Q&A with Robert Abrams: LTC failures attributed to all

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The time has come for providers and other key players and stakeholders to accept "our collective failings" and come together to improve quality of care. That's the view of the leader of a new consultancy and clearinghouse who has invested "millions" to promote information and strategies for long-term care providers. And he's not shy about pointing out what he feels is "shameful" behavior from every camp in the long-term care equation.

A licensed long-term care administrator, Abrams also is an attorney who has represented both provider and consumer interests.A licensed long-term care administrator, Abrams also is an attorney who has represented both provider and consumer interests.


Q Since you feel so strongly that staffing levels have a direct effect on quality, how should the "right" amount of staff be calculated?

A While common sense dictates that all nursing home providers must employ a minimum number of staff, there is no magic number for the exact staff-to-patient ratio each facility should maintain. Those who argue for mandatory staffing levels mistakenly believe that a fixed arbitrary number of staff will ensure quality.
To the contrary, appropriate staffing levels in each facility will vary based on a variety of factors, including, but not limited to, acuity levels and needs of residents, staff training and experience, availability of other resources, and the existence, or lack thereof, of an internal culture within each facility that embraces an unwavering commitment to meet the unique needs of its residents.
Nursing homes must be held accountable based on the quality of care they provide, not the arbitrary number of staff they employ.


Q In your recent report "Government Dilemma," you say inadequate Medicaid reimbursement, low staffing levels and excessive regulation directly correlate to harm to nursing home residents. Basically, you say government policies actually impede care more than they help. Isn't that a little harsh?

A Sometimes the truth is harsh -- and shameful. I find it especially discouraging that the government has imposed excessive regulations without providing the necessary guidance and support that will enable providers to achieve compliance. To compound this matter further, fiscal policies underscore a complete disconnect between the government's regulatory agenda and its self-interested fiscal agenda.
Some of the harmful implications of the government's duplicitous conduct have resulted in a tragedy of errors.


Q Isn't it a bit too convenient to just lay all of this in the lap of "the government"?

A We are all to blame. The government sets the tone as the primary payor and regulator of nursing home care, but providers, consumers and other stakeholders must also accept responsibility for the current nursing home crisis. We must somehow shed the idea that we are adversaries.
The majority of individuals in the nursing home community -- providers, government officials, advocates, consumers  -- share the same objective: We all desire quality care.


Q So what should – indeed actually can -- be done to fix some of these problems?

A In the MyZiva study (www.myziva.net/about/pressrel/myzivanetreport.pdf), we list a variety of practical and realistic solutions that can produce an immediate and positive impact.
While our recommendations would clearly facilitate quality care and potentially reallocate billions of dollars to direct care, I believe that they can never be successfully implemented unless and until the leaders of the nursing home community – government officials, provider associations and consumer representatives – put aside their self-serving rhetoric and agendas and begin to demonstrate a sincere, unwavering commitment to our nation's nursing home residents.
The personal and political agendas of the leaders within the nursing home community are greatly responsible for many of the serious obstacles that exist in the current climate. A few examples of some of the outrageous actions and statements made by the very individuals who are supposed to set the tone for the profession and our commitment to quality care:
• An extremely high-level MedPAC (Medicare Payment Advisory Commission) representative recently explained to a large group of nursing home providers and a provider association, i