Nursing is a field of expertise that has a cumulative population of nurses registered trained at several levels. The levels of training include those with hospital diplomas and those who possess degrees from associate through doctoral levels, practical nurses who are licensed, and assistive assistants such as aides, orderlies and attendants who are not licensed (Senge, 1999). This population works within the confines of an ever changing and flattening structure that is constantly facing shifts. Superior/ subordinate relationships are gradually fading away to pave the way for decentralized, inclusive and transformational management at the practical level. Flat organizational structure normally has a top administrator flanked by first line managers and practitioners. The nursing home personnel customarily work in an environment that focuses most of its attention entirely on the client. One tactic to approach the nursing home structure is that nurses employ the nursing process in their provision of care to patients (Hayajneh, 2007). Many similarities have been established between the process of nursing and nursing home management.
Dynamic Level of Predetermined Motions
The process of nurse management employs a structure that is supposed to run like clockwork. Nurse managers employ the skills and knowledge of management practices that encompass planning, organizing, leadership and evaluation. These elements are cumulatively employed to bring about nursing care. The chief goal of nursing care is to utilize personnel in their different capacities, supplies, equipment, clinical skills and knowledge to provide nursing care to clients in different environments (Senge, 1999). The nursing home manager may also possess other ancillary personnel such as therapists and social workers. The presence of ancillary workers adds to the increased complexity of the provision of quality services in the care of clients. An example of an environment is a hospital station. Nursing gomeplanning coupled with organizing, leading and evaluation is what makes up nursing management. In addition,combining nursing management and nursing practice results in the provision of nursing care to patients. Consequently, a move in management is always geared towards developing a balance of the forces that are players in the provision of nursing care to clients (Johnson, Miller & Horowitz, 2008).
The Human Level
The individual in charge of nursing home management has awareness of their abilities increased. Consequently, they can practice the knowledge and skills of management to attain desired results from the nursing home practice.
Current State of Nursing Homes in the US
Over the past years, nursing home care and long-term care meant the same thing. When elders were in need of long-term care, they inevitably would find the care at a nursing home. In the recent past, the long term nursing care sector has undergone some changes to a significant extent. The system is evolving to cater for the changing demands of it clients. The clients need services provided in a more convenient setting than it was before. The changes include addition of services such as adult day care, care at home by healthcare providers, residential care and aided living (Vasell & Nguyen, 2012). On the other hand, nursing homes still make up a critical part of the long-term healthcare system. According to the National Nursing Home Survey, approximately 1.6 million elderly and disabled persons in the United States receive care in 1 of the 17,000 nursing homes. Most of the issues related to nursing home have been centered around the question of quality. On most occasions, the quality of nursing homes has been judged to be poor and a lot of clients, government agencies and researchers have raised the issue.
Nursing Home Characteristics
Nursing homes in the United States have a wide range of characteristics based on the diverse qualities of the service providers. The diverse characteristics sometimes are detrimental to the use of many quality indicators. Consequently, measurement of quality may be hampered. An obvious example is the presence of a small average number of beds which reduces statistical power. A less frequently examined fact is the unit-based structure of many nursing homes in the United States (Johnson, Miller & Horowitz, 2008). The structural organization can handle unique practices and results in different units. Lawton is of the opinion that a unit based perspective would be the best to evaluate quality in nursing homes. In other words, the averages stated on a facility may cover significant and crucial variation in quality (Hayajneh, 2000). On the other hand, evaluating an intro provider variation limits the statistical power. Moreover, it may result in a quality indicator overload since it reports quality indicators on each unit.
The residents of nursing homes are also a varied selection. Some of the residents do not spend much time at the facility for reasons such as rehabilitation which makes them uninfluenced by the facility due to exposure over time (Vasell & Nguyen, 2012). In addition, health status can be transitional and separating the transitional health changes from adverse changes which are triggered by the facility care can be a troublesome issue. Consequently, there is no such person as a typical nursing home resident. This challenges the quality rubric that is used in assessment of the nursing home quality (Johnson, Miller & Horowitz, 2008).
Problems Associated with Nursing Homes
Researchers are of the opinion that most of the largest for-profit nursing homes compromise quality due to low staffing compared to non-profit and government-owned nursing homes. The largest chains have been established to prioritize low operational costs at the expense of quality. Consequently, they hire less staff to reduce labor costs and to increase profits. Low staffing levels of nurses are considered as a strong indicator of poor nursing home quality. In the United States, the ten largest chains that operate for profit run approximately 2,000 nursing homes in the country. Consequently, they control an estimated 13% of the countrys nursing home beds (Vasell & Nguyen, 2012).
In the recent past, there has been considerable expansion of nursing homes. Before the early 2000s, several chains were publicly traded companies. Several went bankrupt during that period. After restructuring and changes in ownership and improved Medicare payments, the chains attained financial stability. More recently, some large publicly owned chains were acquired by private equity investment firms.
Based on research, two significant hitches affecting the quality of nursing home care in the United States have been established. These are inadequate staffing and a poor availability of skills in staff. The regulations imposed by the federal government require that at least one registered nurse is on duty eight hours a day for seven days a week (Vasell & Nguyen, 2012). Moreover, the law demands that a registered nurse or a licensed practical nurse (also known as a licensed vocational nurse) is on duty during other shifts no matter the facilitys size. The time of training for registered nurses is two to four years and licensed practical nurses have a year of training. Many studies have suggested the staffing standards be raised and have established the existence of broad disparities in staffing within ad across states (Vasell & Nguyen, 2012).
Quality of care in nursing homes has been a constant issue of public concern throughout their history. Policy formulation and regulation framework have been developed targeting to improve the quality of care in nursing homes for more than thirty years. A complex system of regulations by states and federal government exist to govern the nursing home organizations. However, low quality of service and patient abuse appear to be recurring. Additional regulatory reforms should be focused on the lessons learnt from the failures of the existing regulation mechanisms and employ research and formative evaluation.
According to data from Nursing Home Compare, over 1.6 million Americans are residents in nursing homes (Singh, 2005). Majority of the nursing home patients are elderly, frail, and vulnerable. Consequently, there is a high likelihood they will spend most of their lives in nursing homes. Due to their physical or mental limitations, they are unable to be assertive or well aware of their rights and may be taken advantage of. The United States spent approximately $90 billion on nursing home care in 1999 which averages approximately $55,900 per resident (Singh, 2005). Over half of the cost was offset by states and the federal government through Medicaid and Medicare (Singh, 2005). Most of the nursing homes are run by private sector investors (Vasell & Nguyen, 2012). Over more than half the nursing homes are run by for-profit organizations and includes an increasing number of large corporations that have facilities th...
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