Another front page New York Times story highlighting problems with skilled nursing facilities.
I am sure many of you saw the recent New York Times article about understaffing in the nation’s nursing facilities, particularly on the weekends. The new methodology used, based on actual payrolls obtained by Medicare, indicates that staffing is 12% lower than using the previous methodology, which was based on self-reporting.
The article used one small nursing facility in New York as an example of weekend staff shortages. Anecdotally, my next-door neighbor’s mother was in a local assisted living community operated by a prominent national chain, and she always complained about the “Sunday dump run,” referring to the fact that when her mother was taken to the ER, or dumped there, it was always on a Sunday. Never on Monday. Sundays were the hardest days to staff the community, and it didn’t take rocket science to figure out what was going on.
While I understand the difficulties in staffing, especially in a period of historically low unemployment, if the skilled nursing industry wants to be part of the solution, it has to come up with a better response than, “While staffing is important, what really matters is what the overall outcomes are.” The problem is, there is a direct relationship between staffing and outcomes. Now? Congressional investigations. Great.
Who watches over nursing homes and makes sure that they are adequately staffed, never mind providing good quality of care? The agency that gives a heads-up prior to inspections? The Long-Term Care Ombudsman program? Consider complaints about nursing homes nationally (updated only through 2016) are related to staffing:
Improper eviction or inadequate discharge/planning;
Unanswered requests for assistance;
Lack of respect for residents, poor staff attitudes;
Administration and organization of medications; and
Quality of life, specifically resident/roommate conflict
I have known a lot of owners and operators of skilled nursing facilities over 30 years, and the vast majority of them want to do a good job. It is just such a tough business and so dependent on good staff, which is increasingly more difficult to find. I just don’t have any solutions.
The high majority of us operators have the best of intentions but we are all graded by our actions not our intentions. If the facility scheduler is not properly trained, empowered, and given the necessary human resources, it’s a cinch the facility will fail at providing adequate staffing. The facility scheduler is by far the most underrated position in a nursing home and far too many facilities don’t invest the resources in ensuring there’s a chance for success. The answer is very simple….it requires hard work and a high level of motivation from Administrator, the DN, the HR Director, the Nurse Managers, and the Scheduler. If any one of these individuals drops the ball the solution becomes impossible.
Daren, all excellent comments, and I agree it would be great to be graded on intentions, but as you know, it never works that way.
As a provider of post acute services for over 40 years at all size levels from single facilities, CCRC, up to corporations of over 120 properties, this is the worst time in that time frame to secure staff. We have know about the coming staffing crisis in nursing including licensed and front line nursing assistants for over a decade; that crisis is now. It is about money, an accelerated need with the baby boom pushing the care envelop with intensity in the next 5 plus years. State and federal programs don’t reimburse enough to fairly pay the aides for their back breaking work and federal assistance programs continue to pay free dollars to those individuals who don’t want to work and have the discipline to EARN their paychecks. We can talk about good work environments, praise oriented leadership and that is what should be, but ultimately there are not enough workers willing to work for the $$$ available. Insurance companies have manipulated the payment system by paying inadequate reimbursement with managed care, less $$$$, less days, and sicker more demanding care needs. Medicaid can’t support the demand for adequate dollars for staff with care demands escalating. Yes it is a mess!
God help those of us who will need care-givers in next few years for the future is not encouraging.
Charles, well said, and you will get no argument from me on this. People in D.C and the state houses have to wake up to the fact that these workers need to be paid more, that the job is very hard, and the money has to come from somewhere. The one problem is that the higher and higher prices buyers have paid for SNFs means more incremental cash flow goes to the capital providers, and not to staffing. It is a hard cycle to break without having a crash in the market.