Starting your first Resident Care Facility for the Elderly or RCFE can be exciting, fulfilling and daunting all at the same time. Between securing a location and getting your RCFE administrator certifications it can be easy to overlook some of the important basic ideas that will help ensure your first RCFE is a success.
What is an RCFE?
The RCFE model exists only in California. You may hear them referred to as care homes, residential care, rest homes, or assisted living facilities. The care provided at these facilities is for people over 60 who require assistance but not 24-hour care.
An RCFE provides lodging as well as assistance with activities of daily living such as personal care, hygiene, dressing, eating, medications, etc. RCFEs are considered non-medical and therefore are not required to have medical staff on site. Think of an RCFE as something between independent living and 24-hour nursing care.
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Over the years, we have worked with hundreds of newly minted RCFE administrators to make sure their facilities, policies and business strategies are setting them, and their residents up for the best possible experience. In that time, we’ve learned a thing or two (or six) on some of the foundational elements of what makes a successful RCFE. Here is what we would say our 6 most important tips for building a successful RCFE facility are…
1. Spend Time Creating Your Team
More than just a team, you are creating a professional business culture, and where that culture starts is with you and your employees. Those first several hires are vital to any new venture, regardless of the industry, and especially in a care-oriented industry like this one. The people you choose and the personalities they bring set the tone and precedent for all that is to come. Get a firm understanding of what makes a good assisted living administrator and carry those qualities over to your team.
With everything in flux, you might be tempted to “fire drill” the hiring process in a rush to hit the ground running. This is never a good idea. We’ve all heard the phrase beggars can’t be choosers. In hiring, no matter the circumstances, that should never apply. Give yourself permission to spend time creating your team. Yes, your team. You have a vision, and it is okay to be selective on who will join you on your path to seeing it through.
2. Choose Your Residents Wisely
Just as you are creating a culture with your first employees, so are you building an RCFE community. Your first resident is your benchmark and will set the tone for your community in ways you might not expect. For example, if your first resident has Alzheimer’s and has repetition tendencies, then it might be difficult to admit residents who are cognitively with it.
Remember, just as you have a choice, so do your residents — and there are a lot of factors that go into their decision if they choose your RCFE facility. As facilities grow in size, culture and community are becoming increasingly important. If a resident-to-be doesn’t see a community they can engage with (even if one exists), they might very well pass on your community. Whether it’s bound in fact or not, perception is reality.
3. Know All of Your State’s Regulations, Codes, and Policies — And Comply with Them
These laws exist for a reason, both for the protection of your residents and for yours. The quickest way to have your community shuttered is to be out of compliance with your state’s RCFE regulations. That also means current administrators need to stay current by attending RCFE continuing education classes. You went into caregiving to do just that: give care. How can you adequately do that if you’re out of compliance, or don’t even know what codes and policies your community is supposed to be complying with?
Moreover, having a firm grasp of your state’s regulations could very well be crucial down the line. Don’t be afraid to wield them like a shield — the first line of defense towards any future liability claims.
Need to brush up on your policy? Stay up to date by joining a subscription service for Provider Information Notices (PINs). Health and Safety Code (H&S) code1569.155 requires California RCFEs to subscribe to such a service..
4. Communicate Regularly
Not only is communication vital so that everyone on your team can always be on the same page, but it’s also a regulatory requirement. The law mandates that any change of condition in the resident — say, they have a urinary tract infection or they’re more confused than usual — must be communicated to their physician and responsible party (i.e. a family member), if any.
This makes sense, of course. A change in an individual’s condition can have life or death consequences, and a lapse in communication could prevent a resident from receiving critical treatment.
Shift changes present a particular challenge in this regard. There’s a potential for information to get lost in the transition between your facility’s day and night teams. Certain symptoms, such as insomnia — a potential indicator and risk factor of depression — might only present themselves late in the evening, so it’s imperative everyone is kept in the loop, and that changes are noted in writing.
Let’s not forget your duty as a certified RCFE Administrator to maintain communication with your state licensing entity. Any time a resident experiences an unusual incident — such as a fall, an injury, or a medical emergency requiring a trip out to the hospital — a report must be made to your Licensing Program Analyst at the Department of Social Services(DSS) with within 1 business day via telephone, and within 7 days via a written report. This takes us to our next tip.
5. Document, Document, Document
Any time there is a resident incident, such as a fall, it must be documented — either internally, if it isn’t that serious, or on a State-provided form to be submitted to the DSS if you called 911 or something similar. Like the above, incidents need to be reported to the resident’s physician and responsible party, and it’s best to do this in writing so you have a paper trail.
Liability, though you might not want to think about it, should always be a concern. Thus, it’s wise to perform internal audits and random record reviews on a routine basis. You always want to be able to certify compliance if the need arises. This is where the term “defensive documentation” comes into play. When you document incidents, or anything really, specificity, precision, and descriptive detail are all musts.
Resident personnel, and administrative records—must be secured in a HIPAA compliant manner. What does this mean? Records should be kept locked. Employees should not have access to administrative or personnel records. Families cannot have access to resident records without consent or a record release form. Computers must be password protected, on an intranet and passwords change every 45-60 days. As a guideline, take a look at the list of documents and records that must be kept at residential care facilities in California. Remember that every state is different, so unless your facility is located in California, what you are required to retain might be different.
6. Don’t Be Afraid to Say No
The words “this is my island” spring to mind. This facility is yours, and as an RCFE Administrator, you cannot be afraid to say no. We covered this in part in Tips #1 and #2, what to do in the beginning, but there’s a corollary on the other end of the spectrum: what to do when an end is inevitable.
If an employee misbehaves, routinely underperforms, or puts your residents or facility in any modicum of risk (health, liability, or otherwise), then it is your duty to terminate them promptly. With the safety and wellbeing of those in your care on the line, they must be your first primary concern.
But what if an individual’s medical needs exceed your facility’s abilities?
It’s sad to say, but this is a quandary you will likely face dealing with residents suffering from advanced Alzheimer’s and dementia. Much as you might want to keep them in your care, your license might not permit it. The care they require might go beyond the scope of what you can supply. In these situations, or in cases of residents who exhibit violent behaviors or a flagrant disregard for community rules, letting go of a resident might be a necessary course of action as well.
The Essential Component of Success
Looking back on the six tips we just shared, you might notice that at their core they are all about the same thing: care.
Caring enough to do things right. Providing the best care.
Take time to assure your level of care by maintaining compliance and communication.
Although there is a lot more to running a successful RCFEcommunity than just these 6 things, mastery of these will give you a great foundation to build your business on. In the event that you need additional support or training, the experts here at Assisted Living Education are always here to lend a hand.
Assisted Living Education is the premier provider of RCFE certification, RCFE classes, licensing, products and services for assisted living. Our teachers are industry professionals with many years of experience that are engaging, entertaining and highly informative. We offer RCFE consulting services and share real RCFE experience that will help you be successful in this fast-growing career industry.