The Lives of Elders

Senator Casey's Quest for Nursing Home Reform

     Senator Bob Casey  (D-PA) is on the right track in proposing introducing the “Promoting Small House Nursing Homes” bill to the United States Senate. Senator Casey is absolutely right in trying to promote a culture change in the Long Term Care industry.

     Nursing homes have become complacent with providing “quality care”, a definition that is used very loosely, in a hospital-like setting. Imagine making the shift from a cozy household to a facility with florescent lights. Instead of waking up and having breakfast at your leisure, you are awakened at 5:45 am in order to eat at 6:30. This sudden loss of freedom is absolutely debilitating and can cause serious depression, a fact of life for about 20% of the elderly. Change however is approaching. A very innovative idea to integrate quality care with freedom as well as a cozy home-like atmosphere is called the “Green House Movement”.

    An average of ten residents would live in one structure, each with their own private bedroom and bathroom. This would be connected to a common area as well as a kitchen. Instead of florescent lighting, the common area would have incandescent bulbs, just like those found in our homes. The smells from the kitchen would permeate into the living room, making the act of eating much more enjoyable and expanding a sometimes meager appetite. Board games and casual conversation would become commonplace in the living room, bringing residents out of their isolated rooms and into a community of peers.

    The staffing would be done by two or three committed individuals for every home who are trained in cooking, washing of clothes, and daily care. This allows the staff to get to know the residents on a very personal level, and the residents can form their own routine with the staff. For example, if someone likes to sleep late, it wouldn’t be any extra burden for the staff member to wake someone up at 10 am rather than 6 am. If a resident doesn’t like pancakes, fine, she can eat eggs. Doctors and Registered Nurses would make the same type of rounds they do in conventional homes.

    What I thought when I first heard this idea was that it would be insanely expensive to change nursing homes into “Green Houses”. Yes, building new structures would be very expensive. The costs would remain the same in almost every other category. Staffing levels would not increase and staff turnover would likely decline when CNAs would build stronger relationships with the residents.     

    There is anecdotal evidence to suggest that Green Houses would save nursing homes costs from illness’s that stem from immobility. Residents would be able to walk around more and integrate themselves in a community which would reduce pressure ulcers and depression. So why hasn’t the industry taken this step? It takes a tremendous amount of capital to build these new, smaller structures.

    And that is where the honorable Senator from Pennsylvania comes in. He has proposed that the Department of Health and Human Services gives a low interest loan to nursing homes who want to build these structures. They would need to fulfill the criterion that ensures they are creating person centered care, of which the Green Houses is just one strategy. With a little nudge from the federal government, nursing homes would be able to take a step in the right direction that would not only improve the quality of care but also save taxpayers money in the future by reducing needless ailment brought on by the current institutionalized conditions. Contact your senator today and tell him/her that you support the “Promoting Small House Nursing Homes” bill.

Nursing Home Ratings

 

It is such a breath of fresh air to learn that Medicare has offered their Nursing Home Compare service. Just like at restaurants or hotels, nursing homes will now be rated on a one to five star scale. Consumers can simply log on to www.medicare.gov and go to the NH compare section. The folks at Medicare chose three criteria in rating nursing homes; health inspections, nursing home staffing and quality measures. The health inspections section is pretty straight forward. It calculates how many times the nursing home has been found in violation of the health code, the severity of the transgressions, and translates it into a scale from 1 to 5. Quality measures look at the percentage of many different factors such as pressure ulcers, use of restraints and pain.

          

      Since I am in the business of staff education, I have some trouble with how Medicare is rating the staffing category. They have sections for total RN hours per resident, total LPN hours per resident and total CNA hours per resident. It simply takes the average total hours of staff per day and divides it by the number of residents. Using this metric, consumers can figure out how WELL staffed a nursing home is, but not the QUALITY of staff. There are homes where the staff to resident ratio is one to one but because the staff is not well trained they can’t provide quality care.

   

     I film directly in Long Term Care facilities and I have come across some of my favorite facilities that received a 1 or a 2.  Perhaps their resident to staff ratio is on not great but the quality of their staff is superb. One home I have in mind received a 2 simply because of their ratio, but their staff is extremely well trained and stay with this home because of promotion opportunities for dedicated workers. On the flip side, I filmed in another home that received a 4 due to an awesome resident to staff ration but their workers frequently turnover and are not well trained. Thus they do not have a high quality of care.

       

     I understand it is hard for Medicare to rate the quality of staff. Inside the rating system, they have buried some statistics that are telling as to the quality of staff. In the "Quality Measures" section one can find the rate of pressure ulcers and the management of pain. Only through direct observation however can the consumer fully determine the quality of the staff. My suggestion to the consumers remains the same: visit the nursing home and see how the staff interacts with the residents. For my White Paper on this topic, click here.

How is the Weather?

It’s that time of year again! Winter weather is starting to settle in! As I watch the news I see snow storms in Las Vegas, Ice Storms in New England and I look out my window and see snow starting to accumulate on the ground. Snow and winter weather can be very beautiful but very dangerous for a variety of reasons.

The biggest threat to long term care facilities during cold weather times are power outages. Some residents use electricity to help them maintain a quality life, some residents will have issues with sudden change like the lights going out, some facilities have inadequate back up power to sustain operations. The recent ice storm in New England shows that many long term care facilities understand that maintaining the status quo will help their residents continue their routines. In an article published in McKnight Long Term Care News they mentioned that some of the long term care facilities even acted as shelters for the general public because they were so prepared. These New England facilities need to be applauded for taking proactive steps to ensuring a quality of life for their residents.

I only hope that we hear less of the bad stories about how long term care facilities all but abandoned their residents during crisis and start hearing more of the good stories about how these facilities are stepping up in the time of crisis.