I think the title speaks for itself...but I'll try to elaborate.
It would be difficult to find any nurse who would argue against the notion that the status quo of doing business in SNF/ALF facilities needs a huge overhaul. That being said, what are the issues that need addressed?
Staff burnout, poor regulation, and care models that prioritize profit are a few that come to mind. If you work in one of these facilities what would you change?
I think most people don’t understand that your DON and Administrator have absolutely NO SAY in what the staffing level is of the facility they work in. It’s dictated by the company that owns the facility, based on the census and how much money is coming in from Medicare and Medicaid that pay for the “heads in beds”. You need those MDS nurses because if you screw up the MDS, all of the money you billed has to be paid back to Medicaid or Medicare. The root cause of low staffing levels in long term care is because the reimbursement levels for a patient in a nursing home covered by Medicaid is less money than a night at a Best Western. $150/night. In my area, almost 95% of the nursing home patient population have Medicaid as their payor source. For about 2 years I worked as a DON in a very wealthy private pay building where it cost about $600 a night. I had PLENTY of staff, was able to put 1:1 care in place for behavior issues and could order whatever supplies I needed. It was glorious. Sadly the building was sold so that the attached Assisted/Independent living center could install an indoor pool with a gym on the second floor. ?♀️
It’s all about reimbursement for services.
Another point to note, the company that owns the nursing home when faced with the low reimbursement rates will just end up selling off the home. There’s a reason Kindred Healthcare sold off their entire Nursing Center Division. Reimbursement rates from Medicaid and Medicare were so low, it was not at all a sustainable system. So they shut down their entire Nursing Home enterprise.
The government is SHADY AF with reimbursement. Just ask any MDS nurse in Massachusetts right now about our reimbursement for having patients in “Isolation”. They’re making all of the Nursing Homes eat the cost saying that we were already paid because of the “COVID money” that we had to jump through hoops to get in the first place and spent it on whatever price gauged PPE and $200 apiece COVID tests we could finally get in May.
On 10/7/2020 at 12:34 PM, TheDudeWithTheBigDog said:
Nurses standing up CAN fix the problem. The administrative staff that probably includes 0 nurses can't do the care on their own. These places can't run without nurses. The staff needs to get together and throw their weight around. If everyone is going to refuse to work dangerous nursing assignments, something we all technically have a legal obligation to refuse, they have no choice but to start staffing. This is why union jobs strike.
We have the power to force change, we just refuse to.
Dude - respectfully saying this, but I believe you really don't understand the FULL extent/ramifications of what you've posted. So what if all the nurses stage a work outage or walk out in a strike! TPTB will just staff with agency for gen'l care. Remember, mgt nurses (and administrators) are NOT union and are expected to work during strikes. And they will staff with contracted agency if nec to be operational with the mgt/admin staff present.
And after the strike ... ? Back to the same old, same old! No real lasting changes. Yeah, maybe a few conciliatory extra bucks. And the 'troublemaking' nurses will be canned.
Most importantly, PP momoflAndt so succinctly explained budgeting and staffing in relation to 'care/'caid reimbursement. This is the root of the staffing and care issues so prevalent in LTC/NH. Poor reimbursement means minimal income, means miserly operational budget, means bare bones staffing and lack of supplies.
Another PP, Hoosier, also accurately described how staffing is determined by 'the numbers' that States determine to be the minimum hours needed for staff to meet pt care needs. Put those 2 reasons together and you've got the industry in the state it is in today.
Bottom line ... you're beating the same old dead horse when you keep arguing about staffing and unions and nurses rebelling. I worked quite a few years before I realized the TRUE realities of reimbursement and budget and staffing.
to momo - you explained reimbursement so very well! TY
You’re very welcome. If we want to make real and lasting changes we need to work on the real root of the problem. The root of the problem is that reimbursement is abysmal. The acuity of the average nursing home patient has increased drastically, but the reimbursement hasn’t gone up in decades.
staffing is determined by 'the numbers' that States determine to be the minimum hours needed for staff to meet pt care needs. Put those 2 reasons together and you've got the industry in the state it is in today.
