Changing nursing homes: a new perspective

Nursing Homes, July, 2004 by Dennis Hayes

As for point number two, let me quote that oft-used admonition: "There is no "I" in "team." As you indicate in your editorial, "... the care plan should be the product of coequal teammates' input." In other words, if we take a truly interdisciplinary team approach to assessment and care, there is no "number one"--not the doctor, not the nurse.

Although someone needs to coordinate assessment and careplanning meetings, that task should not elevate the coordinator to a superior role as to contribution and authority. Actually, I would go so far as to suggest that a facility that doesn't "get it," that is still debating the relative value of the various disciplines within the community, has a long way to go in buying into the concepts underlying successful quality management. If the facility's culture has, indeed, changed (a necessary prerequisite for successful QM), then there is no place for such a dispute.

Finally, on your observations regarding compensation and its relation to value, be it for nurses or any other discipline: In our economic system, prices are established by the relationship between supply and demand--not necessarily by the value of one's contribution to the care delivered. Just one example: Therapists' salaries in long-term care are not today what they were before the Omnibus Budget Reconciliation Act of 1997. Why? Because the prospective reimbursement mandated for Medicare SNFs by that legislation reduced the industry's demand for therapists and, absent a commensurate reduction in supply, the "price of" (i.e., salaries for) therapists went down. Did that reflect any decrease in their value to patient care? Of course not. But it did reflect a different intersection point on the supply/demand curve.

Editor's note: Opinions expressed in Guest Editorials do not necessarily represent the opinions of Nursing Homes/Long Term Care Management, its publisher, or its staff. We encourage readers to express their views on the content of Guest Editorials. To comment on this article, please send e-mail to hayes0704@nursinghomesmagazine.com.