Warning: After this article was first published, I had some really unhappy readers, so be warned. You can read my reflections on that anger here. No one, not a single person ever wants to end up in a nursing home. There are two reasons for this, one good the other disgraceful. The Good Reason The good reason is that individuals end up in nursing homes because they need significant regular (continuous) nursing care; often meaning they are in their last few weeks, months or years of life and there is no practical way for them to receive the life preserving care they need at home or in a lower level of senior housing. In short their bodies are failing them. The Disgraceful Reason The disgraceful reason is that most nursing homes suck. In truth, the way most nursing homes operate day-to-day, week-to-week and year-to-year is to get through a checklist of tasks:
- Give baths
- Feed residents
- Pass medication
- Provide a required activities program
- Do lots and lots of documentation
Because the government pays for most nursing home care, the only way to make money, or more money, is to reduce costs, which means cutting everything that can be cut. The government, in its all-knowing wisdom, has compounded the problem under the theory that the more regulations, the better protected residents are. A nice theory except that we have more regulations today than we have ever had, and for all the regulations, there are still a significant number of really terrible nursing homes and a ton of barely decent homes. Not to mention more regulations means more task-oriented check boxes.
A Better Way
I recently spent an hour or so talking with Karen Stobbe the Director of Education and Outreach for The Pioneer Network, an organization that is committed to a better way of serving senior living residents. Pioneer Network is all about creating senior living environments that actually makes residents the most important thing. These communities look something like this:
- Senior communities, including nursing homes, operate more like a home than an institution (an interesting paradox, with many assisted living communities moving to more of a medical model)
- Resident choice always comes first, which makes the documentation checklists problematic, but not an impossible barrier. This means things like allowing residents to decide when to get up, when to go to bed, when to take baths and when to participate in activities.
- Direct staff members are empowered to say yes to residents, to make decisions and know they will be backed up by leadership as long as it is about saying yes to residents.
- Activities are designed to not just entertain but to empower.
- Caring for residents becomes a team effort that involves everyone from the aides to the executive director. The idea is that no one ever walks by trash on the floor, a care aide struggling to help a resident or a table server struggling with a stack of dirty dishes.
- Best of all, taking a person centered approach to caring for residents often results in lower costs and longer stays.
No Buzzwords
What Pioneer Network does is not just buzz words like “Culture Change” and “Person Centered Care” for use in marketing or self-delusion. Rather it is a whole way of thinking of providing senior care. It is a way of seeing seniors and the care of seniors from an entirely different perspective. If you are serious about giving each of your assisted living or nursing home residents the best day everyday, Pioneer Network should be important to you. If you want to jump in with both feet, their annual conference takes place August 11 – 15 in Bellevue, Washington. If you are looking to dip your toes in, there are tons of resources on the Pioneer website. Steve Moran
I received this comment by email:
“You have insulted thousands of health care professionals who have devoted their lives to nursing homes. All no doubt can be improved but most/many are good and some are great facilities offering quality care.” (Name withheld)
My response:
It was not my intent to insult anyone, but rather to stir conversation. I think there are many great healthcare providers who are doing the best they can, but none the less, their buildings are not places they would want to live in if the had the resources to avoid it. There are at least 3 primary reasons for this lack of quality:
1. Ownership/Management doesn’t care or see the benefit. Perhaps this is mostly a problem with just doing things the way they have always done them.
2. Often even if there are individual employees who would really like to make things different they are not empowered to make these kinds of changes.
3. Often people are just not aware that there is a better way to do things and that this better way would actually save them money and increase census even in an all Medicaid building.
Steve Moran
i am curious….what is your background? Have you ever been resposible for the day to day operation of a nursing home community?? i find it interesting that people who have never shouldered this overwhelming responsibilty often are the quickest to have an opinion. You say you only mean to stir conversation…there are far better, less offensive ways to do this. I will be removing myself from receiving your emails in the future
Hi Withheld:
I have worked in the senior housing industry including nursing homes for more than half my life. This includes being involved in the operations of nursing homes. I have been in some terrific homes and many more terrible ones. I do have expertise in this area. I agree that it is an overwhelming responsibility, but given this responsibility it makes bad nursing homes a serious problem.
It would seem more fruitful to actually talk about the issues I raised in the article. My question to you is this: What specifically do I have wrong about nursing homes?
Steve Moran
It is very disheartening to see these comments. I have been in the nursing home industry for 40 years trying to provide the best possible care for the elderly of my community. First as an LPN on the floor, then an ADON, Then a Don and now an administrator. Yes there are home that are bad and some that are great but your article gives the impression, with the word disgraceful, that if your family member needs to come in for care they are very fearful that they will be harmed rather than cared for. We have dedicated, hard working staff and have high turn over rates because we do not put up with staff that are not committed to the elderly. After 40 years there are no easy answers. We are regulated to death and still the government adds on more burden taking all of us away from good bedside care. Why is our industry the focus of constant regulation when so many other issues are left unresolved in our nation. We all know no elder of our community will seek us out if they are able to stay home throughout their elder years, but if they can’t, I would hope they do not come here with fear in their heart about the care they will receive. The perception of nursing homes across the country for decades has not been good for many reasons but articles like yours just instill fear in the resident and families, not to mention all the great lawyer commericals out there advocating law suits as they enter the doors. As long as I can I will stand determined to give the best possible care and loving support to my residents and their families. When you have all the answers let me know. I will be canceling your e-mails to this facility but you may reach me at the above e-mail anytime or come by, you are more than welcome to see for yourself that we do a great job, even though, for some people it’s never enough. If I were able I would attend the conference but cannot take the time away from this facility.
