Taking a good look around. (Not-for-Profit Report).

It's just another ordinary day. Everyone is busy caring for residents, cleaning the halls, doing laundry--the countless tasks required to run an efficient and effective nursing home. Suddenly, a long shadow darkens the lobby, and the rhythm of the day abruptly changes from a purr to a tense staccato. A group of people wearing badges and carrying clipboards have announced themselves to the front-desk receptionist. She pales. This entourage is definitely not looking to admit a family member or demonstrate a lift system; they are state surveyors. Your usually dedicated, informed, caring, and professional staff become tongue-tied, forgetful, defensive, and stressed.

During my first year as administrator of the Horizon House Nursing Center, a 56-bed skilled nursing facility that is part of the Horizon House CCRC campus in Seattle, survey time turned the facility upside down because staff were anxious and fearful. To quell these negative reactions, we confronted the problem head-on with confidence-building, hands-on role-playing. We developed our mock survey program to identify our strengths and weaknesses in care delivery, provide continuous quality improvement, educate and train staff, familiarize them with the survey process, and neutralize the fear associated with a state survey. Through this exercise, employees have an opportunity not only to learn about the regulations in the areas of their involvement, but also to see how these rules come into play throughout the nursing home.

Because Horizon House Nursing Center is part of a CCRC, many jobs don't intersect, and many staff never have an opportunity to interact with the nursing home on a daily basis. To orient staff to our nursing center's mission and purpose, the mock survey team is assembled from a roster of interested employees campus-wide. A mock survey facilitator, whose job is to structure the mock survey according to the usual areas of interest, is chosen from among the healthcare managers at Horizon House. Because of the team's diversity, a new level of awareness of what we do in the nursing home is created throughout the organization.

To aid the facilitator in preparing for the mock survey process, a tool kit was developed that translates the complex survey process to a format that staff can easily understand and use. Included in the tool kit are instructions for performing a mock survey, team assignment sheets, report forms that detail what "surveyors" should look for and the questions to ask, a resident satisfaction survey, observation forms, mock surveyor badges and business cards, and recommendations for reward items, such as gift certificates, for those who have agreed to participate in this exercise. To address any deficiencies or weaknesses the survey uncovers, the tool kit also provides an in-service planning form and sign-in sheet for specific training sessions.

Each survey team consists of a nursing assistant; a licensed nurse; a representative from ancillary services, such as social services, activities, or rehab; and a representative from operations, which includes the front desk, housekeeping, janitorial, and maintenance departments. A different team is assembled for each of the three mock surveys conducted throughout the year, thus exposing more staff to the process. We've found that involving personnel from throughout the campus is beneficial because, although they may not be involved with the nursing home on a daily basis, every staff member has some effect on the nursing home and the care and services we provide.

Once the team is assembled, the facilitator presents the focus areas of the survey to the group, and they meet several times to strategize and receive individual task assignments, and later, to analyze survey outcomes. Badges and clipboards to hold assessment sheets are passed out, and the team selects a target date to conduct the mock survey. As state surveys are unannounced, so are the mock exercises. Even I am not given a "heads up" as to when the surveyors will arrive.

After performing their tasks during the mock survey, the team is required to identify any areas of weakness they uncovered and provide an in-service to staff. If a deficiency is discovered, just as in an actual survey, the next team will address that deficiency to see if it was remedied appropriately. For example, mock surveyors found that housekeeping staff did not have a strong sense of the appropriate action to take in a disaster situation--for example, they didn't know where to find a flashlight or how to address residents' immediate needs. The mock survey team put together an in-service on this topic, with specific learning objectives. The tool kit's in-service sign-in sheet documents attendance, so that when the next mock survey team arrives, there's a focus on asking housekeepers specific questions to verify carry-through of the in-service's teachings.

Along with the serious and important learning aspect of the mock survey exercise, the team also manages to have some fun. Tossing aside their daily work apparel, they arrive dressed in serious business fashion, carrying their survey materials and presenting their business cards. Their appearance and demeanor confidently and purposefully reinforce the importance of the job they have come to do. Normally, a nursing assistant would never think of questioning how someone in another department does his or her job, but in the role of "surveyor," he or she realizes the importance of fact-finding, observation, and recommendation.

Our mock inspection procedure gives staff a view from both sides of the LTC compliance fence and, as indicated earlier, helps stem the anxiety caused by surveyors' questions. Through our mock surveys, staff have gained a renewed confidence in their ability to present information to the real surveyors, and with this comes the realization that they really do know and perform their jobs well. Now when a state surveyor asks what should be done if a resident falls in a hallway, or when was the last abuse/neglect in-service and what did staff learn, any staff member--regardless of his/her position--can provide the correct answers with confidence.

The mock survey process is beneficial for new hires, too. Recently, Horizon House hired a new facilities manager who did not have a background in long-term care. Naturally, we drafted him to be part of an upcoming survey team. After the mock survey, he remarked that it was invaluable in helping him to understand his job and his role in the process.

The residents add another dimension to our self-evaluation through our resident satisfaction survey. Eager to share their views and comments with our mock surveyors, they give us another way to identify our strengths and weaknesses in care delivery.

The heart of the mock survey--the tool kit--continues to change as new regulations dictate. At the 2002 Washington Association of Housing and Services for the Aging (WAHSA) conference, we offered the entire program, on CD-ROM, to WAHSA members. But, as with all things regulatory, in a very short time--from August to December--we needed to inserline: THE WASHINGTON TIMES

The Labor Department last week released its estimates of inflation in January at both the producer and the consumer levels, sending seemingly conflicting signals. On Thursday, the Bureau of Labor Statistics (BLS) reported that the producer price index (PPI) for finished goods, which measures price changes at the wholesale level, increased by a whopping 1.6 percent in January. The next day the BLS reported that prices paid by consumers rose a far more modest 0.3 percent last month. The consensus among economists is that there is little short-term danger of a major dose of inflation. That's the good news.

The bad news can be gleaned from a familiar economic chain reaction. For whatever reason (the 1973 Arab oil embargo, the 1979 Iranian revolution, Iraq's 1990 invasion of Kuwait, OPEC's resuscitation in the late 1990s), world crude oil prices soar. Then, if their impact becomes deeply rooted throughout the consumer sector by causing the prices of non-energy goods to rise, the Federal Reserve reacts by raising interest rates to reduce inflationary pressures, precipitating a recession in the process. Thus, the cause of the past five recessions (1974-75, 1980, 1981-82, 1990-91, 2001) can be directly attributed to soaring oil prices. (Technically, the 1990-91 recession began the month before Iraq invaded Kuwait, but it has been argued that the recession would not have occurred without the soaring oil prices following the invasion.)

The causes of the PPI's hefty 1.6 percent January jump included: a 4.8 percent increase in energy prices; a roughly 4 percent rise in auto prices following November-December reductions; and a jump in food prices.

Additional perspective comes from the fact that, while the PPI has increased by 2.8 percent over its January 2002 level, most of that increase resulted from a 17 percent rise in energy prices. Meanwhile, the consumer price index's core index increased a very modest 0.1 percent in January, the third such rise in the past four months. For the past 12 months, the CPI's core increased by less than 2 percent.

Outside of the energy sector, firms continue to lack any pricing power at the retail level. This leads most economists to believe that energy-induced inflationary pressures will be kept in check for the foreseeable future. But the result will likely be a major hit against already-meager profits. That could adversely affect business investment spending, which has been sputtering for more than two years. If consumers retrench, a recession could ensue. That's the really bad news.