It's a sad state, as LTC is one of the heaviest regulated industries in the US, with both CMS and state regs governing. You know someone, somewhere totally has a clue and is rubbing their hand together in a miserly way, laughing. It makes me dread getting older
As a new nurse, you don't have the experience to realize that in theory, what you're saying is great, the reality doesn't match up. One LTC where I was DON did exactly fire all of the staff nurses and some CNAs. It was a tight market, they had replacements hired before showing the previous out the door. Some of them had been there 20+ years, nearing retirement. In some areas with oversaturation of nursing, its a constant merry-go-round of staff due to threats and firings
As someone who's been on the employee side of standing up for ourselves, they don't have a full staff ready to go today to replace everyone if they just refused to work. If you don't have the protection of a union, you can get one. Will they find a way to fire you? Maybe, but burden of proof is on them to prove that you weren't being disciplined in retaliation for organizing, which looks EXTREMELY shady when conveniently all the workers that want to unionize are the ones getting in trouble suddenly. That's what lawyers are for. Nurses have to stand up for themselves or this will never get better, and instead will just gradually get worse and worse as more corners are cut to make bigger profits.
Dude - respectfully saying this, but I believe you really don't understand the FULL extent/ramifications of what you've posted. So what if all the nurses stage a work outage or walk out in a strike! TPTB will just staff with agency for gen'l care. Remember, mgt nurses (and administrators) are NOT union and are expected to work during strikes. And they will staff with contracted agency if nec to be operational with the mgt/admin staff present.
And after the strike ... ? Back to the same old, same old! No real lasting changes. Yeah, maybe a few conciliatory extra bucks. And the 'troublemaking' nurses will be canned.
Most importantly, PP momoflAndt so succinctly explained budgeting and staffing in relation to 'care/'caid reimbursement. This is the root of the staffing and care issues so prevalent in LTC/NH. Poor reimbursement means minimal income, means miserly operational budget, means bare bones staffing and lack of supplies.
Another PP, Hoosier, also accurately described how staffing is determined by 'the numbers' that States determine to be the minimum hours needed for staff to meet pt care needs. Put those 2 reasons together and you've got the industry in the state it is in today.
Bottom line ... you're beating the same old dead horse when you keep arguing about staffing and unions and nurses rebelling. I worked quite a few years before I realized the TRUE realities of reimbursement and budget and staffing.
to momo - you explained reimbursement so very well! TY
Staffing agencies cost more than employees, but there's still training time and actual staffing time. They don't have an entire agency oriented to the company and ready to go. You have to understands the power that the entire nursing staff IN UNISON has. If no nurses show up to work, that nursing home gets shut down, permanently after the tons of fines and lawsuits that are going to come from it. They cannot legally operate without nursing staff actually doing patient care.
And reimbursement has nothing to do with the lack of staffing and supplies in most situations. It's simply an administrative team that doesn't care, combined with a staff willing to put their license on the line for less pay than they'd get at a better run facility. Profits come before the patients. This is no secret.
If you really want to see the extent of the problem, look up your state's actions against RN and LPN licenses, and look at how many are at nursing homes, and directly related to the staffing. As long as that many nurses are willing to put their entire career on the line for a company that will throw them under the bus the second something goes wrong, we're going to be treated awful at almost every nursing home we work at.
It doesn't matter how long I've been a nurse, I've been working almost my entire life. I understand how to not be a pushover. Your license is your entire career, fight for it, because when a patient has a stroke while you're distracted passing meds on 30 patients and weren't able to even notice what was happening, YOU are risking losing your license, and your company is just going to pay a fine and replace you with someone else that will eventually take the fall again for their refusal to staff. Some day you can be the patient having that stroke while the nurse won't be back to your room for another 2 hours because 60 patients for night shift is OK.
This isn't a problem caused by reimbursement, this is a problem caused by all of us just letting it happen because "I need a job." You can go get hired at another facility TODAY if you just go and apply. That should be a huge hint at the power that we have if we could actually work together for once.
momofIAndT
10 Posts
I think most people don’t understand that your DON and Administrator have absolutely NO SAY in what the staffing level is of the facility they work in. It’s dictated by the company that owns the facility, based on the census and how much money is coming in from Medicare and Medicaid that pay for the “heads in beds”. You need those MDS nurses because if you screw up the MDS, all of the money you billed has to be paid back to Medicaid or Medicare. The root cause of low staffing levels in long term care is because the reimbursement levels for a patient in a nursing home covered by Medicaid is less money than a night at a Best Western. $150/night. In my area, almost 95% of the nursing home patient population have Medicaid as their payor source. For about 2 years I worked as a DON in a very wealthy private pay building where it cost about $600 a night. I had PLENTY of staff, was able to put 1:1 care in place for behavior issues and could order whatever supplies I needed. It was glorious. Sadly the building was sold so that the attached Assisted/Independent living center could install an indoor pool with a gym on the second floor. ?♀️
It’s all about reimbursement for services.