Hi Bertha:
I appreciate your taking the time to respond. If your facility is one that is doing a great job, then you should not be unhappy with this article. I would be willing to bet within a 15 minute drive there are some terrible places. The reason that people are fearful of nursing homes, is not just some fantasy cooked up out of no where. People have visited nursing homes and often don’t like what they see.
You are certainly free to unsubscribe, but why? This is a place to talk about how to make things better, how to do it differently. You think I am unfair, then write an article and make your case. I would be glad to publish it.
I don’t have all the answers and if you have read my blog for any time you know I mostly write about how to make things better, but occasionally I do tackle the problems in the industry.
I am sorry to see you go.
Steve
I would love to leave a reply of my five year experience with my mom in an Alabama. NUr sing home.but no one would believe it if I did. I have dozens and dozens of photos. But again no one would believe how our most vulnerable are being treated. I live it.a heavy load to bear.
How about the factors in play when administrative policies and financial ramifications of non-profit environments are made without seeking consult from the skilled staffs employed (nursing, therapies)? All those charitable dollars going toward unsound long-term problems (ritzy looking intricate patterned carpeting which makes for dizziness folks don’t want to admit to, ‘lovely’ satin-like polyester sheets too short for the new beds with shoulder ht positioning remotes inaccessible to the many elderly/infirm who depend on others’ sound and appropriate decisions…).O(T)y vey!
Steve: Enjoy your forums.
Nursing Homes….A National Disgrace
In my opinion, the bottom line is the same as that which was suggested in your recent Dirty Little Secret About Assisted Living;The dirty little secret about our business is that, despite a company’s size, corporate mission, experience, capital resources, quality brochures and even flashy media, this industry lives and breathes based on the actions of a caregiver, making $11.25 an hour, doing the right thing at 3 am…night after night.
And so my questions and remarks are directed to Ms. Stobbe, The Pioneer Network.
– In today’s decaying culture, how do you find dedicated, caring, moral, and ethical staff to recruit and hire? Short of the Amish (who appear to me from a significant distance, to be a people who sincerely care for others and have a hard work ethic) where can you find folks like this? The government incentivizes those who would otherwise be good candidates for these positions, to instead stay at home and receive cost of living benefits without working. To further restrict the labor pool, you have large hospitals who can afford higher pay, better benefits, and on and on and on – who recruit the best of the healthcare workers in a given market place. After all, nursing homes (and assisted living) are restrained by handicapped reimbursements. And as mentioned, if the regulations (imposed by the government) are not reduced, then yes, so much of the staff’s time will continue to be spent “checking boxes” rather than delivering hands-on compassionate care. Finally, I’m sure you will tout the need for a nursing home (or a nursing home company) to develop a respectable initial and on-going education program, but doesn’t everyone else experience retention challenges, as those better employees you have spent time, effort, and expense training and educating – jump ship?!! So what is the answer/solution??
Thank you.
You raise good questions…what is realistic in long term care? Research from Castle in 2011 showed that increasing staff turnover resulted in a decrease for every quality measure looked at. Let’s nor forget behind decreased quality measures are real people… It’s someone in a restraint, someone with a wound. But beyond these people what does decreased quality mean? Most likely a worse reputation in the community, a poorer image with the local hospital/ACO…all leading to decreased census, revenue, and overall a downward spiral.
A 2002 study by Jervis discusses the myths of turnover, such as CNAs don’t have a good work ethic, they will leave for ten cents more an hour, etc. Research shows that how staff is treated by their supervisor and the organization is a key indicator if they will stay. As a former administrator for 15 years and now a trainer that has worked with thousands of employees, I have seen this time and time again in organizations.
SO the big question is what the heck do we do about it? One FREE intervention is consistent assignment. Research shows implementing it can reduce turnover 32% & absenteeism 41%. Another free intervention? Communicate with staff! Not TO staff, but listen to them. Before you jump to respond we already do that I will share in my experience it is the rare community that this is actually happening. The administrator often thinks its happening, but the staff feels very differently. Email me at denise@denisebscott if you’d like a copy of the study and I’d be glad to send your way!
As a closing thought, person centered care made me love my job again when I was an administrator and had basically given up because of all the frustrations. It made my team enjoy their work more, improved both our bottom line and survey outcomes… but best of all the residents were happier! Best of luck to you!
Your comments seem biased against skilled nursing facility (SNF) care in the extreme and not entirely factual, perpetuating the myth that “the government” pays for most long term term care. Much of that depends upon your market. A big mistake that people make is in believing that Medicare will pay for SNF care when in fact they only pay for a limited number of days and that is strictly based on diagnosis, treatment plan, and whether or not the person is likely to improve. Medicaid will only pay once a persons assets have been exausted. Long term care insurance (if you have it) will pay but there are many limitations.
You recently wrote about how Assisted Living (AL) “lives and breathes based on the actions of a caregiver making $11.25 an hour…”. I would first say that this is even more true in a SNF, where residents are even more dependent and secondly, MANY of those caregivers are making far less than that.
The Pioneer Network does fabulous things but they are far from alone in this. Many providers are doing all sorts of innovative things to improve the care and quality of life for residents in all levels of care. You would, I suspect, be front and center if this type of negative article were written about AL. We would all be better served if you were a bit less antagonistic.
Hi Laura:
I was perhaps too antagonistic (article coming this evening about that).
A note about payment: According to an article published June 28, 2013 at the Kaiser Family Foundation (link below) 63% of all nursing home care is paid for through the Medicaid program and another 14% through the Medicare program.
