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Bits & Pieces
In 2009, it was estimated that there were 38.8 million Americans over the age of 65 in the United States.
- The U.S. Census Bureau projects that by the year 2030, nearly one in every five Americans will be age 65 or older.
- This age group is projected to increase to 89 million people by 2050 (U.S. Census Bureau, 2009).
- Recent estimates show that approximately 10 million Americans require LTC.
- Sixty-nine percent of Americans over age 65 will need some form of long-term care before they die and almost one third of the entire U.S. population will spend some time in a nursing home during their lifetime.
- Those under 65 make up 42 percent of those in need of LTC.
- Approximately 70 percent of Americans 65 years or older who rely on long-term care receive services in a home- or community-based setting, compared to 30 percent who receive care through an institutional setting.
- As a nation, the United States spent $206.6 billion on LTC in 2005 (U.S. Department of Health and Human Services, 2010).
- The cost of LTC is projected to more than double over the next 40 years as the U.S. population ages.
As many as 5.1 million Americans have Alzheimer's disease, the most common cause of dementia, and the number is expected to rise as the baby boom generation ages.
- The disease is progressive and terminal. It may take years to run its course.
- It is the sixth leading cause of death in the United States, killing more than 71,000 a year, a figure many experts think is understated.
A new child labor law issued by the U.S. Department of Labor (DOL) Wage and Hour Division states individuals under 18 years of age cannot use "hoists" or "manlifts" which includes patient or resident lifts.
The Fair Labor Standards Act (FLSA) states that bona-fide meal periods (typically 30 minutes or longer) for employees are not work time under the FLSA and the employer does not have to pay for them.
- However, if they are not being paid, the employees must be completely relieved from duty during these meal periods without interruption.
- If an employee is interrupted, the employer can either start the complete meal period over and ensure that the employee is not interrupted or pay the employee for the bona-fide meal period in accordance with FLSA wage provisions.
- There are no exceptions to this law for health care employers under the FLSA and it is the sole responsibility of the employer to ensure that the meal time is not interrupted. It is not the employee's responsibility to ensure that the meal break is uninterrupted.
- Violations of "meal time" provisions can result in six figure fines and penalties for a single facility, so strict adherence to the FLSA is critical.
Getting Ready for Flu Season.
- This year the CDC's Advisory Committee on Immunization Practices (ACIP) voted to recommend universal influenza vaccination for all persons 6 months of age and older.
- The CDC plans to continue to emphasize the importance of vaccinating high risk populations such as long term care residents while simultaneously promoting annual influenza vaccinations for everyone else.
- Also new this year is Fluzone High-Dose vaccine, which contains an increased amount of antigen compared to standard-dose influenza vaccines, and is designed to help generate a stronger immune response in people 65 years of age and older
Some terminally ill patients who receive palliative care live longer and with a better quality of life than those who receive standard medical care, a new report suggests.
- Researchers at Harvard Medical School evaluated the life expectancy and quality of life of roughly 150 patients with terminal lung cancers. They compared 74 patients who received standard medical care in the last months of life with 77 patients who received palliative care in addition to standard care after diagnosis.
- Patients were asked questions about their mood and their quality of life at the start of the study and again after 12 weeks of treatments.
- Patients receiving palliative care, which focuses on treating pain, anxiety and loss of appetite, reported a 50% lower rate of depression than non-palliative patients.
- They also lived an average of 2.5 months longer than the other patients, according to the report. The study appears in the Aug. 19 issue of the New England Journal of Medicine.
Antibiotic use by seniors has increased as a result of better drug coverage under the Medicare Part D drug program, according to a study by theUniversity of Pittsburgh Graduate School of Public Health. While recent changes in drug coverage have improved the use of antibiotics for pneumonia, they could lead to unnecessary spending on expensive broad-spectrum antibiotics and the overuse of inappropriate antibiotics, the study of more than 35,000 Medicare beneficiaries found.
Consumer & Workforce Satisfaction
The 2008 National Survey of Consumer and Workforce Satisfaction in Nursing Homes represents the voices of 425,000 nursing home consumers (residents and families) and workers who completed satisfaction surveys during 2008. Included are responses from 223,449 employees, 54,711 residents and 146,949 family members in 5,075 nursing facilities across the United States.
The level of consumer and workforce satisfaction was stable from 2005 to 2007 and reached its highest level so far in 2008. Both consumers and workers consistently reported high levels of satisfaction with nursing homes. Eighty-five percent of consumers rated their overall satisfaction and their recommendation of the facility to others as either "excellent" or "good" place to work. Sixty-six percent of employees rated their facility to others as either "excellent" or "good" place to work, and 73% rated their facility as an "excellent" or "good" place to receive care.
