Long-Term Care

Tip of the Week: Assuring family that you're caring properly for their loved ones

Contemporary Long-Term Care Weekly, October 11, 2007

Showing adult children that you're caring properly for their elderly parents takes perseverance. An occasional contact with families will not be enough to put their minds at ease. Instead, you should make it a habit to provide weekly or monthly updates informing families of the residents' progress and any new developments at the facility that might affect them.

In talking with experts in the field, HCPro has developed the following list of 10 steps facilities can take to make adult children feel assured that their parents are receiving proper care:

  1. Have an open-door policy. Facilities "should encourage an open door so that family and visitors can come and visit unannounced," according to Janis Ehlers, president of The Ehlers Group in Tamarac, FL.

  2. Encourage family involvement. Ehlers suggests assisted living facilities host events in which the family can participate. Inviting families to come for meals also can foster trust, says Ehlers. She adds that families are grateful for programs that involve all generations.

    Fred Tanner, a Sarasota, FL.-based consultant suggests that administrators serve coffee and mingle with family members during dinners. "That certainly lends itself to credibility and helps show that the administrator is hands on," he says. Moreover, if the staff participates in serving the dinner the family can see how the employees interact with residents.

  3. Create an activity bulletin board. "It may seem bothersome to busy staff, but it goes along way in showing that the community is interesting and residents are involved," says Ehlers. In addition, she suggests facilities "show the children ongoing activities that their parents participate in or have available-not just a calendar of events but real activities."

  4. Develop a quality assurance program. Tanner notes that managers should let family members know the standards the facility is trying to meet. For instance, facilities can share with families their food quality standards, including cleanliness and palatability of the food, he says. "They can show whether the food is considered something the residents want to eat."

  5. Hire and retain high-quality staff. "It makes a better impression to have high quality and consistent staff," says Ehlers. She adds that "low turnover of staff is very desirable [and gives] seniors a friend that they can know by name and who knows them." In addition, the staff look professional by wearing clean, pressed uniforms, says Ehlers.

  6. Hold quality improvement meetings. Chris Hollister, president and chief executive officer of Southern Assisted Living (SALI) in Chapel Hill, NC, explains that each member of senior management at SALI has adopted one or more homes. Every other month, each home conducts a continuous quality improvement meeting with the home office representative and three each of the following groups:

    • family members

    • staff members

    • residents

    The residents and family members identify issues they hear from the other families and residents. The group discusses these issues and implements solutions until the next meeting. "It functions very much like a board," he adds.

    Companies should hold a monthly resident council meeting and invite the family, says Wendy Nowokunski, a director with ZA Consulting in Boston. "Make sure the community has some sort of forum for residents and family to communicate their concerns so that you can address them up-front, rather than letting them fester."

  7. Provide frequent progress reports. If the adult child or other family member does not live close enough to the facility to visit regularly, then the facility could provide updates over the phone or through e-mail, says Nowokunski. For example, her friend who lives on the other side of the continent from his mother and receives weekly e-mail progress reports from her facility. "That's a great way to use technology." Even if weekly updates are not practical there should be some primary contact, such as phone or e-mail at least every 30 days, she says. "Sending photos is greatly appreciated too," adds Ehlers.

  8. Obtain resident feedback. Tanner advises that facilities ask residents questions such as what activities they were involved in during the past, what kind of activities they like to do now or would like to do, and their food preferences. "It gets the residents involved mentally and helps them feel like they have some input," he says. Yet conducting resident surveys can become complicated, adds Hollister. Residents are sometimes afflicted with mental disabilities, he notes. "This makes getting lucid, objective customer feedback difficult or impossible in some situations."

  9. Ask the family for input. Family members should be encouraged to attend care plan meetings and tell the staff about their parents' quirks and special needs, Tanner notes. Involving family members also benefits management when it's time to move the resident to a higher level of care, he adds, explaining that an informed family can help convince the parent when it comes time for him or her to move to a nursing home.

  10. Conduct ongoing surveys. "This is something we are just now implementing," says Hollister. SALI used to do move-in surveys and semi-annual resident and employee surveys. Beginning this month, the company will begin sending out about six surveys per home, per month to families and employees. Each survey asks five questions, regarding satisfaction for both families and employees. The survey results will be factored into the bonus plan for site directors. "By going to monthly surveys, we hope to weave customer satisfaction into our culture," he notes.

This process also provides 12 snapshots of the life of a home throughout the year, he says. "It therefore gives a more accurate picture over time as changes affect the home." For instance, new resident care directors, annual rate increases, and problems in food service can all affect a home temporarily. The surveys help the company see how the home recovers or doesn't recover from these changes.

Tanner suggests posting state survey results near the front door. "Family members should take the time to review the latest state survey," he says.

Nevertheless, even if facilities take great care of a resident, their family may not perceive this, observes Hollister. He emphasizes that it is important to realize that satisfaction of family members is subjective. "The final complication is family dynamics," he says. Often, satisfaction is "subject to second-or third-hand information and/or impressions developed regarding an entire operation based on very limited information," such as a 15-minute visit by an adult child who flew in from out of town.

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