2014 Teddy Award Winner

Healing the Healers

Teddy Award winner Cold Spring Hills Center for Nursing and Rehabilitation proved that even small organizations can make a huge difference in their employees’ lives. 
By: | November 3, 2014 • 7 min read

When Bob Baranello joined Cold Spring Hills Center for Nursing and Rehabilitation as chief executive officer in 2011, the facility “clearly had a lot of work to do” to reduce staff injuries and workers’ compensation costs, he said.

The average claim cost was $7,500, lost-time claims averaged 26 days and with an experience mod of 1.45, and premiums were “through the roof.” The facility had a weak safety culture and a pervasive fraud and abuse problem.

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Cold Spring Hills was not yet enforcing the strict safety standards its owner, National Healthcare Associates, had put in place at its 40 other nursing and rehabilitation facilities.

After Prism Consultants, a health care brokerage and risk management consultant, ran extensive analytics on a large quantity of claims data, National Healthcare discovered its employees were at even greater risk than they had realized, said Ephram Ostreicher, director of operations, National Healthcare Associates.

It brought in Prism to manage all aspects of the workers’ compensation program, and set about changing across-the-board safety, customer service, and quality of care practices.

“When you change a culture, you fix a lot of things,” Baranello said.

New Safety Culture

“We put a lot of work into a new safety awareness culture,” Ostreicher said. The existing culture wasn’t conducive to gaining traction on safety improvements. “There was cynicism and negativity. We had to prove we care.”

“When you change a culture, you fix a lot of things,” — Bob Baranello, CEO Cold Spring Hills Center for Nursing and Rehabilitation

Top of the list: Remediating conditions related to patient-handling injuries and slips, trips and falls, the biggest source of claims, both in number and severity. Targeting the back and shoulder injuries that plague nurses and nursing assistants from constant bending and lifting, Cold Spring Hills initiated its “Journey to Zero Lift” program.

It bought 14 new Hoyer lifts, mechanical devices that spare wear and tear on residents as well as nurses and assistants. It created Journey to Zero Lift “kit bags,” which contain non-friction sheets and gait belts for lifting and turning, depending on the residents’ medical records and care plan. The kits are stored outside resident rooms for easy access.

“By branding the kits and the program,” said Ettie Schoor, the founder and managing principal of Prism Consultants, “we helped employees understand the importance of the program.”

Cold Spring Hills also started to investigate every accident immediately to make sure it never happens again. In the past, investigation of an accident may have lagged three or four weeks, by which time the traceable conditions would have changed.

Now, supervisors immediately go to an accident scene and ask employees to re-enact it, if they’re able. They examine every environmental detail, including lighting, footwear and hardware, Schoor said. This practice identified a mechanical problem with dietary carts, which had injured a number of employees.

“We brought in the vendor to check every cart. They changed the wheels,” she said.

Bob Baranello, CEO, Cold Spring Hills Center for Nursing and Rehabilitation

Bob Baranello, CEO, Cold Spring Hills Center for Nursing and Rehabilitation

The surveillance cameras Cold Spring Hills installed also shed light on how the accidents happened and how they could be prevented.

These efforts, Baranello said, mark a sea change from the dark days just five years ago when injured employees filed 231 workers’ comp claims. That number dropped to 98 in 2013, and is still falling.

Strategic “micromanagement” extends all the way up the corporate food chain. Baranello is directly responsible for safety. He’s involved in every incident, not just the “big ones” that would merit the CEO’s attention at most facilities.

Baranello, department heads, supervisors and line staff participate in monthly meetings of the newly refashioned safety committee so they can spread the safety gospel.

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“Safety of residents and staff is a huge part of every employee’s job,” said Baranello.

Revised resident care plans factor into safety as well, with highly detailed profiles and instructions. One might note, for example, that Mr. Smith prefers a male aide or that he doesn’t want to be awakened before 10 a.m. Care plans conform as closely as possible to the resident’s tastes and pre-facility life, minimizing the behavioral problems that produce a distressing number of scratches and bites to the direct care staff.

