Finding good news and bad news.

Maybe it's not a very dignified position to be in, but sometimes it's nice to be able to benefit from someone else's misfortune. I hasten to add that it's definitely not OK if you are the cause of that misfortune. But if bad things happen to good people, and as a result those good people become available to help you do your job, that's what you call opportunity.

That's the happy situation facing nursing homes. It is exemplified by the comment of one administrator, cited in this space a couple of years ago, who noted that a recession in the U.S. economy was good news for nursing homes facing staffing problems "because McDonald's won't have as much use for our people." More currently, that is a situation that is developing in registered nursing.

It is becoming increasingly obvious that the "nursing shortage" so often noted during the past few years has, in fact, become a nursing oversupply, at least as far as hospitals are concerned. Faced with Tightening Budgets (as is just about everyone else in 1990's America), hospitals are starting to lay off nurses, no matter how experienced, qualified or highly-trained they may be. Lo and behold, look who stands to benefit from all this: that's right, nursing homes.

This is not to overlook the fact that attracting, much less affording, good RNs has long been a challenge to nursing homes. The stigma that they have carried for decades -- institutions offering only low pay, low standards and hopeless patients -- persists, to the extent that even those RNs who are out of work may not be eager to sign on. You will find articles in this issue addressing how to get past all that. Without attempting to steal their thunder, I would offer this suggestion: now is the time to start telling the nurses all about OBRA, and what it is doing to transform nursing homes.

Administrators, saddled as they are with the requirements, red tape and responsibilities imposed by OBRA every day, may tend to forget that "outsiders" may not know very much about this. Admittedly, too, many RNs may think they don't want to know, though today's health care economy should take care of that, at least to some extent. Given half a chance, though, nurses may find that nursing homes, while probably not as lucrative as hospitals, can provide them with professional challenges and satisfactions they didn't think possible.

In short, with so much bad news out there for nursing homes, it doesn't hurt to focus now and then on the silver lining. If, as in this case, the silver lining is courtesy of someone else's cloud, well, that's the way it goes. Why not enjoy the opportunities that present themselves?

Speaking of opportunities, one that nursing homes have started to pursue with some eagerness is the development of special care units for Alzheimer's patients. The bulk of this issue deals with how that trend is shaping up. Certainly from a clinical standpoint, nothing is more germane to nursing homes' current resident care operations than the experiments and advances seen in recent years in the care of Alzheimer's patients. Hopefully our invited authors and experts will give you a firmer grasp of how that one is shaping up. Who knows, perhaps it will offer yet another hope for the future.