Hospitals, Rehabilitation Facilities, Nursing Homes, and Continuous Care Retirement Communities (CCRCs) are all part of the health care system for the aging in the USA.
Much of my day today has been invested in reviewing information available on the World Wide Web comparing nursing homes, and hospitals. Medicare has made some additions to its http://www.medicare.gov website where you can choose to compare hospitals and nursing homes. The government data for nursing homes associated with CCRCs appears to be inadequate--sometimes focused on only Medicare-related services rather than including the entire range of service provided by the CCRC to include skilled nursing care.
Continuous care retirement communities (CCRCs) today include independent living units, assisted living units, memory care units, and skilled nursing care units. So far the government surveys do not focus on the overall community. Instead they focus on sub-elements of one unit. For example, they may look at the Medicare wing (19 beds) of a Skilled Nursing Facility (with 70 beds).
CRCC Oversight
CCRCs are accredited today by the Continuing Care Accreditation Commission (CCAC) which is wholly owned by the Commission for Accreditation of Rehabilitation Facilities (CARF). In many states, this is wholly voluntary and there is no mandate for accreditation by any organization. In the accreditation process, the service provider pays the Commission to conduct an in depth survey of the facility and what it offers. The Commission treats service providers in much the same way a university treats its students. Providers pay for the surveys as students pay tuition to the university for a course. Service providers may or not pass the standards to be accredited just as students may not pass the standards set for course or degree completion by the university.
The CCAC was acquired by the CARF in 2003 and is the nation's only accrediting body for CCRCs and other types of continuums of care referred to by the commissions as "aging services networks." (You can see more detail on the CCAC website listed above.)
This accreditation is at least a step in the right direction of allowing the public to make more informed decisions about healthcare. CCRCs are not inexpensive and a major concern about any such place is ongoing quality of care and quality of life. That's not easy to measure, especially on surveys where not enough residents may be willing or able to complete the survey. At the same time, even if they had a mandate, governmental oversight agencies may not look at (or even for) a clear picture of the quality of care and quality of life afforded at a CCRC.
We are still in a "buyer beware" situation. The information available over the world wide web (Internet) is at least helpful in making more informed decisions. The information needed may not be readily available, however, and may require some depth of research (and time investment) to uncover information crucial to making the informed decisions.
CCRC Decision-making
One thing that CCRCs seem to be doing--in the footsteps of lots of other organizations--is trying to consider themselves as either unique (one of a kind) or too similar (much like) another organization. The CCRC my mother lives in has decided to move to 12-hour shifts for its employees dealing with residents in assisted living and the skilled nursing facility.
In my personal experience of working 12-hour shifts, it is not a healthy option for anyone involved. While on duty at the Pentagon many years ago, my group decided to go on 12-hour shifts. We would start either at Noon or at Midnight and work that shift for several days (four, I think). This meannt that we would work from Midnight to Noon for four days, have two days off, then work from Noon to Midnight for four days and have three days off. While we had time off, I remember sleeping the first two days after the Midnight to Noon shift and not being able to sleep for awhile when we switched to the Noon to Midnight shift. (There were military reasons for the starting times, by the way.) Nursing homes and hospitals usually like a 7AM to 7PM shift and a 7PM to 7AM shift.
At the end of a twelve-hour shift, and even more so at the end of several days of that shift, we were not at our best. The constant switch of our internal clocks really messed people up--we react to lightness and darkness and it takes time to recover. A 34-year-old major working with me had a stroke and died after we were on the new schedule for a few months. He left a wife and two children. No one functioned at his or her best and decisions made when we were not at our best could (in an emergency situation) not have been the best ones to take. (We didn't have that problem during the time I am referring to.)
Many hospitals and now CCRCs are advocating the 12-hour day shift schedule, talking about how much time-off people will have in the course of 14 days and the continuity of care patients or residents will receive by seeing the same people on the same shifts. The CCRCs say that it has been successful in hospitals so they want to implement it. In my experience, what this shift schedule does is insure continuity of worse care for the people being cared for and continuity of a feeling of jet-lag and frustration on the part of the care-givers. It is good for schedulers and may help in financing plans. In hospitals I have seen diminished quality of care from caregivers toward the end of their 12-hour days. CCRC's usually do not have the same intensity of responsibility seen by nursing staff in hospitals and they have their own concerns at the CCRC.
At the end of my day I am aware that I have touched the "tip of the iceberg" and have lots more to learn about ensuring the quality of care and quality of life offered by CCRCs to my family. It's also something I have to think about in my own future as well.
Posts
From the CARF organization:
ReplyDelete"I appreciate your comment about service providers paying for their surveys, I should note that the CARF survey process is a peer-review one. We are not a membership organization with dues. There is no guarantee that a service provider seeking accreditation will be accredited. I rather see the analogy to a student who pays for tuition in hopes of receiving a diploma. Paying tuition, however, does not guarantee a diploma. The outcome depends on the student’s performance, just as the organization’s accreditation decision depends on its conformance to standards as demonstrated to a team of surveyors."
"Since accreditation is usually a voluntary process (except in some states and provinces where accreditation might be mandated for certain services), the organizations that seek accreditation are already motivated to continuously improve their service quality. And, through training and free consultation with CARF resource specialists, we help organizations prepare for a survey and understand what they must do to achieve accreditation."
"We have a public disclosure policy. You may request a summary of a survey report for any accredited CCRC by writing as@carf.org."
Today (November 5, 2009) I received the public summaries of two CARF surveys. They were of two continuous care retirement communities (CCRC) administered by the same corporation. Both surveys showed very positive results. One survey showed some problems related to accessibility and I know that that CCRC has taken on major revisions in both building and policy to deal with that issue effectively.
ReplyDeleteThere is not a lot of information in these summaries of survey reports--the details of interest were in the survey reports themselves. At the same time, the summaries do provide a snapshot without clarifying the standards against which the survey results were measured.