Policies and procedures at senior living and care organizations are the foundation for quality assurance and regulatory compliance. Such policies and procedures are in place to ensure the organization’s frontline staff – whether at independent living, assisted living or skilled nursing facilities – all are following certain processes that ensure the safety and health of all residents.
These guidelines also are an important part of an overall risk management program, helping to protect senior care providers from liabilities. But did you know that some actually may be detrimental to an organization by increasing its risk to exposure?
The reality is, each policy and procedure will be reviewed carefully when a liability claim is presented that notes a breach in the standard of care. If this occurs, then you will be expected to prove that the individual involved with the claim followed appropriate procedures and documented accordingly. You also will be expected to show that your organization’s policies are up-to-date and accurately represent the care being provided by staff members.
Unfortunately, this isn’t always the case. Rather, there’s often a disconnect between how the policies are written and how the staff operates. For example, policies and procedures may create risk when they are:
- Philosophical and written as best practice guidance rather than defining steps of a clear process;
- Disconnected and written as a matter of compliance but never implemented into practice or explained to frontline staff;
- Impractical and not written in direct, instructional language;
- Too rigid, by using absolute language, such as “always” or “never” or accounting for a specific timeframe;
- Inaccessible to staff, such as being maintained in a shared drive where most staff members do not have access.
Several ways exist, however, for community and facility directors, or those in charge of these guidelines at the organization, to address this.
Collaborate with staff: The first step is to work with frontline staff to ensure that policies and procedures are accurate, realistic and consistent across the organization. After all, nurses and other caregivers are the ones who are responsible for the residents at the facility and know what it takes to ensure the safety and health of residents.
For instance, if there’s a policy that states that a caregiver must check on a resident within a certain amount of time to help avoid elopement or a fall, then caregivers know that frequent check-ins may not be the most effective strategy to prevent an incident. The policy instead should direct the care team to develop approaches that are most effective for each resident, with considerations to their individual preferences instead of requiring an intervention that likely will not be effective for most. By doing this, both the staff members and directors will be confident in, and understand the importance of, the organization’s policy.
Review at staff meetings: If not already in place, senior living and care facilities should get into the habit of reviewing policies at regularly scheduled staff meetings.
Suppose that one of your policies states that a resident should not experience weight loss unless an unavoidable reason exists. Take the time during a staff meeting to explain what those reasons may be so that everyone at your organization is “on the same page” and understands the reasoning behind this policy.
These meetings should take place throughout the year and serve as a refresher for staff. Procedures that pertain to high-risk areas should be reviewed more often.
Update on a regular basis: New procedures often are implemented to create certain efficiencies or to be compliant with industry standards. The problem arises when those new procedures fail to be reflected within the organization’s written policies.
So, let’s say your facility changes how food is served to residents. This process also must be updated within your company’s policies.
There also are cases in which an obvious or known process, such as how to transfer a resident from a bed to a chair, is not included in the policy but should be.
Get into the habit of reviewing written guidelines on a regular basis to ensure all procedures are up-to-date and documented.
Hold educational sessions: Facility directors should hold orientation classes and ongoing education sessions for all staff members. It is important to remember that, during these sessions, staff must be taught using the actual policy and procedure, such as procedures around wound care or medication distribution. Although there may be a few ways to do this, and all may be right, nurses and caregivers should be following the process according to the written policy.
Education is critical for both new staff members and those who have been with the organization for a long time. Similar to reviewing guidelines at staff meetings, ongoing educational sessions ensure that all frontline staff are following procedures.
By putting the above tactics into practice, facility directors at senior living and care organizations can ensure that policies and procedures do what they were originally meant to do, ensure the organization is delivering on its promise of quality care and safety for all residents, and support defensibility in the event of a claim. It will be a win-win scenario for both residents and the organization.
It is also recommended that you consult with your organization’s insurance broker or risk management consultant, who can help you navigate the above strategies.