Who is the Interdisciplinary Team in a Nursing Home
Is anyone really coordinating care in nursing homes? Interdisciplinary teams are meant to improve outcomes, but they often fall short. Poor teamwork can lead to missed care and preventable injuries. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Barbara Resnick to discuss the current state of interdisciplinary care teams and where improvement is needed.
Resnick:
If the cleaning person is the best person to explain to the patient whatever test they need, say, then in pace, that cleaning person is encouraged to do it. And that’s the way we really should think about the team. Not you’re stepping on my territory, but who has the most knowledge and who is the best to get that care to that patient?
Intro
Schenk:
Hey, out there. Welcome back to the Nursing Home Abuse podcast. My name is Rob. I’ll be your host for this episode. We are gonna be talking about the interdisciplinary team at a nursing home. The federally reg regulatory required. We’ll just say the federally required. Required by federal regulations, interdisciplinary team that participates in care planning among other things.
We’re not having the conversation about interdisciplinary teams alone. We have Dr. Barbara Resnick, PhD, CRNP. She is a professor and associate dean of research at the University of Maryland School of Nursing, where she holds the Zia Sporkin.
Gersh chair in gerontology. I should have probably reached out and figured out how to say that correctly, so I apologize about that. The Sonya Zipkin Gers chair in gerontology with over 40 years of clinical experience and research experience. Her work focuses on promoting function, physical activity, and resilience, and older adults.
She has widely published, actively involved in national aging organizations and has received numerous prestigious awards. For her contributions to geriatric care, and we are so happy to have her on the show. Dr. Rasnick, welcome to the show.
Resnick:
Thank you. I’m thrilled to be here.
What is an interdisciplinary care team in long-term care?
Schenk:
So let’s just start right into it.
Let’s just, let’s put the rubber to the road. Can you explain to me what the interdisciplinary Ca care team is with respect to nursing home care?
Resnick:
The beauty of nursing home care is that interdisciplinary care is required. It isn’t in other settings, so I think we need to celebrate that. The interdisciplinary team can really vary depending on possibly the size of the facility.
It could be whether it’s a chain or, free standing facility continuing long-term care or a nursing home within a continuing care retirement community. So it really varies, but the team usually includes nursing, ideally medicine. And when I say nursing, the broad range of nursing could be assisted.
Depending again on what state? A direct care worker, a nursing assistant, whatever is working in that state. LPNs, RNs, DON. Some have charge nurses, education nurses, whatever. The level of nurse you have. Then I think rehab is critical as a member of the team. And again, that might be physical therapy, occupational therapy, maybe speech therapy, depending on the setting and what they can do.
Federal requirements for resident care planning are outlined in 42 CFR § 483.21 on the impact of preventive health measures in elderly populations.
Pharmacy. Is critical to the team. Again, they’re not always there, but as a member of, you have to think of a virtual team now, and it could be a pastoral person. In some communities and certainly social work, there could be also, should be, I wouldn’t say could be, but should be also dietary. Because that is a requirement.
Those are really the. Set core members as well as nursing home administrators. You think of maybe not much on the clinical side of things, but certainly on the administrative side.
Clinical findings related to resident outcomes are discussed on the impact of preventive health measures in elderly populations in long-term care settings.
How often does the interdisciplinary team meet?
Schenk:
So you’ve described the super team. You got Superman, wonder Woman, green Lantern, all these people. Okay. And they meet, but what are they doing? What’s the objective of the meeting?
Resnick:
The objective of the meeting is to keep the patient on the, in the center of the table. And I generally, these individuals meet around care planning and it may not be the whole team depending on the needs of the patient, but I think that’s one common meeting point.
Often these teams meet. At the beginning of the week after the weekend to touch bases, some teams meet every morning. So again, that depends on the facility and how closely the team wants to meet. And again, it’s not gonna be all those people, maybe some these days. Best thing from COVID is they can be brought in either via a Zoom meeting or telephone even.
