A report was released a few weeks ago regarding evictions in long-term care, and frankly I have been surprised by the lack of attention or comments on this issue. The report sheds light on the increasing practice of resident discharge, or “eviction” of residents in nursing homes. Increasingly, residents are being discharged to hospitals and then denied readmission to the facility from which they came.
While the articles mentions “nursing homes” in the title, discharge is, in fact an issue in all long-term care environments including assisted living. Given that the rise of occurrence parallels the increase of assisted living facilities, it would be valuable to know the environments in which it occurs most frequently in an effort to decrease the numbers of such a traumatic event that affects the lives of many people.
This is a very complex issue, and can’t simply be described as a good or bad practice employed by good or bad organizations. There are multiple factors involved, and too little information has been supplied by either side to determine solutions. However, I am devastated by this increasing practice and believe there are ways we can all contribute to eliminating some of these unfortunate discharges.
Individuals with memory loss have specific needs and it can be anticipated that many will take more staff time. We also know that their needs will change over time and even if their care is manageable initially their needs will change as the disease progresses and should be anticipated.
I would bet that most, if not all of the evictions are of residents with memory loss.
Two major factors influence the ability of a facility staff to provide quality care to persons with memory loss.
Individuals with memory loss have specific needs and it can be anticipated that many of these needs will take more staff time. We also know that their needs will change over time, and even if their care is able to be managed initially, those needs will change as the disease progress and should be anticipated.
First, in my experience, turnover in most long-term care environments is high. What defines high turnover? Though a turnover rate of 40% is deemed “acceptable” for long-term care, even that rate is much too high in my opinion. Quality memory care is impossible when there is high staff turnover. Critical to person-centered memory care is consistent caregivers who come to know the resident, their history and what makes them tick. It fosters the establishment of relationships with the resident and family, which is invaluable to providing care and satisfaction.
Staff in assisted living and skilled facilities are often not trained in the disease process and management of needs, frequently leaving them to fend for themselves. Initial and ongoing staff training and support is critical, especially for memory care. Training should include all staff, all departments and all shifts. They will not learn everything they need to know in one training, lecture or computer training program. There will always be new residents, and staff who have questions and need additional information, sharing of strategies and support of facility leadership.
For families, the decision to place a loved one in a facility – to turn over the care of someone they love – is one of the most difficult decisions they have ever made. Families do not take this lightly. Homes are dismantled, houses sold, personal items dispersed. What are they to do after trusting you to care for their loved one and you can’t?
While this will not address all of the evictions, it may very well eliminate many sad and unfortunate discharges.