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.
"I'm sorry, but there's nothing more we can do."
No patient wants to hear that. No doctor wants to say it. And with good reason: It isn't true.
It is true that in the course of many illnesses, cure ceases to be an option.
But no hope of a sure cure does not mean no hope at all. It certainly does not mean there is nothing more to be done.
When you receive the information that your illness is serious, a palliative care team can help you handle the news and cope with the many questions and challenges...
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
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.