McKnight's experts tell what's ahead

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Fearless forecasts about what to look forward to in five key areas

Caregivers must change to meet new resident needs

By Anne Marie Barnett, R.N.C.

All of us that are currently working in long-term care ask ourselves now and again, when feeling super exhausted, "What does the future hold if I stay in long-term care?" Many of my colleagues have entered long-term care with noble expectations only to leave feeling defeated due to staff shortages, unending paperwork, long hours and more.
I have close friends who are directors of nursing and working in their facilities six to seven days a week, plus being on call 24/7. This pace is not healthy.
Regulatory pressure still has many leaders in long-term care working in pre-survey, survey and post-survey fear. I still hear nurses saying things such as, "In my friend's facility, they were real hard on them about labs," or, "I hear surveyors are looking close at physician notification," always focusing and fearful about what they "think" surveyors are going to be looking at closely.
The majority of long-term care facilities are still very structured, even though the mix of residents/patients has changed in the past five to 10 years. I use the word "patients" instead of residents sometimes due to the use of subacute units, caring for people who are there for a short period of time, or for rehabilitation after hip surgery. Or maybe people are there because they need IV therapy for several more weeks, or they contracted an acute illness they could not manage at home by themselves.
The same regulations apply to this population admitted to long-term care. In addition, long-term care facilities still care primarily for the elderly, though I once had an 18-year-old patient in my facility (for short-term IV therapy). There are younger and younger residents/patients in long-term care, sometimes victims of accidents, and still the same regulations apply.
As we move forward, changes need to be made to accommodate all who enter long-term care. There are several different versions of a more home-like environment in long-term care facilities; the Eden Alternative is but one of these versions.
Long-term care environments need to change as the patient population and expectations change. Current regulations also must be modified to meet the changing environment. When this is done, regulators must be sure to obtain input from those who are working tirelessly to make a difference.

Barnett is the director of nursing at Charlotte Hall Veterans Home in Maryland, and the president of the Maryland chapter of The National Association Directors of Nursing Administration in Long Term Care.


With technology advancing new dilemmas will emerge

By Charlotte, Eliopolous, Ph.D., R.N.

The future for long-term care will be anything but dull as new challenges arise. With most Americans now using some form of complementary and alternative therapy, the demand is growing for long-term care facilities to incorporate acupuncture, massage therapy, biofeedback, herbal medicine, and other related therapies into their standard services.
We must begin to prepare staff to use these therapies safely and to stimulate efforts to demonstrate the clinical and cost effectiveness of these therapies to third-party insurers for the funding of these expanded services.
Ethical challenges with the expansion of technologies will grow, as witnessed by stem cell technology and planned births for the express purpose of using cells (or even organs) to treat conditions in chronically ill individuals. As the ability to extend youthfulness and life expectancy increases, value conflicts may arise, couched in questions such as, "Why is youthfulness superior to maturity?" and "What is the purpose of extending and saving lives when we don't have the resources to care for them?"
Long-term care providers now must be at the table when these issues are discussed.  Caregivers need to be prepared for ethical dilemmas and be skilled at processing their resolution.
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