A challenge to nursing homes.

As an owner and operator of assisted living facilities in multiple states and a strong advocate of their place in caring for even the frailest seniors, I had long ignored pleas from family members to seek long-term care insurance or otherwise plan for nursing home care for my parents. I said, "We'll never need a nursing home!"

And then my parents were in a car accident that left my father dead and my mother injured, requiring three-person assists, IVs, catheters, and rehabilitation care far exceeding that offered in any assisted living environment. She was only 73 years old and could, until the day of the accident, outwork, outwalk, or outplay any of us in the family.

Helping my mother locate a skilled nursing environment, and then advocating for her there on a daily basis, was an incredible experience for me back in time before my involvement in assisted living. In assisted living, after all, most of the residents have resources and many options, something we were always keenly aware of.

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In my mother's nursing home--the "best one in the city" according to the hospital social worker and several of my other "inside" contacts--peanut butter and jelly sandwiches for lunch and dinner were not uncommon since my mother is a vegetarian and the facility couldn't seem to figure out other meal options (even though we brought in food from home; it was lost within 24 hours). Not one employee ever learned my name, and most had no idea why I seemed to be coming and going on a daily basis. When I did need to ask for help for my mother, I would often stand at the nurses' station and wait for a nurse or other staff person who did not even acknowledge my presence for several long minutes while appearing to be doing nothing. I felt what I'm sure many family members feel: Don't rock the boat, or my totally dependent mother may not get even the most basic care she needs. I saw a constant churn of staff and heard the refrain "we're short-staffed" almost daily. My mother, meanwhile, heard stories of divorce, abuse, poverty, and other personal crises from staff who stopped in to help her.

Meanwhile, I read about culture change and crises in nursing home care and management. In my experience, culture change is only one of the things that is needed. Nursing homes, especially skilled care settings, will continue to be needed even when they're not wanted. How will the industry respond? Yes, staff need to be empowered. They also need to be trained in aspects of care that we take for granted in assisted living: including the family in the unit of care, providing service not just treatment, personalizing care to each resident. Owners need to invest in the physical environment. It doesn't need to look like a hotel; it does need to be clean and have elevators and restrooms that work, however. Management needs to reward staff who take initiative and provide them with a supportive environment to reduce turnover and increase genuine care. Many frontline staff are dedicated; they simply are not supported, trained, or acknowledged.

My family needed the services of a good nursing home. I had believed that in 2006-2007 it wouldn't be that hard to find. I was wrong. Although my family is now investing in long-term care insurance, it has also become clear to me that we all are invested in this challenge. If it's not my mother, it will be yours. What will her care options be? If we don't address this with more than just fancy words and initiatives, we'll all be the losers.

Sharon K. Brothers, MSW, is President and CEO of the Institute for Senior Living Education. For more information, visit www.easyceu.com and www.aquiretraining.com or read Brothers's blog at www.caregivingcrossroads.blogspot.com. To send your comments on this editorial to the author and editors, e-mail [e-mail].

BY SHARON K. BROTHERS, MSW