The result of regulation? It’s all in how you look at it…

Brian Garavalia, Ph.D. makes a compelling case about the relationship between regulation and environmental improvements in long-term care facilities. Hinting that regulation has led the industry to improve the appearance of physical plants, he observes that the resulting improvements don’t necessarily make facility surroundings more homelike for residents. I agree. You don’t judge books by their covers or choose post-acute facilities by theirs.

In an industry dedicated to protecting vulnerable populations, regulation has been a catalyst for improvement. It is also true, however, that highly regulated organizations naturally tend to pull control upwards—to the top—and then maintain compliance through the application of heavy monitoring mechanisms throughout the organization. Hence, we have audits of the audits; and monitors who monitor other monitors. This is true at the facility level and at the State and Federal regulatory level. Any facility that has had a look-back survey understands this dynamic.

So the downside of regulation occurs when a company focuses so hard on basic compliance—measuring quantity, not quality—that decision-making moves away from the bedside and then rests with the monitor.

A quantity-focused company will scrutinize whether this or that form is in the chart, or whether the note is written to reduce risk; and then check to see whether this or that audit was completed before the survey begins.

Instead, a quality-focused company asks whether the whole story of the person is in the record; if a given incident is fully and critically analyzed for root causes by the interdisciplinary team; and whether a personalized care plan is visible. Moreover, its true litmus test might be, “Do we have data to validate that we are doing for residents what we say we will do and what they need most?”

Complex and sometimes conflicting regulations can work against a person-centered approach to compliance.

In such a regulated environment, it’s easy to see how a company might pay more attention to meeting the floor of compliance to please its regulators, and less time on achieving the highest possible quality of care and life that is attainable for its residents. Telling the story can inadvertently reveal information that makes facilities vulnerable to regulatory backlash. Facilities and companies are reluctant to say too much that could potentially make them open to more difficulty.

While it takes a real commitment from their management and staff, the best long-term care companies focus on attaining the best possible quality of care and life for their residents and, within that framework, meets and then exceeds the regulatory requirements.