The mystery of the disappearing resident room (and the lost census)

In complex mysteries you may have more than one party that is responsible for missing rooms in a senior living community. The worst crime scene I ever witnessed had eight missing resident rooms that were later found to be offices, storage rooms and a large break room.

Solving the mystery of the disappearing resident room requires a keen, Columbo-like sense of asking questions and going back again and again until they get answered. In analyzing Columbo’s unique approach to detective work in more depth we find his technique was less about asking the questions and more about his ability to observe the situation and the reactions to his questions.

As in any good murder mystery there are the usual suspects. The detective needs to focus in on who would benefit from the demise of the victim/victims (which we will just call Room John Doe and Room Jane Doe to protect the resident rooms’ real names).

When a home is having census issues and the rooms are full, a good investigator needs to be able to open every door, open every drawer and look at all the skeletons in the closet. It is not uncommon for the executive director to not have a key to every door, let alone every closet. Sometimes the staff is unsure who even has a key to certain spaces. In these situations the patience of Columbo is needed.

So who typically benefits in a murder mystery? The usual suspects are those seeking Power, Money or Love.

The Power seekers are those who feel that an office is needed to do their job. The perfect size and location is empty Room John or Jane Doe and once taken over, everyone forgets about the room’s original identity from here on out. Power seekers will typically cite their need for confidentiality, locked storage or privacy to meet with others in that space.

The Money seekers are those who feel that due to their pay not being in line with their performance, they deserve compensation in the form of “land.” They decorate the room with all their personal items and may even paint and carpet it themselves. It becomes space that they “own” like a captured territory that they will wage war not to lose.

The Love seekers are caught up in a triangle between residents, census and employees. They believe in their heart that if they provide the best staff spaces that this will translate to the best care and thus the census will be great. What they fail to realize is that a love triangle never works out well for anyone. In the end everyone gets hurt. We see this played out in large break rooms, charting rooms, non-code required specific restrooms for “staff only,” huge maintenance shops and storage spaces.

Shining a light on the facts will reveal who is ultimately responsible for the room’s demise or at the very least, who sat by and allowed it to happen, which makes them an accomplice.

Once the victims have been identified and the facts are in order, it’s time to put things right. Census will never be able to live a normal life until it has been vindicated and the record set straight. Punishment for the guilty needs to be swift, but just.

The typical sentences for these crimes are as follows:

Death by Offices needs to have office spaces consolidated into an open plan with systems furniture and then a small conference space for those needing to have confidential discussions with others. Confidential discussions on the phone can be handled with a simple HIPAA agreement, but there are also portable sound masking units for around $200 that can be used by payroll and HR.

Death by Storage can easily be handled in a couple ways. First is the use of adjustable shelving and maximizing of vertical space being used (less than 18" from the ceiling for the sprinkler code). Secondly, consolidate storage. Product expiration and waste are highly increased when supplies are not stored in a central location. Third, move to a just-in-time delivery system vs bulk buying. And finally, medical records need to be moved off-site with the exception of those records required by code.

Finally, Death by Love is the messiest of all. People who had good intentions get punished and everyone suffers. It is difficult to take away space from those who now feel entitled to it. A good rule of thumb for break rooms is to take the number of staff that can be on break at any one time, making sure that the resident/caregiver ratios are being met, and limit the space to this size. I have seen break room crime scenes so large that I question who was taking care of the residents.

After the investigation and the trial and sentence has taken place, there will be some grieving and recovery time to get the rooms prepared for the next residents meant to live there. You have to wonder whether all the pain was worth it. Well, let me ask you, could you use an extra eight residents to help you with your census, which would not have had the space to move in before the investigation? I know my clients want every one they can get.

I Advance Senior Care

I Advance Senior Care is the industry-leading source for practical, in-depth, business-building, and resident care information for owners, executives, administrators, and directors of nursing at assisted living communities, skilled nursing facilities, post-acute facilities, and continuing care retirement communities. The I Advance Senior Care editorial team and industry experts provide market analysis, strategic direction, policy commentary, clinical best-practices, business management, and technology breakthroughs.

I Advance Senior Care is part of the Institute for the Advancement of Senior Care and published by Plain-English Health Care.