Long term care can be referred to as the medical and social services that are tailored to meet the needs of people and particularly the elderly ones who can no longer perform their daily activities following impairment by chronic health problems (Perley, 2016). Examples of these activities include bathing, eating, grooming, using the toilet, and moving around. Long-term care also includes community services such as meals, adult daycare, and transportation services. In addition, long-term care is provided to people who are suffering from other severe conditions, disability, or dementia, whereby a person cannot be able to live independently (Perley, 2016). Old age is another contributing factor to the need for long term health care. We have two facilities in a hospice care facility and a nursing care facility. I hold the responsibility of managing and administrating the two facilities, and it will be my pleasure to take you through how we have been managing long term care and the programs we have in these facilities.
Hospice Care Facility
Hospice care entails the provision of therapeutic services to improve the quality of life of the patients and their families when dealing with diseases that will lead to death (Perley, 2016). As such, hospice care helps to relieve these patients and their families from the physical, psychosocial, and spiritual suffering. Since hospice care involves a detailed approach that is meant to address the needs of all the patients and families, there is a need for a multidisciplinary team.
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The team in our facility is composed of a nurse, pharmacist, dentist, physician, psychologist, nutritionist, physical therapist, speech therapist, a social worker, and a spiritual assistant. In a bid to achieve the goal of our facility, which is to promote the patients’ dignity and improve quality of life, we ensure that these professionals provide quality care practices. As such, the multidisciplinary team is tasked with the responsibility of ensuring that these patients and their families are given appropriate treatment as well as care that helps them view death as the process of life rather than the end of the world. In addition, this team is expected to have healthy interpersonal relationships with the recipients of care and ensure they provide harmonious care aimed at controlling symptoms and ease discomfort since there is no possibility of a cure. Although we expect our multidisciplinary team to portray their professional competence while dealing with the patients and their family members, we also expect them to be sensitive to their needs by being compassionate and respectful to them.
The target population in our hospice facility is those patients suffering from diseases that will eventually lead to their death with an estimated period of 6 months or less. The highest percentage of this population is cancer patients, but we still have patients with end-stage heart, liver, and kidney diseases. We provide hospice service delivery programs according to the patients’ needs, and we ensure that these programs are in line with the acceptable practices for multicultural hospice patients and their families. Some of the services offered through our programs include assisting patients with activities of daily living like grooming and eating, health assessments and pain relief techniques, financial planning, and many others which are provided according to the needs of the patients.
Among the issues that the human resource department is facing in the hospice facility is the need to educate the staff members and patients on cultural and ethnic differences, language barriers as well as cultural sensitivity. The HR department has been prompted to start this education program to promote workforce diversity since most of the employees are not only interested in the employment but the opportunities and experiences they will get while working in our facility.
Additionally, we have been experiencing high turnover and low retention rates of nurses as they complain about low wages and high demands by the organization. The organization tried giving extra day-offs but still did not manage to retain all the nurses. As a result, the facility has been incurring high costs of advertisements for the vacant positions, interviews, and training of the recruited nurses. In addition, the high turnover rates lead to staffing shortages, yet the target population of our facility has been rising, and we expect it to continue increasing (Reilly, Mueller & Zimmerman, 2006). Therefore, there will be a need for more staff to meet the needs of our patients and their families.
Another challenge among the employees is that they fear being held responsible, especially when there is a need to make a critical decision involving a procedure that is likely not to benefit the patients. The facility, therefore, adopted the approach whereby in such a situation, we encourage the participation of the patient prioritizing his/her comfort and quality of life as well as fostering healthy work relationships among the multidisciplinary team.
There have been evolving trends in long term care, and about a generation ago, this type of care in the United States of America was primarily comprised of family care and nursing home care (Statistics, 2017). Medicare did not pay for home health care. However, today there exist assisted living, hospice care as well as alternative community programs.
One of the significant trends that will impact programs in our facility is the aging of the baby boomer generation, which is characterized by their urge to transform institutions as they move along their life cycle (Statistics, 2017). As they are known to be drivers of innovation and change, they will prompt the move towards person-centered care, diversity of care options as well as put more emphasis on home-based care. Again, the baby boomers have already started showing their growing need for information about long term care. As such, our facility will counter this by ensuring we publicly avail information regarding the quality of care delivered in our programs through the social media platforms as well as on print media.
Moreover, there has been an increasing rise in technological advancements, which means that technological innovation is another trend that will have an impact on our programs in this facility. As such, there will emerge various electronic monitoring and decision-making systems that will replace individuals in the multidisciplinary team whose responsibility is to make decisions regarding critical procedures that need to be done on patients (Statistics, 2017).
Again, the technological innovations will bring along robotic care providers that will take up the role of providing care to the patients and families (Statistics, 2017). As such, we will need to hire a technical team that will control the electronic devices in the facility. In addition, there may be an increase in scrutiny regarding the public costs of all care models with the improved payment systems, thus leading to the development of altered care models (Statistics, 2017). Therefore, in such a situation, we will ensure we set affordable costs for our target population and uphold transparency to the public.
