Is your nursing home administration prepared to adapt to new laws, meet federal compliance regulations, and ensure the health and happiness of your residents and employees?
Nursing home best practices are guidelines put in place by administrators based on city, state, and federal requirements and the particular needs of the care facility. Often potential challenges are overlooked until the problem suddenly arises or your facility has a major violation. A successful care facility has best practices in place for any scenario.
What Makes a Great Nursing Home?
Great nursing homes ensure the health and happiness of their residents and staff members. Care facilities can become great by staying up-to-date on elder care reform, prioritizing person-centered care, and being accountable for shortcomings in your facility. Great nursing homes go above and beyond the minimal requirements dictated by law and find the best practices to resolve common nursing home challenges.
The Nursing Home Reform Modernization Act of 2021 (H.R. 1985) was introduced into the United States House of Representatives to combat the decrease in quality care for the elderly. This bill would require the Centers for Medicare and Medicaid (CMS) to create a nursing home ranking system and establish an Advisory Council to “study processes and make related recommendations for rankings.” Low-rated facilities would be “subject to progressive enforcement actions of increasing severity until they meet applicable standards.” High-rated facility programs can “have their designations suspended if they fail to meet the requisite standards.”
Is your nursing home ready to meet the requirement of this bill if it becomes a law? Establishing best practices for the unique problems senior care facilities face will ensure your facility is an excellent home capable of holding a high ranking. Best practices keep your residents and staff happy and healthy and keep your facility from receiving violations, fines, and a bad reputation.
What Are the Unique Challenges Facing Nursing Homes?
Long-term facilities, skilled nursing facilities, assisted living, and other outside-the-home elder-care facilities face unique challenges. Operating as both a business and a healthcare institution, there are a plethora of regulations that need to be followed. The Department of Health and Human Services is the federal agency responsible for nursing home regulations, but there are state and city regulations, too.
In addition to government requirements, ethical standards and professional obligations must be met or exceeded. Most important is the nursing home’s responsibility to maintain or improve its residents’ and staff’s quality of life. Each regulation, ethical guide, and quality of care goal can create problems that best practices can solve. Acknowledging these challenges and being accountable for non-compliance is the first step in developing nursing home best practices.
How to Create Nursing Home Best Practices
Establishing effective, evidence-based nursing home best practices that meet compliance regulations and combat facility shortcomings is vital to the success of your facility and the quality of life for your staff and residents. You can develop guidelines by examining the best practices of other nursing homes and additional resources such as professional nursing home organizations and government agencies.
Follow these steps to create your best practices for your facility’s challenges:
- Step 1: Identify areas that need improving or are in danger of non-compliance via a systemic review of your current policies. Look at how other facilities handle the unique problems nursing homes encounter and if there are any new regulations.
- Step 2: Make your best practices reasonable, measured, and obtainable.
- Step 3: Prepare to implement best practices. Schedule training sessions, have a roll-out calendar, and be prepared to encounter some resistance.
- Step 4: Once implemented, reevaluate your best practices to see if there are adjustments that need to be made or if the guidelines are effective.
5 Nursing Home Best Practices for Common Problems
Every facility has its specific obstacles, but there are challenges almost every nursing home shares. These are the five most common challenges and areas of non-compliance in nursing homes today, and some best practices used to fix these problems:
1. Best Practices When Residents Resist Care
What should you do when a resident resists care? First, know that nursing homes and long-term care residents have rights. One of these is the right to refuse treatment, food, medications, and even doctor’s orders. The Nursing Home Toolkit describes this as “combative with care.”
In order to refuse care, the resident must be competent enough to make decisions and informed by the staff of what the care entails and the consequences of refusing it. For example, if a competent resident is refusing medication, the best practices for staff members would be:
- Assessing the reasons why the patient is refusing treatment
- Making sure the patient understands why the medication is prescribed
- Explaining the physical or mental effects of not taking the medication
- Providing the option of alternative treatments
- Documenting the refusal
- Continuing to provide all other services
- Encourage the resident to maintain as much independence as possible
Research shows that refusal of care happens the most when residents are scared, in pain, embarrassed, or don’t understand the need for the care prescribed. Refusal of care is often directly related to the patient’s sense of dignity.
2. Best Practices for Preserving Dignity
Preserving the dignity of your residents is crucial. The more a resident retains independence and dignity, the less they will refuse care and the happier and healthier they will be.
The Agency for Health Care Administration (AHCA) created a Quality Council that chose these areas to focus on and provided some best practices to help the resident maintain self-respect:
Respecting a Resident’s Personal Care Needs
- Grooming and dressing based on the resident’s preference.
- Don’t transport residents in wheelchairs by dragging them backward.
