Solutions for Owners & Providers

The Nursing Home Crisis, What Can Be Done?

The Long Term Care industry is in crisis. The crisis stems from the industry wide dilemma regarding giving patients everything they need to be restored and the clichéd reimbursement system that makes it difficult to obtain the entitled dollars for each patient. Below are a few thought provoking ideas that may help you make a difference in the lives of your patients, their families and your staff.

The first step is a rearrangement of priorities:

• It is imperative that the number one priority is quality of care and quality of life for patients. This includes the assurance that all patients receive the Medicare (or other) insurance coverage they are entitled to. The entitlement will vary with each patient’s situation, however, Medicare allows up to 100 days for each episode of illness is available if the patient needs it. Using their full entitlement enables the facility to rehabilitate patients to their highest level of functioning, and many return to their prior living arrangements, of independent or assisted living, or graduate to a lower level of care in the facility with a higher quality of life.

• This results in positive word of mouth and your facility will become known as the place to go and get better, consequently more patients will come to this kind of facility to be rehabilitated
• The combination of increased census from positive outcomes and advocating for patients to get their full insurance benefits will result in a much improved bottom line for your facility

• The second priority is to staff according to required qualifications because it is good cost control to do so. A nurse should only perform tasks that require a nurse. When a nurse performs tasks that a CNA should do, it inflates the facility costs. The same philosophy applies to a CNA performing tasks that do not require a certification, and could be done by a non-certified person. Staff can be taught what makes good financial sense for the facility and be enabled to assist in the right direction.

• Start career paths for your staff so that they know that you understand and care about their future. This philosophy results in more efficient and productive staff at the same cost, or less.
• Direct staff to provide care for patients that results in improved patient capability rather than diapering every patient, placing them in a wheelchair in front of the TV which results in diminishment of capability for the patient

• The third priority is to review your therapy practices. The goal for all patients should be to reach their highest level of functioning. When patients reach a point of being repetitively exercised and walked, but are not yet at their highest level, they should be passed to a restorative aide on staff. The restorative aide can be supervised by a therapist or a nurse, at a much lower cost to the facility, creating a much better outcome for the patient.

• The facility is now controlling therapy costs and outcomes by implementing restoratives, at a more reasonable cost, and better results.

• The fourth priority is to insure that nurses know how to define skilled care. Very often the nurses think they aren’t doing anything special for the patient and so it must not be skilled – however, your patient (and facility) could be missing some very important skilled days.

• When nurses supervise aides who are providing restorative care, that is skilled care.

• The fifth priority is to implement a Case Management system internally to make sure that each patient has a Patient Care Plan and that all care is directed by the plan and each task and activity works toward achievement of the patient goals.

• As patients achieve their goals, there will be an unexpected bonus because the staff that assisted that process will be very proud! The staff will be looking for the next patient they can help.
• Creating a happy culture where staff look forward to helping the next patient is a real possibility and results in fewer call ins and reduced turnover.

Read more on the current issues facing nursing home operators...