identify solutions to the challenges presented by your peers. Are there root causes of these challenges that your peers did not identify? Are there some challenges that do not have a solution, and if so, why? posts should be 100 to 150 words, with a minimum of one supporting reference included. 

Response 1

Probably the most ongoing issue with long-term care is the challenges with qualified staffing.  This can be due to overworking staff, lack of funding, or lack of the ability to sustain qualified staff.  As far as overworking staff it can be overwhelming to fulfill all the needs of a long-term care resident.  The care is demanding and takes time to provide the quality care the residents deserve.  If the staff is limited or the resources are not available is it difficult for the staff to perform the necessary care.  In good work environments, RNs have adequate staff and resources, supportive managers, strong nursing foundations underlying care, productive relationships with colleagues, input into organizational affairs, and opportunities for advancement.  (Nursing Home Work Environment, Care Quality, Registered Nurse Burnout and Job Dissatisfaction, n.d.)  With being overworked with limited resources it is not hard to understand why qualified staff becomes burned out.  Root analysis showed that the nursing facilities with the lowest satisfaction scores for staff were for-profit, Medicare-funded or chain owned.  These are where profit is considered above quality care for the residence.  This trickles down to the staff.  The federal policy gaps do not cover funding from Medicaid and Medicare for healthcare prevention.  In recognition of HAIs as important public health and patient safety issue, HHS is sponsoring the “National Action Plan to Prevent HAIs.”  This is a prevention policy to help decrease healthcare-associated infections, improve behavioral health and improve information technologies.  As a leader in a long-term care facility, I would implement a more resident-centered care focus.  This would require that the leaders are more hands-on due to the lack of resources for the facility. I believe seeing the leaders working to aid the residents and staff would help morale as well as help facilitate the lack of resources .

Response 2

 identify solutions to the challenges presented by your peers. Are there root causes of these challenges that your peers did not identify? Are there some challenges that do not have a solution, and if so, why? posts should be 100 to 150 words, with a minimum of one supporting reference included. 
 

  Long-term care (LTC) organizations encounter many challenges before the COVID-19 pandemic. For example, in many facilities, health care workers report to experiencing poor staffing ratios and high burnout (White et al., 2021). During the pandemic, many LTC facilities report challenges in obtaining the necessary resources to support patients. Due to the lack of financial supports, many facilities could not afford the cost of personal protective equipment (PPE) and put their workers and patients at a high risk of contracting the virus (White et al., 2021). In order to learn more about these challenges, the purpose of this discussion is to discuss the problem and identify solutions to help enhance quality care in LTC facilities.  

            One of the biggest challenges that LTC facilities encounter is related to poor staffing. Besides experiencing low staffing, many LTC facilities also face worsened disparity depending on their location. For example, compared to facilities in urban cities, LTC organizations in rural areas have fewer health care workers (Bowblis et al., 2013). In addition to low staffing, nursing homes in rural areas also have fewer skilled staff members. Because many LTC facilities independently operate in rural regions, lack of financial support could be a cause that prevents these facilities from hiring and attracting more workers (Bowblis et al., 2013). As a result, one possible solution to help increase the quality of the health professions in rural areas is by increasing people’s awareness about the problem. This can be done by investing in advertisements and creating donation groups to expand the quality of care. By increasing people’s knowledge about the problem, these mays motivate people to volunteer and develop policies to increase funding.

            Besides poor staffing, many LTC facilities also experience labor challenges. One example of a labor challenge is connected with the work environment (White et al., 2020). For example, when staff-members work in an environment with poor resources, this prevents health care providers to effectively care for patients. As a result, this can increase the patient’s risk of developing pressure injuries and increase the number of hospitalizations (White et al., 2020). In addition, another labor challenge that LTC facilities encounter is related to the high number of turnovers. One of the reasons that there are high numbers of turnovers in LTC facilities are resulted from staff burnouts. For example, one third of patients diagnosed with dementia live in nursing homes (Costello et al., 2020). When working with dementia patients, high levels of stress can develop when there are increased workload and poor staffing. As a result, these factors can negatively impact the patient’s quality of health and increase the number of turnovers (Costello et al., 2020). With many people coming and going, this can also negatively impact the work environment and decrease teamwork. In order to prevent these trends from expanding, it is important for health care providers to reunite and create safe staffing and patient ratio law in LTC facilities. By improving staffing and patient ratio, these cans help decrease the number of turnovers and burnouts.  

            Challenges from staffing and labor are more prevalent in LTC organization because it creates a long-lasting impact to the patient. For example, with acute care, the stay is shorter, and people can easily leave the facility if they wished to. When older adults are placed in nursing homes, most people cannot simply leave and enter another facility because of the payment system and cost of care. So, if these challenges negatively affected people’s levels of care, many aging adults are forced to suffer without having other options.

            Another challenge that LTC facilities encounter is related to the gap in federal policies in addressing health disparities. For example, Medicaid is a government program that helps provide reimbursement in LTC facilities (Thompson et al., 2016). For people who are enrolled in Medicaid, the program help cover the cost of care, such as using LTC services. However, there is a gap that exists in the delivering process of care because the state can control and limit services covered under the Medicaid program (Thompson et al., 2016). As a result, this can create health disparities by decreasing the quality of care for some people. In addition, each state in the United States has their own Medicaid rule for coverage and reimbursement. Because of the variation in Medicaid law, this can expand the gap in care by providing unequal reimbursement for LTC services in different regions (Thompson et al., 2016).  

            Finally, if I was a leader in a LTC facility, I would focus on decreasing the gap in services when addressing health disparities to aging adults. For example, I would reunite leaders from different LTC organizations to propose a change in the Medicaid law. In many ways, I believe the state should not have the power to limit LTC services. If the provided service is approved by the physician and the health care team, for example, then the service should be granted without worrying about the limitation of cost. In addition, as previously mentioned, I would like to implement a policy change and propose patient to staff ratio law in LTC facilities. One of the biggest challenges that many facilities encounter both before and during the pandemic is related to inadequate staffing. As a result, by establishing a safe patient ratio for RN, this can increase the quality of care and decrease the cost of LTC services over time. In addition, this can also help prevent the trend of high turnovers in LTC facilities from increasing.