More Staff Equals A Safer Nursing Home Environment

Posted on May 25, 2010 by John R Kormanik

 A recently published study by the University of South Florida, the authors confirmed what many of us probably presumed was true: Quality of care substantially improved following the Florida legislature's enactment of requirements for increased nursing staff levels and other quality care measures. 

According to the study, beginning in 1999, "Florida began developing a national reputation for State policy focused on nursing home quality" by instituting "regular, unannounced quality-of-care monitoring by state officials, release of information about all state licensed nursing homes via a public Internet site, development of a 'Gold Seal Program' to recognize facilities with outstanding care, and funding of a pilot teaching nursing home project to promote statewide development of best practices." Building on that legislation, in 2001, Florida enacted further legislation which mandated staffing levels, increased regulatory oversight and initiated a moratorium on new nursing home beds. According to the authors of the Florida study: "One consistent finding is that higher Registered Nurses (RN) levels are associated with lower number of falls, fewer pressure ulcers, and other patient care outcomes that indicate better quality of care."

Unfortunately, Idaho has not seen fit to follow Florida's lead. In Idaho, there is a requirement for a certain number of "nursing hours per day" depending on the size of the facility. There is, however, no requirement for additional nursing staff based on resident acuity. Instead, Idaho only requires staffing sufficient to "meet the total needs of the patients/residents." 

As shown in Florida, mandatory staffing levels and other mechanisms make a real difference to the health and well being of nursing home residents. Come on, Idaho! Don't some of our most vulnerable citizens, those who can no longer care for themselves and are relying upon nursing homes for their care deserve better?

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Surprised? Assisted Living Facility Residents Don't Sleep Well.

Posted on May 11, 2010 by John R Kormanik

In a recent Los Angeles Times' "Booster Shots" article, Shari Roan writes briefly about a study of nursing home resident's sleep patterns and habits. The study, published in the Journal of American Geriatrics Society, and conducted by UCLA and the VA Greater Los Angeles Healthcare System, looked at 121 "older adults," 65 and older, living in assisted living facilities. According to the Ms. Roan, the study found: "the residents slept about six hours per night and about 1.5 hours during the day. The most common sleep problems included walking in the middle of the night or early morning or the inability to fall asleep within 30 minutes. Not surprisingly, the study also found "declining function status and quality of life and greater depression over 6 months of follow-up." That meant those residents who slept poorly required more help with their "activities of daily living," such as bathing, dressing and grooming. Unfortunately, the study does not get to the cause of the sleeplessness. Obviously, this is an important issue. What can be done?

Two of the causes of sleeplessness in older adults in general and, likely, residents of assisted living facilities in particular, may be chronic pain and medications. Both of these causes can be addressed and, in all likelihood, fixed. The first step is, of course, recognizing the "problem" exists. The next step is to get the "team" -- that is, the doctor, staff and family -- involved in finding the solution. If chronic pain is the culprit, your doctor and, and should, be able to help. In terms of current medications causing sleeplessness, perhaps the dosage of medication can be adjusted or or the medicine changed all together.

No matter what the cause, the problem of sleeplessness of assisted living facility residents must be recognized, properly diagnosed and addressed. If not, the effects are long-lasting and serious.

 

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