Daily Editors' Notes

Reducing emotion in long-term care

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Elizabeth Newman
Elizabeth Newman

Most people in my life have heard me nattering for the past month about a book called “The War for Late Night: When Leno Went Early and Television Went Crazy.” It's a great book about business, television and personalities. And the audio version is 16 hours, hence my constant updates to my husband or coworkers about what I listened to that morning or evening.

What I think will strike a cord with many people is a section where Conan O'Brien's ratings are not great and Jay Leno is being moved back into the 11:30 p.m. (Eastern Time) slot. What comes up over and over in the book is how “The Tonight Show” was Conan's dream. To be clear, I love watching Conan O'Brien, wherever he is. Leno is...fine. What ultimately comes across him in the book that, in addition to loyalty to NBC, he was a man who wanted to work, and who talked about staying on the job until the lights went off. In the arc over how Leno was destroying Conan's dream, what is conveyed is the bafflement that Leno felt because he saw a job dependent on ratings as well, a job.

I have the same thought occasionally when talking to long-term care providers or vendors. Long-term care may be a calling, but it's still a job, and it's an industry that would be served by a reduction of emotion. That's especially true when discussing the government, which is called out in histrionic terms fairly often.

Long-term care providers often talk about the Centers for Medicare & Medicaid Services in terms a teenager would talk about a parent — “He doesn't understand; she's a terrible unfeeling blank” — as opposed to what it is, which is an entity that makes the rules and pays the bills. It's not personal. The residents may be the customers, much as the way television viewers were the customers for Conan, Jay, Johnny Carson, et al. But it's the government, or NBC, that makes payments — in the latter case, spoiler alert, about $45 million to Conan in 2010 as severance.

This analogy also came up in a webinar yesterday, when speaker Zach Lahey, a research analyst, discussed how automated absence managers are worthwhile because they objectively tell operators who has called out. (This was in the context of an Affordable Care Act requirement, which takes effect in 2015, where providers are required to start providing health insurance if they have at least 50 full-time workers, with certain exceptions.)

“It's about making the right decisions, having important conversations, as well as being transparent with employees,” Lahey said. “Some could interpret this about organizations being cold-hearted, about whether to provide employees with health insurance or not. But it's really about a conversation about hiring.”

No one wants to promote operators becoming cold, or finding new and creative ways to play whack-a-mole with low-level employees. But we – meaning McKnight's, administrators and industry titans – would all be served better by talking more about how nursing homes are a business. That cuts both ways: We can't tell people to live on the good feelings from serving seniors and then be surprised when they leave for a job in retail. Similarly, scheduling should be objective. Good shifts shouldn't always go to the scheduler's friends, and there shouldn't be high overtime costs because it's just easier to slap the same CNA on back-to-back shifts.

Conan O'Brien ultimately went to cable, which I see as analogous to a facility that transforms into private pay assisted living. In both cases, the result is a smaller, niche audience, but they are better fits, and the bills still get paid. 

Elizabeth Newman is Senior Editor at McKnight's. Follow her @TigerELN.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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