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We Still Have A long Way To Go

Published November 19, 2008 1:24 PM by Brian Garavaglia

With all the changes that nursing homes have undergone during the last 20 years, we still have a considerable way to go.  Even with nursing home reform that started slightly over 20 years ago, especially the movement to make the nursing home environment more homelike, the changes that have been introduced still have not eliminated the institutional setting that exists in nursing homes in the United States. 

As I enter many nursing homes I have noticed different levels of accommodations. I have noticed nursing homes in communities that have higher socioeconomic levels having more resources and coming closer to many of the goals that the industry has set for the nursing home industry. However, at the other extreme, as I have toured nursing homes in lower socioeconomic level communities, and I have witnessed not only deprivation within the community but also within the nursing homes that are found in these communities. During our election year it sometimes makes me wonder that although we espouse democracy and equality, we still face considerable obstacles in perfecting these major concepts found outside as well as inside long-term care environments. 

As I walk through many of these nursing care facilities I often wonder why there is so much inequality in resources and care found in these health care facilities. Sociologically, I have to say it intrigues me that the provision of care that exists in many long-term care facilities is predicated upon the deferential level of resources that is found from one long-term care facility to another. This interests me because it reflects many of the same inequalities that are found in our larger society. However, at the same time that it interests me as a researcher, it also saddens me to think that this type of inequality continues to exist at a time when it should not. 

An interesting sidebar that exists is that we attempt to monitor and engage in regulatory oversight using the same standards for all nursing homes. However, how can we apply a universal regulatory standard to all nursing homes when there is such disparate features found among nursing care facilities in the United States. How can we apply the same standards to a long-term care facility that may have abundant levels of financial resources and say that the same standards should be applied and exist among nursing care facilities that have very few resources.   

Often we attempt to delude ourselves so we fail to realize the harsh realities that continue to exist in our world. We do so at times to distance ourselves from the true reality and pain that we would come to feel if we were to let ourselves comprehend the complexity and less than humane circumstances we face in daily life. As we continue to deal with the harsh inequalities that are found in society, we have to come to realize that health care facilities, as institutions of society, face the same endemic problem.

Therefore, it should not come to surprise me, or anyone else for that matter, that the disparity that is found in long-term care facilities continue to exist. It should not surprise us that the ideals for a homelike environment are more closely found among certain facilities and far from it in others. Moreover, it should not surprise us that there is differentials in the type of care that is provided among nursing care facilities based on a large differential in the resources that they have available. 

What should come to surprise, if not astonish us however, is that we continue to delude ourselves by thinking that many of these differences fail to exist. Furthermore, what should surprise us is that we as a society can employ the same standards for all nursing facilities, deluding ourselves into believing that they are all playing on a level playing field. 

Not only do we have to recognize that the inequality of long-term care facilities mimics that found in larger society in general, but we also have to recognize that we cannot continue to employ universal regulatory standards to all nursing care facilities as if they were all equal. If we fail to recognize the great disparity in resources that is found in long-term care, or bury our heads in the sand and say that it is not financial resources that matter, but the personnel that exist in the facility, or say that oversight needs to be equal when that entities that are being overseen are not, we will fail to be able to further enhance our industry.  As one can see we still have a long way to go.                  

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About this Blog


    Brian Garavaglia, PhD
    Occupation: Long-term care administrator
    Setting: Sterling Heights, Mich.
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