Working – 1 (Carol Richelson)

May 11, 2014

Carol Richelson works for a local nursing home—a nursing home that is owned by an out-of-state corporation—as its Resident Assessment Coordinator. She’s a registered nurse who has been a nurse for almost 40 years. The nursing home she works for provides rehab programs for patients recovering from surgeries and illnesses, and also has some long term care residents.

When she responded to my inquiry from several days ago, Carol said she could say “yes” to every question I had posed about jobs generally. Seemed like a job worth finding out about.

Some of what I learned I knew, intuitively but not in any detail:  nursing homes are, effectively, regulated by Medicare through CMS, the Centers for Medicare & Medicaid Services. (States also regulate nursing homes through a licensure process, but state regulations do not address how nursing homes get paid.) CMS does decide who gets paid, and how much they get paid, for providing health care services provided through Medicare and Medicaid. And, effectively, health insurers work off of CMS regulations. (CMS, previously known as the Health Care Financing Administration—HCFA—has been around since 1977. So much for the notion that the Affordable Care Act introduced health care to the government, and vice versa.)

So what does all of this have to do with Carol Richelson? She’s the person who assesses each patient at her nursing home. Her assessments follow a schedule, beginning with an assessment when a patient arrives and follow-up assessments thereafter. The assessments have two primary purposes:  developing a treatment plan; and providing information that gets used in connection with the payment process, whether payment will come from Medicare or an insurer.

So what does Carol actually do? Lots of things. She does several assessments every day, including new patient and follow-up assessments on existing patients. An assessment involves interviewing the patient, gathering information about sleep, eating habits, depression, pain, and a myriad of other issues. Carol does not perform physical exams, but it sounds like she’s conducting what amounts to an old-fashioned physical, sans the actual exam.

She writes up her reports, which involve consolidating interview answers with charts and records she has reviewed. Her process uses software that prompts the questions, which allows for complete reports without relying on memory about this issue or that.

The assessment and review process involves about 35 charts every two weeks. Alone, that seems like a significant amount of information to process and handle, but Carol, has other duties. She spends time on the floor, checking on patients and the nursing staff. (Carol reports to the Director of Nursing and, informally, to the administrator at the facility. That said, she plays an informal supervisory role with the nursing staff, as she has the knowledge base about each patient.)

In addition to the focus on assessments, Carol’s job responsibilities make her, effectively, a quality assurance officer. Again, the knowledge base she gains through the assessment process makes her the “eyes and ears” for patients!

Carol has an office with a desk, a window, and a door, which are features that are not often part of a nurse’s work space, and are features she mentioned with a big smile. She spends time in her office preparing her reports. She does talk on the phone, she does email all day, and she goes to lots of meetings, some regularly scheduled and some ad hoc. She also does some basic nursing work, taking call every week. Generally, Carol knows what she will be doing each day, before the day starts.

Carol works 9-10 hour days, and while she is accountable for outcomes and expected to work every day, she does have the ability to leave for personal purposes. No time clock in her job!

A couple of other interesting points came out of our interview, aside from the fact that we overlapped by one year in high school. Go THS Badgers! First, people do not go to school to learn how to do Carol’s job. It’s a job for which a nursing degree and lots of experience are essential, but it’s a job that gets learned along the way. Second, the health care regimen as it operates in 2014 is incredibly complicated, and will remain very complicated for the foreseeable future.

My conclusions! Very dynamic job, with lots of pieces and parts that matter greatly in the lives of the people with whom Carol Richelson connects.

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