There are some great nursing homes out there, but there are many not so great ones out there. And honestly in my view the industry, our industry needs to spend more time talking about the bad and working on fixing it.
In my view those of you who are running great nursing homes should be angry that bad ones exist, because the very fact that they exist means they are not being held to the same standard you hold yourselves to and what is worse, is that they end up getting passes on stuff you good guys get cited for just because in the bad ones the list would be almost endless.
You are also right that Pioneer is not the only way do it right. In fact Pioneers whole thing is that they are not actually a membership organization. They provide resources and put on conferences that are designed to help local senior communities do a better job of putting residents first.
Finally your are right about the staff payment problem and it is something I asked Karen about at least in a general sense. What she told me was that some of these amazing person centered nursing homes are serving populations that are primarily Medicaid (I know there are lots of variables here, from what state they are in, to what their debt structure is.) That being said, part of the disgrace is that we can’t figure out how to pay our caregivers a decent wage.
Thanks for joining the conversation.
Steve
http://kff.org/medicaid/fact-sheet/overview-of-nursing-facility-capacity-financing-and-ownership-in-the-united-states-in-2011/
Steve,
Your comments are not far off. I doubt that there are many of us that really want to end up in a Nursing Home. And as you point out the biggest reason for this is because of the Mandates required for care.
I am an Architect who has worked in this industry since the early 90’s and when I was traveling between many of the homes we managed I often had my children with me. A comment that they all made was they preferred staying in the car then going inside the Nursing Home. Now they weren’t babies or unable to come in & out as they needed to, so I didn’t “lock” them in the car.
Anyway, during the last couple of years we have been working on some New Culture Change Nursing Homes which is very much what you have described in your article here. Our first facility will be 120 Beds but here is the significant difference. We will have 6 different “Homes” with separate entrances for family to come see their loved ones. The residents will have Private Rooms. The Hallways will only have 10 of these Private Rooms down each Hallway so you no longer have to walk down and around all the other residents. Each home will have a Dining & Living Space so they don’t have to be wheeled down long hallways to eat and enjoy some community time. It will also be much more the choice of the resident on when they eat.
These individual Homes will still have connections to the rest of the facility through our Main Street. All the required services will still be supplied and taken care of but the Big Difference will be to the point that we have a lot more Personal Care and services as a result.
Please check our Facebook Page if you want more info. It is under our Photo Album for Nursing Home Projects.
Hi Christopher: Thanks for your comments and I am always glad to hear about people who innovate.
Steve
Steve,
This article was the most read is because its title held a truth that very few are willing to acknowledge.
I was beyond excited to read your article because I deeply, sincerely, desperately, with every fiber of my being, want to find a way for nursing homes to NOT SUCK! By reading your article I was hoping to find an honest reflection and insight into how to achieve this in a way that equaled the honesty and insight of your article’s title. By the end of the article I actually felt a little discouraged because I didn’t learn anything new.
Your explanation of The Good Reason and The Disgraceful Reason contained simple, straightforward truths that are perfectly accurate based on my experience of nursing home care. Your description of A Better Way probably sounded familiar to me because of my experience with Meadowlark Hills in Manhattan Kansas. The facility director had mentioned his close connection with the Pioneer Network, which certainly shaped the approach to outstanding care at the facility he managed.
I’m sorry you received such negative feedback about your article because I loved the straightforward honesty. We need this honesty to wake us up and see the urgent need for A Better Way!
I absolutely love the Senior Housing Forum. Please don’t censor yourself based on a few vocal critics. Your perspective desperately needs to be heard!
I honestly just don’t know how to write any other way. It is kind of funny, because I think if I had just put a question mark at the end of the headline it would not have inspired so much heat.
Steve,
I am new to this forum but not to long term care. I have been a NHA in MA and in CA for over 30 years. I have managed small , “boutique” nursing homes and “high end”, high volume rehabilitation SNFs (100+ admissions per month). I think you made the same mistake that was made following Vietnam. When we wanted to condemn the war and the military, we condemned the soldiers as well. You are criticizing an industry but have lumped some very caring and dedicated people that have literally devoted their lives to caring for the elderly. My mom was a nurse in long term care following my father’s death at 52. She was left to raise six children under the age of 16. She coped by serving others. She went to work in a SNF, first as a nurse, then charge nurse, supervisor, ADON and for the last 17 years of her 35 year devotion to the elderly as a DON. During t,hose 17 years, her facility had 10 deficiency free surveys. This was not a small private pay long term care facility. It was a 149 bed rehabilitation facility that routinely “pushed the envelope” of DPH regulation in favor of giving choice, and control to its residents.
I think that the frustration that you are hearing in response to your article, which if you are honest with your self was probably not as well meaning as you would like to believe, is that you have painted care givers with the same brush as you have regulators, government budget analysts, politicians, and the average person that has never had to deal with caring for a parent or spouse with the resources to do so.
Do nursing homes really suck or is it the model for care that sucks? It is a horrible model. It is an ineffective way to care for the highly individualized needs of residents who are frail, elderly and require services that they do not have the resources, family or financial, to obtain in any other way. Think of it this way. Look at the USPostal Service. For $.47 they will send someone to your house, pick up your letter, and hand deliver it anywhere in the country to the address indicated, usually within 2-3 days. That service cannot be replicated in any other way for that price. You can send information, quicker and cheaper but you are not sending that personal letter. The best you can do is a scanned copy or facsimile. There is no other way to get that letter to Boston from San Diego for $.47. How can the USPS do that? The truth is they cannot. They do it because they get huge subsidies, they rely on enormous amounts of junk mail advertising revenue, an they eliminated huge amounts of payroll through automating functions that used to be done by hand.
