Published Feb 2, 2003
Since I'm working on elder care issues while I'm at home, I'd like to ask you all what you would do to fix long-term care in this country. How would you go about ensuring sufficient funding, improving staff-to-resident ratios, delivering services, training administration and staff, having adequate supplies on hand, and providing the care these people are paying for?
Any and all ideas would be appreciated, as I'd like to see if there is a consensus, as well as include some of your solutions in an article I'm planning to write for a national magazine or newspaper. (Of course, credit will be given where it is due.) There is so much that's not working, and it seems that no one in a position to do anything about it can be bothered......unless we nurses get together and make them pay attention.
Oh crap, where to start?
System is way to crisis oriented. By the time people get to LTC they and their family have been through so many health and housing crises that they are hostile to work with, and do not trust you. There is no time for proper planning and care implementation once they do reach LTC, so they only receive attention once there is once more a crisis in their health. Something needs to be done to prepare them for the future while they are still healthy and in their homes. It is at this time that they need to be discussing care options and DNR status, not once they have had a stroke and the question of tube feeds and whether to be put on a respirator comes into play [no no no!].
Nurses need to be given to chance to give adequate end of life care to dying patients. This is not possible when they are responsible for 15-100 other patients.
There needs to be enough staff so that their care is never rushed and there is always time to brush their teeth and wash their faces.
Cost would never come into play when considering drugs needed to provide comfort.
Drug and medical equipment companies would be forced to keep their prices low. Everyone needing a wheelchair would receive one that would adequately suit their needs and comfort. Everyone would receive the assistive devices they need.
Sensory stimulation and companion services would be adequately provided. Especially for those with dementia.
Many people in the administration of Long Term Care have never worked on the front line of healthcare. They don't know what all is involved in caring for a resident.
In my humble opinion, anyone who wants to be an administrator in a nursing facility should have at least 6 months experience as a nursing assistant. They should have to observe (shadow) nurses in action for a month, ALL SHIFTS. This would include wound care, med passes, physicians rounds, charting... the whole nine yards.
There needs to be more educating of the public for long term care planning. The media could be a big help with this area. End of Life information needs to be discussed publicly, not waiting for the last minute.
Morals and work ethics need to be taught to our young people. They want the quick fix without the work or the consequences that come with it.
We need to be recognized for doing hard work. Hands on care givers need to be paid better.
The acuity level in skilled nursing facilities has risen. The type of residents we use to have in nursing homes 15 years ago, are now in assisted living. By the time they leave the assited living facility, residents are so far gone they need total care.
Someone needs to let the world know. Good luck with you endeavor.
I agree with everything said thus far. I am in favor of administrator following nursing assistants and nurses. This is one thing I am very lucky about.The administrator in our facility has been a nursing assistant and a QMA and a social worker. She has a good solid grasp on nursing issues.
I too think that DME vendors charge a ridiculous amount of money for products...let's face it...a psecialty bed should not cost 10-15 grand. If a bed of this type is needed it should be provided at a reasonable cost.
The medicare system just totally needs revamped. At this point in time, people are placed in a rug category via the MDS. Then depending on that rug category will determine the amount of money the facility will get reimbursed for that resident. These are not exact numbers..but let's say you have a resident with a trach and they require heavy suctioning.I have costed this out many times. We may get reimbursed 350-400 a day and the supplies alone cost 400 a day. This does not include transportation, room, food, nursing care (nursing assistants and nurses), medication and your other various items. We are talking 400 a day just for trach supplies ( including 2 liters 02 continuoues with warm humidity). How in the world can Facilities afford to take care of these residents and pay the bills? There has to be a better way than PPS.................
I think that setting minimum staffing levels are great, but it does not address the root concern with staffing. The root concern with staffing is getting people to take ownership and responsibility. They have to have a work ethic and I am unsure how to go about instilling that value in people.
Wow Mjlrn..what a big task you've taken on. Everyone so far has hit on important issues that need addressing except one: The owners of LTC facility.
It's easy for the staff to blame and point fingers at the administration (granted often it needs to be) but many many facilities are owned by physicians, lawyers, bankers etc. that have never walked in the facility.
Administrators are given a budget, if they go beyond their budget and create flack with the owners, they are fired. The owners WILL get someone to cut the costs. Residents then suffer.
I've been in this business for years, I've seen pharmacy services, ambulance services, utilities and much more suspended in facilities because owners were pocketing the money. Workers social security was not even paid that was deducted from pay checks. These owners are free, enjoying their yachts in Florida as we speak. Charges were never filed. Why is that? Money talks.
Medicare and Medicaid programs definitely need to be overhauled. ZuchRN mentioned the trach patient that Medicare is paying for...for only 100 days. Then more than likely Medicaid will take over, at approximately $120 per day? LTC eats the cost on the rest.
Families that apply for Medicaid for loved ones need to be more closely scrutinized regarding finances and how much of the property and bank accounts were transferred over to the families in the years following LTC placement.
I don't have the answers for the fix, but I do know that as long as health care is big business, someone gets the short end of the stick while the CEO is out playing golf.
I agree with all! I been in LTC for 10 years. LTC is not just taking care of Grandma/pa anymore lately we have been a dumping grounds for all sorts of patients. I can't tell you the time thats been used to deal with issues that should have never been allowed to happen d/t all the people that our admissions take just to fill the census. I could fill a whole board about the 21 year old MVA that thought we were the hilton and had parties in his semi-private room. And the administrator didn't want to rock the boat by telling him to keep the pot and booze out of the facility
really impressive responses, asking the person in the front line is amazingly effective
Hellllllo Nurse, BSN, RN
OMG....I have so much to say on this issue...
From my years of experience in LTC (as a CNA, and LPN and an RN), I have many ideas and thoughts on ways to stream-line operations in order to allow nurses and aides to provide better care for their residents NOW, without increasing Medicare/Medicaide funding, changing pt loads, etc. Yes, these changes are definitely needed, but will take years. What can we do in the meantime?
I would like to discuss this with you. I think I could express myself better and gets my ideas across more clearly though a conversation, rather than on a BB. I would be willing to speak to you on the phone, if you'd like. You can email me or PM me. I would be willing to call you.
Cure for LTC ills?
Get rid of the government, Jacho, regulations and CEO's then hire more staff for better pay... I'll guarantee you'll see a big difference! I can dream can't I?????
I forgot say get rid of the lawyers!
Get rid of the government, regulations
If you want the government's money from Medicare and Medicaid, the you have to deal with the government. Don't take Medicare and Medicaid funding then you won't have to deal with The federal regulations.
They still don't give a rats butt about what's involved, they only see $$$$$$$$. They've got more money than you'll ever dream of. I say cough it up and hire more staff, it won't hurt them. They need to stop being so greedy and get rid of some of these ridiculous regs. This isn't a communist country.
VivaLasViejas, ASN, RN
I second that emotion, night owl! Seems there's no problem so intractable that it can't be solved by throwing more regulations and more paperwork at it. As for the corporate types who run so many LTCs these days......well, I'm not in the habit of posting things that aren't fit to print, so I won't go there.
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