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Stay Informed -- Section Three: Critical Issues in Long-Term Care (LTC)
Overview In this section, we'll keep you informed of current issues in long-term care (LTC). Our first topic, staffing, is a serious issue that can affect the well-being of residents in any type of LTC facility.
Staffing Staffing is the single most critical issue facing residents in long-term care facilities.
**See our special highlight on this issue on our In The News page.
One of the top complaints received by the LTC Ombudsman Program is that because there are not enough staff, requests for assistance go unanswered, often for long periods of time. This is a serious problem for residents who often have to wait 30 minutes or more for assistance to the bathroom, in getting dressed, dining, bathing, and for medications.
Who provides what care? For many years the industry has depended on low-wage caregivers to provide the bulk of the hands-on care for residents. Nurses, whether Registered Nurses (RNs) or Licensed Practical Nurses (LPNs), typically are hired to provide those treatments (medications, injections, catheter care, etc.) that the law requires be performed by a licensed nurse. Assisting residents in all other activities of daily living are the “direct caregivers,” also referred to as “nurses aids.” The direct caregivers are the ones who usually have the most frequent contact with residents, and get to know their individual preferences and needs. Some facilities report they often must rely on “agency” staff to fill holes in staffing schedules. This brings caregivers into the facility who are unknown to the residents and who do not know the care routines of residents. Other facilities can’t or don’t hire agency staff and when staff is short, they spread the extra work among staff who is there. Either way, resident care suffers.
A continuing problem: Low wages and high costs Demand for caregivers is high, but pay in low and working conditions can be poor. While the work is very physically and emotionally demanding, it is not unusual for the hands-on caregivers to start at $7-8/hour. “Agency” or temporary staff is much more expensive. Facilities report they must pay agencies $25/hour for a caregiver. Agencies pay the temporary caregivers $13-14.
A continuing problem: Consistency in care The caregiver shortage has never been worse. It understandable that workers will work where the pay and conditions are best. This proliferation of agency staff is bad for residents. Quality of care and quality of life is dependent upon a stable group of caregivers who get to know the residents, their needs and preferences, and are then able to deliver individualized care as required by LTC regulations.
A continuing problem: Ratio of residents to caregivers A typical nursing home caregiver may have more than 10 residents to care for during a day shift and if two or three caregivers are absent, that caregiver will be given more residents to care for. Typically the afternoon shift has a higher ratio of residents to staff (1:15-20) and night shifts have the highest ratio (1:20-25) Advocates believe, if as a nation, we do not do something to change this alarming trend of spreading existing staff thin to make up for shortages, our long term care system is doomed to providing substandard care to our elders. A national organization, the National Citizens Coalition for Nursing Home Reform (NCCNHR), has identified staffing one of the most critical issues facing the Long-Term Care System. It has called for federal laws to mandate specific staffing ratios in nursing homes. Their recommendations are a ratio of 1:5 during the day shift, 1:8 during the afternoon shift, and 1:15 at night. This issue is sure to cause debate. The industry feels this will be too expensive to implement and will drive the cost of long-term care higher.
To take action
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(Note: If you have suggestions of topics to include, please Contact Us.)
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