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No Cure-All for Nursing Homes


WebMD Feature

Jan. 1, 2001 -- They occupy the last rung on our nation's disjointed healthcare ladder, the places where the frailest, weakest, and most burdensome among us spend their final days.

Our nation's nursing homes -- the products of years of societal, political, and economic indecision -- care for an aging population that is living, and often suffering, longer. But while recent studies show there has been some improvement in the quality of care, decades-old problems such as inadequate staffing fester like a wound that will not heal.

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Created by a combination of low wages, labor-intense work, often-poor working conditions, and the strain of too many residents per worker, inadequate staffing is one of the thorniest issues facing the nation's 17,000 nursing homes, which care for 1.6 million people. But it is far from the only issue.

Largely supported by federal funding, nursing homes say they find it difficult to offer higher wages. On average, nursing home nurses earn 15% less than their counterparts in acute-care hospitals, and half receive no health benefits, according to government figures. The tight job market also makes it hard to find workers, given the rigors of feeding, bathing, and changing elderly people all day.

The Institute of Medicine, in a landmark 1986 report, wrote the following paragraph, which could have been written yesterday:

"Not all nursing homes have enough professional staff who are trained and motivated to carry out these tasks competently, consistently and periodically. Care is expensive because it is staff-intensive. To hold down costs, most of the care is provided by nurses' aides, who, in many nursing homes, are paid very little, receive relatively little training, are inadequately supervised, and are required to care for more residents than they can serve properly. Not surprisingly, the turnover rate for nurses' aides is usually very high -- from 70% to over 100% per year -- a factor that causes stress in resident-staff interactions."

And quality of life, the report says, "is intimately related to the quality of resident-staff relationships."

In interviews with government officials, nursing home administrators, industry representatives, elderly advocates, and academicians, all told WebMD that the system is in dire need of repair before the huge number of baby boomers reaches old age and further taxes an already burdened system. But reaching consensus on how to fix it isn't as easy.

"Even if we need nursing homes for 3% of the baby boomers, the burden will be enormous," says Garth Brokaw, president of the Fairport Baptist Home near Rochester, N.Y.

While the staffing issue always has been serious, it is reaching crisis levels because the medical needs of patients have increased. Half of nursing home residents -- most of them women -- suffer from dementia, and many are incontinent and have swallowing problems. Without adequate staffing, many don't eat or drink enough. Overall, the number of nursing home residents who needed help with three or more daily activities increased from 72% in 1987 to 83% in 1996, according to government statistics.

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