Maximizing the Resident’s Dining Experience
- Avoiding the use of plastic utensils, plates, and bowls.
- Providing napkins instead of bibs if possible.
- Don’t hover over the residents as they eat.
Allowing Residents to Live in Secure Units
- Not allowing residents to wander.
- Not transporting residents in inappropriate attire, like a towel or undergarments.
- Stopping the use of nicknames like “Granny” and “Sweetie”.
Participation in Activities
- Allowing residents to choose their own activities.
- Assisting them if needed.
- Encouraging them to be on the resident council.
Respecting the Resident’s Room and Personal Space
- Respecting the privacy of the resident by knocking before entering and not handling their property.
- Know the patient’s preference for television or radio stations.
- Make sure they receive their own clothes and don’t dress them in someone else’s clothes.
3. Best Practices to End Isolation
Resident isolation was a problem before the Covid pandemic, and it is a more significant dilemma now. Social isolation creates stress and has a major impact on the mental and physical health of the elderly. The best practices to reduce isolation must balance the need for connection with infection risk. There are many ways to help decrease feelings of loneliness and confinement. Some best practices to increase socialization while keeping residents safe include
Focusing on Patient-Centered Care
Keeping the resident and their families involved in decision-making not only helps the patient’s dignity but also encourages socialization.
Encouraging Friendships with Other Residents
This maintains a healthy risk/reward balance. Additionally, the facility needs to provide socializing opportunities through activities like outings and classes.
Educating and Assisting the Residents on How to Use Technology
Many nursing home residents are unfamiliar with new technology, and learning how to use it can be overwhelming. Computers, phones, and tablets can really expand a resident’s environment virtually, which can increase socialization as they have new experiences to share. The resident can also visit family members and friends without increasing their risk of infection.
4. Best Practices for Resident Health Concerns
Every resident in a nursing home has their own individual health issue, ranging from disease to mental impairment to a lack of mobility. However, other health concerns can develop as a result of being a resident in a long-term facility. Patients may become dehydrated, malnourished, and prone to infection and sickness from a lack of sanitation. Nursing home best practices for facility-specific health hazards include:
- Hiring and training more staff. In 2000, there was one Certified Nurses Assistant (CNA) for every seven to nine residents and one CNA per 12 residents during dinner, which made it hard for CNAs to monitor the meals of their residents.
- Introducing better, balanced meal options based on the needs of the residents as well as their preferences and prior diet habits (especially for religious observances.)
- Having a ratio of one staff member to every two or three residents who require help eating. A large part of the malnutrition problem in long-term care facilities is a direct result of patients not eating because there are not enough employees to assist them.
- Ensuring patients have good oral health and dentition, as well as establishing the patient’s nutritional risks, are two vital best practices to avoid malnutrition.
- Proper hygiene and sanitation aid in disease control. Elderly or sick residents are a vulnerable population as they usually have lowered immunity which can put them at risk for infections and viruses. Both the personal hygiene of the residents and staff and the facility’s sanitation needs to be considered vital to everyone’s overall health. Maintaining cleaning schedules and ensuring your residents are regularly cleaned and bathed are some important hygiene best practices. The Centers for Disease Control and Prevention (CDC) have a lot of information and guidelines you can use to build your own nursing home best practices for infection control.
- Seniors need to stay hydrated. Those residents with memory problems will forget to drink water, not remember the last time they did, and can stop recognizing the physical signals of thirst. Staff members need to encourage residents to drink water throughout the entirety of the day. Foods with a high water content should be offered as well as learning your resident’s non-alcoholic drink of choice.
5. Best Practices for the Emotional Well-Being of the Staff
Nursing home administrators need to concern themselves with the mental and emotional health of their staff. Staffing issues are a major concern for nursing homes. Facilities are understaffed, have high staff turnaround, and have untrained or inexperienced employees. Application of some of these best practice suggestions can positively influence the well-being of the staff, improving morale and aiding in staff retention and higher job satisfaction. If your staff feels supported and cared for, your residents will too. Some ways to create a culture of staff wellness include best practices such as:
- Let your staff know you and your leadership team are committed to providing support.
- Understand the stress and grief that can occur regularly. Provide a place to mourn, a space to destress, and mental health professionals or grief counselors.
- Normalize compassion, active listening, and asking for help.
- Hire additional employees with a passion for health care and elder care. Establish regular training in all aspects of each job so that the quality of care improves and advancement is possible.
Nursing homes, long-term care, memory care units, and skilled nursing facilities are responsible for more than just meeting federal and state minimum requirements for compliance. Your facility can be a successful business by taking responsibility for your residents’ and staff’s well-being by establishing best practices for each area of operation.
