Who’s on first? Avoid the private duty record shuffle
Automation, assigned duties help
Keeping track of private duty employment records is a nightmare. It’s not just the chore of having up-to-date copies of professional and driver’s licenses, the results of physicals, PPD tests, CPR, and other certifications. It’s also being able to know at any given time what is due to expire for each individual staff member, out of sometimes several hundred.
If that’s not enough, then add the variable and transient nature of private duty work. Some caregivers work roughly the same amount of hours for the same company for years; others only pick up shifts here and there and may go in and out of active employment with an agency.
To complicate matters even more, some caregivers are irresponsible about providing updated information, and they drag it out until the agency has to pull them off cases or threaten them with termination.
"Some fax their licenses in and they write notes on the fax like, This is costing me $3,’ but I don’t care. It’s their responsibility. Some bring a copy in the day they get their new license. You remember those. But the ones you have to beg and threaten . . . I just find it hard to lean on the side of those that don’t accept their responsibility," says Lea Wilson, RN, MBA, director of Southfield, MI-based Henry Ford Extended Care.
Stay up to date
No matter what penalties are in place, some staff members will be lax about sending in updated records. Certain measures, however, will encourage them to do their part and help simply the overall record keeping process. Here are some measures to follow:
• Require acknowledgment signatures.
At orientation, Henry Ford Extended Care requires all new employees to sign a statement that acknowledges the items that needed to be updated periodically for their employment files. It also outlines the consequences of their failure to comply, such as being removed from cases and even terminated.
• Offer bonuses.
Providing one’s employer with information that it must have to be in compliance with federal and state regulations and accrediting body requirements is a core job responsibility. Doing so, however, can be just as difficult for the mostly highly skilled professionals as it is for lower-skilled workers. Mary Milardo, director of Middlesex Home Health Services of Middlefield in Middlefield, CT, finds that the company’s bonus system helps its paraprofessional staff keep up with everyday aspects of their job. It has reduced turnover and encourages caregivers to help keep their employment records current and attend inservices. (For more on Middlesex’s incentive program, see Private Duty Homecare, March 1999, p. 29.)
• Automate records.
The best way to ease employment record keeping is to automate, according to Judy Balaban-Krauss, RN, president of Wellness Home Care in Goshen, NY. Wellness recently converted to the Fastrack Acclaim scheduling and billing system. It allows users to maintain record information for each staff member and generates a monthly report of those with impending expirations.
Although such systems vastly reduce the staff time involved in maintaining records, they aren’t foolproof. For example, Wellness must still manually track inservice attendance. "We keep a log and review it quarterly to see who needs what," Balaban-Krauss explains.
• Keep a tickler file.
Neither Middlesex nor Henry Ford have yet automated their employment records. Both use a tickler system that cross-references various due dates for each employee. Middlesex completes a one-page form for each employee and files it by her month of hire. Henry Ford uses color-coded Rolodex cards.
• Make one in-office person responsible.
With documents for sometimes hundreds of employees coming in from all over, having more than one person responsible for filing and monitoring records will only complicate the process and increase the probability of errors. Recognizing that it takes ongoing diligence, it’s better to assign the task to someone already somewhat involved with the caregiving staff who will not be overwhelmed with the additional responsibility.
At Henry Ford, the duty falls on one of the schedulers; at Middlesex, it’s the office manager. The payroll coordinator at Wellness now inputs employment information into the company’s information system; but once the nursing supervisors have computers at their desks, they will be responsible, Balaban-Krauss reports.
Keep it simple
• Convert to set recertification periods.
One way to simplify employment record keeping is to use a set recertification schedule so that all staff will be on the same cycle. Under an annual system, for example, the CPR certification, communicable disease checks, driver’s license verifications, and other requirements would all be due for every staff member during one month of the year.
While such a system may ultimately be easier to administer, it may require even more effort during the conversion year, to fast-forward all records of existing employees to the selected month, and track new employees that will have short-term record time-lines until they get on the next year’s annual schedule. Using a quarterly system may be easier, Wilson suggests.
• Assess penalties.
Henry Ford generates a list of employees with impending record expirations about 60 days before the renewals are due.
At the same time, it sends a reminder notice to the staff member. If it does not have the necessary updates within 10 to 14 days before their expiration, it sends a strongly worded notification letter to the employee in question, warning that they risk termination.
Copies of the notification letter, as well as documentation of any further disciplinary actions go into the employee’s file and are considered during the individual’s evaluation, Wilson says.
Those who do not comply will at least be removed from the cases they’re currently working. Even if they subsequently provide the needed information, they must come in to the office and meet with their supervisor before returning to work.
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