And then often they’ll meet at certain meetings like quality assurance and those types of things. So I think it really varies how often the team meets face-to-face or how often, I’m going to say subgroups within that bigger super team meet.
Earlier foundational research remains relevant on the impact of preventive health measures in elderly populations when evaluating nursing home practices.
Why is a team approach important for nursing home residents?
Schenk:
For any nerds that are keeping up with us at home, if you want to look at the regulation that clearly specifies the interdisciplinary team, that’s 42 CFR 4 8 3 0.21.
And then you’re gonna go down to B and then two. And I only say that to as a preface for the next question, which is why do you think the regulations require a team? Why can’t it just be Superman or Wonder Woman alone? Like why do we have so many people that need to participate, even if it’s in a subgroup?
Resnick:
There’s two reasons I’m gonna say. The one is, ’cause if it’s not regulated, it would never happen. Same reason. Some of, unfortunately, some of the medical reg regulations are there because they were not happening. So I think that’s why it’s in the regs. Why do we have an interdisciplinary team?
Because like it or not, each one of those people brings a special expertise. They have gained that expertise and they’re the best. Person to address whatever that certain problem that meets their expertise. Therapies, social work, medicine and nursing are examples. They each bring something and I think the person that has the skills to meet that patient’s needs should be the one to do it.
Facility-specific care challenges are explored on the impact of preventive health measures in elderly populations affecting resident safety.
Now I will give you an example from PACE programs. In PACE programs, if the cleaning person is the best person to explain to the patient. Whatever test they need, say, then in pace, that cleaning person is encouraged to do it. And that’s the way we really should think about the team. Not you’re stepping on my territory, but who has the most knowledge and who is the best. To get that care to that patient.
Families in Cobb County can speak with a Smyrna nursing home abuse lawyer about neglect or understaffing concerns.
Schenk:
I guess that makes sense. And again and I only say this because I have a toddler and he’s into the Super friends and the superheroes. you got Flash, he runs really fast, you got Superman. He’s real strong, Batman’s real smart. And Batman might be able to do his things that Superman can do, but he can’t do it as good as Superman.
So I completely get that. So let’s kind of transition into, we have the team. We understand why we need the team. If it’s about, at least in part, planning, how often do you do, does it seem that the team should meet with respect to that plan? Is it shift by shift, day by day? Quarterly.
Resnick:
So when you say plan, you don’t mean the patient care plan. You mean how they’re gonna work?
Schenk:
They, no, I’m fair enough. That’s probably a bad question. The comprehensive care plan for the resident.
Resnick:
I think that the team should ideally all be at that care plan meeting. How wonderful that would be.
For our residents. It doesn’t always work that way, but I think we need to work better towards at least somewhat of a report from each one of those individuals. Again, it might depend. Some residents, for example, are not getting any therapy. Therapy doesn’t need to be there, right? So it just depends on the needs of that resident.
The relationship between staffing numbers and resident harm is explored in Nurse Staffing and Quality of Care in Nursing Homes.
And then I think really just meeting based on regs for when the care plan needs to be done. Although I do think it’s very important particularly sometimes in difficult situations for the team to meet ahead of time and be consistent. And speak with a consistent voice. Particularly when there’s an issue.
You don’t want one team member to be responding in one way. Over say, can I watch my favorite show at 3:00 AM and another team member saying something else?
Residents in Muscogee County can explore their options with a Columbus nursing home abuse lawyer.
Schenk:
Okay, typically in your experience, is the outcome of that meeting the care plan itself or does the interdisciplinary team typically generate other types of documents or no documents?
Resnick:
So I think that meeting informs the care plan that really the actual changes in the care plan, hopefully, or development of the care plan. Really probably can’t happen till you get the patient’s voice in there as well. And forgive me, I didn’t include the patient and or the family as part of the team and let’s say I assumed it. They’re at the center of the team.
