Matt Sevier is the blogger who writes at Setting The Nursing Home On Fire . His blog has been an inspiration for us. Matt was a CNA at one time; he went on to become a nurse. It was Matt’s experiences as a CNA that led him to his current career: A consultant to poor performing nursing homes.
We asked Matt for an interview and here it is.

1) Tell us what you do for a living- how you became a consultant to nursing homes…what led you to this career; what are the goals of your service; and, to what extent are CNA’s involved with your work?

I grew up in the nursing home industry — my father was the night charge nurse at a local facility and also held an administrator’s license for many years. When I was in college, I started working as a CNA and found that I enjoyed it so much that I switched colleges in order to get my nursing degree. As a CNA, I was intrigued by all the things “they” didn’t seem to want me to know, like quality improvement, financial management, the federal regulations, etc., and after researching all of these things on my own, I came to the conclusion that “they” didn’t seem to know these things themselves.

I then started doing some freelance consulting work on my days off to help facilities out with these issues, and eventually wound up starting a consulting firm last fall. My firm specializes in helping nursing homes with quality improvement and surveys. As far as CNA involvement goes, I do my best to persuade facilities it is in their best interests to allow CNAs to be heard, because they know more about the nursing home and its residents than anybody else does. CNAs are a tremendous, largely untapped resource.

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2) What is the profile of the average nursing home that seeks your services? Are they good places who want to do better, or, are they under federal/state scrutiny for poor surveys and the like?

The average nursing home brings me in because they feel that they have no other choice, due to a lengthy history of poor surveys. It usually isn’t a pleasant thing for me, because I’m an unwelcome visitor bringing up problems that the facility wishes didn’t exist. A few nursing homes call on me because they actually do want to improve the quality of care they provide, and that is always a joy.
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3) Surveys: Most nursing home management literally “freak” out when it’s “that” time of the year. In your opinion, why does this happen? How can this get better? I’ve seen many administrators beef up nursing staffing, demand maintenance staff stay on overtime to clean and paint and dietary depts. are ordered to cook up meals that are not what is usually served. I don’t know too many aides who haven’t seen this phenomenon occur during a survey.

There are two underlying goals here from the administration’s viewpoint: (1) Avoid getting cited for any serious deficiency, because that could result in fines, loss of funding, and negative publicity. (2) A facility’s performance on survey is part of the administrator’s evaluation from his or her boss. The “freakout” occurs because everyone waits until the last minute to prepare for survey. It makes much more sense to keep the facility in a constant state of survey readiness than to go crazy when the window opens up.
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4) At your blog, you often tell readers that involving/educating CNA’s in the fiscal aspects of running a nursing home is productive and helpful. Do you any specific examples of how management can start such a process?

I think the best way to approach this is to educate all staff on the importance of the MDS, because that document the sole determinant of how much money the nursing home makes for each resident. Accurate ADL coding is not the only part of the MDS that CNAs are involved with. The importance of restorative nursing should also be taught — the MDS will pay the facility a slightly higher reimbursement rate for each resident receiving restorative services.

Also, if two different types of restorative nursing are provided to the resident at least six days a week, that would count as low level rehabilitation, which would shoot up the reimbursement rate dramatically. Another area in which the CNA can be involved is with budgeting. I firmly believe that the DON should be open about the budget and solicit opinions from all nursing staff on how it can be improved.

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5) CNA’s often want to KNOW how they can help facilities DO better- in all areas. They also have knowledge about things they believe could make facilities better. How can management draw out this knowledge from CNA’s?
They should ask, but do so actively. By this I mean just ask the CNA what needs to be improved instead of putting up a suggestion box. Asking the CNA what the nursing home is doing right, and what needs to be fixed, takes virtually no time and greatly improves morale.

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6) At your blog I’ve read posts about how you perceive some nursing home managers as looking down upon their aides. Issues such as sitting at a nurse station reading a paper are often things we get “spoken to” about. You advocate that management take a softer approach to this sort of thing. Can you explain why the softer approach could benefit the facility?

In the vast majority of nursing homes, anyone who isn’t a licensed nurse (or doesn’t have a desk job) tends to be viewed as second class citizens and have all of these arbitrary, asinine rules thrust upon them. A softer approach would result in better morale and lower turnover. People who aren’t respected will quit. I have noticed that the turnover rates are dramatically lower at facilities where CNAs are allowed behind the nurse’s station (this rule is a pet peeve of mine) and don’t have all these crazy rules to follow.

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7) Do you believe most Administrators and DON’s truly respect the CNA’s? I ask this because of the turnover rates at so many nursing homes. It’s high. Aides will stay employed at a place that treats them well and respects them- regardless of the pay. Can management do better in this area and if so, how?

Ask any administrator or DON, and they will quickly respond that yes, we do respect the aides, they work hard, I couldn’t do their job, blah, blah,blah…I believe that they truly do think that they have respect for CNAs, but oftentimes the folks who are supposedly respected would say otherwise. Yes, management *could* do better, but I can’t tell you why they won’t.

Perhaps it’s a fear of change — this attitude is prevalent throughout the industry. The first thing that has to happen is a demonstration on the part of administration that they really do care. Perhaps the administrator and DON could work the floor. After that, the things that need to happen are greatly increased staff education, coaching supervision instead of discipline, and a peer mentoring program.

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About resident abuse issues: Do you think CNA’s should have a better base of education on this? The current courses brush over the subject but it’s a problem in so many facilities. How can resident care be better with the limited training CNA’s now receive?

Without training, it can’t be better. Training needs to focus on attacking the root causes of abuse — dealing with burnout, addressing challenging resident behaviors, etc. There is a really good curriculum for this stuff available, and I believe there is a link to it on your blog as well as mine.

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Be sure to visit Matt’s blog HERE: Setting The Nursing Home On Fire