What do Nursing homes do? For a few hundred dollars per day, they provide a room, bed, bathroom, 24 hour nursing care, in some cases very intensive nursing care, laundry service, a nutrition service supervised by a dietician, an activities program, an individualized plan of care, social services. They provide, financial services, maintenance and housekeeping services, and enough documentation to prove to you that they have in fact done every minor aspect of care and services that you already know you have received. There is no other way to provide the care and services that are required to be provided in a nursing home for the amount of money the average SNF receives. Unlike the post office, there is very little about nursing home care that can be automated except some documentation systems. Spreading the actual cost of care to other payers like Medicare, private payers and Insurers has become increasingly difficult with managed care insurance, increased Medicare regulation and a decreasing number of residents with private resources. There aren’t government subsidies. Medicaid contributes to the problem, by not funding actual cost, it does not help solve the problem.
The solutions will be found when people focus in solutions. Everyone already believes that nursing homes suck. How about a forum for people to brainstorm solutions. Think outside the box and let’s design the best system possible. Start from scratch and let’s come up with the ideal way to care for our aging population. Throw away the old models. Forget about trying to legislate quality. Use the technology available. Steve, you have enough readers with enough collective experience that this is a doable task. What should facilities look like? Should we even have facilities? Who should provide care? How, and where? How can you pay for it all? Focus on what can work, not on what we already know is broken.
Tom,
I respect your experience and value your comments about nursing homes. On July 19th, I shared with folks on this forum information about an organization who has developed a long-term care model that improves lives and improves bottom lines. It’s called The Green House Project. I recently visited this community in Chelsea, MA. Today there are 58 Green Houses in almost every state in the U.S.
To learn more visit http://www.thegreenhouseproject.org
Hey Catherine, we’ve studied the Green House Projects extensively. The idea is great for Senior Health Care but we also understand that the reimbursement rates make it difficult to totally separate out individual Care Homes. We’ve come up with ideas that still allow privacy and many other features that the Green House project has identified but we have a design that allows for both the Individual Home designs along with the ability for the staff to manage the facilities better. Our 20 bed Individual homes allow for staff to handle them properly but we also have Main Streets that tie all the homes together for all the other needs and uses.
We would welcome input on our design and would also be glad to help any communities that desire to get rid of the worn out, archaic old facilities that have become more of a place to go die than a place to rehab and refresh our elderly. Plus we want to give families a place to visit their elderly family members that everyone can enjoy and feel like they are at home and still have good healthcare.
Here is our Photo Album for this design:https://www.facebook.com/media/set/?set=a.415926741764073.92131.169102779779805&type=3
We welcome any ideas or thoughts from this community.
Tom
Some great comments. My readership is primarily senior housing leadership and line care staff and you are right many of them/most of them are doing the very best they can. I also agree that we need to focus on the solutions and I am sure, that coming off the Pioneer Network conference next month you will see a number of solution oriented stories.
One of the things I have been thinking about is publishing a resource book that talks about what senior communities are doing to allow residents to continue to contribute to society (If any one has a story like that I would love to hear about it).
Yet as I talk to people around the country there are some providers who are doing some pretty amazing things in the current environment.
Steve
Your recent posts about nursing homes and assisted living were brave — not too harsh. There is little self-criticism coming directly from top management in either industry — one heavily regulated as ‘healthcare’, sometimes bare bones as facilities, the other perhaps better decorated, perhaps mostly private pay, but heavily resisting regulation, overseen by the ever-shifting state budgets. I don’t believe that architecture or person-centered philosophy will guarantee making either SNFs or ALFs into places we want to move into and stay. The inflexibility of the schedule of the day, the building layout may have issues, but even if they are fixed with person-centered schedules and home like building layout, they can still be disasters. And families will be afraid to speak up for (justified or unjustified0 fear of retribution).
There was an old saying that I believe is as true as ever: “To err is human, but to really foul things up requires a manager.”
Let’s see a broad sample study that tracks turnover of executive directors and nurses as well as care workers — asks about reasons for leaving prior positions, and identifies solutions to motivate and retain. When people like their jobs because they are in a supported environment with managers that care about them — that’s when visiting a SNF (or ALF) will be a good experience and the kids won’t want to stay in the car.
Thanks Laurie:
We as a nation need to creative, because I do believe there are solutions, but as you point out, the first step is a more honest self assessment.
Steve: Your comments have certainly stirred the pot. That’s OK. I have been committed to older adult services for over 30 years and have managed both a nursing home and assisted living organizations. SNF providers are shackled with regulations that take away resident choice and care giver empowerment to do things differently, and arguably better. The MN model for senior housing with services separates housing from services within regulatory authority and those of us in the business continue to work very hard to advocate for less regulations. Yet we also advocate for provider accountability to ensure residents live out their lives as they see fit within an environment that offers enriching experiences and supportive services. Within the SNF model, resident quality of life suffers because care giving staff must FIRST focus on compliance. Regulatory compliance is OK, but not at the cost of diminished life enrichment for residents. I remember my work as a nursing assistant in high school and college (we were called ‘orderlies’ back then!) – admittedly, SNF residents enjoy significant improvements in environment and choice, yet it is not enough. I think everyone agrees we need a new model (hence the growth of AL) – who will start this process for REAL change? For now, we applaud the people committed to the business of taking care of our nation’s older adults, creating good solutions to challenges were they may, while we chip away at change where we are able.
