Tamar Abell

The world is tired. It’s been a long, hard spring. It feels even longer and harder for long-term care providers and staff. This invisible enemy, COVID-19, has wreaked havoc on the eldercare industry, and we are just now maybe taking a deep breath. The death and illness toll to our residents and staff has been staggering, and while nursing homes seem to often operate in “crisis mode,” this pandemic took us to a new level.

Having navigated a quality of care corporate integrity agreement in my organization and helping over a dozen providers navigate CIAs, people get a little nervous when they see me; trouble has officially entered the room. Clients have learned that when I walk through the doors, I’ll be asking the hard questions: the questions the Office of Inspector General will most likely ask to determine that your compliance program is robust. Certainly, the priorities have shifted the last few months and many compliance initiatives have gone on the back, way back, burner. But now that we are taking a deep breath, we must dust ourselves off and refocus. Compliance is not “another thing I need to do,” but it is the way we should do all things.

It is time to go “back to the basics.” Priorities have shifted these last few months and it’s essential to  conduct a robust audit of the “basics” of your compliance program and perhaps reevaluate priorities and risk areas.

  • Risk assessmentThis should be ground zero of your compliance reviews. When assessing the effectiveness of a compliance program, the real focus must be your facilities risk areas. COVID-19 brought the term “risk” to an entirely new level. It’s time to Monday Morning Quarterback: What did we do right and what did we do wrong? This is not a time to point fingers, but rather be retrospective to better understand our areas of risk and vulnerability. Some specific areas to think about:
    • Compliance committee: Evaluate that the right staff are members of the committee.  Things may look different in your building and you might need different members of your staff participating and advising. The compliance committee under the direction of the compliance officer will take an active role on jump starting your compliance program.
    • Emergency preparedness: Of course, we all have robust emergency preparedness plans, right? This was not a drill or a policy on paper; we need to activate protocols we never dreamed of. Take a close look at your COVID-19 plan. The Centers for Disease Control & Prevention is requiring a full-time trained staff to oversee COVID- 19 prevention. According to the CDC these dedicated positions are necessary to cover all aspects of COVID-19 infection control. I view the role of this individual as the team coach needing to coordinate all the plays.  We cannot afford to having recurring pitfalls because of lack of guidance. This individual must be knowledgeable of the most current regulatory guidelines and delegate to the appropriate team members.

Along with an overall review, take a specific look at contracts. The COVID-19 crisis, unfortunately, opened our eyes to resources we didn’t think we would ever need. For instance, do we have a plan in place for a refrigeration truck as a supplement for body storage? Do we need to work with a local hotel for staff lodging if staffing becomes critical? Do we have a relationship with nursing/ staffing agency for back up?  Work with the compliance committee to determine what other relationships need to be addressed.

As part of the emergency plan, consider a strategy to deal with media. Who will be responsible for responding, and is there a statement prepared or a PR firm to work with?

  • Staff morale: The long-term care community experienced a tremendous loss. As a result of the loss, illness, fear and incredibly difficult work conditions, staffing was often at critical levels. As part of the role of compliance, staffing shortages must be evaluated, and proactive relationships should be encouraged. This can include a plan for community involvement for staff morale. The compliance committee should determine that the staff mental health and counseling needs are addressed by administrations.
    • Family communication: This was an extreme challenge for many facilities.  Residents condition were changing rapidly and there was often a severe staffing shortage. Now is the time to review a strategy for family notifications. I highly recommend there is a designated staff coordinating this plan and implementing it.   This is an area we MUST be proactive and innovative to be sure information is timely and complete.
    • PPE:  If your facility was like most, there was a severe shortage of personal protective equipment. I do not think anyone could have possibly predicted the need and national lack of supply. In order to prevent another catastrophe, facilities should complete a PPE Burn Rate based on your historical most active COVID-19 day.  Take a look at the www.CDC.gov website for more information on calculating the Burn Rate. The website also has strategies for optimizing PPE including disposable medical gloves, eye protection, gowns, face masks, and N95 Respirators.
    • Technology: Now is the time to assess the technology in your organization and its capacity.  Specific areas that rose to the top during this pandemic included:
      • Data tracking and trending: You want an efficient way to track and trend data in your facility.  If you can see trends such as temperatures and oxygen saturation, you could be proactive in addressing a potential outbreak at the facility
      • Efficient line listing for staff and residents: Facilities have multiple tracking and reporting requirements that are very cumbersome. Find an efficient way to track and alert you of testing requirements
      • Resident quality of life:  Does your facility have access to devices so residents can Facetime or Zoom with their loved ones? Residents were isolated from their families, friends, and other facility residents for prolonged periods of time. Make sure your activity staff have enough resources to engage the residents while isolated
      • Telemedicine: It’s here to stay and an approach facilities need to explore.
  • Exclusion checks: Verify that all new hires were checked on the exclusion list. Many providers had a staff shortage and were quickly bringing on new staff in crisis mode.  Also be sure your facility has been completing the monthly exclusion checks for compliance.
  • Disclosure program: Communication during the COVID-19 pandemic was a huge challenge for facilities. Now is a great time to revitalize your compliance hotline. Be certain residents, staff and families know it is an available mechanism report for individuals to disclose, voice concerns, ask questions and get answers. It is important for all to understand that the disclosure program is confidential, and the complaint can be submitted to the compliance officer anonymously.  We want to provide as many resources  as possible to provide an open and transparent line of communication.
  • Training: The general theme for training has been donning and doffing of PPE and COVID- 19 infection control … repeatedly. Take the time to review your planned training calendar and reevaluate priorities. Be certain your compliance training includes falls claims, abuse and neglect, HIPAA, billing, PDPM, etc., and are scheduled or rescheduled, as necessary.
  • Policies and procedures: At the facilities I have worked with during COVID-19, there has been a huge overhaul of policy and procedure. The situation was very fluid and CDC, federal and state requirements were constantly changing.  Be sure your policies and procedures are current and based on the most recent regulatory requirements and staff training reflects this.
  • Code of conduct: In our ideal compliance world, the code of conduct has been read, understood, and referenced by all our employees and vendors. Perhaps now is the time to evaluate the code of conduct and see if it is truly “user friendly.” As we assess risk areas, let’s also assess the effectiveness of our code of conduct — the constitution of our building. My advice: short, sweet and to the point.
  • Dashboard: The compliance committee may consider adding additional components to the facility dashboard based on COVID experiences such as staffing and PPE.  More then ever, quality of care must be under the general umbrella of compliance — not an island off on its own that belongs strictly to nursing.  This is certainly not a new concept, but one to strongly reconsider.

It cannot be said enough — long-term care  is the unsung hero of healthcare. We face harsh critiques, negative media and demanding work environment, but the heroes in long-term care always pick themselves up with resolve and start again. As the saying goes, what doesn’t kill us makes us stronger. Let’s show our strength!

Tamar Abell is the CEO of TBA Consulting Group.