The Way Forward for Long-Term Care – The World According to Dr El

Dr El

With staff shortages, reduced occupancy, the ongoing pandemic and other challenges, it is a worrying time for long-term care. A review of the trade headlines might even make one pessimistic about the future of the industry.

Despite these challenges, dedicated and thoughtful professionals – from LTC leaders and researchers to regulators and frontline staff – strive to continue their mission of serving seniors, knowing that the growing aging population will need us. .

From my perspective, after decades in the field, there are aspects of eldercare services that require intervention by those in a position to effect change. Some on the list below have received attention recently, some perpetually, and some less, but I think taking care of these areas will contribute to success in the next few years and into the future. .

  1. Be part of a continuum of care – Even before the pandemic, no one wanted to enter a retirement home (unless they did not have a home of their own). Since the pandemic, that sentiment has increased exponentially. For the country’s financial health, the focus should be on home care. For the financial health of the industry, facilities should be part of a continuum of care that allows participants to be admitted, discharged, and returned as needed, while the continuum earns money for assistance throughout. along the process.
  1. Become a member of the community – To allay fears about nursing homes, facilities should rely on the fact that most residents or their family members are local citizens. Nursing homes could be more like community centers, with educational and recreational programs for the elderly and educational and supportive programs for their families, so that the facility moves from a dreaded possibility to a friendly place. , informative and comfortable filled with familiar helpers. In other words, the kind of place that wouldn’t be so bad to move in if needed.
  1. More single rooms than double rooms – “Semi-private room” has to be one of the worst euphemisms in the healthcare world. Double rooms, in addition to increasing the risk of transmission of infection, greatly contribute to the emotional distress of residents. Two words best sum it up: “sleep” and “dignity”. Modernized and livable nursing homes will have private bedrooms and, where possible, private bathrooms.
  1. Financial transparency – It is difficult for the industry to make a credible plea for additional resources when the status of current funds is unclear. Increased financial transparency could eliminate bad actors and allow others to obtain the necessary financial support.
  1. Increased Medicaid Payments – A system based on payment tariffs lower than the cost of services will never add up. Perhaps 2022 will be the year when this issue is addressed.
  1. Capitation and value-based care – If I wanted to reduce costs within a capitation system, I would increase the number of helpers, improve their training and professional career, and offer more end-of-life support to residents and families. Well-trained assistants would detect changes in physical and emotional health before they turn into costly medical crises. Education and end-of-life support would reduce the frequency of unpleasant, frivolous and expensive medical procedures and increase the likelihood that residents would experience a “good” death.
  1. Living wage – As I have pointed out here, decent wages help retain staff, and reducing turnover is the key to better and more preventive care.
  1. Family-centered care – In theory, we admit residents. In reality, we admit families. A system designed around this reality would provide more help to families as they navigate essential paperwork, changing family roles, end-of-life issues, and transitions between providers and levels of care. For more thoughts on this, read “7 Powerful Ways to Provide Family-Centered Care.” The elderly care system will also need to find a way to meet the needs of a growing number of residents without families to help them. Investments in families (and care managers) will be recouped through improvements in care transitions.
  1. Improved mental health care – Mental health treatment under the current fee-for-service model is inadequate for the needs of the system. Services should be offered not only to individual residents with diagnosable mental health issues, but also include educational support groups for residents and families, EAP services or open office hours for staff members, staff and team training, regular behavioral rounds, and ongoing consultation as needed for the wide variety of organizational concerns that would benefit from a psychological perspective.
  1. Services for people with severe mental illness – As I wrote in “Critically Mentally Ill Residents: A ‘Perfect Storm’ Creates an SNF Wave”, this cohort has grown significantly over the years. These residents typically enter LTC following a brief medical crisis and, after its resolution, have difficulty finding housing and community services that can manage their concurrent mental and physical health needs. This relatively young population would be much better served in an environment that is less restrictive and not designed for and filled with frail seniors.

Despite the many obstacles on the road, there are even more creative and compassionate people trying to overcome them. By working together, these challenges, while difficult, are not insurmountable.

Eleanor Feldman Barbera, Ph.D., author of The savvy resident’s guide, is a Winner of the Award of Excellence in the Blog Content category of the APEX Awards for Publication Excellence program. She is also a Bronze Medalist for Best Blog in the American Society of Business National Publication Editors Competition and Gold medal in the Blog-How To / Tips / Service category in their Midwestern regional competition. To contact her for speaking engagements, visit her at EleanorFeldmanBarbera.com.

Opinions expressed in McKnight Long Term Care News guest submissions are those of the author and not necessarily those of McKnight Long Term Care News or its publishers.


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