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Tuesday, August 21, 2007

The Long Term Care Staffing Connundrum

Elderpride: Chapter 6

We have discussed the underlying payment methods to nursing homes and how the manner in which they have been structured leads to problems in the Long Term Care industry. But that is only the tip of the iceberg. Let’s pile on another layer….let’s start examining what it costs we,the people to care for patients in skilled nursing facilities and nursing homes. The layers are ultimately all connected and interwoven, but by examining them one at a time, I hope to increase your understanding of the magnitude of the multiple issues facing legislators, nursing home administrators, physicians, nurses, therapists, and aides; and, how those issues are in the forefront of what patients and families experience. It is frustrating for everyone involved and a very heavy burden for families and patients.

There are many things that happen in a nursing home that make the administrator and staff feel like victims of the system. We will just talk about one of those today. Let’s begin with the staff that cares for our loved ones. We all want to see people paid fairly for a day’s work – what I am talking about are the hidden costs involved in employing staff in the Long Term Care industry.

If you can, put yourself in their place for a moment, think about coming to work everyday, and each day a quarter of the staff doesn’t show up. Yes, that’s right – 25% of the staff, on average, call in sick on any given day! I suppose some are legitimately ill, however I think many of the “call-ins” are due to frustration with the work environment, discouragement with the system, disenchantment with the work, and lack of a plan to improve their circumstances.

The daily round of the Nursing directors include hours on the phone trying to find someone to come to work on their day off to fill vacancies left by “call-ins”. As the days go by staff begin telling the nursing director they have plans they can’t change that day – or they don’t answer the phone at all, now that Caller ID tells them they are once again being asked to work an extra shift. Aggravating to both the Nursing Director and the staff, there seems to be no way out of what they see as their plight. Whether you are the Nursing Director who is responsible for seeing that all the patients are cared for, or the staff who is continually asked to work extra shifts, job satisfaction is less than what any of us would want for ourselves.

The cost of absenteeism to the industry as a whole is $832 million annually in “sick pay” and replacement costs. Even if we could afford this price tag who wants to live this way? Productivity suffers. Morale suffers. Imagination for creating a better environment suffers. Going all out for the patient suffers. Reimbursement suffers. We have come full circle!

Added to this staffing concern is another even bigger concern. The average turnover of staff on an annual basis is 89%. Astounding, yes – but understandable when given the environment created by the issues we have already discussed. This kind of turnover generates another series of problems. When 89% of the nursing home staff is turning over each year, the staff available for your own elderly parent has likely only worked at the nursing home for 6 months or less. The corollary to that is the staff member you are meeting today is likely to be leaving for another job within the next 6 months. What is the motivation here for the staff members to get to know your auntie? Or your Mom?

Is it important that the staff understand that your Mom is a diabetic and shouldn’t be allowed to have cake at the birthday party being held in the dining room? What about your auntie? Is it important for staff to understand that she was an artist in her own right and has only had fuzzy thinking since her stroke? Yes, to both of these questions. It is important that your Mom and your auntie be well known to the staff in order for the staff to provide the best care; in order to provide Elderpride. Treating patients as the individuals they are is the hallmark of Elderpride. Treating patients as though they have lived their life and are now expendable is part of the problem we see in nursing homes.

There is a big price tag to the employee turnover that is rampant in the industry too. It is costing the American taxpayer a lot of money. The cost of employee turnover in nursing homes is an astonishing $7.1 billion each year in recruiting and training new staff.

It is an easy leap from here to see that accountability for the right task, at the right time for the right patient is impossible to establish. Administrators live in fear that the dedicated staff who do show up for work when they are supposed to will crumble under that kind of pressure. The resulting low productivity costs from absenteeism, high turnover and the paucity of accountability for the work performed is costing we, the people another $13 billion.

It seems to me there is a lot of room for improvement here. In how the industry faces issues, how these issues are allowed to impact the very people charged with the care of our loved ones and how our nation spends its tax dollar on eldercare.

1 comment:

SJ said...

Hi There, I work for the NHS in the UK, I have worked in the care idustry for 18 years and the past few years I have seen a dramatic decline in care for vunerable people. It disheartens and upsets me to see nurses abusing patients that are in their care. There is a deffinite lack of elderly care givers in the UK and on the whole they are people that , to be quite honest cant do anything else because they have no training. My Grandmother is in a home for the elderly and she hates it. To be quite honest I hate it too. The staff try their best but they dont understand her condition and they dont have the time to sit and talk to her. I had imagined that in the USA it was amuch better system with well paid and motivated staff because it is private health care. Obviously this is not the case.