Complacence can creep in so slow
It wouldn’t be something you’d know
But it’s there after years
In lots of careers
When you just kind of go with the flow.
Synopsis: I’m a family practitioner from Sioux City, Iowa. I’m slowing my career down, and while my one-year non-compete clause ticks away, I’ve gone walkabout, travelling, working, and visiting family and friends.
My twenty-year tenure as Medical Director of Touchstone Living Center (previously known first as Indian Hills Care Center, then as Indian Hills Nursing and Rehabilitation Center) has come to end during these months of going walkabout.
I came on board in 1990 as a result of the Omnibus Budget and Reconciliation Act, and I found a lot of complacency. I worried then that I wouldn’t know when the same problem would overtake me.
At the first Quality Assurance meeting I established an agenda: falls, pressure ulcers, deaths, hospitalizations, infections, physical plant problems, and personnel problems. At the second QA meeting we discussed the sixty-three falls from the previous month; we looked took a hard look at the five patients with the most falls. I recommended physical therapy, changes in their medication regimen, and changing their rooms. Bit by bit, the number of falls slowly decreased.
I went out of my way to include housekeeping and maintenance in the monthly meetings, and in return received the two biggest pieces of progress. By moving all the patients out of one wing every day, and opening the windows for two hours, we cut in half the number of respiratory infections. By removing the carpeting from one hall, where the patients tripped going out of their rooms, we did away with half the falls.
Over the years, I’ve seen eleven administrators come and go; none of the nursing staff present at the first meeting works there currently. I’ve had excellent working relationships with the staff pharmacist and the Directors of Nursing.
I never thought to ask for a raise, but I received a couple of them anyway. On a few occasions I realized I hadn’t gotten a check for a few months, but it came promptly once I asked.
Influenza struck hard in 1993, with patients dying less than an hour after developing symptoms. Even in retrospect we could have done nothing to prevent the terrible mortality that year. By the end of the flu season, neither love nor money could have bought you amantadine, rimantidine, or a flu test kit. The staff morale plummeted. I hope I never see a flu season that bad again.
The Assisted Living movement cut into the Nursing Home business, and the facility re-invented itself as a rehab facility with one Hospice wing and one Alzheimer’s wing. Over the years, the patients have progressively averaged more severe problems. Still, the number of falls has continued to decrease until some months we applauded single digits. The count of pressure ulcers starting or worsening in-house has dropped, most months to zero.
The death rate continues, not surprising for the patients and diagnoses involved.
My original contract stipulated that I keep minutes of the QA meetings. After roughly 250 meetings, I had a pile of paper a foot thick. I took it to the administrator’s office today and dropped it off.
I know the doc taking over as Medical Director to be solid and sensible, with both feet on the ground. I suspect he will bring a fresh approach to certain problems.
I hope he doesn’t find I’ve been too complacent.
Tags: administrator, Alzheimer's, amantidine, Assisted Living, deaths, Director of Nursing, falls, Hospice, Indian Hills Nursing and Rehab, infections, influenza, maintenance, Medical Director, minutes, nursing home, Omnibus Budget and Reconciliation Act, pressure ulcers, Quality Assurance, rimantidine, Touchstone Living Center