IDEAS YOU CAN COUNT ON
GREEN LIGHTS, RED FLAGS An expert examines community resource use—what to watch and why
For all its rewards, senior living is a tough business. What may be toughest for execu- tive directors and similar professionals is balancing the need to embody servant leadership and stay true to mission while running a thriving business. We’re told that business heads need to
be constantly calculating and look at the world through clear, sometimes even cold, eyes to be sure to get maximum value out of everything spent. But many senior living leaders have found
the key to making it work: They realize that keeping a business healthy is part of their stewardship mission; that tracking expenses and hours benefits residents and employees; and that taking care of business adds up to more resources for more birthday cakes and more entertainment and activities—and most of all, the time and peace of mind that makes it possible to do just a little something extra for a resident. Patrick McCormick, CPA, works with leaders to help them get to that point. As a
consultant and partner at Plante Moran, he has 27 years of experience in helping senior living leaders maximize value and quality. In a recent conversation, he gave a frank and informative “highlights tour” of what to watch out for, what to do more of, and how to measure what matters.
Start with the hard part Service creep. It doesn’t sound pleasant. No wonder many associates and even leaders would like to put it out of their minds. “This happens with doctors, too,” Mc-
Cormick says. “They’ll say, let’s get 20 different tests. And you have to ask: How much will that cost? They don’t ask, so we have to ask.” Direct caregivers encounter this all the
time: They’ll give a little extra help in bath- ing, or in helping a resident to the dining room, for instance, and they don’t think of it as an extra, he says—it's just part of the day. But if extras become a pattern, this could indicate a health problem or simply
Consistently giving care beyond a resident's usual level is a warning sign. Document extra services, or you risk overlooking a resident's health issues and overloading staff.
that needs are increasing with aging. You won’t know it’s happening unless you can document the extras. Without that knowl- edge, you risk overlooking health issues and overloading staff. Consistently giving care beyond a resident’s
MAXIMIZING VALUE CHECKLIST
✔ Open respectful dialogue with direct-care workers about their ideas for greater effectiveness.
✔ Re-evaluate your meeting schedule to make sure each is necessary and has the right people at the right time and place.
✔ Hunt for patterns in overtime hours by department to find out where the amount or type of work spills over.
✔ Document when extra care is needed, so you’ll be able to check for patterns. It may indicate resident health or other quality issues to address.
✔ Benchmark food and energy costs. ✔ Make a habit of daily monitoring hours reports.
✔ Look for budget variances and discern their backstories—was it a one- time need, a pattern, a community issue, part of a larger economic trend such as food prices?
✔ Develop a five-year strategic plan and align yearly budgets to that.
usual level is a warning sign, even though it feels like doing a favor. And when it happens, it’s time to step back, find out what’s happen- ing, and get the family in on the conversation, showing them documentation on why their loved one might need to move to a different care level or need other services. It’s critical for the resident and the fam-
ily that “service creep” be documented and dealt with. And it’s just as important for associates. “I often hear staff say they feel like they’re
overworked. So I say, let’s step back and see what you’re doing. Let’s document it.” Caregivers can be reluctant to report that
more services are needed, because they’re concerned those they care for may be charged more. “It comes from being good caregivers and having a big heart,” he says. But it can end up being harmful for the resident and the caregiver in the long run.
The difficult conversation The desire to avoid facing changing needs square-on manifests in many ways. One is reluctance to document. The other is a lack of awareness.
10 SENIOR LIVING EXECUTIVE SEPTEMBER/OCTOBER 2020
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