Schenk:
We, yeah, we’ll give you that one. We’ll give you that one. That’s okay. ‘Cause that was about to be my next question is how important. How important do you think it is that the resident’s family member be there for? That
Resnick:
I, again, that depends on the resident. If you have a resident that’s living with some dementia has some impairment, maybe even just has really bad hearing, then I think somebody should be there to be their voice.
Regulatory warnings about staffing shortages are examined in CMS Warns of Low Nursing Home Staffing Levels.
Schenk:
Do you ever see, and I think you hinted at this a little bit in your experience, is there ever any rivalry, like in other words, like perhaps the dietician thinks that the intervention should be more dietary versus you have perhaps the DON that might think it’s, no, these other interventions and things like that, and you have a, I don’t know, what was that book?
Team rivals: what was Doris Keens about Abraham Lincoln’s cabinet? You got people fighting over, how are we gonna take care of this person? Does that ever happen?
Resnick:
I think it happens all too often, and that’s what I mean, where it’s critically important for the team to be consistent. Because you’ve got a toddler and toddlers and children know how to play one parent against another.
Documentation failures and regulatory violations are analyzed in Care Plan Documents in Georgia Nursing Homes.
Schenk:
True.
Resnick:
It’s not good if. The DON says something, the charge nurse says something else, the medical director comes in and says something else. Particularly when you know there’s issues that are gonna be raised at that care plan meeting, a pre-meeting is needed, I think.
Schenk:
I see. Yeah, because that, again, that, that’s, at least for this podcast, that’s definitely something that kind of is a lesson in every episode is that family involvement can be critical depending on the type of resident that you’re dealing with. Because if the resident is nonverbal. It’s important for somebody to be there to say, like when at nighttime she gets, maybe she gets upset or she’s, her whole life she was a teacher, so sometimes she’s talking and that’s what she’s doing.
She’s conducting a class in her head. Things like that. So that you might not get just if the attending physician is there because the attending physician hasn’t known the resident her whole life.
Resnick:
I think truthfully, the inclusion. The resident and the family are critical, and I do hear teams sometimes will exclude the resident because of dementia because of behavioral issues or whatever.
The other thing that we didn’t raise was we talked about having a resident there and a caregiver. Sometimes what happens is though we have multiple family members. And they are the ones that are disagreeing. And that’s a whole another issue. And again, it’s helpful if those things can be identified ahead of time and depending on who is the best to address those get addressed outside the care plan meeting.
Staffing responsibilities and failures are discussed in Nursing Home Staff and Their Roles – Episode 91.
And number one, it means the care plan meeting can go on forever and can be very uncomfortable for the resident, for other staff. And it’s. It gets really ugly sometimes. So that would be the only thing that I would say is, we can’t really limit the three daughters that want to come in, but thinking that through, particularly if you know that there’s often strong differences and my experiences.
Often the social worker within the community is the best at a number one. Being aware of that issue and also addressing it ahead of time, letting the family know we’re not going there at this meeting. I’ll speak with you after, or I’ll set up a time for you to redo the advanced care planning, or whatever the issue is.
When immobility and neglect lead to serious wounds, our page on bedsores in Georgia nursing homes explains potential legal claims.
Schenk:
I feel like on the spectrum of family participation on one end that you don’t want is no one’s there. And then I guess the next level up is you have the children fighting about how to do things and I, I guess that’s the next worst thing. But Barbara, we really appreciate you coming on the show when sharing your knowledge with us today.
Resnick:
You are welcome.
Schenk:
So any astute viewer who has stayed. And watching this far into the program will notice that at the beginning of the episode. I was not wearing a tie, and then during the interview I was wearing a tie, and now I’m not wearing a tie again, and that’s because the introductions and the outros of the episodes are recorded after I record the interview and I forgot to do that.
So I had taken my tie off and it’s so hot in my studio. That I didn’t wanna put my tie back on it again. So that’s a little piece of a little behind the scenes magic for you. If you have an idea for someone that you would like for me to talk to, let me know. If you have an idea for a topic you would like for me to talk about, lemme know that as well.
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Barbara Resnick’s Contact Information: