Selected Podcast
Managing Risk in Long Term Care and Senior Living Settings
Health care risk management is a very diverse field and when you meet one risk manager, you meet one risk manager. One size does not fit all. This podcast series will look to discuss risks inherent to a variety of areas in health care. The first of the series will explore the unique challenges of health care risk management in the skilled nursing care, assisted living and independent living settings.
Featuring:
During his twenty-three years as an attorney, Mr. Allman has focused his career on general health law, including all areas of regulatory compliance on the federal and state levels, healthcare risk management, and litigation. More specifically, Mr. Allman’s has provided expertise in areas of strict government regulation, such as Stark, Anti-Kickback Statute, False Claims Act and HIPAA, as those matters become increasingly complex in today’s environment. Mr. Allman’s clients have included major regional medical centers, small community hospitals and individual physician offices. Mr. Allman is also a frequent lecturer to physician groups, residents, nurses and risk managers on a variety of healthcare topics. He has published articles on a variety of healthcare topics, including HIPAA, licensing matters, e-Discovery, Healthcare Reform and was a contributor to the ASHRM Healthcare Claims and Litigation Playbook.
Mr. Allman is a Certified Professional in Healthcare Risk Management (CPHRM), a Distinguished Fellow of the American Society for Healthcare Risk Management (DFASHRM), a Past President of the Michigan Society of Healthcare Risk Management and has served as the Chair of the Advocacy Task Force for the American Society for Healthcare Risk Management (ASHRM) from 2012-2014, on the ASHRM Finance Committee in 2018 and 2019, and the ASHRM ERM Task Force. In addition to his current activity with the ASHRM, he is also an active member of the State Bar of Michigan – Health Law Section and the American Health Lawyers Association. Mr. Allman graduated from Wayne State University Law School in 1996 and Hope College in 1992.
Chris Allman, JD, CPHRM, DFASHRM
Christopher Allman is the Vice President of Compliance, Integrity & Risk Management at Trinity Health Senior Communities, located in Livonia, Michigan.During his twenty-three years as an attorney, Mr. Allman has focused his career on general health law, including all areas of regulatory compliance on the federal and state levels, healthcare risk management, and litigation. More specifically, Mr. Allman’s has provided expertise in areas of strict government regulation, such as Stark, Anti-Kickback Statute, False Claims Act and HIPAA, as those matters become increasingly complex in today’s environment. Mr. Allman’s clients have included major regional medical centers, small community hospitals and individual physician offices. Mr. Allman is also a frequent lecturer to physician groups, residents, nurses and risk managers on a variety of healthcare topics. He has published articles on a variety of healthcare topics, including HIPAA, licensing matters, e-Discovery, Healthcare Reform and was a contributor to the ASHRM Healthcare Claims and Litigation Playbook.
Mr. Allman is a Certified Professional in Healthcare Risk Management (CPHRM), a Distinguished Fellow of the American Society for Healthcare Risk Management (DFASHRM), a Past President of the Michigan Society of Healthcare Risk Management and has served as the Chair of the Advocacy Task Force for the American Society for Healthcare Risk Management (ASHRM) from 2012-2014, on the ASHRM Finance Committee in 2018 and 2019, and the ASHRM ERM Task Force. In addition to his current activity with the ASHRM, he is also an active member of the State Bar of Michigan – Health Law Section and the American Health Lawyers Association. Mr. Allman graduated from Wayne State University Law School in 1996 and Hope College in 1992.
Transcription:
Prakash Chandran: Welcome to the ASHRM podcast made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare throughout enterprise risk management. You can visit ashrm.org, that is A-S-H-R-M.org/membership, to learn more and become an ASHRM member. I'm Prakash Chandran.
When it comes to long-term care for seniors, the image is often an all-in-one facility that serves both the health and lifestyle needs of the residents. But catering to the wide range of abilities, interests and medical conditions also means a lot of moving parts and potential for risk. So how can the facility be run to mitigate these risks and to provide peace of mind for the staff and the residents?
Here to tell us more is Chris Allman. He's the Vice President of Compliance, Integrity and risk Management at Trinity Health Senior Communities. Chris, thank you so much for joining us today. I really appreciate your time. I'd love to get started just by asking you to tell us a little bit about what you do.
Chris Allman, JD, CPHRM, DFASHRM: Thank you, Prakash. I appreciate it. What we do is we have senior communities of all varieties that are across the country including skilled nursing facilities, assisted living, independent living-type facilities. And my job specifically is to make sure that the senior communities are the most compliant, they comply with all the rules and regulations and anybody who's in long-term care knows that there are a lot of rules of regulations that go along with senior care, as well as making sure that we reduce our risk as much as possible. And for that, we really kind of use an enterprise risk module to make sure that we can keep our facilities as safe as possible for our residents, our employees, and our visitors.