Hi Mark:
Thoughtful comments. Pioneer networks is one way for people to explore making things better for seniors. I think they would say they are more about a concept than about having “the way”. It is exciting and fun to talk to people who are dreaming and innovating, making things better. We have great potential and great opportunity. Part of tapping into it, is being honest about the problems.
Steve
When attending a conference the presenter ask the room of probably 200 if any of them would want to end up in their nursing home. Not one of them raised there hand…
I came to the industry 4 years ago after being laid off from the Tech industry. So I was not ‘tainted’ per se from being in it for my career. It was extremely disheartening to see how ‘management’ – not the worker bee’s – dealt with things. I had one management person tell me “The fact is we deal with human warehousing”…my heart still skips a beat as I type this. We all go to seminars about providing things and such but when it comes down to a CNA wanting to comfort a dying resident that she has cared for the past 10 years all she/we can think of is they don’t have time – have to get the next resident to lunch…
Thankfully I am no longer in the industry. I know for a fact a brought a breath of fresh air to my residents, resident families and co-workers. But I did not bring that same breath of fresh air to management. It is NOT about providing for residents for them – it is a business called “Human Warehousing”.
From LinkedIn Groups:
Senior Care Services Companies
I couldn’t agree more!
By Karen Crossman
From LinkedIn Groups
Boomers: Aging Beats The Alternative
Most, but not all, are pretty bad places. And, they also have a terrible reputation so no one ever wants to go there. But, it’s the only place for the elderly who have run out of money. A sad state of affairs.
By Lorie Eber
From LinkedIn Groups: Boomers: Aging Beats The Alternative
At least you got a reaction — most things are ignored.
By F. Todd Winninger
From LinkedIn Groups: Mature Market Experts
The short answer is yes. I am a fan of the Pioneer Network and Green House Model, but don’t believe you build a new model or paradigm by attacking dedicated professionals with universal statements like, “most” nursing homes suck.” One of the biggest problems facing today’s long term care centers is government regulations and reimbursement policies, and Obamacare will only add to the challenge of declining margins that result in private pay patients subsidizing those on Medicaid. My wife has been a long term care social worker for 30 years and each year ends up spending less time being a social worker and more time completing state and federal documentation requirements, many of which make no sense.
The culture and medical model is clearly outdated and Pioneer offers one alternative, companion care with skilled support is another and telemedicine offers the potential of reducing some costs. “Most” long term healthcare centers do a stellar job considering Medicaid reimbursement policies and regulatory controls. The nonprofit operators do an especially good job. Does MDS stand for Mindless Documentation Syndrome? Do most Pioneer Homes accept Medicaid? I believe you would discover that providers that do not accept Medicaid provide exceptional service in most cases. As the old saying goes, no margin, no mission.
Yes, there are terrible nursing homes and there will no doubt be terrible Pioneer Homes at some point. We need to rethink the entire senior living and long term healthcare alternatives available and work toward positive solutions rather than attacking an industry that has been serving older adults for over a century
By G. Richard ‘Dick’ Ambrosius
From LinkedIn Groups Senior Care Services Companies
You took a poke at a sacred cow. Good for you.
By Dave Mainwaring
From LinkedIn Groups Senior Living & Care Professionals
Steve – I think that article was well written and should of just meant to be a plantform for some good debates. I find nothing in that article so revolting that I would be angered.
By T.J. Alexander
From LinkedIn Groups The Senior Housing Investor’s Forum
After reading the article and your response to the comments and reactions to the article, Steve, I don’t see it as offensive in any way to any provider. The statements you made as to unfortunate conditions caused by excessive governmental controls that trend toward minimum performance (rather like education that is geared toward test results rather than learning) instead of the improvement of care standards were valid statements about governmental controls and their result. And, those statements were a lead in to an alternative culture being instituted by the actual subject of the post. Or did I fail to read the post from an appropriately defensive position? Perhaps someone who found it offensive could enlighten me.
By Susan Barnes Rice
From LinkedIn Groups LeadingAge
The simple truth is that if everyone likes what you post, most likely you are not doing something right. I enjoy your posts Steve. Thanks.
By Brett Nowell
From LinkedIn Groups Skilled Nursing Facility Management and Ownership
No, you didn’t go too far. It is a disgrace. Not to indulge in generalizations, but most I’ve encountered in this biz can’t handle the very uncomfortable truth that their consumers want nothing to do with them. If you happen to be in a pleasant and well run facility, then step back and look at a dozen of your nearest competitors and tell me you are still outraged by Steve’s article.
By Chris Dials
From LinkedIn Groups ADVANCE for Long-Term Care Management
Love your article, Steve. There are lots of good things about long-term care and lots of wonderful people working there. You are right in stating there are serious problems because not all people working in long-term care are trained properly or do the work for the calling.
Training and education must be a daily function of each facility. Teamwork which includes family caregivers is essential to maintaining an acceptable level of care and service to those in need of long-term care.
~ Ethelle
Dr. Ethelle Lord
http://www.Remembering4you.com
Pioneers in Alzheimer’s Coaching
By Ethelle Lord, DM
Steve,
I appreciate your comments and a good resource with Pioneer. I go from hospital to hospital and rehab and skill facility regularly all over the Triangle where I live visiting mostly the elderly who live or have lived in my 55+ community. I advocate and care for one man in a skilled facility. My mother from Iowa visits her eldest sister weekly in a town nearby and her youngest sister in another state monthly, as well as volunteers twice per week at a local hospital; she’s 89. We share the same experience. We can easily see who really is running a good facility and the problems it experiences. It’s not a pretty picture for most of those we see and we also hear from the residents of these facilities whether they like it there.
