One of the major problems encountered by LTC charge nurses is the atypical way in which geriatric patients present with a new or recurrent acute problem. That is, when children and adults get an infection, they usually present with a fever; not so in the geriatric population. The usual first symptoms are a change in mental status or activity level. Their complaints are usually vague, making identification even more difficult. This challenge is further increased because geriatrics has not been a traditionally strong part of nursing education. This has improved in the last few years.
The charge nurse will usually have two to four nursing assistants to help care for the 30 patients. These care-givers are the most hands-on nurses in LTC. They have great responsibility in that they are the most likely to note a change in the customer's condition. Yet, training is usually somewhere around 80 hours, spread out over a number of weeks. Many are incapable of noting important changes without many years of experience and lots of education from the nurses they work with.
Long-Term Care centers usually employee many RNs, but it is rare that they provide hands-on care. They spend most of their days assuring regulatory compliance and documentation. Every individual admitted to an LTC center has an eight-page assessment form (a federal document similarly difficult to your tax forms) that is supposed to help the center assess the whole individual. The form has undergone some revision over the years and is in theory an excellent tool. A 240 bed LTC center with which I have affiliation has two registered nurses whose only job is to complete these state and federally required assessment forms.
Last year, LTC centers were presented with a new challenge, a new method of payment from the federal government called the Prospective Payment System (or PPS for short). Under PPS, LTC centers are paid a flat daily fee to care for Medicare recipients, based on the assessment form I mentioned in the previous paragraph. This daily payment is made regardless of how much it may cost the center to care for a customer. Its impact has been devastating to the industry. To date over 1,600 long-term care centers have filed bankruptcy across the U.S. as a direct result of PPS. This includes some of the largest nursing home chains, and many others are struggling to stay afloat.
