I need some advice, on an assignment for an "Issues in Health Care and Professional Nursing" BSN class. In our first class we were asked to identify an issue we've identified in nursing, and the professor asked those of us that are working to choose something in our related fields because she would like to see us be able to do something with the project at the end of the semester. My currently employed is as a field intake assessment nurse by a Medicaid Managed Long Term Care (MLTC) company.
I'm putting my disclaimer here - I am in no way trying to offend anyone who may work in any of the fields mentioned further in discussion, I am only going by what I have noticed in my personal experiences, and I am only mentioning it as a way to complete my assignment and hopefully improve patient care in the process.
Up until 2 weeks ago, my primary function was to go into a patient's home, determine eligibility for the plan based on a functional assessment, and collect relevant data pertaining to services that might already be in place to establish continuity of care. I have repeatedly noticed a deficiency in the quality of care provided in settings that lack direct supervision, and I had already been pondering this issue in my head for some time when the project was presented. Once I brought the topic up in class two of my colleges agreed and shared experiences where they identified the same issue.
After identifying the issue, we then had to relate the issue into a professional nursing issue discussed in our textbook, and write a 1-2 page log introducing the topic. There is a series of logs due throughout the semester, which build off the previous, adding new literature and research to validate our claims and provide a possible solution. Of course this issues was not one that was listed in the text, so I spoke about whistle blowing, discussing the fact that no one involved in the continuity of care are reporting anything, internally or externally. I discussed reasons nurses wouldn't whistle blow, and made a suggestion for Press Ganey-type patient reporting. Not my best work, but I had an extremely hard time finding supportive literature. I partially regret picking something so challenging, but I am very passionate about improving the quality of community care given to the Medicaid population.
In a meeting at work today the term "Home Care Worker Wage Parity" kept coming up so I questioned my boss and she provided me with a lot of information. Apparently, as part of Medicaid reform, NYS recognized that home care workers are grossly underpaid, and they set up a provision to increase the wages. I have worked enough "unskilled labor" positions to understand the correlation between fecal matter pay and fecal matter services. I asked my boss if the NYS law addressing their pay was recognition of poor quality, and she confirmed.
I know this wage parity stuff fits here, but I'm not sure where to go with it. All home health aids come from either LLHCSAs or CHHAs, and work under a nurse. If there is a care quality problem an aid, then there is a care quality problem a nurse who oversees a patient, identifies poor quality care, and does nothing about it, or provides such poor care herself she doesn't think there is anything to report. I have not been able to find literature to support these claims, and the few articles I have come across that seem relevant are always in journals that require $40 before you can even read the abstract.
How am I going to prove this is a problem that needs to be addressed by more then a $2/hr salary increase? I feel that not having any bedside or clinical experience might be hindering my ability to have realistic expectations for the roles I'm discussing, and I don't want to look like a fool. I would really appreciate any input/guidance/advice anyone can offer, because I'm racking my brain here!
Actually, this is one of the problems I'm having. That article is on nursing homes. The point of MLTC and home care is to provided the same services in the home to prevent the need for a nursing home. Employees of nursing homes do have direct supervision. In my opinion, the reason for poorer quality in those types of facilities is a direct result of the patient load the nurses are expected to care for. Either way, you pointed to look at the DOH. Thank you!!!
Well, glad I could provide some help. Also have you seen this report:
It is a review that does an assessment of the MLTC's in NY. Chapter nine has some abuse cases that they found and also lists some other sites with relevant information. At any rate, glad the DOH suggestion provided some help.
eagle78
304 Posts
Well, glad I could provide some help. Also have you seen this report:
http://www.ltccc.org/documents/LTCCC-Report-NYS-Nursing-Homes-MLTC-2013_001.pdf
It is a review that does an assessment of the MLTC's in NY. Chapter nine has some abuse cases that they found and also lists some other sites with relevant information. At any rate, glad the DOH suggestion provided some help.