Our hospice care facility has multiple service providers who ensure long term care needs of patients are addressed. As the organization, we ensure there is a coordination of activities as well as collaboration across organizational boundaries. In a bid to provide more integrated care, we partner with other corporate care networks that are at the primary, secondary, or tertiary levels. We have realized that inter-organizational collaboration for integrated care has contributed significantly to our workplace diversity to both patients and the service providers as well as helping us improve the quality of care we give to our target population to ensure they are comfortable in their last days of living (Béland & Hollander, 2011). Again, we also ensure that our service providers are aware of their interdependencies and the significance of managing them by impacting them with knowledge of values, mutual trust, and discipline for each other (Béland & Hollander, 2011).
Our management is usually open to and ready to financially support any innovations that are related to both inter-organizational and inter-professional collaborative practices. We use a bottom-up leadership approach whereby the team is free to air their grievances, and the leaders of the various departments are expected to give them feedback and consider their suggestions if they will help improve the quality of care provided. We have also set common patient-centered goals which the multidisciplinary team acknowledge and work towards achieving them.
Nursing Care Facility
In our nursing care facility, we have skilled nurses that offer a wide range of services, which includes health and personal care services. The nursing care facility is much focused on the health care services to the client. The services include nursing care in 24 hours with supervision. The clients are provided with three meals a day, and they are also given assistance on everyday activities such as grooming and bathing. Other services that are offered in the nursing facility include rehabilitation such as physical and occupational and speech therapy.
In most cases, the clients are forced to stay in the nursing facility permanently because they have ongoing health challenges that require continuous supervision. Despite that, others can be discharged to go home after the treatment when their conditions are not severe and can be managed while at home. Again, the communication within the facility is in the hierarchy just as the organogram of the institution. The head of every department forwards the information from the department until the manager gets it.
The departments in our nursing facility include the executives that are comprised of the Chief executive officer, the manager, the facility board, and the human resource officer. The other departments are the clinical department, which is made of the physicians, pharmacists, and clinicians, the nursing department that is comprised of the nurses, and finally, the subordinate department that is made of secretaries, cleaners, the kitchen staff, and the security personnel. The target population in this facility is the older people and the drug addicts who are on rehabilitation for them to recover to their healthy lives.
The challenge in the staffing and human resource in the nursing facility is inadequate funds to help in recruiting more staff that can help the clients in the facility (Reilly, Mueller & Zimmerman, 2006). The shortage of funds as resulted in the straining of the existing team and when they do so, they are overworked and cannot be able to give the best services as required. Another challenge is that some of the clients in the rehabilitation wards are very violent, which scares the nurses. In most cases, they end up being depressed because of iniquity and disrespect. Another challenge is that the number of specialized physicians is low as compared to the client’s intake hence the resources in the facility are strained to accommodate the high number of clients
The significant trend in the operation of the facility is the shortage of funds due to late disbursement by the government (Statistics, 2017). When this happens, most of the staff feel their needs are not cared for by the facility, and they end up resigning, leading to a shortage of staff in the facility. The action to overcome this challenge is to charge the clients a little amount so that it can contribute toward the funds needed to run the facility. Again, the management of the facility is seeking financial support from faith-based organizations and non-governmental organizations. Therefore, organizations come on board and are able to give funds or materials such as food, drugs, and medical equipment’s, thus reducing the cost of purchasing. As such, the funds are being put into use within the facility, thus solving the challenge.
There is cooperation in various departments of the facility; for example, the physicians give a strict diet menu to the clients in the facility, and the kitchen staff prepares the meals as requested in order to help the client recover. The physicians also give prescriptions on the medication of the clients, and the pharmacist help in providing the drugs to the nurses. The nurses take the responsibility of ensuring that the clients receive the medicine on time as prescribed by the physicians. All the departments adhere to the quality assurance standards of the facilities that offer long term health care to the old persons and those in rehabilitations (Béland & Hollander, 2011). When they do so, it makes it easier for the internal quality control officer to access the facility and give the best report to the management of the facility. The accountants are very crucial, and they ensure that the financial records are recorded well because they are essential when the facility wants to plan for the future and also for the provision of services.
References
Béland, F., & Hollander, M. J. (2011). Integrated models of care delivery for the frail elderly: international perspectives. Gaceta Sanitaria, 25, 138–146.
Perley, R. (2016). Managing the Long-Term Care Facility: Practical Approaches to Providing Quality Care. John Wiley & Sons
Reilly, K. E., Mueller, C., & Zimmerman, D. R. (2006). A Nurse-staffing Taxonomy for Decision Making in Long-term Care Nursing Facilities. Journal of Nursing Care Quality, 21(2), 176-186. https://doi.org/10.1097/00001786-200604000-00014
Statistics, N. C. (2017). Health, United States, 2016, with Chartbook on Long-Term Trends in Health. Government Printing Office.