Key Findings
- Consumers rating their overall satisfaction as "excellent" increased from 31% in 2007 to 35% in 2008.
- Consumer satisfaction increased across all demographic groups and facility characteristics.
- Although rates of improvement varied, workforce satisfaction increased across job classifications demographic groups and organizational characteristics (e.g., type of facility ownership, geographic region, size and other facility characteristics).
Family and Resident satisfaction
Although their perspectives are not identical, both families and residents are important stakeholders who are able to provide valid feedback about the quality of nursing home care. Input from both groups can help improve nursing home performance overall.
- Family and resident satisfaction are positively correlated. Facilities ranked high on family satisfaction also have high resident satisfaction, and facilities ranked low on family satisfaction also have low resident satisfaction.
- The most powerful drivers of whether a resident or family member would recommend a nursing facility are workforce issues; care or concern shown by staff, competency of staff, quality of service, and attention to the resident's choices or preferences.
- Differences exist in terms of how residents and family members experience care, as well as in the factors that are most strongly correlated with the recommendation of a facility to others.
- In planning quality-improvement initiatives, providers need to look carefully at their results to better understand how the responses of families and residents are interrelated.
- Resident overall satisfaction rose from 81% in 2005 to 86% in 2008.
- Family overall satisfaction rose from 82% in 2005 to 86% in 2008.
Workforce and Consumer Satisfaction
The relationship between consumer and workforce satisfaction is seen in the factors that underlie satisfaction among these groups. For consumers, the care and competency of staff are the most important drivers of satisfaction. This holds true for both resident and family respondents. For employees, management practices are the most important drivers of satisfaction. Most importantly, these same management practices are among those rated the lowest by employees.
- Facilities with higher workforce satisfaction also have higher consumer satisfaction.
- Competent and caring staff is a consistent predictor of resident and family satisfaction.
- The level of satisfaction in America's nursing homes can be increased through strategies to simultaneously enhance quality from the consumer's perspective and improve the work environment for staff. Clearly, an effective strategy for quality improvement has to include a focus on the workforce that provides care for residents and their family members.
- Nurse overall satisfaction (defined as "excellent" and "good") rose from 54% in 2005 to 58% in 2008.
- Nursing assistant overall satisfaction (defined as "excellent" and "good") rose from 54% in 2006 to 58% in 2008.
Opportunities for Improvement
National benchmarks for consumer and workforce satisfaction are powerful tools that providers can use to drive greater value for all stakeholders. By comparing the performance of individual facilities against national benchmarks, providers can identify opportunities for improvement.
Survey items that are important drivers of satisfaction, but are low scoring, are potential areas that facilities can prioritize for improved satisfaction. Residents and their families identified "choices/preferences,' "management responsiveness," "grooming" and "nursing assistant care" as opportunities for Long-Term Care Facilities to improve satisfaction.
Nurses and nursing assistants have identical results for primary strengths and primary opportunities. Survey items that are important drivers of global satisfaction based on the respondent's recommendation of the facility as a place to work, but are low scoring, represent potential areas that providers should target for improvement.
Help with job stress is the top priority item for both nurses and nursing assistants. Nurses and nursing assistants both identified "help with job stress and burnout," "management listens," management cares," "training to deal with difficult residents," "supervisor appreciates," and "adequacy of equipment/supplies" as opportunities for Long Term Care Facilities to improve workforce e satisfaction.
Implications for practice
For the field of practice, this year's report contains very positive results. The level of satisfaction in the country's nursing homes is showing incremental improvements for the first time since these data were first collected in 2005.
This report highlights the interdependence of resident and family satisfaction. It also underscores the interdependence of workforce and consumer satisfaction. . . . [G]ood leadership, good management and good supervision are likely to have salutary effects on resident, family and employee satisfaction. . . . [L]eadership competencies are strongly associated with job satisfaction in nursing homes. We recommend that aging services professionals focus on leadership competencies and workforce development as key initiatives to sustain quality improvement efforts in nursing homes.
Compiled directly from the 2008 National Survey of Consumer and Workforce Satisfaction in Nursing Homes by report contributors: Leslie A. Grant, Ph.D.; Brad Shiverick, C.P.H.Q.; Peter Janelle M.P.P.; Michael Davern, Ph.D.; Amy Hu, M.S.; and Eric Lewerenz, M.S.
Excerpted from My InnerView, May 2009
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