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Is That Really Any of Your Business

February 15

It has been twenty years since Nutritional Food Labeling became mandatory in the United States, but I can still remember how hard the food manufacturing industry fought the initiative. Basically, they felt it wasn't anyone's business how much saturated fat, cholesterol, sugar, fiber or sodium was in the food items they put on the grocery shelves. Before the Nutritional Labeling and Education Act was signed on November 8, 1990, it was nearly impossible for consumers to make solid nutritional decisions. Today, people take the labeling for granted and they are able to make quick and informed decisions.

I think the business of providing long term care may feel a bit like the food industry did 20 years ago. Healthcare Reform requires long term providers to be much more forthcoming about who actually owns the facility, how long the staff members have been on the job and at what rate are they turning in their resignations. Beginning March 2011 they will need to report this via a national web site that will be accessed by consumers, government regulators and employees. Maintain good tenure and retention and you'll be the facility of choice for both patients and employees, report low retention and you can watch your facility become known for a poor practice and living environments.

Many providers must be asking themselves, is it really any of the government's business how many RNs resigned this year? But of course it is, and these new requirements will change - at least- the face of recruitment and retention within the long term and assisted living arena, and probably all of healthcare delivery.

When it came time for my sisters and me to select a provider for our mother, the first thing I would do was abandon the "family tour" and seek out the employees. I knew that was key. Did they like working at the facility? How long had they been employed there and what made the facility different, better, the right one to select? It was only because of my occupation that I felt this was the most important research I could do. But it did not take long for my sisters, who had taken all the tours at face value, to begin seeing the importance of having access to better labeling for the facilities through the employees.

Because long term care is the fastest growing sector in healthcare and Medicare and Medicaid spends disproportionately on the last years of life, the Patient Protection and Affordable Healthcare Act, or Healthcare Reform, includes many new regulations for this one area of care. No one has indicated if these regulations will bleed over into the reporting requirements for the 6,500 acute care facilities in the United States, but I cannot imagine that it won't eventually.

With the stroke of a pen, successful facilities need now, more than ever, to embrace keeping employees of all generations engaged, happy, productive and, most importantly, on the job. Hiring Managers who have been allowed to blow through staff will need to be held accountable because no longer will it be a quiet fact within the facility- it will be a national statistic.

But staff tenure and turnover is not the only aspect of healthcare reform that is impacting long term care and assisted living facilities. Built into the law are incentives to move people out of long term beds and back home with the family. Community Living Assistance Services and Support (CLASS) is a sub category of the broader Healthcare Reform bill and it provides, on average, about $50 a day for visiting nurses and other direct care providers within the home setting. It is believed that this will keep people out of long term beds, but what it will definitely do is increase the competition for these direct care employees as the business for home care escalates.

By 2014, 38 million more people will have insurance or be covered by Medicare or Medicaid. With so many more individuals covered, there will be a scramble for "Medicare Beds" in long-term and assisted living environments. All facilities receiving government dollars (the great majority) will have to maintain records of complete background checks for all employees. And while this may seem no big deal, it will totally increase competition for the best entry-level employees as well as the balance of the team. Not just in long term care, but all patient care.

One of the biggest areas of competition will be for rehabilitation professionals. The new law has lifted the cap of treatments individuals at long term and assisted living facilities may receive. The reimbursement for these treatments will often times mean the difference between losing money and making a profit for the facility. Since the average employee drives $125,000 in profit for all healthcare facilities, think about the competition for Physical Therapists, Occupational Therapists and Speech Language Pathologists and what having them on staff, billing treatments and staying engaged will mean to the bottom line.

Long term care is the first in line for scrutiny but they won't be the only one in that line. Maintaining a good practice environment has always been one of the most important elements to good patient care, but now the labels are becoming easier to read. The Human Resource function will take on a much greater emphasis as the consumers begin to demand more research when making decisions about healthcare. Being able to recruit the right individual for the job by controlling the recruitment process will become even more important—right along with solid retention programs, great training for Hiring Managers and overall accountability.

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