I applaud Nancy Taylor for her willingness to put her experience into print ("From Both Sides of the Coin" [Voices From the Field], Nursing Homes/Long Term Care Management, June 2003, p. 69). I am a regional LTC ombudsman with 18 counties, no local office staff, and very little clerical or backup support. Our volunteers cannot be paid for mileage or for long-distance phone calls. Our funding is continually challenged, and our unit is constantly attempting to make a "real" difference with almost nothing but determination and experience. We do at times make a difference for one person on that day; but "systems advocacy" is so desperately needed, and that has been stripped out of every piece of legislation and budget in government these past lean years.
You see, I've found no "empirical methodology" that will measure how many things do happen just because a volunteer is on the floor of a facility, or how many things that might not have been done are done simply because someone had the time to focus some thought on what the resident was trying to tell us. And how, exactly, do we quantify "peace of mind," "comfort," "compassion," "trust," "dignity," or "respect"? Where can I "code" these, and to what "funding stream" for "billable hours" and "RUGs reimbursement"? Yet, what gets measured, gets done....
Thank you, Nancy Taylor, for adding your voice to those of us who continue to try to add the above-mentioned dimensions back into daily life for those who are in care facilities. I finish an in-service on "Dignity" with the following lines:
- We must become people who have the courage to make the choices that will allow the voices of the most vulnerable among us to be heard. Why? Because, barring a very unpleasant alternative, one day we will all be old. The level of care we support and deliver is the level of care we will teach those who follow us to call "acceptable"; this will become the benchmark for the care we will receive. But for the grace of God, there go I....
Thank you, Nancy, for giving testimony to that.
Sue Schuster, LMSW
Regional Long-Term Care Ombudsman
Nancy Taylor wrote about her experience staying in a nursing home after a car accident. She says that although they were always short, the staff worked hard and she received good care. She says that "love is a sparse element" and considers that we have a "failing system." She believes that our government should provide more funds for nursing homes. She says we are "inwardly killing these people" and it is "a sin to treat people this way."
As an administrator for more than 30 years, I can agree with some of her conclusions. Certainly we can always use more funds for more staff. However, money is not going to solve the problems she sees. Money does not buy love. We need a kind, compassionate staff. If we had an unlimited amount of money to pay caregivers, we would doubtless have more applicants who would take the jobs just for the money.
Ms. Taylor refers to patients with dementia and the blank looks on their faces. Some patients have families who love them and visit them, even though the patient cannot remember their visits from day to day and sometimes does not even recognize his or her own loved ones. This is a disease-based problem and money will not solve it. We can sympathize, but we should not blame the government for insufficient support.
For those who still have their mental ability, of course it is humiliating not to be able to care for yourself physically. If you have a physical problem, this is something you have to accept, whether it is permanent or temporary, like Ms. Taylor's accident. The government can supply money to have someone bathe you and feed you, but it cannot help you with your feelings of humiliation.
Where do Medicare and Medicaid get the money to pay nursing homes? From American taxpayers. Does Ms. Taylor think that taxpayers are not paying enough? How does she think the Medi-Medi money should be apportioned? In my
facility, we have raised wages to the nursing staff considerably in the last few years. We have had to pay double our workers' comp premiums of a few years ago, although we have had few injuries. Our biggest problem has been that our liability insurance premiums have quadrupled because of attorneys who bring unjustified lawsuits, and the insurance companies are leaving our state.
It is a constant effort trying to see that all patients, whatever their needs, receive good care. We value the employees who show love and kindness.
Leona Berglund, Administrator
Crestview Convalescent Hospital