Where perfection is the only acceptable goal.

My experience with owners and operators has been at times both challenging and difficult, but always rewarding.  Some of my best clients, some of whom have even become good friends, have presented hurdles to great care and service.   Some have viewed great care and service as "too expensive."  Some have viewed residents and their families as adversaries. 

I am glad to say that, over time, most of my experiences have turned positive, due to owners/ operator clients either 1) growing to realize that nothing is more important than great care and service for the elders they have the privilege of serving or 2) the recognition that great care and service really is more profitable in the long run than bad care and service. 

Here are my 10 tips for owners/operators to get you to embrace at least one, if not both of these beliefs.


1)      Care and service is not an important thing; it is the ONLY thing that matters. Put nothing ahead of it. Good care and service is the best way to make a profit, and of course it is the RIGHT thing to do. Seek to establish a family environment where care is everyone’s responsibility.


2)      Be transparent.  When things happen, admit it, find the real problem, and solve it.  Denials and cover-ups only worsen the situation. Talk to the family when things go wrong and don’t be afraid to say “we’re sorry.” Try to resolve any problem as early as possible. Do whatever you can legitimately do to avoid lawyers and lawsuits.  You are the client/insured, so do not let insurance carriers dictate your resolution strategies.


3)      Take care of your care staff.  If your caregivers are unhappy, failure is not far away. Do not tolerate anyone or anything that minimizes the caregivers’ critical importance for success, which is defined solely as the best care and service.


4)      Hire the right administrator and ensure that she/he, in turn, hires the best staff and department heads.  Train him or her and ensure that they can work well vertically—"up" to senior management/the owner and “down” to all levels of staff. Constantly monitor how the administrator is doing with residents and staff. If the staff does not like or even trust her, should you?


5)      Have realistic policies and procedures, follow them and hold people accountable when they are breached. Train your staff in them and ensure they appreciate the importance of your policies and procedures.


6)      Know when to say “no” to census. When circumstances change, take the hard steps to counsel with the family and the resident if appropriate when your facility can no longer deliver the care and service required by the resident. Residents and staff need a safe environment for everyone.  When acuity levels exceed what you can adequately provide with the staff you have, everyone is at risk.


7)      Document, document, document. ANYTHING the law or your policies and procedures require MUST be in the record.


8)      Know a resident’s rights and NEVER ignore them. You are privileged to serve them and to maintain their home.  They have every right of a homeowner.


9)      Measure, measure, measure.  The most important indicators are resident and staff satisfaction and turnover. They are the key indicators of how you are doing with care and service. Discontinuity in staff precludes continuity in care and service. 


10)  Regulators are NOT your enemy.  Hide-and-seek is a fine game for children.  It has no place in healthcare, however, particularly when the elderly are involved.


Fort Pierce, Florida



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