INCREASING SAFETY, MANAGING RISK.

The four-letter word that makes every provider shudder, risk diminishes only with safety awareness heightened to the max

BEFORE CRIMINAL BACKGROUND CHECKS BECAME STANDARD INDUSTRY PRACTICE, A LONG TERM CARE administrator in Illinois paid $15 per inquiry for such checks on potential hires for the facility. Management ordered the inquiries halted for budgetary reasons. A few months later, facing holiday staff shortages around Christmastime, the administrator hired two new aides to help round out a skeletal staff.

"I did the registry checks, the reference checks, everything came in fine," recalls the administrator, who asked to remain anonymous in our reportage. "I came back in on Monday--Christmas was on Sunday--and got a report from [a resident's] family members that their mother had been sexually abused Christmas night."

A year later, in legal proceedings over the incident, the administrator was summoned to give a deposition about the center's hiring practices. In fact, it had been discovered that one of the aides hired did have a record of abuse. Because the administrator cited that he was not permitted to perform criminal background checks, a decision with which he disagreed, he became a key witness for the plaintiff. Management admitted liability and paid $1 million in damages awarded the plaintfiff.

That story comes as no surprise. You know the consequences. Fail to keep a resident safe and face a nightmare: staff reprimands, fines, liability--with no end of legal and compensatory costs, even potential regulatory shutdown. A single incident involving compromised safety among residents can tarnish an otherwise impeccable record of caregiving. And you must keep staff safe as well. Employee downtime from physical or psychological harm is bruising to morale and teamwork--and the bottom line.

Ensuring the well being of every resident and worker demands the convergence of several factors including effective design, maintenance, and vigilance. As a starting point, good planning can ease many potential perils--such as slippery surfaces, fire hazards, or inappropriate wandering by residents (see" 10 steps to safety," page 17). Detail-oriented maintenance programs can include periodic safety checks designed to pinpoint and alleviate additional dangers. And vigilance, instilled by solid safety awareness and promotion programs and specific training, becomes the 24/7 responsibility of every provider.

Rich Blackburn, president of Eldercare Risk Management in St. Charles, Ill., makes a business of evaluating safety concerns and potential risk in a range of long term care environments. At a basic level, suggests Blackburn, facilities should look at safety problems and care-issue problems as part of their quality-assurance programs. Safety committees become an integral, critical part of the mix, according to Blackburn. "Good basic quality assurance programs mean identifying problems and rectifying them at the time," he says.

SAFETY FIRST, BY COMMITTEE

Given the enormous care demands, staff shortages, and resulting time constraints placed on aides and administrators, how can you ensure that common sense …