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Care Quality of Nursing Homes in America

By bragak12 Nov 15, 2013 2186 Words

Care Quality of Nursing Homes in America
The quality of care in nursing homes around the country is a topic that has become heavily researched over the past 30 years. In some parts of the world, like Wales, residents appreciate the care they receive from loving nurses and good programs (Palfrey, 2011). However, in many countries such as the United States, residents argue that there is a major need for reform in the nursing home industry. This issue has recently become overwhelmingly important, because the elderly of our country will soon become twenty percent of the overall population (Phillips et al., 2004). As moral citizens it is our duty to make sure that this vast and growing population is treated as well, if not better, than we would want to be treated in their position. Some possible solutions to help the quality of nursing homes in America are to improve the technology implemented in the homes that control medications, and keep track of check-ups, decrease the staff turnover rates, and to better educate the staff on what residents look for in a quality nursing home environment. I believe that giving nurses incentives to continue with their jobs would best decrease the staff turnover rates and would benefit nursing homes across the country by encouraging nurses to become more invested in their patients’ needs.

The question of poor care quality in nursing homes was first nationally realized in 1987 with the implementation of the Nursing Home Reform Act (NHRA). The NHRA was a law written to try to improve the conditions of all nursing homes across the country through government regulation. This law made sure that all nurses had a mandatory certification needed to practice in nursing homes. It was also put in place to improve such things as physical restraints, urinary catheters, and the use of unnecessary medication in the typical nursing home environment (Zhang et al., 2004). The government is the main purchaser and regulates the recipients of Medicare and Medicaid in the nursing home industry, and therefor found this new law to be very important (Zhang et al., 2004). Some researchers believe that the NHRA has positively affected every aspect of the quality of nursing homes in the United States; however, many people believe this law was an overall failure and are still fighting for a new law that will make a greater impact on society to this day. Many researchers believe that the issue of care quality in nursing homes has been drastically improved over the past 30 years. A study was done researching the impact of the NHRA on today’s nursing home care system. In this research, it was found that the NHRA did in fact make a positive difference on how modern nursing homes are run by the improvement of care quality and staff regulations (Zhang et al., 2004). This law drastically improved staffing regulations that had previously, nearly been non-existent in nursing homes across the United States. Some of the staffing regulations that positively affected the industry required that “Medicaid and Medicare certified nursing homes have licensed practical nurses (LPNs) on duty 24 hours a day; a registered nurse (RN) on duty at least 8 hours a day, 7 days a week; and an RN director of nursing in place. The NHRA also mandated that nurse’s aides (NAs) receive a minimum of 75 hours of training and pass a competency test” (Zhang et al., 2004). Without these rules and regulations there would most likely be many more nursing mistakes on a day-to-day basis. These simple mistakes are now easily avoided due to the implementation of the staffing regulations in the nursing homes of our country. On a global scale, nations like Wales are implementing programs to help their nursing home’s care quality in the same way that the United States is. An interview was done with a woman named Rachel Kemp who is a manager of a nursing home in Wales, that holds up to 68 residents. She was given a national honor for her achievements in the nursing home field and when she received the award stated, “We are a strong team and we provide an excellent quality of life for our residents” (Palfrey, 2011, 24). The affection Kemp and her staff shows towards their residents proves that there are some nursing homes around the world that are taking the correct steps in making a quality environment for the elderly to enjoy at the end of their lives. Their staff believes that having a good relationship with the residents creates a happier and healthier living environment for everyone, and has proved their theory correct by creating an award-winning program.

Along with positive feedback on the progress of nursing homes over the last 30 years, there have also been many questions of concern about the steps that our country has taken in this growing industry. Many studies have been conducted in order to pinpoint the major obstacles that nursing homes need to overcome in order to be successful in their goals of creating a happy living environment for the elderly. One study done by Dr. Nicholas Castle, researching how nurses staying with their jobs for a long period of time affects the quality of care for residents found that “When care is labor intensive, high staff turnover can have far-reaching consequences, including increased facility operating costs and lower caregiver job satisfaction. The most serious consequence of caregiver turnover is the potential negative health outcomes for residents” (Castle et al., 2007, 650). This quotation explains how staff turnover rates affect nursing home quality in many different ways than one, and can quickly become a costly problem if not taken seriously. It is obvious that nursing homes need to take better care of their staff in order to solve many of the problems that they are facing, including financial and medical set backs. Researchers like Castle believe that there are many more issues in the nursing home industry, like staff turnover that need to be solved in order to make it a successful program. Another point of research that has been strongly criticized in nursing homes is the likelihood for residents to gain infections. One study focusing on the impact of infections in nursing homes across the country found that “Approximately 2 million infections occur in United States nursing homes each year” (Montoya et al., 2011, 889). This statistic shows how wide spread this problem has become in our country. It is extremely unsafe to have such a high rate of infection in nursing homes across The United States. For some elderly the slightest infection can cause them to suffer from serious illnesses, diseases, and possibly even death. Researchers have found that “Catheters and feeding tubes have a significantly higher chance of causing an infection in elderly patients” (Montoya et al., 2011, 889). This proves that even the medical equipment that is used the most often in nursing homes can be misused and dirty. Informing nurses of how to better clean the medical equipment used in these procedures would help to cut down on this significant problem.

