Letters to the editor.

Dear Editor:

I applaud Nancy Taylor for her willingness to put her experience into print ("From Both Sides of the Coin" [Voices From the Field], Nursing Homes/Long Term Care Management, June 2003, p. 69). I am a regional LTC ombudsman with 18 counties, no local office staff, and very little clerical or backup support. Our volunteers cannot be paid for mileage or for long-distance phone calls. Our funding is continually challenged, and our unit is constantly attempting to make a "real" difference with almost nothing but determination and experience. We do at times make a difference for one person on that day; but "systems advocacy" is so desperately needed, and that has been stripped out of every piece of legislation and budget in government these past lean years.

You see, I've found no "empirical methodology" that will measure how many things do happen just because a volunteer is on the floor of a facility, or how many things that might not have been done are done simply because someone had the time to focus some thought on what the resident was trying to tell us. And how, exactly, do we quantify "peace of mind," "comfort," "compassion," "trust," "dignity," or "respect"? Where can I "code" these, and to what "funding stream" for "billable hours" and "RUGs reimbursement"? Yet, what gets measured, gets done....

Thank you, Nancy Taylor, for adding your voice to those of us who continue to try to add the above-mentioned dimensions back into daily life for those who are in care facilities. I finish an in-service on "Dignity" with the following lines:

   We must become people who have the courage to make the
   choices that will allow the voices of the most vulnerable among
   us to be heard. Why? Because, barring a very unpleasant alternative,
   one day we will all be old. The level of care we support and
   deliver is the level of care we will teach those who follow us to
   call "acceptable"; this will become the benchmark for the care
   we will receive. But for the grace of God, there go I....

Thank you, Nancy, for giving testimony to that.

Sue Schuster, LMSW

Regional Long-Term Care Ombudsman

Kansas

Dear Editor:

Nancy Taylor wrote about her experience staying in a nursing home after a car accident. She says that although they were always short, the staff worked hard and she received good care. She says that "love is a sparse element" and considers that we have a "failing system." She believes that our government should provide more funds for nursing homes. She says we are "inwardly "killing these people and it is "a sin to treat people this way."

As an administrator for more than 30 years, I can agree with some of her conclusions. Certainly we can always use more funds for more staff. However, money is not going to solve the problems she sees. Money does not buy love. We need a kind, compassionate staff. If we had an unlimited amount of money to pay caregivers, we would doubtless have more applicants who would take the jobs just for the money.

Ms. Taylor refers to patients with dementia and the blank looks on their faces. Some patients have families who love them and visit them, even though the patient cannot remember their visits from day to day and sometimes does not even recognize his or her own loved ones. This is a disease-based problem and money will not solve it. We can sympathize, but we should not blame the government for insufficient support.

For those who still have their mental ability, of course it is humiliating not to be able to care for yourself physically. If you have a physical problem, this is something you have to accept, whether it is permanent or temporary, like Ms. Taylor's accident. The government can supply money to have someone bathe you and feed you, but it cannot help you with your feelings of humiliation.

Where do Medicare and Medicaid get the money to pay nursing homes? From American taxpayers. Does Ms. Taylor think that taxpayers are not paying enough? How does she think the Medi-Medi money should be apportioned? In my facility, we have raised wages to the nursing staff considerably in the last few years. We have had to pay double our workers' comp premiums of a few years ago, although we have had few injuries. Our biggest problem has been that our liability insurance premiums have quadrupled because of attorneys who bring unjustified lawsuits, and the insurance companies are leaving our state.

It is a constant effort trying to see that all patients, whatever their needs, receive good care. We value the employees who show love and kindness.

Leona Berglund, Administrator

Crestview Convalescent Hospital

Rialto, California

Dear Editor:

I enjoyed your magazine's recent article on young people in the nursing home (Fridkin D, Awan E [interview]. "Not Just an 'Old Folks' Home,'" Nursing Homes/Long Term Care Management, May 2003, p. 16). I can relate to this article because we opened a 35-bed young persons' wing in our home a couple of years ago. I took over admissions and marketing in this 179-bed facility with 60 beds to fill. I began my job by going out to other nursing homes and taking a tour to see if I could identify a niche for our home. What I found were young people, living with a bunch of old grayhairs, playing bingo every day. This seemed like a perfect niche, and my owners and management agreed to try it. It has been a struggle because young people in a nursing home are often angry and demanding, and staff are challenged with behavior problems. We asked for volunteer staff for this wing and are blessed with wonderful caregivers who enjoy taking care of this unique population. Our activities person for this wing is a very energetic and innovative 20-year-old. She does a great job trying to please a difficult group of residents. We were recently featured on a local television program, What's Right With Tampa Bay, for arranging for a local airplane pilot to take one of our residents up in his four-seater for a joyride. We have been successful at getting some of our residents placed in assisted living facilities or back with their families. Some of them could live here for 50 years or more. Others have terminal illnesses, and we have to help them through the dying process.

I wish more long-term care facilities would try providing a young persons' facility. They are very much needed.

Denny Rodebush, RN

Admissions and Marketing Director

South Tampa Health and Rehabilitation Center

Tampa, Florida