“For everybody’s safety, we hold closely to the care plan,” said Ostreicher. “It’s part of the training.”

Showing the Love

When accidents do happen despite precautions, Cold Spring Hills and Prism show employees “a lot of love and care,” said Schoor. That means frequent and regular follow-up calls with the employee and all medical providers. It might also mean providing nursing care at home, household help, child care, delivered meals and even flowers — any way possible to lift injured workers’ spirits and accelerate their return to work. This kind of attention can also forestall the litigation characteristic of disgruntled workers.

When a dietary worker suffered third-degree burns, the insurance company anticipated initial exposure of $480,000 and potential exposure of over a million dollars in medical treatment and lost time. It predicted a long, grim life of disability for the worker and subsequent lifetime indemnity payments.

Prism assisted Cold Spring Hills in pulling out all the stops to aid the injured worker’s recovery and boost her morale. Employees from both organizations, including Baranello, visited her in the hospital.

They sent cards to her and food to her family. When she started to fret over the depleted minutes on her mobile phone plan, they funded her cell phone so she could concentrate on the important job of getting better.

Nine months, multiple surgeries and $80,000 in medical bills later, the worker declined a $150,000 insurance settlement, choosing instead to return to work — this time at a desk job instead of in the kitchen where she was burned and traumatized.

“She said, ‘Because of the way I was treated, I will never leave this facility,’ ” Schoor said.

Return to Work

That worker’s modified assignment is a key part of National Healthcare’s claims management strategy.

“We try to get all employees back to work no matter what their restrictions are,” said Ostreicher. “We find a meaningful job they can do within their restrictions,” while monitoring progress on the path to full duty.

Prism works with National Healthcare and doctors to identify temporary restricted duty (TRD).

Ettie Schoor, founder and managing principal, Prism Consultants

Ettie Schoor, founder and managing principal, Prism Consultants

A nursing assistant who underwent spinal fusion was still in a wheelchair when she was released to return to work. “We worked with her to identify tasks she felt were important to the operation: folding residents’ clothes, polishing handrails/walls and reading to and feeding residents,” Schoor said.

Cold Spring Hills paid her previous salary, so she experienced no loss in compensation, and she felt her contribution, although different, was still important.

When injured employees return to TRD, they report their progress regularly to supervisors, who are “hands-on involved” in returning workers to full duty as soon as medically appropriate. “They know we’re on top of it,” Schoor said.

The team also ensures that as workers’ restrictions ease, their jobs change also. This minimizes exposure while earning the worker’s loyalty.

Smoking Out Fraud

As much as Cold Spring Hills, its parent company and Prism show the love to genuinely injured workers, they turn an equal fury on fraudsters.

“If you mess with us, we’ll catch you and be all over you,” Schoor said.

“Tender and tough — that’s our policy,” — Ettie Schoor, founder and managing principal, Prism Consultants

“When an accident happens, we work with our staff to make sure the same one won’t happen again, and when we do have an accident, we help the employee return to work,” Schoor said. This keeps exposure down, and so does meticulous follow-up on claims.

“If we smell something — not necessarily fraud — we follow up. If the doctor says the employee is disabled but she’s able to lift her kids, we’ll use that information to get a release to work. That also keeps exposure down.

“Tender and tough — that’s our policy,” said Schoor.

In one spectacular case of gumshoe insurance investigation, a worker “disabled” by a shoulder injury called Prism about her workers’ comp check. The caller ID showed the name of a beauty supply store.

Prism sent an investigator equipped with a wrist-watch camera to the store and asked the worker to reach up for several items. The movement engaged the putatively injured shoulder, which he filmed surreptitiously.

When he paid for the items, he captured her name on the sales slip. Between the two pieces of documentation, the fraudulent injury claim collapsed.

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An overwhelmingly honest workforce isn’t spooked by these aggressive tactics, said Baranello, but rather welcomes them.

“Good people don’t want to see fraud, and most are hard-working and responsible,” he said. “They want us to prosecute the few bad apples who try to game the system.”

