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Additional Staff Training Must Accompany the Increasing Complexity of Care

Published June 22, 2009 9:48 AM by Brian Garavaglia

Click here to read Brian's column "Gerotalk" on the ADVANCE for Long-Term Care Management Web site.

According to AHCA, many long-term care organizations are increasing the levels of services they provide:

  • More than 36 companies are adding rehabilitation suites or units."
  • 16 are planning to add new services such as Alzheimer's care, secured units, and respite rooms.
  • 23 providers will start offering ventilator services.

At first blush this shows the increasingly progressive nature of many long-term care environments. It also demonstrates the need for many companies to attempt to capture higher reimbursement rates that these services potentially hold. However, although these services provide a greater potential for increased revenue as well as heighten the level of professional services offered, they do not come without a cost. 

There is a monetary cost based on the capital expenditures that definitely needs to be considered.  Equipment such as respirators, special safety devices for Alzheimer's residents, rehabilitation equipment that is purchased, as well as the construction costs all incur hefty capital outlays.

This is during a period of time when state and federal reimbursement is facing potential declines.  State governments are looking to make cuts during these difficult economic times in numerous areas that will affect Medicaid reimbursement and the Centers for Medicare and Medicaid are also looking for possible reduction in funding for skilled nursing care centers. 

So even as the skilled nursing care environment becomes increasingly competitive, with many companies looking to gain an edge on their competitors by adding more skilled services, the financial cost in doing so will be considerable.  As mentioned, in an era where many decisions to reduce reimbursement have been made, many companies have to make sure and be cautious in approaching this type of expansion. A good example of this can be found in the hospital industry, where many hospitals that also are part of a highly competitive environment, have actually put out incredibly great capital outlays, just to find out that they often have poorly calculated payback periods. 

However, there are other costs that will need to be examined as well. The staff that needs to carry out many of these services will definitely need to be upgraded as well. For instance, introducing a ventilator unit in a facility will entail hiring an optimal number of respiratory therapists that are on staff for 24 hours, seven day a week. Furthermore, many of the nurses that nursing care facilities rely on are typically licensed practical or vocational nurses. With ventilator units, often you need more nurses that are registered nurses and also specially trained with advanced cardiopulmonary training. Many facilities that decide to add neurological units will in turn need advanced nursing care and training among their nursing staff.

Upgrading training will not only be important for nursing staff, but it will also be necessary among social workers, activity professionals, rehabilitation staff, and in particular among certified nurse assistants.  Since most clinical care is provided by certified nurse assistants or CNA's, this group of workers will need greater periods of training. Most certified nurse assistant training is short and generalized, being focused on the traditional nursing care issues that are often found among the frail clientele of nursing care centers, such as providing basic care and assistance with the activities of daily living. 

With the provision of more complex clinical services, this group, which is often recipients of a very short period of training, will need to obtain greater levels of specialized training to address many of the more complex clinical needs that they will face. There are many that currently think that certified nurse assistant training is too short as it is. Therefore, with the introduction of specialized Alzheimer's services, ventilator care services, or neurological care services, certified nurse assistants will definitely need greater training to support the needs of the higher complexity of residents they will be working with daily.       

With increased training and the level of work that many of the specialized areas will lead to, remunerating workers so that their wages are commensurate with their training and workload with also enhance the cost for a facility. Again, one has to be mindful of the current economic climate in which government subsidization for services are being lessened rather than increased. Furthermore, one has to also be aware of the potential for increased liability, which will definitely increase as resident acuity increases.  Therefore, to minimize the risk, proper training and education of workers in these new specialized areas will be mandated, all escalating the cost to the nursing care center and for nursing services that will be provided to residents. 

As the culture of nursing homes continues to change, moving toward acceptance of a higher acuity clientele, and concomitantly more complex services, it will lead to not only greater costs for the long-term care industry, but much greater levels of training that many companies may not have totally envisioned.  As nursing care centers will address the needs of residents with greater clinical complexities than has been traditionally seen in long-term care, it will become imperative that many of the frontline individuals involved in the provision of clinical care will obtain greater levels of training.

Long-term care companies that envision enhancing the clinical complexity of its nursing care environment, as well as enhancing their revenue base through increasingly specialized services, will need to realize that the core element of these services, its professional staff, will also need to be part of these changes.  


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About this Blog

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