National Disgrace, yes, it surely is, but it’s not usually the fault of the caregivers (nurses, CNA…), it’s usually the management who care more to sit in their offices than to ensure their staff is trained, regulated and even cared for. One facility I visit regularly have 2 full-time nurses and one part-time nurse with only 3 full-time CNAs with approximately 200 patients. They bring in extra staff each day from a temp agency. The result: I never see the same nurse or CNA and none of them ever know the man I care for by his name or malady. This IS the sad state of affairs: Staff who come in on a temp situation and do not get any training by the facility or get the opportunity to know the patients.
I ask anyone to consider: Would you want your mom or dad to live their last days in “this” facility?
Bea you are right that the problem and the solution needs to come from the top.
Steve
Indeed, it’s great that there are forward-thinking providers that are doing all sorts of innovative things to improve the care and quality of life for residents in all levels of care which are challenging the status quo in the field of aging services.
NCB Capital Impact is one that is reinventing and transforming traditional models of long-term care. On 6/25/2013, I had an opportunity to learn about and visit THE GREEN HOUSE PROJECT at the Leonard Florence Center for Living located in Chelsea, MA. The Chelsea Jewish Foundation adopted this revolutionary model of long-term care that has proven to “improve lives and bottom lines”. This is the 1st Urban setting that replicated The Green House Project.
In 2001, Dr. Bill Thomas, a Harvard trained geriatrician, in conjunction with the Robert Wood Johnson Foundation collaborated to bring about Bill’s vision of “Green Houses”. He did not want to eradicate nursing facilities, he wanted to eliminate the traditional, institutional model that was adopted by nursing facilities nearly 50 years ago. Today there are 58 Green Houses in almost every state in the U.S. For more information, visit http://www.thegreenhouseproject.org.
Luckily as a reformer, Dr. Thomas continues to lead the charge to rethink senior care residences. He claims that “the No. 1 problem is that people believe that what we have in old age is as good as we can expect.” Therefore, families don’t press nursing homes with hard questions like, “How do you plan to change in the next year?'”
I truly believe that there is an urgent need to also redefine “old age” and to question everything about the aging process by challenging conventions in order to create and implement new standard-of -care approaches. I’m returning to the field of aging services in part because I want to be involved in shaping the conversation about aging and the types of communities and services that are needed for the seniors of today and tomorrow.
Hi Catherine:
I am a big fan of the Green House Model, the biggest challenge it provides though is cost. As I understand it, they cost as much or more than a typical skilled nursing community, which means that it is beyond the reach of the Medicaid/dual eligible’s that represent 65% or so of our nursing home population.
Steve
“the traditional, institutional model that was adopted by nursing facilities nearly 50 years ago.” begs the question whether there are other models, in our past or in other countries, in addition to the Pioneer model and the Green House model, at which we should be looking.
I agree with others here that this has been a worthwhile discussion, and none need take it personally. People in this field have good intentions, we’re all just concerned to improve, which is less likely when we get defensive.
Well! Goodness! So. Your title was designed to catch people’s attention. My reaction – Pioneer Network has been around for 10 yrs. and is doing great work. My philosophy has always been that you can be part of the problem or part of the solution.
Good long-term care is expensive and families do not want to pay for it. Our nursing homes are a reflection of what WE, not the government, are willing to pay for. Plain and simple. There are entire industries built around shielding assets so that the family can qualify for Medicaid. That is the real shame. And we live in America where our economy is based on profits. We as a nation find money for wars, money for professional athletes, $40 to paint our nails. Need I continue?
I have worked along the continuum of care for many years, including SNFs. Most of those employees on the floor are soldiers.
If every church group, Boy and Girl Scout group, social group – if every group visited ONE nursing home within 5 miles ONCE a year, just think how much better they would be. Again, nursing homes are everyone’s worst nightmare – not because of the government, not because of companies who try to make a profit for their shareholders – but because the “dirty little secret” is that we, as a nation do not believe our elderly are worth the money it takes to provide excellent care.
Charlaine,
Thank you for your comments because it is one more thing that our nation must stare down. Daily, I see families dumping their parent(s), so they don’t have to face their parent’s aging issues. It’s so sad, but yet they’re the first to stand at the door cleaning out their homes when they pass.
It’s always a joy for me to see families coming to visit, putting forth the effort, time, money and care for their loved one. I wish more families would remember our responsibility toward our parents. Maybe we don’t have the money but typically where we put out time is a choice. When I come home from these facilities, I feel drained and saddened by what humans endure in their elder years. God bless the caregivers, relatives or not.
Charlaine, You make some great points.
Steve
I work in healthcare risk management, both long-term and acute care. The field is undergoing tremendous change, and the folks who succeed will be the ones who can take a long, hard look at their practices and figure out how to do it magnitudes better and more efficiently/effectively. The comments above reflect some of the challenges in that. It is a journey, not a destination, and the best will always be looking for ways to improve. I know that sounds like pablum, but I see it over and over. So keep poking sticks at the skunks of our business. If you make folks uncomfortable, you are probably doing your job.
Steve, I don’t think you went too far. In fact, I don’t think you went far enough. Being in the seniors housing industry, I feel too much blame was placed on operators, and not where much of it rightfully belongs…on the regulatory bodies in charge of overseeing them. With the increase in regulations comes an increased responsibility of operators to document compliance, which takes more and more of the time alotted theoretically to the resident care. What did not get increased with the regulations is the funding to cover the additional hours now spent documenting. What suffers? Resident care, of course. Perhaps the decision-makers should “walk a mile” in the shoes of the care providers struggling to find the balance between proper resident care and required documentation…
Cindy
I agree that much of the blame goes to the regulations and regulators and that if we were serious about solving the nursing home problem we would start over with the regulatory and reimbursement process. Yet for all of that, there are some people who are running buildings that are primarily Medicaid and are able to do some pretty empowering things for residents and staff.