_______________________________________________________

Read more about all of the 2014 Teddy Award winners:

11012014_02_cs_honda_150x150Building Value with Trust: Honda of South Carolina boosted its involvement with injured worker cases, making a positive first impression on employees and health care providers.

 

11012014_03_cs_harley_150x150The TLC Behind the Roar: A proactive and holistic approach to employees’ well-being has resulted in huge reductions in work-related injury claims for Harley-Davidson.

 

11012014_04_cs_compass150x150Quick to Act: Compass Group is lauded for its safety initiatives and for a return-to-work program that incorporates all of its business lines.

 

 

11012014_05_cs_coldspring_150x150Healing the Healers: Teddy Award winner Cold Spring Hills Center for Nursing and Rehabilitation proved that even small organizations can make a huge difference in their employees’ lives.

 

Susannah Levine writes about health care, education and technology. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Absence Management

Establishing Balance With Volunteers

It’s good business to allow job-leave for volunteer emergency responders, whether or not state laws apply.
By: | January 10, 2018 • 7 min read

If 2017 had a moniker, it might be “the year of the natural disasters,” thanks to a phenomenal array of catastrophic or severe events— hurricanes, tornadoes, wildfires, ice storms and floods.

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Combined with smaller-scale fires and other emergencies, these incidents tax the resources of local and state emergency services, often prompting the need to call volunteer emergency responders into action.

But as lean as most organizations are already running, volunteer activities can sometimes cause friction between employees and employers. Handling conflicts the wrong way can potentially lead to legal headaches, harm employee morale and batter a company’s reputation.

State by State Variations

Most employers are aware of the various federal and state leave laws protecting their employees, including family and medical leave, pregnancy leave and military leave. But leave laws that protect the livelihoods of volunteer emergency responders are more likely to fly under the radar of some HR managers and risk managers.

Such laws don’t exist in every state, but more than 20 states do have some type of law in place to protect volunteers including emergency responders, firefighters, disaster workers, medical responders, ambulance drivers or peace officers.

Marti Cardi, vice president of Product Compliance for Matrix Absence Management

The laws vary broadly. Nearly all specify that such leave be unpaid, and that employees disclose their volunteer status to employers and provide documentation for each leave. But there is a spectrum of variations in terms of what may trigger an eligible leave. Some, for instance, apply for any emergency that prompts a call from the volunteer’s affiliated responder group. Others may require a government declaration of emergency for the law to be triggered.

While many of the laws do not explicitly require employers to let employees leave work when called to an emergency during a shift, most specify that an employee may be late or even miss work entirely without facing termination or any other adverse employment action.

Some states mandate a maximum number of unpaid leave days that a volunteer can claim. But others may place more significant burdens on employers. In California, for instance, employers with 50 or more employees are required to grant up to 14 days of unpaid leave for training activities in addition to any leave taken to respond to emergency events. For multistate employers, keeping on top of what obligations may apply in each circumstance can be a challenge.

Significant Risks

Large or mid-sized employers may rely on absence management providers to keep them in compliance. For smaller employers though, it may be as simple as looking up a state’s law via Google to find out what’s required. However, checking in with the state department of labor or the company’s attorney may be the best way to get the correct facts.

“I would caution that just because you don’t find something [on the internet], it doesn’t mean it’s not there,” said absence management and employment law attorney Marti Cardi, vice president of Product Compliance for Matrix Absence Management.

For example, Cardi said, an obscure Texas law provides job-protected leave for volunteer ham radio operators called into service during an emergency.

Cardi said employers should task HR to investigate the laws in each state the company operates in, and to ensure that supervisors are educated about the existence of these laws.

“If a supervisor is told by one of his or her employees, ‘Sorry I’m not coming in today … I’ve been called to volunteer firefighter duty for the [nearby region] fire,’” she said, you want to be sure that the supervisor knows not to take action against the employee, and to contact HR for guidance.

“Training supervisors to be aware of this kind of absence is really important.”

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An employer that does terminate a protected volunteer for responding to an emergency may be ordered to pay back wages and reinstate the employee. In some cases, the employee may also be able to sue for wrongful termination.

