The State

One of the big concerns in nursing homes is the visit from The State. Periodically (I have no idea how often) the Department of Public Health (DPH) comes in and surveys the records, charts, and files. The goal of the nursing home is to have a survey with no deficiencies.

Ideally, all of us want to give good care. We want to be attentive to our patients' needs, caring in our interactions, manage pain, prevent falls, etc. And, of course, we want to document that we have done all of this without making every visit note sound like every other visit note. We want to individualize the care we give, even when our care plan forms don't always give us enough choice in our check boxes to show that we're doing so.

Some days it feels as though all we do is check off boxes and write narratives. Some days it feels as though we spend more time documenting what we do than doing what we do.

Yesterday, I was "snagged" by The State. As I was leaving a nursing home, a DPH worker stopped me to ask some questions. After telling her I was an outside provider, and thus ensuring that they knew there were hospice patients in the building, she asked a few questions about our patients. One of the things DPH looks at is coordination of care. Does the nursing home staff talk to the hospice staff? Do we collaborate on the care plan? Do we work in coordination or in competition?

While internally hoping that I had checked all the appropriate boxes on my forms and that my narratives were complete, I was pleased to be able to talk a bit about this nursing home. Not just because we do coordinate care, but because the staff in this nursing home are caring and attentive. They give superb care to some very challenging patients. It is one of my favorite places to visit. It was nice to be able to share this outside the circle of my co-workers (who feel the same way) and beyond the nursing home staff (whom we have also told how much we enjoy coming to their facility.)

Still, the next time DPH is in one of the facilities I serve, I hope I slip though the building without their notice.

Signage

On a nursing home door:

"Door is alarmed."

It looked pretty calm to me. Perhaps the calm was a facade.