Identify possible policy solutions or industry changes that are needed in response to these problem factors. What are barriers to these policy solutions? Is it lack of need, financial resources, etc.?  posts should be 100 to 150 words, with a minimum of one supporting reference included. 

Response 1

Identify differences in the quality of care residents receive in long-term care facilities and discuss why.
According to White et al. (2020), a major factor driving poor quality care in nursing homes is nurse burnout and job dissatisfaction. With that being said, I would like to include nursing support staff in this statement. Certified Nurse’s Aides (CNAs), have more time with hands-on care and bedside care with the patient than nurses do in the nursing home setting. They are the backbone of the care the residents receive. Donoghue (2010) reported that the turnover rate for CNAs in nursing homes was about 74.5%! This was followed by 56.1% for registered nurses and 51% for licensed practical nurses. On the other hand, White et al. (2020) report that strong leadership and staff involvement in organizational decisions can improve teamwork and safety climate leading to better quality care. Shared-governance is a term I learned when working at a community hospital. The goal of shared-governance was to empower nurses in making the work environment better for all and subsequently improving the quality of care and reducing cost. Barden et al. (2011) state that through empowering nurses by way of professional practice models of shared governance retention of staff was evident, as well as improved quality patient care and cost containment. 

Discuss the disparities within long-term care and what factors you find surprising. Discuss root causes connected to these factors, and discuss why.
After learning the reality of the astronomical costs to residents in long-term care, it surprises me that these facilities are so understaffed (White et al., 2020). I was also surprised to hear that segregation is prevalent in nursing homes (Mack et al., 2020). Both issues contribute to poor quality care. The root cause connected to these factors are the lack of good leadership. A good leader and adequate staffing can have the resources to implement innovative ways of inclusive care.

What differences between rural and urban health care offerings did you find interesting? Why?
I found it surprising that staff shortage didn’t make up a bigger part of the disparities between rural and urban nursing homes (Bowblis et al., 2013). That is still a sad fact, that no matter the location, nursing homes are still short-staffed. According to Temkin-Greener et al. (2012), both urban and rural nursing home staff have low-quality training. The staff is the backbone of any company. We need to recognize that if we are to truly improve the quality of care in nursing homes. Rajamohan et al. (2019) found that job satisfaction among nursing home employees not only increased the quality of care delivered but al the quality of life of residents. It really isn’t rocket science. 

Identify unique challenges aging veterans experience in long-term care settings.
Some unique challenges aging veterans experience include homelessness, alcohol abuse, being admitted to nursing homes from the hospital if homeless (Jutkowitz et al., 2019). Mental health and substance abuse are two challenges that make caring for aging veterans in a nursing home a challenge.

Response 2

identify possible policy solutions or industry changes that are needed in response to these problem factors. What are barriers to these policy solutions? Is it lack of need, financial resources, etc.? Your reply posts should be 100 to 150 words, with a minimum of one supporting reference included. 

 Unfortunately, the quality of care that residents receive in long-term care facilities varies based on the facility in which they reside. The quality of care that the residents receive can be greatly influenced by staff work environments. Nurses play a major role in care management, and studies have shown that a positive work environment can improve care quality. In a study completed by White et al. (2020), results showed that nursing homes with wholesome work environments had decreased rates of hospitalizations, pressure ulcers, and antipsychotic use amongst their residents. In addition, nurses working in these nursing homes were less likely to experience burnout (White et al., 2020). Nurses are better able to perform their duties and properly care for their residents when they have adequate staffing ratios, positive management, and adequate resources.

Some disparities that exist within long-term care facilities are influenced by socioeconomics, race, ethnicity, and location. Nursing homes that primarily house Medicaid patients have limited resources due to financial constraints. The quality of care within these nursing homes can be negatively impacted due to the inability to afford the resources they need to properly care for their patients. Medicaid reimburses at lower rates, and when a nursing home does not have an adequate number of residents with insurance that providers higher reimbursement rates, they are unable cross subsidize by using surplus from other resources to cover the Medicaid deficit (Mor et al., 2004). I find it most surprising that nursing homes are divided into two tiers; an upper tier and a lower tier. Lower tier nursing homes are primarily funded by Medicaid, and care quality is hindered due to inadequate resources. I find this unsettling as a patient’s quality of care should not suffer due to their inability to pay for private health insurance, considering Medicare does not cover the cost of long-term care.

Race and ethnicity can also influence the quality of care received. One example being that African Americans are more likely to reside in a lower tier nursing home than whites (Mor et al., 2004). For this particular reason, African Americans may experience reduced care quality due to inadequate resources within the facility that they reside. Health care disparities also exist amongst long-term care facilities in rural and urban areas. Long-term care facilities in rural areas have inferior care quality due to inadequate staffing ratios, facility structure, and finance sources (Bowblis et al., 2013). Since long-term care facilities in urban areas are better able to obtain the resources they need, patients residing in these areas are more likely to receive a greater quality of care. I find it particularly interesting that long-term care facilities in rural areas are less likely to offer specialized services to their residents. This can also impact their quality of care as they may be less likely to receive the physical therapy that they need, or less likely to socialize due to lack of an activities program. Disparities also exist amongst aging Veterans that reside in long-term care facilities. Homeless Veterans are more likely to enter a nursing home at a younger age due to many of them suffering from substance use, mental illness, physical illness, and unique social needs (Jutkowitz et al., 2019). Due to the complex health needs of the homeless Veteran as it relates to physical, social, and mental health; long-term care facilities may struggle with providing Veterans with the services that they need.