And of course, “you don’t want to be the company in the headlines that is getting sued because you fired the volunteer firefighter,” she added.

If an employer bars a volunteer from responding, the worst-case scenario may be a third-party claim. Failure to comply with the law could give rise to a claim along the lines of “‘If you had complied with your statutory obligation to give Jane Doe time to respond, my loved one would not have died,’” explained Philadelphia-based Jonathan Segal, partner at law firm Duane Morris and managing principal of the Duane Morris Institute.

“That’s the claim I think is the largest in terms of legal risk.”

Even if no one dies or is seriously injured, he added, “there could still be significant reputational risk if an individual were to go to the media and say, ‘Look, I got called by the fire department and I wasn’t allowed to go.’”

The Right Thing to Do

What employers should be thinking about, Segal said, is that whether or not you have a legal obligation to provide job-protected leave for volunteer responders, “there’s still the question of what are the consequences if you don’t?”

Employee morale should be factored in, he said. The last thing any company wants is for employees to perceive it as insensitive to their interests or the interests of the community at large.

“Sometimes employers need to go beyond the law, and this is one of those times,” — Jonathan Segal, partner, Duane Morris; managing principal, Duane Morris Institute

“How is this going to resonate with my employees, with my workforce, how are people going to see this? These are all relevant factors to consider,” he said.

There’s an argument to be made for employers to look at the bigger picture when it comes to any volunteer responders on their payroll, said Segal.

“Sometimes employers need to go beyond the law, and this is one of those times,” he said. “Think about the case where’s there’s not a specific state law [for emergency responders] and you say to a volunteer, ‘No, you can’t leave to deal with this fire’ and then people die. You as an employer have potentially played a role, indirectly, because you didn’t allow the first responder or responders to go,” he said.

The bottom line is that “it’s the right thing to do, even if it’s not required by law,” agreed Cardi.

“I feel that companies should have a policy that they’re not going to discipline or discharge someone for absences due to this kind of civic service, subject to verification of course.”

Clear Policy

While most employers do strive to be good corporate citizens, it goes without question that employers need to guard their own interests. It’s not especially likely that volunteer responders will try to take advantage of the unpaid leave allowed them, but of course, it could happen.

That’s why it’s important to have policies that are aligned with state laws. Those policies could include:

  • Notifying the company of any volunteer affiliations either upon hire or as soon they are activated as volunteers.
  • Requiring that employees notify a supervisor as soon as possible if called to an emergency (state requirements vary).
  • Requiring documentation after the event from the head of the entity supervising the volunteer’s activities.

If at some point it becomes excessive – someone has responded to emergencies five times in nine weeks, then it’s time to examine the specifics of the law and have a discussion with the employee about what’s reasonable, said Segal. It may also be time to ask specifics about whether the person is volunteering each time, or are they being called.

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In some cases, the discussion may need to be about finding a middle ground, especially if an employee has taken on an excessively demanding volunteer role.

“We encourage volunteers to pick the style that best fits their schedule,” said Greta Gustafson, a representative of the American Red Cross. “Disaster volunteers can elect to respond to disasters locally, nationally, or even virtually, and each assignment varies in length — from responding overnight to a home fire in your community to deploying across the country for several weeks following a hurricane.

“The Red Cross encourages all volunteers to talk with their employers to determine their availability and to communicate this with their local Red Cross chapter.”

Segal suggests approaching it as an interactive dialogue — borrowing from the ADA. “Employers may need to open a discussion along the lines of ‘I need you here this week because this week we have a deliverable on Friday and you’re critical to that client deliverable,’” he said, but also identify when the employee’s absence would be less critical.

No doubt there will be tough calls. An employer may have its hands full just trying to meet basic customer needs and need all hands on deck.

“That may be a situation where you say, ‘First let me check the law,’” said Segal. If there’s a leave law that applies, “then I’m going to need to comply with it. If there’s not, then you may need to balance competing interests and say, ‘We need you here.’” &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]