Managing Worker Performance in a Nursing Home Setting

To minimize risk of abuse and neglect, establish employee management strategies that include candidate screening, active supervision, performance management and reviews, coaching and disciplinary action.

While many well-meaning individuals are employed in the care of residents at skilled care nursing facilities, it is unfortunate that there are still cases of abuse and neglect leading to lawsuits and large pay outs.

For example, the estate of a family member who died in nursing home brought a wrongful death lawsuit against a facility in Kansas. The family filed suit when it learned that an employee, on staff for six months without a background check, had repeatedly raped and abused their loved one who suffered from frontal lobe dementia.

In another case, a Georgia residential care facility employee was sued for physically beating a resident on multiple occasions, neglecting to properly care for his needs and forcing him to vote for the owner’s sister in a local election. The plaintiff also alleged that the facility knew about these abusive acts but failed to stop the abuse.

Whether the issue is negligent hiring and retention, failure to supervise, or punishing whistleblowers, poor management issues can create an environment of neglect and abuse.

The U.S. Department of Health and Human Services Centers for Medicare & Medicaid Services (CMS) has rigorous policy requirements for healthcare facilities.  More specifically, facilities must develop and implement written policies that prohibit abuse or neglect through candidate screening, employee training, and incident investigation and reporting.

In Florida, the standard of care establishes a strict set of regulatory standards designed to maintain the health and safety of residents and the minimum standards of care. Any violation of these regulations that leads to the harm of a resident can leave a nursing home vulnerable to state action, criminal penalties, and/or civil liability.

Nursing home employer liability

Liability is not limited to employees. For instance, if an employee caused harm while performing work duties or acting on the employer’s behalf, the employer may be found liable for its employee’s acts.

In Florida, nursing home employers may generally be held liable in five key areas:

• Negligent care leading a resident to suffer injuries from an employee failing to act with a reasonable degree of patience

• Negligence in the workplace through hiring, retention, entrustment, supervision and training

• International acts including stealing a resident’s personal possessions, depriving a patient of their medication or medical equipment, physically or verbally assaulting a resident or subjecting the resident to emotional or sexual harassment

• Breach of contract through abuse or neglect

• Crimes, including nursing home abuse, aggravated assault and criminal neglect as per Florida law

What can employers do?

Organizations should ensure that they thoroughly and rigorously screen their candidates and ongoing employees. It’s also important for employers to create a culture of transparency.  Employees should have various avenues they may follow to report concerns, risks, and/or violations.

Remember to apprise an employee of performance issues, use concrete examples, describe the desired performance, and explain the consequences of continued performance issues when completing this task

Managers should establish ongoing and open lines of communication with employees and residents to stay close to the workplace culture, employee behavior, and the resident experience.

For example, supervisors should conduct regular one-on-one meetings with their direct reports providing an opportunity for their employees to ask questions and identify areas of confusion or concern.  Likewise, managers should conduct regular and documented performance evaluations with their employees.

Managers’ feedback should be honest, transparent, and timely. For example, waiting weeks to correct an employee’s behavior can create liability for the organization and rarely has the intended performance improvement impact. Immediate feedback however, may result in positive supervisor/employee relationships, and improved problem-solving and employee conduct.

Employers should thoroughly screen candidates including national and state sex offender registry searches, drug screening, and identity, employment and education/certification verification.

To better empower supervisors, these professionals should be encouraged to engage in active listening, self-management, self-reflection and non-judgmental communication.

Another important professional development strategy is coaching. This includes sharing knowledge and experience, giving feedback and observations, and using questions to stimulate thinking. Other coaching includes facilitating by listening, encouraging brainstorming, exploring options and consequences together, and allowing employees to find their own conclusions/solve their own problems when possible.

Ultimately, the goal should be to enable employees to increase their self-awareness and confidence, and explore how the employee thinks, feels and responds to people and situations.

To create a structure to this process, elderly care facility leaders should build out documentation to:

• Define a standard

• Specify the violation/performance issue

• Provide the opportunity to correct mistakes/shortcomings

• Provide regular supervision in addition to the performance review

• Review past actions

Further, this feedback should be provided consistently.

Supervisors should choose their words carefully when writing this documentation because others will be reading these reports. Remember to apprise an employee of performance issues, use concrete examples, describe the desired performance, and explain the consequences of continued performance issues when completing this task.

To help determine when to engage in discipline, supervisors should evaluate what went wrong, whether the event/issue has happened before, and then determine if there are resources available to help the employee. In addition, supervisors should ascertain if there is a relevant policy, and what the desired behavior or performance looks like, in addition to knowing the consequences if the issue continues.

Following these best practices, it is possible to significantly decrease the risk of abuse or neglect and foster a positive, productive, and fulfilling work environment for staff and residents.