By Mark Friedman
As someone with an extensive business and management consulting background, I realized the eldercare industry is fundamentally different from most other industries. For most businesses – regardless of if they are for-profit businesses or non-profit organizations – what drives the decision making is very straightforward. However, decision making in the eldercare field is anything but straightforward.
Eldercare Caregivers = Right Brain. Eldercare Business Managers = Left Brain
The issue is that there are multiple people in the decision making process. For simplification, they fall largely in two categories: Caregivers and Business Managers. The care givers have a right brain focus on decisions: they are focused on the care of the patient, the type of care they get, what the next steps are, when the appropriate time for discharge is, and other care-related activities.
The left-brain people on the business side, while also concerned about quality of care and outcomes are more heavily influenced by macro-level issues such as re-admission, public perception of the quality of care, and organizational risks underling care decisions. To further complicate the situation, there are two additional concerns:
- Both the Care and Business perspectives are impacted by the involvement of third party payers that can impact highly complex series of decisions to make, both on an individual level and on an institutional level.
- Part of the continuum of care is out-of-pocket
Patient Care and Business Requirements Make Continuity of Care Challenging
This decision-making environment makes it extremely difficult for the industry to provide continuity of care across the continuum. Just some of the factors include that the players may be for-profit organizations or may be non-profit organizations; they may or may not have a relationship with Medicare, Medicaid or private insurance; they may or may not have a relationship with the left brain side of the house; or if they do, the right brain side of the house may wonder why the left brain side is involved at all. The end result is often that the macro decisions and the micro decisions may not be aligned, regardless of what communication happens between all the players.
While there’s no one answer to improving the continuum of care in eldercare, I’ve found that understanding three aspects of the situation can help make the decision making easier:
- Understand the objectives of the gatekeeper. A lot of times the objectives of the gatekeeper is not clear. For some, the objective is simply to move the patient on to the next stage of care. But what might be a good decision from a care perspective may not be the right decision from a business perspective, a payor perspective or financial perspective of the individual or family! (and vice versa.) Organizations and the decision makers in those organizations must have great clarity of roles and clarity of what defines a good decision or a bad decision.
- Understand who makes what decisions. Roles and responsibilities of the organizations involved can vary by state and by organization. For example, here in Massachusetts, part of the continuum of care is governed by the Department of Public Health. Some isn’t! Organizations and individuals need to understand who they are talking to, what rules are those organizations are following and what decisions those people are really charged with and have the capacity to make..
- Establish guidelines to map the journey of the individual. The journey of eldercare includes factoring goals for the individual, specific needs for care, quality of life and more. Mapping and managing this journey is often left to the family who may or may not be equipped to do so. They rely on institutions who, most often, only support part of the continuum. For example, private pay services (such as home care or community based living) are often completely left out of the conversation, yet they may be the most impactful resource to manage risk, particularly that of re-admission. The answer to solving this challenge is to define the overall continuum and easy to understand roles and responsibilities across the full continuum of care. This will enable holistic decision making through the whole journey across the continuum of care.
When faced with a decision, the individual—be it the family, the patient, a nurse or a business manager—needs to understand if they are dealing with a right brain issue or a left brain issue and the role of the person with whom they are speaking. Identifying these factors helps to then determine what conversations to have with whom. And all of this then makes the decision making process easier and more easily understood.
Mark H. Friedman is the owner of Senior Helps Boston, a leading home-care agency service the greater Boston metropolitan area. He is also the founder and managing partner at Real Time Strategy, a general management consultant. Mark holds an MSIA (MBA) from Carnegie Mellon University (now The Tepper School of Business) and a BA in Economics from the University of Virginia.