows about it and can make conversation with the parent.
       On occasion, a family member might find that something is amiss. This gives them the opportunity to be a partner with the long-term care facility by pointing it out and getting it corrected. Other things to consider for reducing liability exposure:
       • Responses to resident alerts need to be executed in a timely manner. Time of staff response and length of time spent with the resident need to be recorded as well. Elite Care’s “CARE” system technology also provides graphs on response time.
       • Assessments need to be done carefully and with great thought. Then, days later, someone translates that into a service plan. Because that person is human, things get missed. This means that a real source of risk is introduced. There is little excuse for this, as there are many software packages that can create a service plan to ensure nothing is overlooked.
       • In the long-term care environment, where turnover is up to 100% annually and personal staff accountability is low, we have to view our employees as potential problems. Employees embellish incidents to gain the whistleblower status while not taking responsibility for their own actions. The common response by an employee, who is questioned after an incident, is that he or she was never shown or trained, that everybody did it that way, and that it was the facility that was at fault. If staff members are not committed to the organization, why should they take the blame?
       • Staff is hired and given basic training. But the training is often late and overlooked. Having a good training and reminder system and documentation protects you from the rogue employee who looks to make life more dramatic. Staff members need to know that you have accurate records that document what happened, who was responsible, and whether they were properly trained.
       • When an event like a fall occurs and needs action to follow up, it is too easy to do the job halfway. Proper follow up has to be done and documented. Task lists need to be generated to make sure that all the Service Plan activities in daily living (ADL) are done for each resident.

Conclusion
       Attorneys need to feel that you are not an easy target, especially for punitive damages. You need to be able to show consistent, quantifiable behavior that is well documented.