Latest / The Shift Ahead with Ken Bell / The Respiratory Risk SNFs Miss with Al Hoak
Transcript
- speaker-0: For example, pulse oximeter. They may be in failure because carbon dioxide is building up as a component of respiratory failure that eventually sends them over the edge, which means the resident goes to the emergency room. speaker-1: Mm-hmm. I'm Ken Bell with Careability, and this is the shift ahead. Five minutes, three questions, and one expert, helping operators and clinicians prepare for what's coming next. Let's get into it. As both a respiratory therapist and a nursing home administrator, what do you think SNF leaders still misunderstand about respiratory care? speaker-0: A lot of them also underestimate the need for respiratory therapy. And really, it's important that it falls under and collaborates with medical directors or physicians. Case in point, 45 to 55 percent of residents in SNFs have a chronic lung disease. That's not to mention the other percentages that have congestive heart failure. So both of those really attribute a lot to the need for respiratory therapy. but also to really get the administrators in line to pursue this so that there's adequate nursing training, which is paramount, because a lot of the nurses in the SNF setting are LPNs or LVNs. They're managed and overseen by RNs. The one thing that I see and have seen over my years of experience and also in the practice is there tends to be a big gap between administrators who are not clinically Trained that have a big gap between what's going on clinically versus operational. The big gap is the director of nursing is saying XYZ, but the administrator that doesn't have a clinical background is saying ABC. So there's never a convergence of those folks really getting together and saying we need to do this to improve our outcomes with respiratory patients. The director of nursing has other issues she needs to address and putting out fires. While the operational side of an administrator that doesn't understand fully the clinical side of it really gets put in a dilemma. And they leave within a year. So you really get stuck in a point where you don't advance because you're constantly replacing people that have left. speaker-1: What's one practical change a facility can make to identify RT needs earlier and then keep residents from handing it back in the hospital? speaker-0: Excellent question. So to look at this as a complete and concise comprehensive program, it really initially starts with training and education. That's the tip of the iceberg. Of course, experience base also comes into it. So clinical knowledge, clinical expertise, and background, piggyback on top of that to make it stronger. So when we look at a comprehensive program, is understanding the assessment, the tools at your disposal, but also Having the knowledge and clinical base to take action. Recognizing when a person is going into failure is really critical. However, it this takes years of understanding how to assess the person for that particular complex disease and not assess monitors or pulse oximeters or anything else. Assess the person. speaker-1: Based on all your expertise in respiratory therapy, your history as an administrator, what is the next big shift that healthcare leaders in our industry should be preparing? speaker-0: The other thing that really comes into play, and I think this is critical from all levels, is turnover. There needs to be a shift and a real concentrated shift on reducing turnover. And these are statistics that are derived from CMS directly. Now, when we look at skill nursing versus the entire workforce, now we're looking at 82% turnover. The important piece is that CMS is recognized that five star facilities. Have a lower turnover. And that's primarily in due because of their training opportunities. So it's important to have training and education for the nurses to be able to manage those turnovers adequately, but also increase your revenue base, eliminate those travelers, and really develop your staff that exists. So when we look at if nobody really owns respiratory therapy in your building, what I look at is you're going to have. Ongoing transfers to high level of care. You're going to be sending them back within the first week. Readmissions are critically high, particularly when staff is not well prepared, well educated, and trained to manage chronic lung disease referrals and congestive heart referrals. If you're constantly putting out fires, you're not moving forward.