Steve
I agree to all of you there is good and bad in all Nursing homes ALF’s , I generally have visited and worked in great ones, However the times have changed… I am now seeing ones that should not be open, These people the owners have bought actually HUD developments that went up for forclosures in south Florida Cheap, some have Bed Bugs and roaches, these are Medicare and Medicaid funded,, the staff works cheap because they th mostly are from a third world country most are from Haiti , I could not believe the living conditions even the gates are locked so nobody can go in or out unless a staff member is present.. it reminds me of a out door jail with unpleasant living quarters I cannot believe they actually can get away with having residents live like that,,, I just looked around and it was so scary I walked out…I asked a CNA she told me she makes 8.00 per hour.. and no benefeits..
John
Exactly the thing I am talking about.
Steve
It is unfortunate but true that there are many organizations passing themselves off as care givers when in reality they are primarily interested in having “a head in the bed” rather than maximizing a resident’s potential and sending them home, when possible. It is true that the industry is heavily regulated but if your intention is to make a profit over giving superior care; than I say, go into another business where your profit margin will not negatively affect a person’s quality of life.
I have almost twenty five years in the business so I have been exposed to many different organizations and regrettably there are only a handful that actually deliver what they claim during their admission process.
You are correct in your saying that that no one wants to end up in a nursing home. What have they got to look forward to. Even the simple things such as a good meal and some meaningful activities are being cut to save on expenses. You keep on speaking your mind.
Thanks Walter
Steve
Not many high school students want to end up driving a mini-van either!
It doesn’t mean most mini-vans are a “national disgrace” because they are not sports cars – it just means that mini-vans are not designed for high school students. However, ask a frazzled mom with 3 kids to swap her 2-door sedan for your mini-van, and she’ll think she just won the lottery.
In the same way, nursing homes are not designed for healthy, younger, active folks. That’s why “not a single one of them ever wants to end up in a nursing home.” However ask any home-bound, bed-ridden, lonely, TV-dinnered, pain-wracked Senior if he’d swap his apartment for a room in your nursing home, and he’ll most likely jump at the chance. Those are the ones nursing homes are designed for.
Steve, I hope I never need to get fitted for a wheelchair, dentures, hearing aids, or a prosthetic limb, but someday getting one of those little beauties might just make me the second-happiest guy on the block – second only to you after moving from your smelly ol’ house to your lovely little room at Sunset Manor. AS soon as you get settled, I promise to come and visit you in my new senior-mini-van. Its called The Geezer and it’s the COOLEST thing in the world. 🙂
Hi Keesey:
Well . . . first I like mini vans. Thanks for sharing your thoughts.
It is not the fact that nursing homes exist that is a national disgrace, it is rather that there are so many of them that don’t provide a great quality of life for their residents. My experience tells me there are a few really great ones, a lot of “so so” ones (which means they get the basics of caring for residents done, but not a lot more) and while far from the majority there are some pretty terrible ones. The mix varies a lot from state to state. But the perception people have about nursing homes doesn’t come from no where.
Steve
I deduce that an awful lot of these outraged respondents have rarely if ever worked in a nursing home after 6 PM. Day shift always looks almost tolerable because the staffing is better and the problem-solvers are more likely to be on hand. As both a staff and an agency RN I have walked into facilities to take care of residents with no orientation whatsoever, no access to policy and procedure manuals (and certainly no time allotted to review them if they WERE there), and no way to identify residents except from faded admission pictures in charts that are often over 5 years old.
Face it folks, he’s right. NOT ONE OF YOU WANTS TO BE A RESIDENT OF A NURSING HOME! You all have smartly developed OTHER PLANS. Good luck with that when you are regarded by your family as inconvenient (old and in the way), or incontinent, or noisy, or need rehab, or you become chronically debilitated, can’t shop or cook for yourself any more, live too far out to get visiting nursing support, get uppity or in some other way try to oppose relatives you let move in to “assist” you who now need you out of “their” house that’s still in your name. And do you even know how much abuse and neglect occurs in the name of “durable power of attorney for health care”? Did you know that nurses caring for “agitated” (read uppity) residents very often go directly to the DPOA for medication and care plan changes without consulting the resident even she or he is still in full command of his or her faculties?
If you don’t believe him or me, try staying all night with a friend or a relative in a “home”. Stop in around 11:)) PM during report, and see all the call lights on. You will quickly understand why nursing homes are called Roach Motels. It absolutely is a national disgrace.
The Pioneer Network sounds promising. There is a better way, thanks for sharing your thoughts. It is unfortunate, but there are plenty of administrators who care about the cash flow more than providing quality care. There are also plenty of amazing administrators who run exceptional facilities.
I know of one woman who wanted to get into a nursing home who found the outside world too difficult. For someone poor, unemployed and elderly, a nursing home was like a cruise ship that never left port. Free meals, entertainment and transportation to doctors, maid service and medical treatments all provided by medicaid. So in glass is half full, not half empty.
The wealthy can afford home health nurses and doctor visits and 24 hour nurses. The percentage of nursing beds has been shrinking steadily in FL due to home health options.
Corporate greed is responsible for the decline in the quality of care in nursing homes. Some facilities are more concerned for quarterly profits than quality care. The minute the census goes down, cuts are made across the board, staff let go, activity budgets cut. Who wins? the administrator gets his bonus for coming in under budget. Staff moral sinks, and the CNAs who work so hard on the day to day care of the residents are not able to pay their bills at home.
