Long-term care facilities face changes in way they operate in Oklahoma

Americans are aging rapidly. The over-65 population is expected to increase 63 percent by 2030. That will cause some major changes in the way long-term care facilities treat residents.

Bob Lane, nursing home/health project manager for Oklahoma Foundation for Medical Quality, said each state is working on the problem. Specifically, OFMQ works on the problem of turnover of certified nurse aides in the state. The turnover rate in Oklahoma is 135.5 percent.

There are a number of contributing factors to employee turnover at nursing homes, and Lane said research shows management can prevent it.

“We found an organization that values its employees, empowers them and involves them in the decisions that affect them can lower their turnover,” he said.


It all starts with management

Organizations that give CNAs a voice in the daily operation and help the front line staff understand why they are doing their jobs will increase employee satisfaction, he said. A national study compared two long-term care facilities that were in identical labor markets and reimbursements but had different outcomes.

“One had a revolving door and poor clinical outcomes. The other was the opposite. It started with management. The way the administrators and top leaders go about dealing with employees had a positive effect,” he said.

Concepts such as permanent staffing have worked. As example, nursing homes typically rotate staff from wing to wing, he said. Leaving them in the same assignment produces better retention rates because aides get acquainted with residents on a deeper level, Lane said. Consistency of routine creates a higher degree of satisfaction with the job, because aides know it better and are more proficient, he said.


The high cost of turnover

Turnover is costly to care facilities. Most facilities can ill afford to lose those dollars, considering the reimbursement rate and tight regulations of the health care industry, Lane said. The more than 70 facilities working with OFMQ on solutions represent a cross section of size, geography and for-profit and not-for-profit organizations.

According to a work force development survey taken by the governor’s office in cooperation with The State Chamber, turnover costs the provider $2,500 to $6,000 per person in Oklahoma.

Concepts affecting retention rates also are designed to improve care, including the practice of moving to more individualized treatment of residents. For example, most facilities awake residents at the same time every day, so they can get them to the dining room at the same time. Leaving a person to awake when he or she wants and eat when he or she wants reduces stress, Lane said.



Instability on the front lines

Clinical outcome studies have shown when there is a lack of stability, the ability to deliver services declines and outcomes suffer.

“Poor quality care results from instability of the front-line caregivers,” he said.

When an individual makes the transition from home to a nursing home, he or she gives up a lot. People lose much of themselves, he said. If they go to a more institutional setting, nursing home staff members tell them when to get up, when to bathe and when and what to eat. In the individual model, Lane said, if a person is accustomed to getting up at 9 a.m., eating grapefruit and drinking coffee while reading the paper, that is recognized. Nursing home residents also are able to bathe on their own schedule.

“It’s trying to extend home into the realm of a nursing facility. When people feel like they have more control, they will be more involved in activities and social relationships,” he said. “If they are eating what they want to eat, they will likely eat more, and nutrition will improve.”


Putting residents in control

Making that type of change will involve more than the dietary department, Lane said, but will change the operation of the entire facility. Rather than keep the dining room open all day, some care facilities have established bistros in various places in the building, or a snack bar close to the nurse’s station.

“Some facilities are there now, some in Oklahoma and nationally that are on this journey. A culture change is not something that has a real end to it. When someone endeavors to start doing it they commit to doing it forever. It’s a different way of thinking than we are used to in the industry,” he said.

“The individual model goes a long way toward alleviating symptoms of depression,” he said, “and people can do more for themselves because they feel like they have some control.”

Excerpt taken from EnidNews published July 2, 2006, written by Robert Barron, Staff Writer.