Allied Health Services Avoiding Crises (1989) / Chapter Skim
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8 Allied Health Personnel and Long-Term Care
8 Allied Health Personnel and Long-Term Care
Pages 259-280
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From page 259... ...
Clearly, financing policies are a key to quality care, although the available evidence on nursing homes at least has not shown what the minimum reimbursement, staffing levels, and staff qualifications must be to provide adequate care (Institute of Medicine, 1986a)
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From page 260... ...
Second, this is a process that relies on a flow of information concerning an individual's needs, required services, and potential for recovery. Long-term care can be provided in institutional settings such as nursing homes (mostly skilled nursing and intermediate care facilities)
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From page 261... ...
. · Marital status influences the use of long-term care services (especially nursing homes)
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From page 262... ...
· Infectious disease patients are likely to cause a noticeable increase in the demand for long-term care and the services provided by allied health personnel. The number of AIDS patients jumped from 183 in 1981 to more than 49,000 at the end of 1987 (Centers for Disease Control, 1987a)
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From page 263... ...
. The number of allied health professionals providing nursing home care on a salaried basis is comparatively small: in 1985 there were approximately 7,000 dietitian/ nutritionists, 2,900 registered physical therapists, 2,600 registered medical record administrators, and 1,500 registered occupational therapist FTE employees (National Center for Health Statistics, 1987a; G
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From page 264... ...
When funds are available to hire allied health personnel, many facilities appear to have difficulty in attracting such staff. Registered nurses supervise or coordinate the direct care of patients in nursing homes, and one tool for enhancing communication among care givers is the team meeting.
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From page 265... ...
(Boehner, 1984) As a practical matter in today's nursing home environment, the rehabilitation services that allied health personnel might be providing directly are either absent or stretched across a large patient base.
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From page 266... ...
(Institute of Medicine, 1986a) Because of their importance to the quality of care provided in nursing homes, as well as in home care, the levels and content of aide training have been focuses for reform.
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From page 267... ...
HOME CARE Home health care, which A: often viewed as a substitute for nursing home placement or extended host talization, shares many of the same generic problems faced by nursing homes. Agencies find it difficult to recruit and retain staff at the aide level, and teamwork is frequently inadequate among nursing and allied health personnel.
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From page 268... ...
Because some therapists operate on a contract basis or work in agencies that are not certified by Medicare, these proportions probably understate the actual number working in home care. For example, about 22 percent of physical therapists work at least part of their week for home health care agencies (American Physical Therapy Association, 1987~.
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From page 269... ...
The following represents the viewpoint of the Health and Public Policy Committee of the American College of Physicians, which has argued that physicians ought to be actively involved in assessing the continuing functional as well as medical needs of homebound patients and advising patients on the use of home health care services: Although Medicare requires the physician to certify a home health treatment plan, typically the physician describes the patient's medical condition to a home health agency, and a registered nurse actually develops and implements the home care plan. Physicians should play an important role in home health care, not only as providers of medical care, but also as case managers and coordinators of care.
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From page 270... ...
REHABILITATION In moving from a consideration of nursing homes and home care to a discussion of rehabilitation facilities, a major distinction is soon apparent: the team approach to clinical management is a well-recognized fixture in the rehabilitation world. Collaborative behavior among health care practitioners is reinforced by the fact that rehabilitation patients are generally treated for a functional rather than a medical disability.
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From page 271... ...
By tradition, allied health practitioners, together with nurses, play a central role in the delivery of team health care. For example, the ratio of FTE physical therapists to registered nurses is 1 :2 in rehabilitation hospitals, compared with 1:43 in acute care hospitals (American Hospital Association, 1987~.
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From page 272... ...
A corrective therapist was assigned to the unit to assist patients in walking. In addition, because of a lack of staff, the physical therapy treatment room in a newly built nursing home care unit remained closed.
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From page 273... ...
The lack of occupational therapists in another southern medical center resulted in slight modifications of the duties of assistants and such adjustments as program cutbacks and delays in starting new programs. The chief of occupational therapy stated that nonfederal occupational therapy jobs in that city paid $4,000-$5,000 more than what the VA paid, and that it was virtually impossible for the VA to hire experienced therapists.
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From page 274... ...
3. Collaborative behavior among allied health practitioners, as well as between allied health practitioners and other health care workers, is insuff~ciently promoted by management in nursing homes and home care agencies and by educational institutions in the educational experiences provided to students.
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From page 275... ...
Tolerance of and empathy with old, chronically ill, disabled, or demented patients is an elusive but critical attribute to be sought among care givers. Without this attribute, individuals are not likely to choose work in longterm settings as a career.
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From page 276... ...
When in training, allied health students may not rotate through long-term care facilities or programs to experience personally the technical difficulties that arise in evaluating and caring for older or chronically disabled persons. The committee recommends that all allied health education and tra~ning programs include substantive content and practical clinical exper~ence in the care of the chronically ill and aged.
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From page 277... ...
Improved Teamwork The committee noted that the collaborative behavior seen among rehabilitation hospital staff is frequently absent in nursing homes and home care. In the absence of financing incentives that encourage teamwork, the responsibility rests with managers to organize their personnel in ways that maximize interaction among allied health practitioners and other care givers.
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From page 278... ...
1986. Nursing Homes, A Sourcebook.
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From page 279... ...
Background paper prepared for the Institute of Medicine Committee on Improving Quality in Nursing Homes. Washington, D.C.
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From page 280... ...
1987b. Use of Nursing Homes by the Elderly: Preliminary Data from the 1985 National Nursing Home Survey.
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