Click here to subscribe today or Login.
Monday, August 07, 2000 Page: 6A
THIS TIME LAST year, a drought emergency gripped Pennsylvania after months
of low rainfall resulted in insufficient natural resources to meet people’s
needs.
Today Pennsylvania – and the nation face a similar drought as the human
resources needed to provide quality long-term care and services evaporate.
The untenable consequences of not being able to meet these staffing
challenges are dramatically underscored by recent news coverage of an
anticipated federal Health Care Financing Administration report on minimum
nursing-home staffing levels.
Based on initial reports, we are pleased the HCFA study acknowledged that
staffing was “much higher” at not-for-profit homes than for-profit
facilities.
Another difference that’s important to note is between the national average
and what’s happening here in Pennsylvania. While it’s true there are no
minimum federal staffing requirements, the state Department of Health revised
Pennsylvania’s long-term care licensing regulations last July, raising the
minimum mandated ratio from 2.3 to 2.7 hours of nursing care per resident per
day.
The Pennsylvania Association of Non-Profit Homes for the Aging not only
supported that higher staffing standard, but took the lead in recommending and
promoting it, because residents coming into nursing homes are increasingly
older, more frail and have greater medical needs. This standard is already
well above the minimum 2.2-hour level suggested in the federal report, and we
are confident that PANPHA members meet and often exceed that state standard.
But, as the report itself recognizes, the issue is more complex than
national minimum staffing levels alone can resolve. Enrollments in bachelor’s
degree nursing programs have declined for the fifth year in a row, according
to the American Association of Colleges of Nursing.
From the perspective of certified nurse aides, 40 percent of newly hired
nursing home aides leave within the first 90 days.
We need to do a better job collectively of understanding why and working
together to halt and reverse the decline of professional caregivers in this
field.
Before we can even begin to address these problems in sincere and
meaningful ways, we need to understand all the dynamics involved. To surmise
that every provider who earnestly struggles to fully staff every shift and
still falls short is willfully neglecting care to cut costs is too simplistic.
Merely mandating facilities to hire more staff is meaningless if more quality
candidates and/or adequate funding are not available.
We need to seed the clouds, be better rainmakers, before the pool of
quality long-term care workers dries up.
There are some things the profession itself can do, and PANPHA is committed
to investing in more educational programs, opportunities and resources for our
members to improve staff training and job-readiness efforts, as well as
sharing best practices in new models of management and care delivery.
Other strategies will take a collective commitment to be successful. For
example, we’re exploring possible solutions to legislative and regulatory
barriers to hiring qualified employees, and we continue to encourage providers
and government to support meaningful wages reflective of the important mission
long-term care workers serve.
But higher reimbursement translated into higher wages, more staff education
and enhanced management styles alone will not reverse the shortage of
long-term care workers.
Staff satisfaction surveys and others indicate the primary reason good
workers stay in long-term care is because of the residents themselves.
Ideally, workload, scheduling and management should allow as much time for
staff-resident interaction as possible.
But staff shortages and a profusion of paperwork are major obstacles to
that goal. Some PANPHA members estimate their staffs complete a total of 80
hours of paperwork per day, and that doesn’t even include the director and
assistant director of Nursing.
In addition, an unrelentingly negative public image of nursing homes and
long-term care only serves to drive away potential quality workers. Is it any
wonder, really, that we face a shortage of workers in a field that is almost
always and only portrayed in a damaging light? Where quality efforts and
positive outcomes are rarely if ever recognized or rewarded by regulators?
We must stop the wholesale bashing of an entire profession based on the
indefensible abuses of a chronic but small percentage of providers.
And we must target as much of our limited government resources as possible
on improving or closing persistently poor performing facilities.
In short, we need to change a survey process that isn’t working and, in
fact, may be jeopardizing the ability to recruit a quality workforce for the
future.
When faced with a water shortage, government, consumers and providers focus
on working cooperatively to preserve that precious natural resource. Can we
look into the faces of our elders, potentially shortchanged by a dwindling
supply of long-term care workers, and do any less?
providers of long-term care and housing for the elderly across
Pennsylvania. Its members include nursing facilities, personal care homes,
housing providers and continuing care retirement communities serving more than
65,000 residents with the help of over 51,200 dedicated employees.
Ron Barth is president and CEO of the Pennsylvania Association of
Non-Profit Homes for the Aging in Mechanicsburg representing over 350 PANPHA
represents over 350 non-profit religious, fraternal, community and government
sponsored long-term care facilities that serve more then 65,000 residents and
employ over 51,200 workers.