Prakash Chandran: Yeah. So I guess expanding on that, maybe talk to us a little bit more about what risk managers who are in hospital health system or acute care settings, what do they need to know about senior care in general?
Chris Allman, JD, CPHRM, DFASHRM: Absolutely. Well, you know, I think the one thing that I would want them to know is that really senior care is really a continuation of acute care. Many of our residents come in from acute care facilities, such as hospitals or, you know, physical therapy or anything along those lines. And they come in specifically to continue that care. And what I want them to know is that this really is a continuation of that care and that handoff from acute care into more long-term settings is vital. So the thing that they do and the records that they have and the treatment that that patients have seen on the acute care side will continue on the long-term care side.
So keeping those lines of communication open between acute care and long-term care is vitally important and will help all of the patients and residents once they get over to the long-term care side to make the most out of their experience and have the best type of recoveries and the best type of residential living situations, you know, for our residents and patients.
Prakash Chandran: Yeah, that makes a lot of sense. I'm curious, what are the top risks that you come across when it comes to a senior living setting?
Chris Allman, JD, CPHRM, DFASHRM: Well, in this day and age, you know, really the top risk that we run into is staffing. And I say that because really staffing at this point really kind of drives all of our other risks. Long-term care right now across the country and not just in Trinity health, but in all sorts of facilities across the country, staffing is at a critical phase. The pandemic really made getting nurses, getting certified nurse assistants and other personnel very difficult to come by in senior care settings. And, you know, we are doing everything that we can obviously to make sure that we have proper staffing so that our residents can get the best experience possible, but it's difficult.
And when you run into things like staffing shortages, again across the country, you have things like increased falls, you have more medication errors, you have more pressure ulcers. And then just in general, your entire risk goes up pretty much across the board. And it's not just even necessarily in resident care but also includes things like, you know, technology and, you know, disaster preparedness and other things that we look at in an enterprise risk model. The less staff that we have, the tougher it is to do the types of things that we need to do to keep our residents safe. So, you know, right now I would say the number one risk that we have are staffing issues.
Prakash Chandran: Yeah. You know, I didn't even think about that being the number one issue, but it totally makes sense as you start to unpack it. And I guess this is related, but you know, there's a lot of nuance when it comes to long-term care and the dedication it really requires. So how would you break down the compliance surrounding that and what really makes it work and run smoothly?
Chris Allman, JD, CPHRM, DFASHRM: Well, again, kind of coming back to staffing and one of the things that really makes us run well are good people. And having good people in the right places helps immensely. And I think, by and large, most people who are in long-term care, they really care about their residents. And that's not to say that people in acute care don't but, you know, when you work and live every day with your residents in skilled nursing care, as well as in assisted living and independent living, when you're with these people every day, you kind of get to know them and you'll learn more about them. You learn more about their families, you get to know their families. You know, you get to know them. And so having good people in place really helps you make sure that that not only can reduce risk for your residents, but also, you know, comply with all those rules and regulations that are there really to keep everybody safe and to make sure that all the facilities are the best they possibly can be for our patient-centered focus on our residents.
Prakash Chandran: So, you know, you talked a couple of times about your approach being the enterprise risk model. Can you unpack for us what exactly that means?
Chris Allman, JD, CPHRM, DFASHRM: Sure. Absolutely. Hopefully, you know, risk managers who are in acute care know a little bit about our enterprise risk module and that's been very important to where ASHRM has been going for years. But really what it does is it looks at risks all across the spectrum, whereas prior in the '80's and '90's, it really focused only on patient safety. When you kind of unpack patient safety and keeping our patients safe, you have to look across the entire spectrum of what risks may be to a patient in a facility. So it's not just necessarily the care that they receive, but that care that they receive is affected by, you know, the compliance with the rules and regulations.
Compliance is dependent upon the technology. It's dependent upon disaster preparedness. As I've kind of hinted a couple of times, it's dependent upon the staff and the workforce that are in the facility. And all of those things have risks that are inherent among themselves. And really to, you know, rate the risk and to gauge the risk at any facility, you need to look all across that spectrum as to what the risks are to make sure that your facility in whole is completely safe as it can possibly be again for your residence, for your workforce and for your visitors and anybody else who may possibly walk through your doors.
