10 Tips from the Long-Term Care Trenches

Looking for ways to improve the quality of long-term care your organization provides? Try asking the experts: the clients and families on the receiving end of care. After all, they’ve been there.

CareScout recently convened a consumer panel to hear directly from clients about their long-term care experiences. The panel of five included four family caregivers and one care recipient sharing their stories, and each offered helpful insights into improving the quality of care.

 Although many of these insights may seem obvious, the fact that the panelists emphasized them indicates that they aren’t universal.

Bill’s 93-year-old mother was showing early signs of dementia, but was still taking yoga, art classes, and Tai Chi. Although she still had her driver’s license, she would get lost and it was no longer safe for her to drive. However, the home care agency Bill hired sent a caregiver who couldn’t drive—a big miss. “We had to fire that company,” Bill said. A second company provided a caregiver who could drive Bill’s mother to her many activities. She lived to be 101.

Key takeaway: A careful intake process that includes a thorough review of client preferences and a care plan that incorporates those preferences can inform staffing and ensure those needs being met.

Barbara looked after a friend whose radiation treatment for brain cancer left him unable to communicate. “Many times it happened where somebody would just show up that we never had talked to,” she said. Because Barbara’s friend couldn’t express his wishes, the substitute couldn’t provide adequate care. “It was very limited,” Barbara said. The experience left her feeling very negative about that home care agency.

Key takeaway: Making sure all potential caregivers have either met the client or family or have been thoroughly debriefed can help ensure better continuity of care.

Elizabeth has nothing but high praise for the assisted living center she found for her mother. “It worked out very well,” said Elizabeth. “She was able to really thrive.”
What does Elizabeth attribute this to? “It was something about the atmosphere there and that they cared about and nurtured the residents,” she said. “And they were all treated with dignity and respect.”

Key takeaway: Fostering a person-centered care climate in which every client feels seen and cared for can improve clinical outcomes while also enhancing provider reputation.

Joseph needed home care after a bad fall landed him in a wheelchair for several months. Unfortunately, the first agency he hired sent a caregiver who spent more time on her phone than with him. “She had something other than taking care of me top of her mind,” said Joseph.
He fired that agency and found a second caregiver who Joseph describes as a “blessing” “He was fantastic,” Joseph said. “His attitude was very positive. He was energetic. He was compassionate. He was all the things that you really want a caregiver to be.”

Key takeaway: Joseph put it best. “When you have someone helping you who has empathy, makes you feel better, just being kind, polite … it's a world of difference.”

Bill said the first agency he hired was incompetent when it came to billing the long-term care insurance company. “They had a form,” Bill recalled. “Just fill out the number of hours, the number of tasks that were done, the dates. And they could never get it right.” Bill took over, sending the insurance company his canceled checks and records. “I was the auditor and I always had to fix it,” he said. In fact, the insurance company came to trust Bill’s submissions over the agency’s.

Key takeaway: It isn’t just the quality of care people remember. It’s the processes, too. Get them right.

At her mother’s assisted living center, Elizabeth’s family was always involved in her care. “There was a team approach and we regularly met with each staff member that had a certain portion of her care,” Elizabeth said. “And so we were always informed as to what was going on.”

Key takeaway: Families naturally feel anxious about their loved one’s care. Partnering with them not only helps keep staff accountable but improves the care experience for everyone.

Every member of our panel expressed frustration with trying to find good quality long-term care—including two panelists who work in the industry.
Joseph has been an insurance broker for 35 years and sells long-term care coverage. “When you're searching for a caregiver, it's blind luck if you get someone good,” he said. “What's a reliable rating source – who do you call?”
Philip is an industry authority who has worked with both payors and providers. He and his sisters — one of whom is a patient care director and another a lawyer — searched for care when their father’s health suddenly declined. “We were caught pretty unaware,” said Philip. “I would say we scored a solid D on navigating and doing the best for my dad.”

Key takeaway: Even those in the know may be struggling to find you when needs arise. Strategize to raise your visibility. Options include building your referral base, improving your web site’s search engine optimization (SEO), and joining a provider network such as the CareScout Quality Network that helps care seekers find quality care.

Clients and their families go through a lot. “I was the one who found providers and faxed in the time sheets to the company,” said Barbara. “I was lucky I had a job that let me do all that because it was almost a full-time job.”
“It's a whole different ballgame,” Joseph said about being a care recipient. “I feel basically helpless. It's frustrating. It can be almost depressing.”
“There is an element of trauma that almost everybody experiences when they come up against the system that we currently have in a time of crisis in their family,” said Anne, an industry expert who helped her father at the end of his life. “And oftentimes they will need to spend a lot of time telling their story.”

Key takeaway: Remember that just listening can constitute quality care. When interviewing potential hires, look for great listeners.

Joseph’s first caregiver wasn’t the only home care professional glued to a screen. While Bill’s mother’s main caregiver was very good, “the substitutes were horrendous,” he said, remarking that they would spend more time on their cell phones than with his mother. “They were neglectful,” said Bill.

Key takeaway: There’s no substitute for human interaction when it comes to quality care. Be clear with staff about expectations concerning device usage while with a client.

Not once during our consumer panel did anyone use the words “person-centered care.” Yet every positive aspect of care they called out falls under this highly individualized model of care.

Key takeaway: Every provider will say they provide person-centered care. Differentiate by spotlighting your person-centered care tools to potential referral sources and clients. These may include a dignified intake process, any continued person-centered care training your staff receives, and great notes and communication so that any backup caregivers are fully aware of client preferences.
None of these tips requires a big budget or an organizational overhaul — just the focused care and attention your clients deserve. Take them to heart. They may give your organization the lift you’ve been looking for.

This article is part of a three-part series created from our Consumer Voices panel discussion. Read the other articles:

• What Your Care Clients Want You to Know: Read Insights from Actual Customers

• Even LTC Pros Have Trouble Navigating the System