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Disclosure Movement Forgetting Nursing Homes??

Is the disclosure movement forgetting all about nursing homes? I think so, and everyone -- including folks in acute care -- will suffer if we continue to skip over our friends in the world of assisted living, rehab, and long-term care.

Earlier this summer, we reviewed the launch of the much-awaited CANDOR Tool Kit funded by AHRQ. It's a very comprehensive kit, but not one mention of nursing homes! It's all about acute care. See our review here. Then you look at the folks spearheading the "Collaborative for Accountability and Improvement," which is a nationwide effort to promote disclosure. Lots of good people leading this organization (including many of the folks who created CANDOR), but, nobody from the nursing home industry is listed as part of the leadership team. Moreover, when you think about it, all of the celebrated and publicized disclosure success stories have been about hospital-based care.

We are missing a big opportunity.

Nursing homes have huge liability exposure...there are lawyers and law firms who specialize in suing nursing homes. And this liability exposure can potentially blow back on hospitals and physicians as many patients and families are constantly shuttling back and forth between hospital, rehab, and the nursing home. It's a sad day if a) something bad happens to a patient/resident; b) the hospital discloses and tries to do the right thing, yet c) the nursing home does not have a disclosure program, so d) the family gets ticked, visits a lawyer, and halls off and sues everyone who had anything to do with mom's care. Moreover, many clinicians during the course of their careers will spend time in both acute and long-term care settings. Also, many hospital systems, as part of the consolidation in the healthcare industry, own or are acquiring assisted living, rehab, and long-term care facilities. Nursing homes should be a big area for the disclosure movement, but we are not seeing it yet.

Teaching disclosure to nursing homes is not tough, but it's different than working with a hospital or physician's office. You have different terminology, relationship dynamics, and cases within assisted living and long-term care facilities. The customers are not "patients"...they are typically called "residents." The relationship between staff, residents, and families is often much different, and typically much deeper versus an acute care setting. A family may only see or talk with an ER doc for a grand total of 12 minutes and 19 seconds, but they may spend months or even years conversing with staff at dad's nursing home. So, imagine the hurt when staff members, who felt like family, turn their back on the resident and her family when something goes wrong? Unfortunately, some families have a lot of emotional baggage and guilt that can be projected onto the nursing home staff, and this can be especially problematic if something goes wrong. Further complicating matters, staff turnover can be incredibly high at some nursing homes. So, lots to think about when implementing disclosure within a long-term care organization, but, when something goes in a nursing home, residents and their families want the same thing as hospital patients: accountability and honesty. At the end of the day it's all about how would you want to be treated if something bad happened to you or a loved one. This is the message we need to be taking to the nursing home industry.

At Sorry Works!, we have had the privilege of working with many nursing homes across the country and in Canada as well. Moreover, our literature -- The Sorry Works! Tool Kit Book and the Little Book of Empathy --is written for both acute and long-term care audiences. Our content always includes appropriate terminology and cases for both audiences. For more information, e-mail or call 618-559-8168.


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