Wednesday, October 8, 2014

When more costs less: more RN's in nursing facilities equals better and less costly outcomes for patients

Some of the most severely developmentally disabled people have medical needs that go beyond what most community settings and group homes can provide and may only be adequately met in Intermediate Care Facilities for people with intellectual and developmental disabilities. But what is the cost of not meeting those needs through the availability of competent nursing services?

Here is a clue from an article in the New York Times, "Where are the Nurses?" by Paula Span, 8/13/14. It looks at the effects of too few registered nurses in nursing homes:

"The 1987 federal law intended to reform the country’s nursing homes required a registered nurse on-site only eight hours a day, regardless of the size of the facility. Supporters at the time understood that in a building full of sick and disabled elders, health crises could occur at any hour. But getting the legislation passed required substantial compromises, including in regulations allowing reduced nurse staffing.

"'It’s something advocates have wanted to return to ever since,' said Robyn Grant, director of public policy and advocacy for the National Consumer Voice for Quality Long-Term Care. 'I think most people will be both shocked and appalled that there’s not an R.N. on duty around the clock.'"

Representative Jan Schakowsky, Democrat of Illinois, wants to fix this through proposed legislation, HB 5373:

"Adding registered nurses will hardly solve all the quality problems at nursing homes, which need more staff of other varieties, too. But it’s important unfinished business.

"'Otherwise, we probably should refer to these facilities as something besides nursing homes: 'pre-hospitalization holding facilities,' perhaps, or 'well-intended residences for the incurably underattended to.' You can probably come up with a few even-less-flattering names yourselves.'"

Studies cited in the article support the idea that providing adequate nursing care in nursing facilities will save money in the long term: 

"Studies have repeatedly pointed to the importance of registered nurses. With higher registered-nurse staffing, patients have fewer pressure ulcers (aka bedsores) and urinary tract infections and catheterizations. They stay out of hospitals longer. Their homes get fewer serious deficiencies from state inspectors. Their care improves, but it costs less."

Perhaps we could learn something from this for people with DD.

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