Advinia Care

The first time I read the survey history of the building I was about to lead, I counted 77 deficiencies. And if I’m being honest, it was the first time I couldn’t bring myself to read the entire 2567, because it was endless and unlike anything I had ever seen before.

The message was clear—the problems were across every facet of every department, and every resident on census was at risk. It was a CMS Special Focus Facility, one of the nursing homes regulators watch most closely because of a persistent history of quality problems. Staff were exhausted. Families were worried. And everyone had a theory about whose fault it was.

I've spent my career in long-term care on the North Shore of Massachusetts as an LPN, an infection preventionist, a clinical consultant and a Director of Nursing. I've walked into a lot of buildings in trouble. The one lesson that holds everywhere is simple. You can't fix what you won’t acknowledge as an actual problem.

Read the Citations as a Map

In a struggling building, the instinct is to defend, explain, or blame the last leadership team. None of that changes anything for the resident in the bed. What worked for us was treating every citation as a map of where systems had broken down, owning that honestly with staff, and fixing one process at a time. Not a new binder of policies. Processes people could actually follow at 3 a.m. with two call lights going.

That building went on to a deficiency-free annual survey, graduated from the Special Focus program in record time, and earned a three-star rating. I didn't do that alone. A team that decided to stop working around broken systems did that.

Standardize the Process, Not the Person

People sometimes assume consistency and individualized care pull against each other. In my experience, one makes the other possible. Consistency belongs in how we assess, communicate and follow up. Every fall gets the same honest look at root cause, while every change in condition gets reported the same way on every shift.

The one lesson that holds everywhere in long-term care is simple. You can’t fix what you won’t acknowledge as an actual problem.

That structure is what frees a team to think. The plan for a resident who falls trying to reach the bathroom at 4 a.m. should look nothing like the plan for a resident whose new medication is making him dizzy. When teams only have a checklist, everyone gets the same bed alarm. When they have a good process, each resident gets an answer to their actual problem.

The Workforce Is a Clinical Issue

Residents are arriving in long-term care with more complex needs, and the people caring for them, especially nursing assistants, are stretched thin and often new to the field. I spent two years teaching in a nurse assistant program, and the students who stayed were the ones who found someone on the floor willing to teach them. Training and retention aren't HR problems. They're clinical work, and leaders need to treat them that way. Good, invested people grow good, invested people.

For the Next Generation of Leaders

Learn the floor before you try to lead it. Say yes to the unglamorous jobs; infection prevention taught me more about systems than anything else I've done. Treat regulations as a blueprint, not a threat. And take care of your people. Nobody remembers the policy you wrote. They remember whether you showed up on the hard night. My staff may not agree with every decision I make, but they will never tell you I was the DON who refused to work the floor or help with resident care during a particularly heavy shift.

A Word to Families

If you're choosing a care setting for someone you love, look past the lobby. Ask what happens when a resident falls. Ask who the nurse calls at night. Ask how long the nursing assistants have worked there. The answers will tell you more than any brochure.

Long-term care is hard, unglamorous work, and it's the most important work I know. Our elders deserve leaders willing to look honestly at what's broken and patient enough to fix it, one system at a time.