Revisiting House Rules

Revisiting House Rules

Author: Mark Parkinson RPh:  President  AFC-CE

Credit Hours 1- Approximate time required: 60 min.

 

Educational Goal:

To expand the perspective of Adult Foster Care providers about the writing and use of house rules. 

Educational Objectives:

Explain about the opposing expectation of residents, caregivers and licensers and how to use the house rules to align them.

Provide suggestions on how to write house rules for broader purposes. 

Explain that house rules are actually a statement of company policy.

Provide additional sources of information about writing company policy.

Procedure:

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Disclaimer

   The information presented in this activity is not meant to serve as a guideline for patient management. All procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this article should not be used by care providers without evaluation of their patients’ Doctor. Some conditions and possible contraindications may be of concern. All applicable manufacturers’ product information should be reviewed before use. The author and publisher of this continuing education program have made all reasonable efforts to ensure that all information contained herein is accurate in accordance with the latest available scientific knowledge at the time of acceptance for publication. Nutritional products discussed are not intended for the diagnosis, treatment, cure, or prevention of any disease.

Revisiting House Rules

The unique feature of our industry is that you provide medical care out of a regular home. It gives you a competitive advantage over other types of medical care by tapping into the resident’s and their family’s sense of home.  It also creates the perception that the job is easier and more relaxed for caregivers.

This may be strength, but it is also a weakness. Expectation for the caregiver’s home to be like the resident’s own home is very high. At the same time, it is oh so easy for caregivers to forget their house is no longer a home - it’s a business. A business set up to meet the needs and expectations of paying customers.

Adding to that complexity is another layer of government standards of caregiver behavior that must be complied with and will be inspected for regularly. It is no wonder that things get a bit tangled and frustrations occur over time.  

What we are really talking about is a conflict of expectations. The caregiver, resident, and government licensor all have divergent perspectives and expectations on what should occur in the care home. When all three align, things run smoothly. When they don’t, problems start to occur.

Bringing all three expectations into harmony is the difference between a good home and a poorly run home. But how do the good homes do it? How do they get everyone on the same page and keep all three perspectives in agreement the answer lays in the three Cs: Clear Consistent Communication.

 

Easier said than done, right? I can’t even remember what I said to my wife a week ago, and I’ve been married to her for 30-plus years. How is a person supposed to communicate consistently and clearly with customers and government officials day after day, week after week, year after year?

There is a communication tool that can accomplish just that: Your House Rules. What? I thought I heard you collectively moan, “That’s not a communication tool. That’s just something the government makes me do.” Go on, you can admit it. Some of you only think about house rules when a customer moves in and when the government licensers shows up. Think about that for a minute. House rules and communication with the customer and the government, hmm.  Yes, that’s right. House rules is a tool that you use to communicate clearly and consistently with customers and government licensers year after year. But if you’re only using it a couple of times a year, you’re not get much use out of it.

Here’s a story for you that illustrates my point. In my garage is a big fancy box that contains a practically unused table saw. I have to admit; even though I bought it I have never used it. I did loan it to my neighbor, and he used it. Then he packed it back into the box and there it has sat ever since. I don’t ever use it because I don’t want the hassle of putting it together, and I tell myself, “You don’t know how to use it anyway.” So there it sits, a big fancy box that I lug around with me year after year, move after move.  What a waste. I wonder how many times my life would have been easier if I had unpacked it and learned how to use it.  On a wall somewhere in your home pinned to board is a big fancy communication tool. It’s just sitting there, practically unused.

Why don’t you take it down and let’s take a gander at it. You have had training from the state on what must be included in each house rules. That training emphasizes the minimum requirements and leaves the rest of the details up to you to figure out. In my opinion, that minimalist training has unintentionally limited the focus of the document, which in turn has limited its usefulness and made it harder to use.  So let’s work on some of the details to make it a more functional tool that is also easier to use.

What you are actually looking at is a statement of company policy or how the boss wants things done. It should contain all the rules and procedures that the business owner wants everyone to adhere to, not just the minimums. Each house rules will differ from all others, just as each foster care business is different from all others.

 

Generally though it should:

1. Instruct the resident about what to expect for payment and any limitations they have while staying at your home.
2. Tell the employee what the owner wants them to do and how to act.
3. Include any government regulations that everyone must adhere to.

The larger the organization, the more extensive the company policy should be, especially if the employees spend a significant amount of time on their own without the boss supervising them or if there is a large turnover of employees. Smaller organizations can get by on less.

Important Note*

I’m not going to attempt to tell how to make the perfect one-size-fits-all house rules because there isn’t such a thing.  I will tell you some tricks, tips, and ideas that I think will help you craft your own company policies. It’s going to be up to you to write a more useful house rules for yourself. Don’t think that just because you’re not an owner you’re off the hook. Employee caregivers also can help with ideas and feedback that will help the owner in this difficult task.

 

Tip One: It’s a living document.

            

Writing the house rules is never really done. You should be open to revising it whenever needed.  I suggest the following process of revision.

• Review significant incidents. Things like accidents, complaints, customers moving out, and inspection deficiencies. View these events as opportunities to improve.
• Figure out the root cause of the issue, not just what happened but why it happened. Get feedback from employees, inspectors, and customers.
• Determine what could be done to prevent the occurrence in the future.
• Write the first draft of the revision and then get feedback on it, especially from government inspectors. This will prevent future problems with the revision and possible inspection deficiencies.

 

Tip Two: It’s a tool to use constantly.

Just don’t pin it to the wall, make copies of it and:

• Put it in the employees’ manual. If you don’t have one, make one.
• Turn it into a self-inspection check-off list.
• Use it as an agenda outline for employee meetings.
• Use it in employee training.