Prakash Chandran: And, you know, I guess a part of that, you talked about how important the handoff from acute care is. Can you talk a little bit about the nuance of really getting that right? You know, I know there are different components of that. I'm sure there's like data and record keeping components, as well as just the communication that you have with the previous provider. Maybe talk about some of those nuances and what risk managers should be aware of during that handoff.
Chris Allman, JD, CPHRM, DFASHRM: Absolutely. And I think you've already kind of hit on, you know, the major parts of the handoff, is making sure that we have the proper records and making sure that we have a good medication reconciliation that comes over from the acute care side so that, you know, we know what medications our residents should be taking once they get into the end of the long-term care facilities. And making sure that lines of communication stay open. I mean, to me, communication is the number one thing that any facility, whether it's acute care or long-term care, can do to manage risk and in their facilities. And keeping those lines of communication open are of vital importance within healthcare.
And, you know, once the handoff happens, once a resident or patient goes from acute care and becomes a resident in a long-term care setting, keeping those lines of communication open is important so that we can continue to learn and know, you know, what the hospital that they came from knew, you know, and physicians, what they know and what their physicians that they see on a regular basis, you know, know and can let us know so that we can provide the best possible care you know, for our residents.
So, those are really, you know, kind of the major points of making sure that those handoffs are as smooth as they possibly can be as well as the most informative for everybody. And one of the things that I would also say as far as that's included would be also to include the resident to the extent that we can. I mean, some residents aren't able to participate in the handoff process. But to the extent that we can, including that resident in the handoff process helps them also be involved in their own care and they can help us, you know, by making sure that they clarify, you know, issues maybe that we aren't quite aware of that don't get communicated in quite the right way from the acute care side, and so making sure that those residents are involved in that process as well.
Prakash Chandran: Now, you know, especially when it comes to long-term care and senior living settings, I imagine that there are a lot of third parties that are involved. Let's say the children or relatives that all have opinions and maybe even important information that you need to know during that handoff. How do you think about managing risk when it comes to communication with all of those third parties?
Chris Allman, JD, CPHRM, DFASHRM: Yeah. Again, communication is vitally important and, you know, communication to the extent that the laws allow us to do that, you know, with the family are of vital importance. You know, because the family can still hand a lot of information to the long-term care facilities that we may not necessarily be able to get, you know, even from the residents sometimes if we have, you know, residents that have cognitive issues and then maybe can't really verbalize issues that may be going on with them, family can certainly always fill that in for us. And so, you know, for us, keeping those lines of communication open with the family are of vital importance. While at the same time, you also have to remember sometimes the families, I'm not saying all the time, obviously, but the families sometimes have, you know, agendas maybe of their own and so, you know, also keeping that in mind as well is of importance. But, you know, making sure that the families always know what's going on, you know, with the resident to the extent that we were allowed to do that helps keep everybody safe. Again, not only the resident, but also helps our workforce members and our colleagues, you know, help take care of that resident.
Prakash Chandran: So Chris, just before we close here today, is there anything else that you'd like to share just regarding managing risk and long-term care for these senior communities?
Chris Allman, JD, CPHRM, DFASHRM: You know, again just I think that it's of vital importance that people know that it is really just a continuation of healthcare. And it's not in acute care just kind of sending a resident, then you're out of there. You know, out of sight, out of mind, out of the acute care facility and, you know, they don't necessarily need to worry about it anymore or worry about that resident anymore. And, you know, for us, it is really a continuation of that and making sure that the lines of communication are open and really kind of viewing it as the next step in somebody's care, in a resident's care is important, I think, you know, mostly for our residents to make sure that they get the best possible care on all levels of the American healthcare system.
Prakash Chandran: Well, Chris, thank you so much for your time today. This has been a truly informative conversation.
Chris Allman, JD, CPHRM, DFASHRM: My pleasure. Thank you very much for asking me to participate.
Prakash Chandran: That was Chris Allman, the Vice President of Compliance, Integrity and Risk Management at Trinity Health Senior Communities. The ASHRM podcast was made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management.
Visit ashrm.org/membership to learn more and to become an ASHRM member. My name is Prakash Chandran. Thank you again for listening and we'll talk next time.
Prakash Chandran: Welcome to the ASHRM podcast made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare throughout enterprise risk management. You can visit ashrm.org, that is A-S-H-R-M.org/membership, to learn more and become an ASHRM member. I'm Prakash Chandran.
When it comes to long-term care for seniors, the image is often an all-in-one facility that serves both the health and lifestyle needs of the residents. But catering to the wide range of abilities, interests and medical conditions also means a lot of moving parts and potential for risk. So how can the facility be run to mitigate these risks and to provide peace of mind for the staff and the residents?
