Building the Paperwork

If you’ve ever started a new business, you already know there is a point where the exciting ideas have to meet the paperwork.

Forms. Policies. Procedures. Applications.

Training records. Checklists. Logs. Signatures.

More forms.

And then, just when you think you’re finished…

Someone needs another form.

True North Living is no exception.

In fact, we’re spending a tremendous amount of time building the paperwork and documentation systems before the first resident ever moves in.

And that’s intentional.

Paperwork isn’t the mission.

We don’t believe paperwork is what makes a good residential program.

A binder doesn’t provide compassion.

A form doesn’t build independence.

A policy doesn’t make someone feel safe.

People do those things.

But good documentation creates the structure that allows people to do their jobs consistently and responsibly.

That’s why we’re taking it seriously.

If it isn’t documented, it’s difficult to know what happened.

Imagine that a resident has an unusually difficult day.

One staff member notices that they didn’t sleep well.

Another notices that they weren’t eating normally.

Someone else notices that they became overwhelmed during an outing.

The next shift doesn’t know any of that.

Without communication, the information disappears.

With good documentation, the next staff member can see what happened.

Patterns begin to emerge.

Questions can be asked.

Changes can be reported.

And the team can make better decisions.

Documentation creates continuity.

We want staff to know what “normal” looks like.

One of the most important pieces of documentation we plan to develop is information about the individual resident.

Not just:

• Diagnosis
• Medication list
• Emergency contacts
• Physician information

Those things are important.

But they aren’t enough.

We want staff to understand the person behind the paperwork.

What are their strengths?

What can they do independently?

How do they communicate?

What do they enjoy?

What are their routines?

What situations are difficult for them?

What are their sensory preferences?

What are the early signs that they are becoming overwhelmed?

What helps?

What doesn’t help?

How do they prefer to be supported?

What are their goals?

The more we know about a person when things are going well, the easier it becomes to recognize when something has changed.

Policies tell us how True North operates.

We’re developing policies and procedures covering the many areas involved in operating a residential home.

Medication management.

Emergency procedures.

Incident reporting.

Resident rights.

Confidentiality.

Transportation.

Staff responsibilities.

Abuse, neglect and exploitation reporting.

Fire and evacuation procedures.

Infection control.

Behavioral support.

Documentation.

Money and personal property.

Community activities.

Visitors.

Safety.

And much more.

These policies aren’t being created simply so we can put them in a binder and say, “Yep, we’ve got policies.”

They’re there so staff know what is expected of them.

And so residents and families know what they can expect from us.

Checklists aren’t about distrust.

Some things are too important to rely on memory.

Did the medication count get completed?

Was the refrigerator temperature checked?

Were required safety checks completed?

Was an incident documented?

Were shift responsibilities completed?

Was important information communicated to the next shift?

A checklist provides a reminder.

It also provides accountability.

The goal isn’t to catch someone doing something wrong.

The goal is to make it easier to do things right.

Documentation protects residents.

This may be the most important reason we are building these systems carefully.

Good records help establish what happened.

They can demonstrate that medications were administered appropriately.

They can document changes in condition.

They can show that incidents were reported.

They can track appointments.

They can record progress toward goals.

They can identify patterns.

They can provide information to families, guardians, medical professionals and other members of the individual’s support team when appropriate.

Most importantly, documentation can help ensure that the resident’s voice and experience don’t disappear between shifts.

Documentation also protects staff.

Good staff should never have to rely on:

“I told somebody.”

“I think the other shift knew.”

“I can’t remember exactly what happened.”

Clear documentation creates a shared record.

It allows staff to communicate important information.

It establishes expectations.

And it gives employees a framework for doing their jobs.

We want our staff to know:

What am I responsible for?

What do I document?

Who do I tell?

When do I report it?

What happens next?

Those shouldn’t be mysteries.

We are building systems before we need them.

One of the lessons we’ve learned during this process is that it is much easier to build a system before you are overwhelmed by the people who need it.

Once a home is full and staff are working and residents are living their lives, there isn’t going to be unlimited time to sit down and decide:

“Hmm…how should we document this?”

We want those systems established beforehand.

Then we can test them.

Improve them.

Train staff on them.

And change them when we discover a better way.

But we don’t want paperwork to become the care.

This is an important distinction.

We don’t want staff spending so much time documenting that they stop interacting with residents.

We don’t want people staring at a computer while someone is sitting across the room wanting to talk.

We don’t want a resident’s life reduced to checkboxes.

Documentation should support care.

It should never replace care.

The best record in the world means very little if the person providing the service isn’t paying attention to the person standing in front of them.

The goal is accountability, not bureaucracy.

Every form we create should eventually answer a question:

Why do we need this?

If the answer is resident safety, continuity of care, regulatory compliance, communication, accountability or quality improvement, then it has a purpose.

If nobody can explain why a form exists, we need to ask whether we actually need it.

We want enough documentation to create a strong system.

We don’t want paperwork simply for the sake of having paperwork.

Building True North means building the foundation.

Right now, there are no residents waking up in a True North home.

No one is asking what’s for breakfast.

No one is deciding what to do this afternoon.

No staff member is handing someone their medication.

Not yet.

But that doesn’t mean nothing is happening.

Behind the scenes, we’re building.

The companies are being established.

The financial systems are being created.

Policies are being written.

Forms are being developed.

Training requirements are being identified.

Property requirements are being researched.

And yes…

There are a LOT of binders.

Because when the first resident walks through the door, we don’t want to be figuring out how True North operates.

We want to be ready.

The paperwork is part of the promise.

Our promise isn’t that True North will never have a problem.

That’s not realistic.

Our promise is that when problems occur, we will have systems for recognizing them, documenting them, addressing them and learning from them.

We want families and guardians to know that their loved one’s information matters.

We want staff to know what is expected of them.

We want residents to know their rights.

And we want True North to be accountable for what we say we are going to do.

Because building a home isn’t just about choosing the right house.

It isn’t just about hiring staff.

And it isn’t just about opening the doors.

Sometimes building a home starts with a blank sheet of paper.

And we’re filling those pages carefully.

One policy.

One form.

One procedure.

One checklist.

One decision at a time.

Because when the first resident arrives, the paperwork shouldn’t be the thing we’re building.

The paperwork should already be supporting the home.