Some of the simplest solutions to help the nursing home industry could prove to be the most beneficial for this program. One possible solution is to improve the technology used in nursing homes to help with the medical needs of the patients. One program that has become significantly pushed for within the medical field, in the last ten years is called eHealth. This service would give doctors and nurses a more efficient way of keeping up with patients’ changing medications and daily checkups (Matusitz et al., 2013). One study done to research eHealth’s effectiveness states that “eHealth gives healthcare practitioners access to information and enables them to make higher- quality decisions about healthcare. In addition eHealth saves time and improves the stability of care” (Matusitz et al., 2013, 28). This shows that however costly improving technology in nursing homes would seem at first, in the end it could solve more problems for nursing homes than was previously thought possible. A way for nursing home staff to improve their time efficiency could be a huge breakthrough, and would allow for nurses to spend more time getting to know their patients which is very important for happiness in nursing home environments. Another way to help improve nursing home care quality would be to give the staff better training on what the residents want in a happy healthy living environment. This could be an easy way to make the residents feel more involved in what goes on in their nursing home. Having residents fill out surveys and partake in interviews about their views on how homes are being run is a great way to improve nursing homes across the country (Bowers et al., 2001). This solution would be especially simple because it would cost nearly nothing to complete. The results nursing homes would receive from the resident feedback would be well worth the hassle of creating surveys and partaking in an interview process. These simple solutions could prove to make a world of difference in an industry that is so important to society, and is growing even more important every day.

Although technology and resident feedback are extremely important, I believe nursing homes across the country could best improve their programs by strongly reducing their staff turnover rates. One way that nursing homes can accomplish this is by giving the nurses incentives to stay with their jobs and their patients. Simply creating programs that allow nurses to become closer with their patients and their fellow staff will help keep nurses working in one nursing home for a longer amount of time. These programs would allow nurses to create bonds in the nursing homes that would make it much harder for them to pick up everything and switch jobs. In one study done to see how residents defined care in their nursing homes, researchers found that the residents who were known as “real sweeties” usually described good care as having a relationship with their nurse (Bowers et al., 2001). These patients explained care further as “The affect of their caregivers, their caregivers’ motivation, and the evidence of real friendship that they found in their relationships” (Bowers et al., 2001, 541) This study proves that helping and encouraging nurses to create closer bonds with their patients can influence a happy living environment for the patients, and in turn create a happy working environment for the nurses. Nurses working in a good environment are much less likely to leave their jobs which would create a decrease in the national staff turnover rate, and would overall make nursing homes in the united states more efficient.

Although there is a mixed opinion in the research world about whether or not nursing homes in the United States have a good enough care quality system, it is evident that there is still work to be done in this field. Everyday, the elderly population becomes larger and larger, and this growth means a need for greater concern about how the elderly of our country are treated. These problems in nursing home systems can easily be fixed by putting some time and effort into the most important aspects of nursing homes including the nursing staff, the medical equipment, and the residents themselves. As Tom Petty once said, “If you’re not getting older, you’re dead.” Through this quote we must remember that getting older is an important experience in each one of our lives that should not be taken lightly. As younger citizens it is our duty to help improve the nursing home system and to make sure that we treat the elderly, as we want to be treated when we reach their age. I know that when it finally becomes time for me to pick a nursing home, I want to be able to choose between a variety of options all with a loving environment, and a knowledgeable and helpful staff.

Works Cited
Bowers, B. J., Fibich, B., & Jacobson, N. (2001). Care-as-service, care-as-relating, care-as-comfort: Understanding nursing home residents' definitions of quality. The Gerontologist, 41(4), 539-45. Retrieved from Castle, N. G., PhD., Engberg, J., & Men, A. (2007). Nursing home staff turnover: Impact on nursing home compare quality measures. The Gerontologist, 47(5), 650-661. Retrieved from Matusitz, J., Breen, G., & Wan, T. (2013, February). The Use of eHealth Services in US Nursing Homes as an Improvement of Healthcare Delivery to Residents. Aging Health, 9(1), 25. Retrieved January 28, 2013, from Health Reference Center Academic. Montoya, A., & Lona, M. (2011, December). Common Infections in Nursing Homes: A Review of Current Issues and Challenges. Aging Health, 7(6), 889. Retrieved January 28, 2013, from Health Reference Center Academic. Palfrey, S. (2011, April 13). Home sweet home: award-winning matron Rachel Kemp believes her job is to improve the lives of residents. She talks to Sharon Palfrey. Nursing Standard, 25(32), 24. Retrieved February 4, 2013, from Health Reference Center Academic (A255085998). Phillips, C. D., Holan, S., Sherman, M., Malgorzata, L. W., & Hawes, C. (2004). Rurality and nursing home quality: Results from a national sample of nursing home admissions. American Journal of Public Health, 94(10), 1717-22. Retrieved from Zhang, X., & Grabowski, D. C. (2004). Nursing home staffing and quality under the nursing home reform act. The Gerontologist, 44(1), 13-23. Retrieved from

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