Part 3: Crisis in Long-term Care

A silent crisis: Nursing homes commonly ignored

This article submitted by Michael Jacobson on 12/27/00.

People don't want to think about nursing homes, don't want to talk about them, and certainly don't want to admit that they may need one someday.

The result is public perception hasn't kept up with the changes in nursing homes in the past 20 years, according to local nursing home administrators, leaving these institutions misunderstood and underappreciated.

Tom Kooiman the administrator for the Good Samaritan Care Center in Paynesville and Hilltop Good Samaritan in Watkins frequently asks people to guess the average stay at a nursing home. The usual response he gets is two to eight years, but the reality is an average stay of only 58 days.

In 1999, 70 percent of admissions stayed for less than 30 days.

"(The public) doesn't realize what nursing homes do today," agreed Bev Mueller, patient care administrator at the Paynesville Area Health Care System. "They're what hospitals were 20 years ago."

The misperception of nursing homes as a protracted death bed is something the industry is trying to battle with a grassroots information campaign. The industry hopes to raise public awareness about the current state of nursing homes and the crisis in funding, regulations, and staffing.

And then it hopes to channel that support into reform measures at the state and federal levels.

Changing facilities
A change in the past couple of decades is the availability of alternative care measures. In-home care and meal programs help keep elderly people in their homes longer. Assisted-living facilities and other types of senior housing exist in great numbers these days, providing housing options for seniors.

Still, explained Willie LaCroix, PAHCS administrator, "There are times when alternative services aren't appropriate and you need a skilled facility. And you need a good one, too."

Nursing homes are used more and more for rehabilitation, and stays, as a consequence, have gotten shorter.

The Koronis Manor, for instance, now handles patients that would have formerly been limited to the hospital.

Karen Ampe, director of nursing at the Koronis Manor, said her nurses now regularly perform procedures once confined to the hospital. Things like tube feedings, intravenous tubes, and chest tubes are now common in the Manor. "We are an extension of the hospital completely," said Ampe.

Much more rehabilitation is done in the Manor these days, with physical, occupational, and speech therapy offered at PAHCS.

Ampe noted that improved care saves more lives of stroke victims now and gives the patients greater opportunities for rehabilitation. Where 20 years ago stroke victims might be limited to a nursing home bed for the rest of their life, now they might stay for a few weeks of rehab and then head home.

Even though the role of nursing homes is changing, it's still a subject that people don't want to think about, let alone discuss as a future need.

Most people don't want to believe that they will need a nursing home, said Kooiman, but "the reality is that at some point most of us will need some long-term care."

"We need to make sure that care is available and top of the line," said Sen. Michelle Fischbach (R-Paynesville).

The challenge is to getting it on the agenda and then paying for it.

Rep. Doug Stang (R-Cold Spring) said the reluctance to look seriously at nursing homes extends to the Minnesota Legislature. "It's not a topic that people like to think about or talk about," he explained.

Full reform could take $500 million ($150 million in one-time spending and $350 in yearly appropriations). Stang said the passage of such a package was not too likely, but that pieces could be approved to address specific problems. This would be less expensive to the state than the full reform promoted by the industry.

"The bottom line is real reform is going to be real expensive," he said. Former Minnesota Senator Dave Durenberger, who authored numerous health care initiatives in the Senate, is now chairman of a national coalition that is trying to attract attention to long-term care. The organization tried during the recent primary and general election campaigns to raise the issue of long-term care with national political candidates.

"Ultimately," said Durenberger in a published interview, "we found the candidates to be very receptive to our efforts, and our continued conversations with their staff have indicated to us that they recognize this as a serious issue."

"Unfortunately," he continued, "the issue has not made its way to the forefront of the issues the public wants to see solved. And without that public pressure, policymakers are often slow to react."

(Next week, in our fourth article on long-term care, we will examine how the demographics and demands are changing.)

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