Nursing Homes Will Be Stronger Than Ever After COVID-19

To all my friends and colleagues in the nursing home and assisted living world, I have the utmost respect and admiration for all of you. I have heard from many of you how difficult staffing has been, how impossible obtaining the necessary equipment and supplies has been, and the under told story of how painful it is for you and your staff to witness such a large amount of deaths occurring with residents and in some cases, co-workers and colleagues. This crisis has pushed many in the long-term care, home care and assisted living world to their limits. But often, when we are pushed to our limits, it really shows us what we are made of.

And …there is a light at the end of the tunnel. Nursing home funding, regulatory oversight and their value in the healthcare landscape will hopefully never be taken for granted again. It may be hard to think about now, but everything you are and will experience during this time will serve as an invaluable learning experience to you and the senior care industry - and really the healthcare industry overall. You will get through this and be stronger, and if we are constructive about what this crisis taught us, the future will be even better for us all. 

The senior care industry will recover and rebound, and I have outlined some areas below that I feel senior care facilities, companies, front line staff, and leaders should think about to ensure the past couple of months were not in vain:

1.       Postmortems: Start making a list of all the issues, processes, systems and departments you need to assess and evaluate as it relates to performance during this pandemic. It is critical to make an assessment of what worked and what didn’t work so that the next time, whether it be a similar or different crisis, you fix things that are broken and do more of what worked. Include your team in this process to make it as collaborative and productive as possible. A good exercise might be for all managers, front line staff and directors to do individual S.W.O.T analysis and look for common themes together. As you know, however, a difficult part of postmortem’s is evaluating who rose to the challenges and who didn’t. If there are legitimate issues with certain employees or departments who could have done better, these issues must be addressed, and in some cases, changes should be made.

2.      Supply Chain: How did your vendors and suppliers perform? Who was responsive to your needs and who wasn’t? What do you need to stockpile for future events to not be empty handed the next time? Check with other facilities in your community and competitors to get their perspective, they may have suggestions and partners who came through that you never knew about and may want to switch to. Did your lab come through? your pharmacy? your food supplier? etc. Conversely, assess what suppliers and vendors came through that offer more services that you can build upon. Make sure to go out of your way to thank and recognize those vendors who came through for you after the crisis, those people are invaluable to your facility and company and these relationships are vital for future crisis.

3.      Staffing: Do you need more per diem staff?, Do you have a relationship with an agency who is reliable? Did you move quick enough on wage incentives?, Were you able to move quickly and manage remotely your staffing plans daily and throughout the week?, Did administrative clinical staff pivot and assist with hands on care?, etc. Much of the staffing dilemma, call outs and no shows probably could not have been avoided – so don’t beat yourself up, everyone dealt with and are still dealing with the same issue. But maybe there are things you can do to solve your overall staffing issues moving forward to make things better – out of the box ideas like paying for child care, offering take home meals to staff, or more strategical initiatives such as profit sharing or housing support (onsite, financial assistance or other ideas), etc. One thing is crystal clear now more than ever, the front-line nurses and nurses’ aides make or break our business. And, the time for disruptive change with regard to recruiting, training and retaining our front-line care staff is now …. or you may not survive.  Band aid remedies to address staffing and recruitment shortfalls simply don't work anymore. Find out what other facilities and companies are doing or did to attract staff during the crisis – did they offer better incentives or do something creative that made them stand out as an employer?

4.      Budgeting: Whether you are a clinical director, administrator, corporate vice president or regional manager, you must think differently about what you need in the future, especially the next 12 months. For example, our hospital peers will for sure be budgeting for more ventilators, PPE to stockpile, etc. Although assisted living and nursing home communities operate on much tighter budgets (dollar amounts), it is still critical for you to think about what you need not only if there is a second or third outbreak of COVID-19, but also what you may need to replenish supplies, staff and/or materials that were depleted during this first outbreak. Clinical managers must have a seat at the table in this discussion. It is my view that too many budgets in health care are developed by individuals who are not as connected to what the reality is on the frontline and therefore can cause gaps in care and supplies like we are experiencing now.

5.      Operational Review: This crisis has forced us to look at things differently such as dining services (eliminating the communal aspect), the need perhaps for more private rooms, segregating populations (infected vs. non infected), remote technology for families to connect to their loved ones, etc. In your postmortem, think about changes you may want to make permanently that helped you manage your facility or operations better regardless of the crisis. For instance, do you (and can you) make more private rooms available, or reconfigure a unit to be more accommodating to patients with infectious diseases? Are there systems related to pharmacy or housekeeping for example that need to be changed to be more response to the new landscape? Additionally, review your emergency management plan…was your current plan practical? What part of the plan needs to be enhanced and amended? These plans are intended to be functional, not just regulatory compliant. Time invested in reviewing yours is time well spent now that you have been through this crisis. You should also think about risk management and legal considerations that you may be or have been exposed to and consult with your attorney/counsel and insurance carriers on situations that require their expertise.

6.      Assess Your Health Care Partners: How well and often did you interact with your hospitals, physicians, home care agencies, transport providers, etc. If you had issues with communication and service delivery, odds are they existed before the coronavirus crisis. Additionally, how are your relationships with local OEM and health boards? etc. I am sure everyone has found these relationships are very important, now more than ever. When the dust settles, think about investing more time in developing these relationships so that people understand your operation and that you have relationships in place to help you with things you can’t possibly get done alone.

Finally, the obvious...take time to thank everyone on your team, in your healthcare community, your patients and residents, their families and any other community members who were there for you during this time. In my experience, when a crisis ended, what stuck out the most to me were the acts of kind, unsolicited generosity and caring from individuals and organizations – it is important to acknowledge them. Like you, they are also heroes whose efforts and contribution should never be forgotten after COVID-19.