Here to tell us more is Chris Allman. He's the Vice President of Compliance, Integrity and risk Management at Trinity Health Senior Communities. Chris, thank you so much for joining us today. I really appreciate your time. I'd love to get started just by asking you to tell us a little bit about what you do.
Chris Allman, JD, CPHRM, DFASHRM: Thank you, Prakash. I appreciate it. What we do is we have senior communities of all varieties that are across the country including skilled nursing facilities, assisted living, independent living-type facilities. And my job specifically is to make sure that the senior communities are the most compliant, they comply with all the rules and regulations and anybody who's in long-term care knows that there are a lot of rules of regulations that go along with senior care, as well as making sure that we reduce our risk as much as possible. And for that, we really kind of use an enterprise risk module to make sure that we can keep our facilities as safe as possible for our residents, our employees, and our visitors.
Prakash Chandran: Yeah. So I guess expanding on that, maybe talk to us a little bit more about what risk managers who are in hospital health system or acute care settings, what do they need to know about senior care in general?
Chris Allman, JD, CPHRM, DFASHRM: Absolutely. Well, you know, I think the one thing that I would want them to know is that really senior care is really a continuation of acute care. Many of our residents come in from acute care facilities, such as hospitals or, you know, physical therapy or anything along those lines. And they come in specifically to continue that care. And what I want them to know is that this really is a continuation of that care and that handoff from acute care into more long-term settings is vital. So the thing that they do and the records that they have and the treatment that that patients have seen on the acute care side will continue on the long-term care side.
So keeping those lines of communication open between acute care and long-term care is vitally important and will help all of the patients and residents once they get over to the long-term care side to make the most out of their experience and have the best type of recoveries and the best type of residential living situations, you know, for our residents and patients.
Prakash Chandran: Yeah, that makes a lot of sense. I'm curious, what are the top risks that you come across when it comes to a senior living setting?
Chris Allman, JD, CPHRM, DFASHRM: Well, in this day and age, you know, really the top risk that we run into is staffing. And I say that because really staffing at this point really kind of drives all of our other risks. Long-term care right now across the country and not just in Trinity health, but in all sorts of facilities across the country, staffing is at a critical phase. The pandemic really made getting nurses, getting certified nurse assistants and other personnel very difficult to come by in senior care settings. And, you know, we are doing everything that we can obviously to make sure that we have proper staffing so that our residents can get the best experience possible, but it's difficult.
And when you run into things like staffing shortages, again across the country, you have things like increased falls, you have more medication errors, you have more pressure ulcers. And then just in general, your entire risk goes up pretty much across the board. And it's not just even necessarily in resident care but also includes things like, you know, technology and, you know, disaster preparedness and other things that we look at in an enterprise risk model. The less staff that we have, the tougher it is to do the types of things that we need to do to keep our residents safe. So, you know, right now I would say the number one risk that we have are staffing issues.
Prakash Chandran: Yeah. You know, I didn't even think about that being the number one issue, but it totally makes sense as you start to unpack it. And I guess this is related, but you know, there's a lot of nuance when it comes to long-term care and the dedication it really requires. So how would you break down the compliance surrounding that and what really makes it work and run smoothly?
Chris Allman, JD, CPHRM, DFASHRM: Well, again, kind of coming back to staffing and one of the things that really makes us run well are good people. And having good people in the right places helps immensely. And I think, by and large, most people who are in long-term care, they really care about their residents. And that's not to say that people in acute care don't but, you know, when you work and live every day with your residents in skilled nursing care, as well as in assisted living and independent living, when you're with these people every day, you kind of get to know them and you'll learn more about them. You learn more about their families, you get to know their families. You know, you get to know them. And so having good people in place really helps you make sure that that not only can reduce risk for your residents, but also, you know, comply with all those rules and regulations that are there really to keep everybody safe and to make sure that all the facilities are the best they possibly can be for our patient-centered focus on our residents.
Prakash Chandran: So, you know, you talked a couple of times about your approach being the enterprise risk model. Can you unpack for us what exactly that means?
Chris Allman, JD, CPHRM, DFASHRM: Sure. Absolutely. Hopefully, you know, risk managers who are in acute care know a little bit about our enterprise risk module and that's been very important to where ASHRM has been going for years. But really what it does is it looks at risks all across the spectrum, whereas prior in the '80's and '90's, it really focused only on patient safety. When you kind of unpack patient safety and keeping our patients safe, you have to look across the entire spectrum of what risks may be to a patient in a facility. So it's not just necessarily the care that they receive, but that care that they receive is affected by, you know, the compliance with the rules and regulations.
