What does long-term care think of itself? Nursing Homes/Long Term Care Management readers were asked to self-assess their industry on several counts.

Recently Nursing Homes/Long Term Care Management asked The Marlin Company, producer of the "Communication Station" line of print and Internet literature aimed at employee education and improved morale, to cosponsor a survey of the magazine's readers on their own perceptions of long-term care. Much about long-term Care is published and lectured on and many analyses are offered--but what do the field's managers and workers themselves think about the long-term care issues of the day? Randomly selected for the survey were 8,585 readers, of whom 605 responded to a thoroughgoing questionnaire (see "Respondent Base," p. 20). Key responses follow, with commentary from Nursing Homes/Long Term Care Management and from The Marlin Company (see "Commentary from Marlin Company Vice-President of Editorial Ed LaFreniere," p. 18).

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Key Findings From the Marlin Survey

According to the Nursing Homes/Long Term Care Management readers responding:

* The top three problems/issues that faced the LTC workplace within the past year were: cost/reimbursement issues (58%), employee morale (54%), and employee turnover (41%).

* 78% of respondents indicated that the workplace injury rate has either fallen (38%) or stayed the same (40%).

* Employee turnover rates: 46% report 0-25% turnover and 42% report 26-50% turnover.

* 64% of respondents report that workers' compensation claims have either dropped (17%) or stayed the same (47%).

* The most frequent causes of injury in the workplace are caused by improper lifting/transferring of patients (64%) and slips, trips and falls (24%).

* 72% of respondents reported that fewer than 5% of workers were injured because of work.

* Respondents say that the two most effective ways to communicate with employees are staff meetings (77%) and face-to-face communication (66%).

* 90% of respondents reported having an employee recognition program of some kind: 76% used public verbal recognition; 68% used awards such as certificates, trophies or plaques; and 65% used verbal recognition, privately.

* When asked about growth plans for the future, 67% of respondents planned to admit more Medicare post-acute patients, and 60% planned to keep costs under tight control to maximize Medicaid.

Open-Ended Responses

When asked if there was one change they would like to see happen in long-term care, 470 readers responded as follows:

* 29% of respondents wanted to see changes made to the regulatory process. 21% of the 29% specified that they meant changes to the survey process. 16% wanted a change in the "voluminous documentation."

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* 21% of respondents (97 of 470) fell into an "other" bucket, with 12 (or 12%) of the 97 seeing a need for more compassion, 7 (or 7%) seeing a need for more funding, 4 (or 4%) wanting more communication, 4 (or 4%) seeking better employee recognition, and 4 (or 4%) looking for higher salaries.

* 26% wanted the reimbursement process to change (including the amounts of funding, services covered, and the process for obtaining it).

* 9% wanted to see long-term care's image change, both within the healthcare community and within the general community ("image change," that is, from not being respected as healthcare professionals and from enduring the negative image that people have about long-term care in general).

* 7% wanted to see broad-ranging changes in how staffing is addressed (including staffing ratios, quality and quantity, turnover, recruitment, retention).

* 7% wanted more availability of training, skill development, interdisciplinary training.

* 5% wanted to see culture change (defined as improved quality of life for residents, more homelike environment, more individual choices, more person-directed care).

Commentary From Nursing Homes/Long Term Care Management:

In a time of negativity, it's satisfying to focus on the good news that emerges from this survey. According to three-fourths of respondents, workplace injury rates have not worsened and, for 38%, have even fallen. A strong majority says the same for workers' compensation claims. Turnover is high, but at least it is not approaching triple digits for most of them. Nearly everyone claims to engage in employee recognition of some type--a crucial need in this field, if ever there was one. And only a very small minority, relatively speaking, thought salary increases were a priority issue for them--most gave much higher priority to such issues as reimbursement and regulatory reform and industry image enhancement.

Less positive--and not surprising--was that focus on long-term care regulation and reimbursement as areas needing major reform. Interestingly, too, more respondents were sensitive to the field's image problems than were sensitive to issues involving staffing, training, and culture change.

Were respondents telling us, in general, that long-term care is a field in serious need of a pick-me-up before other good things can start happening?

If so, is anyone listening?

To send your comments to the editors, e-mail [e-mail].

A Marlin Company Survey

RELATED ARTICLE: Commentary From Marlin Company Vice-President of Editorial Ed LaFreniere:

"In our work with thousands of long-term care providers, we continually see people struggling with morale and turnover issues. Healthcare professionals feel underappreciated, undervalued, and overwhelmed by compliance and regulatory issues. Where is all that time for quality care, for compassion, for the reassuring conversations that engage those in their care? Sadly, professional self-fulfillment growing out of daily one-on-one successes has to be fit into a schedule dominated by documentation and other requirements, not the other way around.

"In such an environment, it is doubly important to engage employees and help them focus on the more personal issues--showing compassion for residents, getting to know their personal histories, bringing a smile to dementia patients by reminding them of loved ones and happy times. This is the stuff of true resident care, as envisioned years ago, and the reason we do what we do. Our survey shows we have many good people working in this field, but we have a long way to go to maximize their work."

RELATED ARTICLE: Respondent Base

* 91% offer skilled nursing care

* 36% offer assisted living 

* 21% independent living

* 28% other (Alzheimer's, dementia, home healthcare, adult day care)

* 80% have 75+ employees with 43% at 150+

* 89% have 100+ beds