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Running head: LONG-TERM CARE OVERHAUL

Long-Term Care Overhaul: A Proposal

Amanda C. Birowski

Delaware Technical Community College

NUR420 Nursing Policy

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Abstract

Long-term care has not been reformed since 1987 – for thirty-three years not much has

changed. There are three major concerns in this area of health care – staffing, funding, and

authority of the power of attorney. Bill “Long-term Care Overhaul” explores ways to address

these issues and create change.

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Long-Term Care Overhaul: A Proposal

Introduction: Identifying the Problem

Long-term care facilities – more commonly referred to as nursing homes - are private

institutions providing their residents with twenty-four/seven health care. The elderly population

is usually who resides in these types of facilities. A lot of improvements have taken place within

this system of the years, however there is still room for improvements. I personally work in

what is considered a nicer, upscale nursing home – and I see several issues while I’m at work. I

am proposing bill “Long-term Care Overhaul”. This bill deals with three important problems

that the majority of long-term care facilities face – staffing, funding, and roles of the power of

attorney. Ultimately the issues in each of these areas negatively impacts the care of the elderly.

Part I: Staffing

A survey among nursing home residents generated a list of top complaints. Number one

on this list was slow response times to calls and number three dealt with staffing issues (Murray,

2019). The workload of the clinical staff members – this is typically certified nursing assistants,

licensed practical nurses, and registered nurses – in nursing homes is very heavy. Primarily

nursing assistants are required to toilet, dress, feed, and bathe residents. Nurses are to pass

medications, supervise nursing assistants, perform wound care, complete incident reports, and

complete regular documentation (Wofford, 2019). This is a long list of tasks, and I might have

missed specific duties. The current staffing ratios in Delaware are as followed – RNs/LPNs on

day shift 1:15 residents, evening shift 1:23 residents, and night shift 1:40 residents, CNAs on day

shift 1:8 residents, evening shift 1:10 residents, and night shift 1:20 residents (State of Delaware,

n.d.). Having a long list of job duties to perform on this many people is unsafe. Residents have

to wait extended periods of time for their needs. A lot of the times, residents become impatient
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waiting and attempt to perform tasks themselves – such as transferring from the wheelchair to

the toilet. This can result in negative consequences such as falls, skin tears, or bruises. Staff is

stretched too thin, which ultimately results in high turnover rates at these facilities. Constantly

having to hire new staff means providing appropriate training – which is another issue. Many

facilities have new staff orientation for one or two shifts – then they are expected to perform on

their own. This bill proposes that staffing ratios be evaluated and changed in order for residents

to receive more individualized, quality care. Improving ratios would also make the clinical staff

members at these facilities feel less overwhelmed – which I’m sure would drastically change

those high turnover rates.

Part II: Funding

In America, the elderly population is fast growing. People are living longer – with this

more chronic health problems are emerging, which can result in disability or functional

dependency. These health conditions and other issues with aging can ultimately result in the

elderly needing to live in long-term care services. These services can range from transportation,

food preparation, and other activities of daily living. On average, nursing homes can cost over

$87,600 (National Council on Aging, n.d.). It is frequently thought that private insurance or

Medicare provides the money for these facilities and services. However, that is not the case.

Many families are unaware of this and not prepared for such a cost – which can lead to their

loved one not receiving the care they need.

Currently, the National Council on Aging – along with several other organizations. –

have proposals to help fund long-term services and supports. It has been suggested to create a

long-term care insurance financing system. The goals would include increase affordable options
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for working Americans, not excluding purchasers based on pre-existing health conditions, and is

fully paid for. An official policy has not been approved by the government as of today.

The need for some sort of financial plan is evident. Fifty-three percent will be paying these costs

out of pocket (Bipartisan Policy Center, 2016). Long-term Care Overhaul would agree with this

insurance financing system, as well as finding a way to make care more affordable.

Part III: Roles of the Power of Attorney

Vulnerable populations can be defined as “groups and communities at a higher risk for

poor health as a result of the barriers they experience to social, economic, political, and

environmental resources, as well as limitations due to illness or disability” (NCCDH, n.d.). The

elderly fall into this category.

This age group tends to have multiple health issues occurring at once. Studies have

shown that many elderly do not receive the care recommended for them – especially preventative

care. This can occur for several reasons – not having transportation, unable to afford, support

and encouragement from family, or just denial. Eventually, they might need more care or total

care provided for them. Relying on others to care is a limitation which could result in poor care

(Joszt, 2018).

Individuals in this age bracket are also considered vulnerable due to the memory issues

that often occur during this time. They might not be able to express their wants and wishes

regarding their health, so the power of attorney – which is often a family member – steps in. I

personally see this all the time at my nursing home job. Sometimes you question if this is

something that the individual really would have wanted. The most common example I encounter

is the refusal of Morphine and Ativan use when a resident is actively dying.
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Currently there are no policies to ensure the elderly receive the care they need. The

biggest recommendation “Long-term Care Overhaul” has for this is limiting the power of

attorney’s authority in certain situations – like the above example. Sometimes nursing

judgement should trump the thoughts of families.

Conclusion

In order to make these above changes take place, it is important to get federal and state

legislators on board. Most nursing homes receive Medicare and Medicaid funding. The Nursing

Home Reform Act of 1987 set regulations for facilities to follow in order to receive this funding.

However, the regulations are very vague and have not been updated in thirty-three years.

The next ninety days requires a lot of work. The most effective tool is talking. Many

people do not want to discuss nursing homes because they think they or their loved one will

never be there. The reality is – they just might. If people were educated on the changes that

need to occur, they would be more inclined to act. Government officials needs to be aware of

these problems. Seeing them firsthand would be beneficial – arrangements could be made for

these officials to tour and observe at different facilities.

I feel very strongly about this bill. I have worked in a nursing home environment for

over three years now. I see that these three concerns – staffing, funding, and authority of power

of attorney – drastically impacts the care of residents. These residents deserve to receive quality

care. I’m sure that’s one of the reasons they left their own homes – they believed a nursing

facility could cater to their growing needs. However, as of today, facilities are not upholding

that belief.
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References

Bipartisan Policy Center. (2016, February 01). Initial Recommendations to Improve the
Financing of Long-Term Care.

Joszt, L. (2018, July 20). 5 Vulnerable Populations in Healthcare. Retrieved from

https://www.ajmc.com/newsroom/5-vulnerable-populations-in-healthcare?p=2

Murray, C. (2019, March 8). The Top Complaints Residents Have About Nursing Homes.
Retrieved from https://www.caitlin-morgan.com/the-top-complaints-residents-have-about-
nursing-homes/

National Collaborating Centre for Determinants of Health. (n.d.). Vulnerable Populations.

Retrieved from https://nccdh.ca/index.php?/glossary/entry/vulnerable-populations

National Council on Aging. (n.d.). Long-Term Care Financing. Retrieved from

https://www.ncoa.org/public-policy-action/long-term-services-and-supports/long-term-
care-financing/

State of Delaware. (n.d.). Laws of Delaware. Retrieved from

https://delcode.delaware.gov/sessionlaws/ga140/chp490.shtml

Wofford, P. (2019, July 11). Nurses Say Staffing Ratios in Long Term Care Facilities Are
Unsafe. Retrieved from https://nurse.org/articles/nurse-staffing-unsafe-long-care-facilities/