How we can improve troubled nursing homes
Attention baby boomers. There is a crisis in our state and you better start paying attention to it. The entire nursing home sector in Pennsylvania recently scored an “F” in quality in a Families for Better Care report based on data reported to the federal Centers for Medicare and Medicaid Services. And some nursing homes in the state made the list of the 400 worst such facilities in the nation, according to a report released by Sens. Bob Casey and Pat Toomey.
This report only confirms what front-line caregivers already know — that facilities that care for the elderly in this state face many problems. These include understaffing, low pay, high turnover of staff, inefficient processes for care delivery and poor outcomes — all of which lead to increasing the collective costs of health care for all of us.
There are two steps that need to be taken for Pennsylvania nursing homes to consistently deliver the kind of care we want for our loved ones.
Front-line caregivers work hard to provide the best care they can in very challenging conditions. But when a facility tries to save money by providing too few licensed practical nurses or certified nursing assistants, quality of care, and patients, suffer. So, first, the outdated state regulations that set minimum staffing levels for nursing homes need to be changed.
Pennsylvania’s staffing regulations require
only 2.70 hours of direct care per day, among the lowest in the country. With increasingly sicker patients and increased regulatory demands that take caregivers away from the bedside, staffing requirements must be increased. Talk to any caregiver in a nursing home and they will tell you that having too many patients to care for puts the patients at risk and leads to high turnover rates that have become common in this industry.
In addition to staffing, there is another commonsense, less-talked-about solution to improving quality. And the good news is that this solution can also lower costs. Front-line staff in nursing homes are experts on caring for patients. They, collectively, are with patients 24 hours a day, seven days a week. They know their patients and they know the type of care they need. Yet they rarely have any input into decisions about how care is delivered.
The alarmingly poor state of care in Pennsylvania nursing homes suggests that the top-down management style currently employed in most facilities is not as effective as it could be because it fails to utilize the experience, knowledge and commitment of front-line caregivers. An increasing body of research suggests that the best way to operate a health care facility is for managers and caregivers to work together in collaboration, drawing on the ideas of both groups. But change is not easy; it takes a willingness to try something new on the part of both administrators and caregivers.
Front-line caregivers, represented by their union, SEIU Healthcare Pennsylvania, and the management of two Lehigh Valley nursing homes, Phoebe Home and Cedarbrook Nursing Home, worked together over the last year to try a new approach. The collaborative initiative they developed involves training for both managers and staff and a clear structure and process for LPNs, CNAs, other support staff and managers to meet and work on a regular basis to solve problems that impact the quality of care and often just increase costs.
For example, a patient fall can lead to serious medical complications for the patient and as much as $15,000 in extra costs in care. The caregivers in these initiatives have used their hands-on experience to come up with strategies that have reduced the incidence of patient falls.
Collaborating with their managers, these front-line staff have come up with and implemented ideas that include such things as preventing bed sores and falls, eliminating pharmacy errors, and greatly reducing waste — all of which improve quality of care and save health care dollars.
Unfortunately, collaborative efforts that truly give front-line caregivers an opportunity to use their knowledge, experience and commitment to improve care are the exceptions and not the rule in Pennsylvania nursing homes. Both experience and research make it clear that simply using the same approaches now, as used in the past, to improve quality will not succeed.
It’s time for the nursing home industry to both improve staffing and also to invest in and embrace a new model that gives front-line staff a greater voice in decision-making concerning patient care.