Home care in jeopardy. The impact of severe fiscal pressures on patients, management, and staff: the perspective of management and staff.
This article has summarized staff experiences and reactions to a revolutionary financing methodology which has been mandated for the nation's Skilled Nursing Facilities. The true impact, beyond the initial observations outlined above, has yet to be realized. In an industry that is characterized as a large cost center of the nation's health bill, it is expected that severe measures will be taken to stem the rising costs; but it is also an industry that directly fulfills a nation's solemn obligation to its most vulnerable and needy constituents. The long-term-care industry has always suffered from marginal staffing ratios and heavy workloads for its providers, thus any new measure that gives nurses more to write with less time to write it means decreased morale, burnout, and career migration. This package will be more palatable when the computer technology, so prevalent elsewhere in our society, is effectively visited on this process. To date, none of these technologies has made the grade. It is of more than passing interest that the pressure brought by PPS and the heavier care patients in SNFs have produced legislation on mandatory staffing with bills in Arkansas, California, Florida, and Minnesota. It will be of great interest to see how the new U.S. President and Congress will address these vital issues.