little funding for either equipment or interventions using technology; very little money is available to place electronics into nursing homes to enable early interventions; and electronic health records have not been adopted widely in geriatric care practices (Committees on Energy and Commerce, Ways and Means, and Science and Technology, 2009; Hillestead et al., 2005).
Despite the abundance of challenges, Beverly cited accomplishments in long-term care and geriatric nursing led and supported by the John A. Hartford Foundation, the Geriatric Nurse Leadership Academy, the Donald W. Reynolds Foundation, stateside education consortia in Oregon and Minnesota, and the Sigma Theta Tau International Center for Nursing Excellence in Long-Term Care. For example, Sigma Theta Tau’s Geriatric Nurse Leadership Academy just produced its first cohort of 16 nurses. The program “has had phenomenal results,” said Beverly, “and we will be moving into our second year this spring.”
Beverly offered three recommendations to the committee. First, a well-prepared long-term care workforce is essential for providing quality health care for older adults. There needs to be a strong pipeline, starting in middle schools and high schools, that leads to registered nurse programs. Also, the in-home health care curriculum is neither mandatory nor standardized in nursing education currently. “Nursing needs to play a role in making sure we have a strong curriculum that includes topics such as dementia and other topics.” In particular, Beverly said that geriatric curricula in all registered nurse programs need to be reviewed “because a lot of programs say, ‘we don’t have a stand-alone [unit] but we integrate it,’ but then when you look for where it is integrated, it’s not.” All registered nurses working in assisted living facilities, in nursing homes, or in home health care need to have adequate preparation in geriatric nursing. Closer relationships are also needed with geriatric nursing centers, which are supported through a federally funded program to provide education for health care professionals, noted Beverly.
Second, Beverly suggested that nurses must participate in and influence any major health care discussions about long-term care. Nurses “have not been aggressive in positioning ourselves to be part of that decision making,” she said. Evidence-based models of care need to be incorporated into the health care delivery system, with the most appropriate provider paired with the right need. The role of registered nurses should be clearly articulated in every aspect of long-term care, and reimbursement systems should be rebalanced to embrace the full use of registered nurses.