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NaCCRA Forum: Assisted Living & Skilled Nursing

Reporting of variances in the healthcare areas
Leslie Durr

Another request for information about what happens at other CCRCs:

Does the Board of a non-profit CCRC receive reports from healthcare areas?

Is there a risk manager and if so, does the RM get reports of variances, i.e., things that should have happened but didn't (missed dose of medication) or things that happened but shouldn't have (a broken lounge chair not replaced promptly that led to a resident/patient having swollen legs)


Geoffrey Hughes

Leslie Durr, I'm wondering if your 5/18 question is really asking about the what information the Board of Directors gets, or do you mean the Resident's Council or Healthcare Committee? I guess it is a question of scale, but for a Board of Directors to be involved with such granular detail strikes me as micro-management. Does your community have certified nursing home administrator? I would think that individual would be responsible for monitoring such reports.

Leslie Durr

Yes, sorry.

I was asking if the Board gets information at a level for them to fulfill their fiduciary responsibilities or are they window dressing who are feted for lunch or dinner.

The real question was if there is a designated risk manager. That would not be the healthcare administrator since there might be competing motives: one to identify variances so the system can self-correct and one who has a vested interest in everything looking good.

And a third situation arises when the CCRC has eliminated an accreditation agency which can keep "eyes" on a system. How does the system self-correct?

William Samuel

I can't respond in a lot of detail. We don't have anyone called a Risk Manager. At our Corporate Level over the three communities we have, there is a person whose title I cannot readily find who is responsible for accreditation and quality assurance, so that would be our position that I think corresponds to what you are asking. He was previously the Healthcare Administrator at our community, so he is very aware of the areas you are particularly talking about. All three of our communities are CARF accredited and are up for CARF review this year. I think the Board gets a lot of information, but I don't know exactly what. It does have a committee that deals with compliance issues.

Bill Samuel, Ingleside at King Farm, Rockville, Maryland

Leslie Durr

Thank you, but that would be the healthcare administrator who has told nursing staff "don't tell residents we don't have enough staff."

Administration IS the problem. What can be done?

Geoffrey Hughes

You clearly have a problem with “philosophy” if even one administrator is sweeping things under the rug rather than encouraging transparency. But the flip side is that residents have to be realistic about the nationwide supply problem with CNA’s and nurses of all levels. Only changes in immigration and education policies will address the macro problem. At the local level, Goodwin Living in Northern VA has established relations with several local nursing programs, whose students do a “rotation” through our various levels of care.

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