Last week, New Zealand passed the country’s first “well-being budget,” with billions in funding directed towards mental health, suicide prevention, addiction treatment and combatting poverty. This development had me considering what a “well-being budget” would look like in long-term care facilities.
Reducing financial hardship
Combating poverty in nursing homes would have to address adequately funding treatments so that facilities are bringing in enough money to cover the expense of services as well as to manage upkeep and comply with regulations. It’s difficult for a business to engender well-being when under the threat of insolvency.
At the same time, any effort to reduce poverty in long-term care would certainly require living wages and reasonable benefits for workers at all levels. That would make it more likely that facilities could attract and retain capable staff.
A well-being budget would also need to increase the Personal Needs Allowance (PNA) of residents to account for inflation. While a few states have provided modest increases in resident’s monthly allowances over the years — with Florida the trailblazer at $130 – most have remained the same for decades1. In my state, New York, for example, the PNA was set at $50 in 1980. Adjusting for inflation would make New York’s PNA $155 in 2019, a more reasonable amount considering that residents are responsible for paying for their own clothes, haircuts, telephones and other personal items and have become impoverished in order to qualify for Medicaid. Sadly, however, it is still $50.
To improve the mental health of those who live in nursing homes, my well-being initiative would first tend to the mental health of those who work in long-term care. If employees aren’t emotionally well-balanced, it’s much more difficult for their charges to be.
I’d begin with Employee Assistance Program offerings, such as brief counseling services and community referrals for those with greater needs. Also included would be financial management classes and other educational perks, including partial tuition reimbursement to help staff advance in-house. Funding would go towards on-site day care and elder care both for employees and for those in the community, allowing better integration into the local area and providing a big draw for young workers with children and older workers with aging parents. Topping that off would be flexible scheduling, including split shifts to lure those who might otherwise select flipping burgers for their hourly wage.
My well-being plan would push for full staffing because that would reduce stress on everyone in long-term care. It would minimize turnover, improve care and decrease the expense of finding and retraining new workers. There would be funding to analyze why employees were leaving a facility and what could be done to stem the tide. Does a home need more staff training, better transportation options or greater management support? A well-being budget would allow managers the time they need to be creative in their retention efforts.
A well-being strategy for residents would give equal weight to mental health and medical care. All new residents would be assessed by psychologists, just as they’re evaluated by physicians, nurses, dentists, recreation staff, rehabilitation therapists and other departments — because people enter long-term care not just in physical crisis but in emotional crisis as well.
Funding would be adequate to provide group mental health services as well as individual treatment so that residents know that they’re not alone with their troubles. When residents emotionally support one another, this can reduce the burden on staff members.
There would be an investment in the recreation department so that residents would not only have engaging leisure pursuits, but also the opportunity to go off-campus on a regular basis, a service that seems to be in decline in recent years due to cost-saving measures. Funding would allow recreational programming to include an educational track, such as “Living with Diabetes,” and to facilitate regular communication with family members through the use of electronics such as video chats.
Families too would benefit from an educational series, ranging from “How to work with the team” to “Coping with loss” and everything in between.
My well-being budget would include resources for community education and support for local townspeople even before they become residents or families of residents, making the facility a good neighbor and a familiar choice when the time comes for skilled nursing care.
And of course, I’d do research on all of this, so that I could prove that investing in well-being pays off not just in better mental health and happier LTC communities, but also makes good financial sense for those seeking to run a sustainable business.
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 award-winning website at MyBetterNursingHome.com.