Long-Term Care Survey Alert

Don't let your own staff undo the facility.

You know that staff with loose lips or an axe to grind can sink your survey. But taking the following proactive steps can help keep your survey record afloat.

1. Don't hire a problem you can't fix. Facilities that do their homework up front will be more likely to hire dedicated employees who are assets rather than a survey disaster waiting to happen. To do that, design the job interview to get applicants to talk about their pasts, suggests Clint Maun, a management consultant and principal of Maun-Lemke in Omaha, NE. "That's the best indicator of how the person will act in the future," he says.

If the resume shows the person changes jobs often, find out what keeps the person hopping around, suggests Maun. Make sure to check references--lots of them, he advises.

"Ask the applicant to sign a form allowing you to talk to the person's past employers, neighbors and landlords--and anyone those individuals mention. It's the second and third dig that usually gives me the information."

Try this: If the applicant's former employer won't say anything except to confirm she worked there, ask him if he'd hire her again for a similar position. If he declines to comment, then say, "It sounds like you're giving the person a negative recommendation," suggests Francis Battisti, a nursing home consultant in Binghamton, NY. If the person doesn't clarify his position at that point, "that speaks volumes."

2. Train staff how to deal with interactions with surveyors. That way they won't suffer performance fright that exits stage left into F tags. "We spend hundreds of hours training staff on pilling and billing--and very little time helping them know how to handle difficult ... human interactions," says Maun. The latter includes confrontational surveyors who try to get people to say things.

Put staff to the test: Conduct "mock surveys where you bring in people whom staff don't know aren't surveyors," Maun suggests. "Give lots of kudos to staff who handle interactions the right way based on training--and recoach those who don't." Ask people who've been in the trenches--nurses, administrators, CNAs--to tell staff how they have handled tough situations with surveyors, Maun advises.

3. Develop a radar system to detect employees with concerns. Ask managers which staff members have concerns or complaints, suggests Maun. The managers "should be able to say 'Sally is saying we constantly work short' or 'Sue says we aren't doing nursing care by the regulations.'" Then have conversations with those people to determine the accuracy of their concerns and take corrective actions. That way, the unhappy staffers "feel like they have some recourse other than talking to surveyors about problems."