OPINION: JAN NOYES — A crisis in the making

Assisted-living facilities and nursing homes are filling up. This isn’t a topic that grabs the attention of a wide range of people, but we and our loved ones are all getting older, and what we do now affects the future as well as the present.

Right here in Kootenai County there are waiting lists at assisted living facilities for people that can pay privately. There is very little room for people that depend on Medicaid, unless they pay privately for 2-3 years or pay extra. Nursing homes accept Medicaid, but full-time care paid privately is very, very expensive.

The number of Americans 65 years and older is the fastest growing segment of our society and many will need daily assistance, either at home or in a facility.

The big push now is to age in place, at home, with a family or paid caregiver. Finding outside help is increasingly difficult. There aren’t enough trained caregivers to fill the expanding home-care need.

Inadequate staffing is the No. 1 facility resident complaint — too few caregivers for too many residents. Inadequate staffing means inadequate care. There are facilities that put the residents first before the bottom line and facility convenience, but there are many that don’t. Many caregivers do their job well, but many are not adequately trained, and the turnover is huge.

Residents of long-term care are there for a variety of health reasons, but dementia has become common as the population grows older. Caring for people with dementia can be challenging, particularly if behaviors become difficult to manage.

All too often, because of a lack of staff, a lack of training, a lack of patience and a lack of time, residents don’t get the attention and direction they need. Inadequate behavior management may lead to a physician’s prescription for a psychotropic medication, a form of chemical restraint.

It’s easy to blame the caregivers, but it’s the corporations looking at the bottom line, the administrators following the dictates of the corporations (not always to their liking) that need to share the spotlight. Self-monitoring doesn’t always work. A readjustment of standards is needed now.

Currently, it is up to the facilities to determine how many caregivers is sufficient. “Sufficient staffing” is a vague term that is often determined by the bottom line. There is a bill now before Congress, The Quality Care for Nursing Home Residents Act that deals directly with the ratio between the number of residents and caregivers (H.R. 5216).

There are also two bills pending with misleading titles: The Nursing Home Workforce Quality Act (H.R. 4468) (J.R. 1265) and The Ensuring Seniors Access to Quality Care Act (S. 2993) that weaken already existing nurse aide training standards.

Calling, writing or emailing your representative in Congress is a way of showing that these issues are of importance to the future of all of us, and particularly to the residents currently in long-term care facilities. They need our protection.

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Jan Noyes is Associate Ombudsman for the Area Agency on Aging in Coeur d’Alene.