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.
She could deal with constantly forgetting her shopping list, and she'd made
a habit of writing down where she'd parked her car, each and every time. But in
her mid-50s, Janis Mara's memory problems started costing her money. Late fees
began piling up because she forgot to pay her bills.
"Over time, it really intensified," she says. "I wanted to think
I was just getting older, but my fear was that it was Alzheimer's."
After bugging her HMO for an MRI, Mara discovered that her lapses weren't
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.