When the state comes in for a survey, all the laid off workers come in and can work overtime while survey is on. Once the survey is over, the staff shrinks to levels not permitted by the state. There needs to be more oversight by the government to prevent poor care and fraud.
Our governor, Rick Scott, was head of a nursing home business that ripped off the government and was ordered to pay back billions of dollars.
From LinkedIn Groups
Wendy Meyeroff
Healthcare/Tech/Science: Executive Editorials, Custom Content, Reaching Boomers+
As a former reporter and, since 1987, a serious writer of materials for/about seniors, I am very disheartened, frankly, for what I see as a very uneducated posting. To be frank, I see little to commend in this story:
1. The words you use are unnecessarily harsh. Simply putting a question mark after the headline could have let you cut through the clutter (your supposed reason for using the language you did) to something that could have become a launching for serious discussion; i.e.: “Nursing Homes…A National Disgrace” to “Nursing Homes…A National Disgrace?” (Plus, there is other questionable language in your copy.)
2.Your posting reads too much like an advertorial or a political dissertation, not like a serious look at the issues facing seniors and their housing now and as we move forward.
3. The statement that people only wind up in skilled nursing is generally ’cause “their bodies are failing them” is not correct. There are quite a number of reasons. For example, someone can be in relatively good health, but they shouldn’t be alone, even for a few hours at night. Independent living doesn’t monitor them as carefully as needed, so homes for assisted living or skilled nursing (both of which BTW are nursing homes) is their best option.
4. There are quite a number of concerns about nursing homes, and some quite warranted. But to simply lambast all of them shows little understanding at all of the industry. Hardly what I’d expect from the editor/blogger or whatever of Senior Housing Industry News.
I am also a fan of Bill Thomas and have had the privilege of interviewing him. I’d be interested to hear Bill’s thoughts on this piece.
FInally, you leave me little confidence in your expertise when your question at the top asks, “Did I go to far?” when it should be “TOO far” ….
My Response to Wendy
Hi Wendy:
Thanks for your comments . . . . you got me for sure on the to or rather too. But I kind found myself grinning as I read through your comments. I assume you read the whole article and the thing I feel mostly badly about is that you missed the primary point of the article which was to encourage readers take a look at Pioneer Network an organization that is committed to transforming skilled nursing facilities into places that provide amazing life affirming living.
It feels to me that in your challenges you are largely doing to me what you accuse me of doing to . . . . someone.
Responding to your specific points:
1. My words were unnecessarily harsh – This was the biggest complaint I got from others. There were perhaps two harsh statements, the article headline and “nursing homes suck”. In truth, this is largely the public perception and it is largely the public perception because there are many nursing homes that are pretty grim. Beyond that, you might have a philosophical disagreement with my thinking on this, but the headline was written to be a headline that would get people to read the article and respond to it.
2. You say: “Your posting reads too much like an advertorial or a political dissertation, not like a serious look at the issues facing seniors and their housing now and as we move forward.”
This is so hard to know how to respond except perhaps to say, many people disagreed with your view. This blog is not, strictly speaking a news outlet, It is my voice my opinion and honestly largely people read it because I don’t write and think like everyone else. I am okay you don’t like it, but many others did like that article and like what I write.
Ultimately your view is well . . . . your view, your opinion.
3. The statement that people only wind up in skilled nursing is generally ’cause “their bodies are failing them” is not correct. . .
First, Assisted Living is not skilled nursing.
Second, most people are in skilled nursing because their bodies and minds are failing them. For sure not all; Some are there for short-term rehab, while I don’t know the exact statistics, the number of people who are in skilled nursing at any given time are there for the reason stated.
I don’t know if Bill Thomas read the article and if he has, what he thinks, but it seems pretty clear that the reason he choose the path he did was because he felt there were huge problems how we do nursing homes today.
4. . . . to simply lambaste all of them . . . I think a reasonable reading of the article would not offend anyone who is running a good to great skilled nursing facility. In fact, two weeks after I published that article I was at a conference for Skilled Nursing CEO’s and almost to a person those who had read the article agreed with my overall assessment of the state of the industry.
There are some great skilled nursing facilities and unfortunately many more not so good ones. The reason there are so many not so good facilities is complex. The ultimate point of the article is that the people of the Pioneer Network have figured out how to do it better even given the financial challenges.
Finally, if you would like to craft an article that takes me to task, I would be glad to publish it.
Steve Moran
Highly descriptive post, I liked that bit. Will there be a part 2?
My web site; online forex – Katrice,
Hello,
I know this is an old post but felt the need to comment. First of all, I’m a rehab professional and have been working in nursing facilities for over 10 years. I’ve worked as a traveler in multiple nursing homes across the country as well as single homes for long periods of time. And I 100% agree with the comment “nursing homes suck.” Those of you responding about how wonderful things are may be the exceptions to the rule. However, what I’ve noticed is that there are many people in the health field there for their own self-serving purposes. Don’t get me wrong. All positions are difficult in a nursing home however there are too many people with the attitude “Look at me and what I just did for you” or “Look at me and whoa is me.” There is WAY too much “LOOK AT ME” attitude floating around. I’ve met very few people truly in it because they 100% care about those they serve. Not shocking that so many people wrote in “I work in a nursing home and find your comments offensive” or some variation on that theme. Open your eyes people and listen people!! Mr. Moran has very valid points and a great ideas about his approach to healthcare. Perhaps there would be a lot more happy campers if we really did make it about THEM.