Long-Term Care Survey Alert

Preempt complaints before they trample your survey record.

Every facility has dream families and occasional nightmare ones. But either way, you can go a long way toward improving care and avoiding F tags by implementing systemic strategies designed to support all family members.

Step No. 1: Every facility should have a plan for meeting family needs across the board "whether the family is happy with the facility or has a hair trigger or is grieving or angry," counsels attorney Loretta LeBar in Louisville, KY.

And that plan should address a chief complaint from families: Administration doesn't take time to answer their questions and address their concerns, says Lebar.

Avoid this mistake: The worst set-up is one where the administrator has to handle every family complaint, although the administrator should know about the complaints, says LeBar. But if a facility has 50 or more beds, the administrator won't be able to personally manage every complaint, LeBar points out.

Instead: Empower staff to handle the complaints, LeBar suggests. Give them "permission to listen to a family person's problem." If it's not a problem that requires immediate resolution, the staff person might say, "I'd like a little time to think about this and find the best person to answer the problem. We have a daily stand-up meeting and the managers there will know how to handle this, etc."

Then the staff person and care team, if needed, has to follow up until they help resolve the complaint, emphasizes LeBar.

Common example: A family complains their resident can't sleep at night due to noise. The facility has tried various environmental adaptations, including putting the resident in a quiet room down the hall. As a next step, the care team might take a look at what's going on with the person, says LeBar. For example, a medication may be making the person unable to sleep -- or the timing of family visits or how they go may be keeping the person up at night.

Staff management gem: Identify staff people who are good at handling certain issues involving families, suggests LeBar. "The social worker may be great at dealing with complaints about lost or stolen property. Another person may be good at understanding complaints about medications or making a person feel comfortable in a room."

Step No. 2: Follow up after a negative event. Consider doing "post-event" surveys to see if families are satisfied with how the facility handled their resident's fall or unexpected hospitalization, as examples, suggests Steven Littlehale, ARNP, MS, chief clinical office for LTCQ Inc. in Lexington, MA. Then the family doesn't feel as if no one at the facility listens or cares, prompting them to call a plaintiff attorney, which can start the survey ball rolling. Often attorneys suggest the family lodge a complaint with the state agency, observes Littlehale.

Listen up: "It's often observed that plaintiffs just want someone to listen to their story," says Joseph Bianculli, an attorney in private practice in Arlington, VA.

Step No. 3: Teach staff to avoid judging families. That's important, because family members who feel judged by staff can end up harboring a grudge against the facility that triggers them to file a complaint.

For example, Alois Alzheimer's Center teaches staff not to judge families' choices and responses, reports Susan Gilster, PhD, RN, executive director of the facility in Cincinnati.

Staff should realize that it's a difficult situation for many families admitting a resident to the facility, adds Susan LaBelle, MSN, RN, senior consultant with LTCQ Inc. in Lexington. "You don't always know the history and dynamics and events that led to the admission or what's affecting their response to the situation," she says.

Step No. 4: Offer education and social support for families. Doing so helps families become more resilient and engenders appropriate hope. Alois Center hosts lots of social events and educational sessions for residents' families. The latter include "every topic you can think of," says Gilster, ranging "from new research on an Alzheimer's vaccine to how to spend quality time with a family member who can no longer talk."

Step No. 5: Refer struggling families for outside help, when needed. Not all families are created equal in their ability to cope. That's why you need a system in place to refer families with issues or crises that the facility staff isn't equipped to handle, which is what Alois Center does.

How can you help prevent a family from feeling singled out by such a referral? Inform all families at admission that the facility has a family counselor and services available to help them with the transition and issues that arise when a loved one goes to a nursing home, suggests Francis Battisti, a social worker and nursing home consultant in Binghamton, NY.  "Introducing the idea prepares families for receiving the service, if they need it," he says.

Tip: One of the best ways to make referrals is to "tap into some of the pain in the family," suggests Battisti. Then let them know there's help available.

Editor's note: For tips on how to prevent families from abusing a resident -- and how to detect signs of abuse and rough handling after an offsite visit with the family -- see the next Long-Term Care Survey Alert.