Dr. El

In the old days, Young Readers, before the goal of eldercare was merely profit, nursing homes used to have things called “missions.” Missions focused on the well-being of the elders they cared for — not only their physical well-being but also their emotional and spiritual health. 

Back then, facilities often catered to a specific clientele, such as those of a particular religious or ethnic group, because they sought to fill the needs of their local community. Sometimes homes adopted a philosophy of caregiving that was thought to best serve their residents. 

Missions were wonderful things. They were guideposts that all workers could use to steer their actions, to decide whether they were consonant with the goals of the organization. 

Over the years I worked in places that offered specialized care to Catholics or Jews or Episcopalians, or those that had large groups of Chinese or Caribbean residents, or younger residents, or people with multiple sclerosis. Others used an Eden Alternative philosophy or had specialized dementia units. 

All were proud of their missions and strove to provide excellent care for their residents and heartfelt jobs for their employees. The benchmark of decision-making was whether it was in accordance with the mission and good for the residents.

Nowadays, as you’ve no doubt seen, Young Reader, the goal is profit and choices are consonant with that goal. Nursing homes are owned by corporations because it’s virtually impossible — margins being what they are — to run an independent facility. 

Decisions are made by corporate.

What kind of decisions, you might be wondering? Back in the day, for instance, if someone received a medical treatment, you could be 99%, 95%, sure it was because it was something they needed and not because it was a high-reimbursement procedure being provided by an affiliated company. 

I know that this is common now, but back then, this was considered shocking, immoral and illegal. Actually, it’s still immoral and illegal but no longer shocking as it seems to have become the standard of care.

I’m not saying things were perfect back then, or that only saints were running the homes, no. 

When I first started working in the field, there was a bed hold policy of 30 days. Then it was reduced to 21 days, then 14, then none. Facilities received 75% of their day rate while their residents were in the hospital, allowing them funding while ensuring that the individual had a room to which to return. 

One couldn’t help but notice that residents returned on the 29th day or the 20th or the 13th, defying clinical logic. It did mean, however, that a resident who had been living in a facility for, say, three years, didn’t need to worry that a brief hospitalization would lead to displacement from what had become their home.

Those days are long gone, Young Reader, but new days are coming. The current situation cannot hold. 

Lawmakers are calling for investigations into private equity ownership. Last week McKnight’s ran a story with the alarming headline, “Only 25 percent of operators believe they’ll survive financially through 2021.” Experts are recommending greater investment in homecare services and a reimagining of long-term care.

My guess is that there will always be a need for the type of services provided in nursing homes; some situations are simply too complicated to manage at home. Perhaps facilities will be smaller or have only single rooms or be better funded and better staffed. 

I know for sure, though, that whatever the nursing homes of the future look like, they will offer superior care and more meaningful jobs if they revolve around a mission rather than around profit, and, Young Reader, we will need your help to get there.

Eleanor Feldman Barbera, Ph.D., author of The Savvy Resident’s Guide, is an Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is a Bronze Medalist for Best Blog in the American Society of Business Publication Editors national competition and a Gold Medalist in the Blog-How To/Tips/Service category in their Midwest Regional competition. To contact her for speaking engagements and/or content writing, visit her at EleanorFeldmanBarbera.com.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.