Back in September, I shared my insights in McKnight’s Long-Term Care News about the importance of being your own data defender. In that blog, I expressed a viewpoint that I believe strongly in: Every nursing home should consider appointing a “data czar.”
This strategic move positions the facility to excel in representing itself to external stakeholders and, crucially, defending against potential reputational challenges.
Since that writing, my conviction in the concept of appointing a data czar has only grown stronger. Several recent experiences have concretely shown how a dedicated individual in this role can make a substantial difference. These experiences allowed me a more comprehensive understanding of a data czar’s role in ensuring data integrity and contextualizing the data to uphold the reputation of their nursing home. I’ll talk about one of them here.
A recent courtroom case I took part in involved a frail elder admitted to a nursing home with several pressure ulcers, post-CVA. One of the ulcers became unstageable, and shortly after admission the resident was transferred back to the hospital, where he died. Although he resided in the nursing home for less than a month, the nursing home was being held accountable for the pressure ulcers. Low staffing was part of the complaint.
Plaintiffs commonly include low staffing in their complaints, and this case was no different. Here, the plaintiff relied upon staffing sheets, various depositions from staff and family, and their interpretation of the state’s staffing requirements.
The defense cited PBJ data and presented a more precise analysis of the staffing requirements in the facility’s state. Both of these sources supported the idea that the nursing home met the federal and state staffing requirements.
Related to the pressure ulcers, while I wasn’t providing expert testimony on them, I did point out that the plaintiff’s expert was using a contemporary MDS 3.0 definition of ulcer coding that didn’t align with the MDS coding conventions that were in place when the nursing home assessed the resident. Thus, the plaintiff’s conclusion of “MDS manipulation” wasn’t valid.
All that said, as I stood in the courtroom, it became clear that while accurate and contextualized data is undeniably crucial, it has its limits. The jury’s preconceptions of nursing homes, their comfort level discussing sensitive subjects like death, and the emotional state of the plaintiff’s family all played pivotal roles in the proceedings.
Throughout this legal battle, it became evident that my empathy to the resident’s family and to the nursing home, coupled with my steadfast focus on the nursing home’s data story, was the key to achieving a favorable outcome.
I’d like to acknowledge that finding a jury with a neutral opinion about nursing homes, and about aging in general, may be near impossible. The societal stigma attached to aging and death, and to the institutions associated with those realities, remains deeply ingrained no matter how we try to change it.
In moments like these, I’m reminded of my favorite W. Edwards Deming quote: “Every system is perfectly designed to get the results it gets.” However, I’d like to take that concept a step further and add a twist. Despite systemic challenges, regulatory constraints, and reimbursement designs, the nursing home industry consistently exceeds what it’s expected to achieve. I fervently believe that this is due to the mission-driven individuals who work with the elderly. But perhaps that’s a topic for another blog!
As the “proxy” data czar during this courtroom case, my experience as a nurse working in nursing homes proved to be irreplaceable. In this role, I wasn’t just capable of telling the quantitative data story; I could also provide the vital qualitative perspective. It was the synergy between my data expertise and my deep understanding of the nursing home’s daily operations, as well as the human side of healthcare, that ultimately contributed to a positive outcome for the defense.
Data without subject matter expertise can be a double-edged sword, capable of being weaponized against you. However, the key to mounting a strong defense lies in knowing your data intimately and having the ability to tell your story in a way that only you can.
Furthermore, the empathy derived from working in a nursing home, where one understands the inherent joy and sadness of aging and the inevitable reality of death, is an invaluable asset. Compassion for residents and their families should be an essential part of the data czar’s job description.
Steven Littlehale is a gerontological clinical nurse specialist and chief innovation officer at Zimmet Healthcare Services Group.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
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