Is 'person-centered care coordinator' the next must-have staff member?

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Tim Mullaney
Tim Mullaney

Long-term care operators take note: You soon could fail residents, anger family members, increase survey deficiencies, drop Nursing Home Compare stars and lose money unless you hire a Coordinator of Coordinators.

Don't worry, I'm joking — although I understand if you're not laughing. After all, you've read this message about so many other types of coordinators in the past, perhaps most recently regarding managed care coordinators. The Minimum Data Set coordinator already is a crucial player in the nursing home. And, of course, many facilities have long had an activities coordinator and admissions coordinator.

Scheduling coordinator, marketing coordinator, household coordinator for nursing, household coordinator for social services, human resources coordinator and grants coordinator all are titles listed in the most recent LeadingAge-endorsed “Nursing Home Salary & Benefits Report,” published by the Hospital & Healthcare Compensation Service in cooperation with the American Health Care Association.

I understand that long-term care facilities are complex organizations in need of coordination; picking on the number of “coordinators” on their payrolls might be like picking on the number of “editors” working for a newspaper. But I also think it says something about overly complex long-term care regulations and payment systems that there are nearly as many “coordinator” titles listed in the salary report as there are titles with the word “nurse” or “nursing” in them.

That's why I roll my eyes a bit at the prospect of adding any more “coordinators” to the roster of must-have staff members. Yet, I really have no strong argument against doing so, considering that the government is not simplifying nursing home regulations, and patient acuity is rising even as sweeping changes to the healthcare system take root. Contract expert Annie Mix made a very convincing case for why facilities need to have a managed care expert on board. And there are strong arguments for a “person-centered care coordinator” in an article I read last week in BMC Health Services Research.

The Canadian investigators reviewed the scholarly literature to determine what “tools and guides, education and infrastructure resources” are available to help providers and health systems move toward person-centered care. To be fair, they didn't actually use the word “coordinator.” But they wrote that efforts to foster patient-centered care are “too important to be happening off the side of someone's desk,” and “dedicated resources should be applied.” This sounds to me like the rationale for a “person-centered care coordinator.”

Perhaps a more accurate title would be “resident engagement coordinator” — I like how clearly the researchers framed person-centered care as a matter of increased engagement:

“The outcome of this model is that patients and their families are actively and meaningfully engaged in discussions and decisions concerning policies, programs, service delivery and implications of the care provided. The challenge for healthcare institutions is to locate or develop, and implement the mechanisms, tools and resources essential for preparing and supporting patients, their families, healthcare providers and healthcare administrators to effectively and successfully practice patient engagement.”

Many current initiatives, from reducing antipsychotics to large-scale culture change projects like the Eden Alternative, aim to move nursing homes toward a more person-centered care model. Thinking of patient and family engagement as the lynchpin of these efforts clarifies, in my mind, what a person-centered care coordinator would do: namely, ensure that residents and their loved ones are being appropriately and effectively engaged both through culture change projects already underway and through new initiatives.

The job is a big one, according to the researchers. First, there are significant barriers that a coordinator would address and monitor. For example, medical professionals often feel their authority is threatened or simply don't believe that patients have the expertise to know what is best for them, and so they undermine greater engagement, the analysts determined. A coordinator could conduct clinician training and education sessions on how to engage patients and what benefits it brings.

Person-centered care coordinators also could be in charge of operationalizing proactive patient engagement strategies. The study authors identified many methods of engagement, which they grouped under five categories: inform, consult, involve, collaborate and empower. Spearheading a project under just one of these categories — say, a resident advisory council (listed under “collaborate”) — could require a substantial effort. I could see how coordinating all five categories would be a full-time job.

Of course, actually hiring someone to focus solely on patient engagement might be a pipe dream, with margins tight, turnover high and recruitment tough enough already. But administrators who want to enhance patient engagement would probably be wise to read this report and consider available staff resources carefully. The temptation might be to put social workers on the job here, since they already are a touch point for families, residents and caregivers; however, recent research shows they're being asked to do a lot already and wearing so many hats could lead to burnout. (Check out the upcoming May print issue of McKnight's for more on this.)

Boosting resident engagement might in fact be a great opportunity to give more responsibility to an up-and-coming certified nursing assistant with the makings of a manager. Or perhaps an older nurse who wants to transition out of a physically demanding role could take on responsibilities in this area, as this type of work shifting has been shown to have benefits. (This will be another topic addressed in the May issue.)

I'm sure innovative administrators have even better ideas about how to juggle available resources to accomplish goals related to person-centered care. After all, administrators already are the Coordinator of Coordinators. The title sounds silly and bureaucratic, but there's no denying it denotes a skill that is of vital and ever-growing importance to the provision of high-quality long-term care.

Tim Mullaney is Senior Staff Writer at McKnight's. Follow him @TimMullaneyLTC.

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