 

Tip Three: Write it so it is usable.

If your house rules are awkward or difficult to use in any of the above, change the wording. Just as with process, it is going to take many revisions until you get it right.

• Make the policies realistic for the size, style, location, and clientele of your business.
• Don't be condescending or patronizing. Imagine being a staff member reading them. Would the policies or their language upset you?
• Place the items into shorter sections that are easily revised.
• If an action is mandatory, use “must” in the language. Avoid the use of “should” and “shall” as it implies that it’s optional if the occasion warrants it. Try to limit the use of “will” to occasions that describe a future action and not as a synonym for “must.”
• Use wording that is positive in tone.
• Avoid being gender-specific. Use “they” instead of “he or she.”
• Make the rules easy to follow.
• If your house rules become too lengthy, consider breaking them up. One version is to be used when residents move in. The other is to be used when training new employees.

 

Tip Four:  Don’t go it alone.

Writing company policy is hard. Get help.

• Go to the library for a book on how to write company policy.
• Search the internet; it may cost some money to get the good stuff.
• Get input from employees, government licensees, and home health nurses. Go to adult foster home provider meetings and ask around.
• Get copies of other house rules. Include looking at nursing homes, retirement centers, and even senior centers. Those institutions may not call them house rules. They may be known by other names like company policy.
• Send the first draft to a proofreader. It will cost but not much. There are plenty of willing and able people on the internet that will review your documents. Go to the website Fiverr. I personally use http://www.proofpositivepapers.com/. She charges a penny a word.

 

Tip Five: Be goal oriented.

Determine what goals are important for your business. Write the document so that it enables you to accomplish those goals. Write it and use it with the goal of becoming the best functioning care business out there. To help, I suggest you ask the following questions.

• Will this document help get and retain customers?
• Will this document help make and retain good employees?
• Will this document satisfy government licensees so that there will be no inspection deficiencies?

 

Tip Six: KISS

Keep it simple stupid (MIT’s language, not mine). Write only what is needed. Write for the broad situation, not the specific incidence.

Write a policy:

• If there might be employee confusion on how to behave. (dress code, telephone use, limitations)
• If guidance is needed on how to act. (emergency procedures)
• If consistency is needed. (smoking policy, progressive discipline, safety rules, privacy rules, telephone and computer use)
• If the issue behind the rule can apply to everyone. One employee or resident’s poor behavior should not require a policy that will affect all other employees or residents.

 

Tip Seven: Get approval beforehand.

Don’t forget to get final approval from government licensees of your finished and polished house rules before you post it. Get approval on any future revisions. Be patient and keep in mind the following:

• Be courteous to the government officials. They don’t exactly have a lot of extra time on their hands.
• Tell them that you’re just trying to be cooperative and compliant with the rules and regulations.
• Identifying problems with the house rules before they are implemented takes less time and effort on everybody’s part than changing them after and an inspection deficiency notification.

Benefits

It may take some extra work, but a well-written house rules that is consistently reviewed and put into practice is worth the effort.

• Employee training and discipline will be easier. Employee morale will improve, and turnover will decrease. Owner’s action will be more consistent and less confusing to others.

• Residents and their families will know what to expect and be more content. That leads to fewer complaints filed that need to be investigated.
• You can’t be there all the time to make sure that things operate correctly but your company policy can.
• If you have included the government licensor you will have gotten approval on how you operate in advance. That means there will be fewer deficiencies at inspection time.
• A living document means you will constantly improve, and those improvements will stick. Caregiving will get easier. If there is a bad issue happening, adjust the company policy to avoid it the future.

 

Conclusion

Clear, consistent communication is the certain way to align the expectations of resident, owner, employee, and government licenser. A well-written and appropriately used house rules is the assured path to the three Cs.

A good quality care home will use them to get the employees to act a certain way, get approval from the state in advance, and fine tune the business to be more appealing to customers and employees. Wise owners will evaluate problems that have occurred and revise the house rules or company policy to prevent future problems from happening.

It may require more work, but it will be worth it. Get assistance if you need it. I hope that the above tips have helped.

As always, good luck in your caregiving

 

Here are few sources that provide more insight and examples that I found on the internet. Do your own Google search.

http://www.spadacarehomes.com/wp-content/uploads/2015/08/SH-PoliciesProcedures_01012015.pdf

 

https://www.thebalance.com/how-to-develop-a-policy-1918870

http://www.adrielcarehome.com/documents/HouseRules.pdf

 

References:

1. Module 1, Introduction to Adult Foster Care for Individuals with Developmental Disabilities. Developmental Disabilities Adult Foster Care Training Manual, Oregon Department of Human Services. http://www.oregon.gov/DHS/PROVIDERS-PARTNERS/LICENSING/IDD-FOSTER-HOMES/Documents/AFH%20Training%20Manual.pdf
2. Leslie Contreras Schwartz. Guidelines For Writing Policies and Procedures. Smallbusiness.chron.com. http://smallbusiness.chron.com/guidelines-writing-policies-procedures-1803.html
3. Nicole Long. How do I Develop a Policy & Procedures Manual?. Smallbusiness.chron.com. http://smallbusiness.chron.com/develop-policy-procedures-manual-2903.html
4. User Guide to Writing Policies. University of Colorado. https://www.cu.edu/sites/default/files/APSwritingguide.pdf
5. Oregon Administrative Rules, Chapter 411, Div.50. Oregon Department of Human Serviceshttp://www.dhs.state.or.us/policy/spd/rules/411_050.pdf
6. Susan M. Heathfield. How to Develop a Policy. The Balance .com. July 23, 2016 https://www.thebalance.com/how-to-develop-a-policy-1918870

 

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