CHARLOTTE, N.C. — There are many ways to go about choosing a senior care community for a loved one. You may be overwhelmed with questions to ask. How do I pay? What percentage of the staff is vaccinated? Are they for-profit or not-for-profit? The list goes on, however If you want to hone in on one thing, consider the subject of staffing. Here to help us sort it out is aging expert Anthony Cirillo.
How serious is the staffing issue?
- According to a survey published in September from the American Health Care Association, “86% of nursing homes and 77% of assisted living providers said their workforce situation has gotten worse over the last three months.”
- While this has been worsened by Covid, it is nothing new. In my book, Who Moved My Dentures?, that published in 2003, a professional from the New Jersey Ombudsman’s Office said this: “The biggest problem today is staffing and it applies to all states. Years ago, abuse was the biggest problem. It still exists but now the bigger issue is neglect because of inadequate staffing and poor work ethics.”
- Trust in long-term care has eroded. With that, consideration of long-term care has dropped. That has an impact on census, revenue and budgets. So, what happens? People are let go. Those who stay are asked to do more and burn out.
Why is staffing so important?
- Fewer medication errors
2. Lower patient mortality
3. Shorter stays
4. Lower patient care costs associated with readmission
5. Less nurse fatigue and burnout
6. Increased patient satisfaction
7. Higher patient care survey scores
So where do you start to evaluate?
- You start by first getting some help. A Geriatric Care Manager can help you sort through your options. Then consider a registered nurse who can come with you as you tour a place and help you ask the right questions.
- Unfortunately, assisted living is less regulated than nursing homes so hard and fast data is hard to come by when evaluating staffing. However, the government’s Nursing Home Compare site, weighs staffing when awarding “stars” to facilities. Five stars is considered the highest. This is a good baseline from which to start but not your ending point. When the Star System was first introduced, staffing was self-reported and the data was unreliable. Places reporting appropriate staffing did not always turn out to be the highest quality places because in reality the staffing was over-reported. As staffing is probably the single biggest indicator of quality, well, you can see the dilemma.
- U.S. News and World Report also has a reliable rating system for long-term care homes. Again a starting point.
At some point, you will have to go in-person and evaluate these places. What do you observe and what do you ask?
- There are certain minimums in nursing homes that the government mandates. The state of New Jersey went further in early 2020 when it enacted legislation that mandated one certified nursing assistant to every eight residents for the day shift; one direct care staff member (registered nurse, licensed nurse practitioner or CNA) to every 10 residents for the evening shift and one direct care staff member (RN, LPN or CNA) to every 14 residents for the night shift.
- So with that ask questions like:
- How many aides per patient are there?
- How many LPN’s and RN’s per patient are there?
- How long has staff been on board? What is the turnover rate?
- Are temporary people used? What percentage and how often?
- Is management stable?
- Does a facility conduct criminal background checks?
- As mentioned, you may want to take a nurse with you when you go to visit a place that you are thinking about as they can ask even more detailed questions.
- Oh, and one more thing. Whether a place is for-profit or not-for-profit is a choice point. In general, the average for-profit facility has been found to have poorer quality of care relative to the average not-for-profit facility.
For more information visit the TheAgingExperience.com