National Nurses United

National Nurse magazine May 2011

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5 pg_6 pg copy 6/3/11 4:18 PM Page 19 be careful, because they'd be sued if they tried to pull what freestanding nursing homes do." And while it's not 75 patients per RN, it seems that many hospital-based SNFs expect their registered nurses to care for 10 patients, on average. "Nine if we're lucky," said one RN. At CPMC, where Brooks works, it's eight or nine patients per nurse, but to bring down the patient load, the RNs had to organize a sick-out and conduct time and motion studies to prove that what they were being asked to do was unreasonable and often impossible. As far as Brooks and other National Nurses United nurses are concerned, the SNF is a were readmitted to the hospital within 30 days. The report concluded that the state could save $227 million a year if it reduced avoidable readmissions by just one day. While that report dealt with hospital patients and not SNF patients, the study does hint at the overall cost of patients not being permitted to stay where they would receive the appropriate level of nursing care. But studies can't capture the stress and trauma patients and their families experience when skilled nursing facilities shut down. In early December 2010, just weeks before Christmas, parents George and Carol Lerner learned at a hastily called meeting by Lodi Memorial Hospital that it was closing its skilled nursing facility Jan. 31. Lodi Memorial is located almost 40 miles south of Sacramento, Calif. and had been trying to shut down its SNF for years. Every time, long-term care advocates and the community had fought them back, but this time the hospital had let its SNF census dwindle to fewer than a dozen patients, so it faced little opposition. The Lerners, whose adult daughter has muscular dystrophy and had been cared for in Lodi Memorial's SNF since 2004, went into a panic. There were very few skilled nursing facilities in the inland Central Valley where they lived, and no others attached to hospitals. The closest ones were in Sacramento or in Los Angeles, 350 miles south. "We said, 'You can't do this to us. You can't just kick us out,'" said George Lerner. "These patients, all they do is throw them away. All they're interested in is the dollar. Just because you can't make a profit from them, you can't just dump them. These big hospitals, they've forgotten their moral obligations and their core values." Even worse, the hospital called up the Lerners right before Christmas and pressured them to move their daughter in just two days, saying that it had found a placement for her at a freestanding nursing home, but that if they waited, they might lose the spot. Their daughter, who is confined to a wheelchair, moved to her new home, Windsor Elmhaven Care Center in Stockton, Calif., on Dec. 28, 2010. The Lerners say that they don't believe their daughter is getting the same quality of care at the freestanding SNF as she did at Lodi Memorial. Unlike hospital SNFs, many freestanding SNFs are merely renovated convalescent homes. While the Lodi Memorial SNF had plumbing for oxygen and other equipment built directly into the walls, everything at Windsor Elmhaven needs to be brought into the already small rooms as a portable device. "The noise is terrible," said Lerner. "There's no space to move around with all the equipment. There are two patients per room, so when they are moving her roommate, she's got to get out of the room, or they end up bumping her. A lot of times, she gets stuck in the corner. She's on a ventilator at night and when she needs suction, they just don't respond as quickly." And the Lerners' daughter is one of the lucky patients who has parents to advocate for her, who visit her daily to check up on her care. With hospital-based skilled nursing facilities becoming extinct, where will patients who need this kind of care go? "You might as well push these people out to the parking lot and call the coroner," said Lerner grimly. "Hospitals used to be part of the community and served the community. Now they're large corporations serving stockholders. Everybody's trying to make a dollar. It's just good business." "I don't have sympathy for my medical center. They're very profitable—they make a huge profit—and they enjoy their tax-free status. They're not for profit, so damn right they need to step up to the plate and care for those who have nowhere else to go." convenient place to stash post-acute patients without having to staff appropriately—thereby saving money on the backs of the patients and the RNs. "This is a hospital loophole," she said. "They can place acutely ill patients in wards where the ratios don't apply and save some money." In federal ratios legislation NNU has proposed and in states where NNU is now sponsoring ratio bills, minimum staffing levels for SNFs and rehabilitation centers are included at one RN for every five patients. espite their great need, about half of hospital-based SNFs have closed and more are shuttering their doors each month. No one has yet done much research on where those patients go and how their health has fared as a result. Zhanlian Feng, assistant professor of community health at Brown University and author of a study on the effects of the prospective payment system on nursing home closures, has some ideas, however. Feng recently completed a proposal to the National Institutes of Health to study the health effects of such closures—perhaps the first study of its kind. He doesn't expect the results to be good. "We want to know: Are their functional skills and abilities declining? We expect them to decline more precipitously," he said. "We're talking about a population with an average age of 82 and many of whom are quite frail and in wheelchairs, that the results would probably be adverse." He suggested that patients released from hospital-based nursing homes might fare slightly better because many of them have wounds that should heal, but even that is questionable. A recent report from the California Discharge Planning Collaborative found that one in five patients released too quickly from acute-care hospital settings D M AY 2 0 1 1 Heather Boerner is a medical writer based in San Francisco. W W W. N AT I O N A L N U R S E S U N I T E D . O R G N AT I O N A L N U R S E 19

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