The long term health care problem has been acknowledged by many health care institution and health care organization as difficult to address. Dennis Robbins admitted that the difficulty lies in obtaining “accurate and up-to-date guidance” (p. 1), towards addressing conflict, developing policies, and also the many ethical problems that usually come up in health care context.
Robbins noted that despite of those vast arrays of health care institutional settings.
Many legal cases came up when the patient was no longer confined in these institutions. Robbins pointed out that there are about 21,000 long term care facilities, 14,000 hospitals, and 38,000 nursing and personal care facilities that caters to these problem of long term health care. He emphasized that long term care are services provided in institutional settings, yet, he also disclosed that estimates showed that almost “three quarters of the seventy disabled who receive home care services received that care from family members or volunteer care givers (p.1).
However, long term health care institutions are not exclusively the sole provider of a long term health care. Home care is an alternative; those who need long term treatment may opt to choose considering cost of hospital bills. However, the problems that need to be solve both by the long term health care and home care is the lack of sufficient “health care professionals to staff many of these committee in home care and long term care” (Robbins, p. 16).
Robbins pointed out that these problems are resulting to a diminished or lacking in post accurate care settings that include quality assurance and risk management committees, attending physicians and related groups. Thus, long term care facilities are viewed by some as “necessary evil” (p. 17).
Beyond the many legal and ethical issues that surround long term health care, are the problems that deserve to be addressed. These are: under-funding of the long term health care, high staff turn over, and quality of report card.
According to an advisory issued by the committee on ways and means sub-committee on health of the United States House of Representatives “about nine million adults are receiving home term care assistance, either in community settings or in nursing homes” (p.2). This report cited that “nearly sixty percent of these elderly persons receiving long term care assistance and rely wholly on unpaid care givers mainly their immediate families either their spouses or the children; only seven percent of these elderly can afford of paid services.
The report further cited of around one hundred thirty five billion dollar on long term care for the elderly through the different agencies that caters to the needs of these groups such as Medicard and Medicare and other private insurance (p. 2). However, this budget did not include any amount devoted to long term care provided by the informal care givers.
In this report, United States law makers are alarmed of the growing numbers of elderly people and booming problems of long term care in the face of diminishing numbers of professional health care givers. The hearing of the committee was to address the current financing for long term care services and the range of services available in the continuum of care from home as well as community-based services to nursing home care” (p. 2).
According to some studies presented in this hearing, there was actually substantial funding for the long term health care. The Director of Congressional Budget office pointed out a total of over two hundred billion dollar was spent in 2004 equivalent to twenty four thousand dollars per senior with impairment (p. 9). The problem that they see was not on funding but rather on government rules that hinder public from preparing for their own future. The statement says, “Those rules create incentives that discourage people from making their own financial preparation and encourage them to rely on government assistance” (p. 9).
The anticipated increase of number of elderly people by two and a half times poses another problem as the number of adult eighty-five and older who uses long term care are likely to increase by five percent in 2050, triple more than the 1.5 percent in 2000. Thus, the committee on health is encouraging to promote alternative delivery systems such as an “early intervention and care management in nursing homes and the community as well as greater use of home and community based care” (p. 36). They saw institutional long term care as costly and in efficient and leads only to poor outcome.
Dr. Meghan Gerety of the University of Texas, College of Health and Sciences, testified that the current system is lacking of necessary incentives for promoting “alternative delivery systems” (p. 36). Dr. Gerety said, “Many people have signified their desire for care in the home and community yet, the current financing system has a strong institutional bias (p. 36).
Dr. Gerety revealed that of the 83 percent who need long term care, seventy-eight percent of their help come from unpaid sources such as family and friends (p. 37). The problem therefore of under funding does not necessarily pose problem in such a way that there is sufficient funding being allocated for elderly and those adults with impairments. What is lacking is a more creative, more practical approach into this part of the society.
The next question that needs to look into is the high turn over of staff.
Various orientations on nursing home administrations provide training for long term care workers. Learning modules are easily available and it seems that there are pretty much demands of long term health care workers all over as the number of elderly people are looming and those who are seeking long term care are doubling.
As we have seen in the committee report of the Subcommittee on Health by the United States Congress, there is an anticipated increase of numbers of elderly people of about five percent by 2050, as the so-called baby boomer generation is coming to end. Not only this pose financial burden but it also needs additional long term care personnel. But according to Douglas A. Singh, despite of efforts to identify the cause of turn over, and despite efforts to prevent the erosion of manpower, “staff turn over remains one of the most daunting problems of nursing home industry” (Singh, p 468). Singh noted that the efforts to address the issue have produced only a little success up to this time. He disclosed that despite of the turnover, there was no attempt to increase staff retention given the fact that turnover is expensive. Singh identified two major costs related to turnover problem namely the placement cost and the training cost for the new worker (p. 468).
Singh identified one of the staff turnover causes is easily burnout among new employees. He noted that consistent shortages of staff and often picking up of employee to fill the slack is demoralizing and leaves feelings of disillusion powerless and incompetent for the position (p. 471).
Another source of turnover of staff is sexual harassment on the part of women health workers. Jeff Hearn said, there was a very “high turn over of female care staff in this area. Hearn noted that management knew about the high staff turnover in this area and which the reason was just to choose not to act on it. Hearn observed that “grievances were simply ignored and never got any action; and that management is likely to prefer to replace female care worker than dismisses the officer” (p. 116).
The high turnover of staff therefore is not simply related to compensation but rather more personal reasons which the management often chooses to ignore or not act on it. Solution to this problem according to Douglas A. Singh is to impose an effective Human Resource and Staff Development orientation which would offer learning modules to all personnel, concerning their duties, obligation, rights and accountabilities. This module also serves as encouragement as they will be oriented of their benefits and other incentives that would keep them stay in their work without fear of harassment or exploitation.
The Report Card
Florence Kavaler and Allen Spiegel said that “Health care providers’ helps consumers make informed about a provider refutation through the report card.” But they noted that the report made by a United States Health Plan Employer Data and Information in September 2001 indicates “declining member satisfaction with the New York Health Plan (p. 105). They also noted the decline in satisfaction of members with diabetes from 53.7 percent in 1994 to only 49 percent in 2000 (p. 105).
This report card is one of the three clusters-smarter markets through report cards. It seemed that this card offered only limited benefit for the holder as it only provides option for a better choice of a service. This is probably the reason for the decline of report card use. As one observer commented, report cards have not the desired effects because consumers are not aware of the quality problems that have been observed in health care. Therefore, it is not surprising then the decline of the use of this report card.
What to do with this card? I would suggest they dissolved it and think of a more relevant initiative that would cater to better health care option.
Dilulio, John and Nathan, Richard (1994) Making Health Reform Work: The View from the States. Brookings Institution Press
Hearn, Jeff (1989). The Sexuality of Organizations. Sage Publications.
Kavaler, Florence and Spiegel, Allen D. (2003) Risk Management in Health Care Institutions: A Strategic Approach. USA: Jones and Bartlett Publisher, Inc.
Long Term Care: Hearing before the Subcommittee on Health of the Committee on Ways and Means. US House of Representatives One Hundred Ninth Congress (April 19, 2005, Serial 109-46). Diane Publishing
Robbins, Dennis A. (1996) Ethical and Legal Issues in Home Health and Long Term Care: Challenges and Solutions. Jones and Bartlett Publishing, Inc.
Singh, Douglas A. (2005) Effective Management of Long Term Care Facilities. MA, USA: Jones and Bartlett Publisher, Inc.