Compliance is dependent upon the technology. It's dependent upon disaster preparedness. As I've kind of hinted a couple of times, it's dependent upon the staff and the workforce that are in the facility. And all of those things have risks that are inherent among themselves. And really to, you know, rate the risk and to gauge the risk at any facility, you need to look all across that spectrum as to what the risks are to make sure that your facility in whole is completely safe as it can possibly be again for your residence, for your workforce and for your visitors and anybody else who may possibly walk through your doors.
Prakash Chandran: And, you know, I guess a part of that, you talked about how important the handoff from acute care is. Can you talk a little bit about the nuance of really getting that right? You know, I know there are different components of that. I'm sure there's like data and record keeping components, as well as just the communication that you have with the previous provider. Maybe talk about some of those nuances and what risk managers should be aware of during that handoff.
Chris Allman, JD, CPHRM, DFASHRM: Absolutely. And I think you've already kind of hit on, you know, the major parts of the handoff, is making sure that we have the proper records and making sure that we have a good medication reconciliation that comes over from the acute care side so that, you know, we know what medications our residents should be taking once they get into the end of the long-term care facilities. And making sure that lines of communication stay open. I mean, to me, communication is the number one thing that any facility, whether it's acute care or long-term care, can do to manage risk and in their facilities. And keeping those lines of communication open are of vital importance within healthcare.
And, you know, once the handoff happens, once a resident or patient goes from acute care and becomes a resident in a long-term care setting, keeping those lines of communication open is important so that we can continue to learn and know, you know, what the hospital that they came from knew, you know, and physicians, what they know and what their physicians that they see on a regular basis, you know, know and can let us know so that we can provide the best possible care you know, for our residents.
So, those are really, you know, kind of the major points of making sure that those handoffs are as smooth as they possibly can be as well as the most informative for everybody. And one of the things that I would also say as far as that's included would be also to include the resident to the extent that we can. I mean, some residents aren't able to participate in the handoff process. But to the extent that we can, including that resident in the handoff process helps them also be involved in their own care and they can help us, you know, by making sure that they clarify, you know, issues maybe that we aren't quite aware of that don't get communicated in quite the right way from the acute care side, and so making sure that those residents are involved in that process as well.
Prakash Chandran: Now, you know, especially when it comes to long-term care and senior living settings, I imagine that there are a lot of third parties that are involved. Let's say the children or relatives that all have opinions and maybe even important information that you need to know during that handoff. How do you think about managing risk when it comes to communication with all of those third parties?
Chris Allman, JD, CPHRM, DFASHRM: Yeah. Again, communication is vitally important and, you know, communication to the extent that the laws allow us to do that, you know, with the family are of vital importance. You know, because the family can still hand a lot of information to the long-term care facilities that we may not necessarily be able to get, you know, even from the residents sometimes if we have, you know, residents that have cognitive issues and then maybe can't really verbalize issues that may be going on with them, family can certainly always fill that in for us. And so, you know, for us, keeping those lines of communication open with the family are of vital importance. While at the same time, you also have to remember sometimes the families, I'm not saying all the time, obviously, but the families sometimes have, you know, agendas maybe of their own and so, you know, also keeping that in mind as well is of importance. But, you know, making sure that the families always know what's going on, you know, with the resident to the extent that we were allowed to do that helps keep everybody safe. Again, not only the resident, but also helps our workforce members and our colleagues, you know, help take care of that resident.
Prakash Chandran: So Chris, just before we close here today, is there anything else that you'd like to share just regarding managing risk and long-term care for these senior communities?
Chris Allman, JD, CPHRM, DFASHRM: You know, again just I think that it's of vital importance that people know that it is really just a continuation of healthcare. And it's not in acute care just kind of sending a resident, then you're out of there. You know, out of sight, out of mind, out of the acute care facility and, you know, they don't necessarily need to worry about it anymore or worry about that resident anymore. And, you know, for us, it is really a continuation of that and making sure that the lines of communication are open and really kind of viewing it as the next step in somebody's care, in a resident's care is important, I think, you know, mostly for our residents to make sure that they get the best possible care on all levels of the American healthcare system.
Prakash Chandran: Well, Chris, thank you so much for your time today. This has been a truly informative conversation.
Chris Allman, JD, CPHRM, DFASHRM: My pleasure. Thank you very much for asking me to participate.
Prakash Chandran: That was Chris Allman, the Vice President of Compliance, Integrity and Risk Management at Trinity Health Senior Communities. The ASHRM podcast was made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management.
Visit ashrm.org/membership to learn more and to become an ASHRM member. My name is Prakash Chandran. Thank you again for listening and we'll talk next time.