The Long-Term Care Conundrum

Dear Friends,

In 2022, the Biden Administration published a brief, Protecting Seniors by Improving Safety and Quality of Care in the Nation's Nursing Homes. Last month, the Administration took the step of proposing a minimum nurse staffing ratio of 3.0 nursing hours per resident day (NHPRD), with at least .55 of those hours being given by an RN and the remaining 2.45 by a certified nursing assistant. There were no LPNs built into the recommendation, although nursing homes rely on LPNs to do the work that is within their scope of practice, while RNs can focus on what they are licensed to do. This proposal has a 60-day comment period and then will probably take about 12-18 months before it is actually implemented.

This proposal has been met with mixed reactions. It creates what I have called in the past "the 3 legged stool" conundrum. The 3 legs are quality and safe care, supply of RNs, and salary constraints. No one believes that people in nursing homes should have substandard care, but to provide the NHPRD to care for this vulnerable, complex population of older adults, we need a greater supply of nurses going into and staying in Long-term Care (LTC), and the LTC industry must receive reimbursement that allows for competitive pay scales.

Research has shown that increased RN hours in nursing homes increases the quality and safety of care. However, research also shows recruitment of nurses to long-term care is difficult, and turnover is often as high as 50% per year. Further complicating retention is that the salary scale in LTC is often as much as 20% less than in acute care hospitals.

The Nursing Home Staffing Study conducted in 2023 found that between 3.8 NHPRD and 4.6 NHPRD would be adequate to keep rates of omission of activities of daily living (ADL) and clinical care below 10%. Importantly, these ratios do include LPNs, who are a very important part of the LTC workforce.

Yes, we do need to have an adequate mix of RNs, LPNs, and certified nursing assistants to provide safe and quality care to this increasingly complex nursing home population. However, we need creative solutions to increase the supply of nurses wanting to practice in LTC with excellent nurse leadership in nursing homes to enhance retention and a payment system that incentivizes and compensates nurses who do this extraordinary work.

Have a wonderful October.

Best Wishes,

Tara A. Cortes, PhD, RN, FAAN

HIGN Receives Grant from Mother Cabrini Health Foundation

HIGN has received two years of grant funding to support the "ArchCare Nurse Fellowship Program" to create and implement a hybrid nurse fellowship. The fellowship program will be implemented at ArchCare, The Continuing Care Community of the Archdiocese of New York, in its seven long-term care facilities. This Program will provide nurses new to long-term care with resources to facilitate their integration into the environment, support and mentoring, and education on the uniqueness of providing quality, person-centered care for older adults in residential long-term care.

Organizational Health Literacy

October is Health Literacy Month. Health Literacy is typically defined as an individual's ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. Recognizing that individuals act in a larger health system, Healthy People 2030 added a new category of health literacy: Organizational Health Literacy. Failure to incorporate health literacy principles into an organization can lead to miscommunications and barriers that result in patient safety events. Health literate organizations help people better navigate complex health systems, impacting healthcare delivery and outcomes.

Click here to learn strategies to improve organizational health literacy.

HIGN's Brittany Hamilton earns Master of Arts in Learning Technology and Experience Design

Congratulations to HIGN's Director of eLearning and Technology Brittany Hamilton for graduating this summer with her Master of Arts in Learning Technology and Experience Design from NYU Steinhardt. This was the second Master's degree she has completed. Her work and research in NYU Steinhardt's program focused on learning from failure and combating fear of failure in learners using gameful pedagogy and gameful learning management systems. This fall, she begins her doctoral studies in NYU Steinhardt's Higher Education Doctor of Education (EdD) program where she will continue her research on the use and effectiveness of digital technologies in education.

Leadership Series

Growth as a leader is a continuous journey. The HIGN Leadership Series will enable people to build on their experiences and enhance their ability to use strategy and innovation to lead in a continually changing healthcare environment. As healthcare organizations face higher turnover and a limited pipeline of workers, establishing a culture that values respect, diversity, and community is more important than ever. Nursing Continuing Professional Development credits are available for each course.

Courses:

Click here to learn more.

HIGN Highlights

Prof. Selena Gilles was inducted as a Fellow in the Academy of Nursing Education and will be inducted as a Fellow in the American Academy of Nursing.

Prof. Fidel Lim has been featured in a podcast hosted by the National League for Nursing (NLN) to discuss Chatbots Impact on Student Learning

Prof. Fidel Lim wrote an essay entitled Being Sharp in Health Literacy in his monthly blog for the American Nurses Association's American Nurse journal.

Prof. Komal Patel Murali was selected as a 2023 Hospice and Palliative Nurses Association Research Scholar.

Prof. Jasmine Travers was featured in a JAMA article that highlights how we can solve the issue of understaffed nursing homes their positions.

Clinical Prof. Dorothy Wholihan, along with adjunct faculty Shila Pandey, conducted a national training course: ELNEC-Geriatric (End of Life Nursing Education Consortium) in Charleston, South Carolina, which focused on care of older adults with serious illness.

Grant Awards:

Prof. Ab Brody received the following grants:

Title: "Emergency Departments Leading the Transformation of Alzheimer's and Dementia Care (ED-LEAD)" Sponsor: (U19) NYUSOM | National Institutes for Health

Title: "Leveraging Electronic Health Records for Reducing Dementia Screening Disparities in Diverse Communities" Sponsor: (R01) NYUSOM | National Institutes for Health

Senior Research Scientist and Project Director Shih-Yin Lin received the following grant:

Title: " Development and Validation of a Delirium Caregiving Self-Efficacy Scale"

Sponsor: NIDUS Delirium Network | National Institutes for Health

Prof. Jasmine Travers received the following grant:

Title: "A Psychometric Study of IN-HOME: Identifying Needs to Help Older Adults Maintain Everyday Community Living" Sponsor: NYU Meyers Pilot Funding

Prof. Bei Wu received the following grants:

Title: "Daily Psychosocial Stress and Cardiometabolic Health of Older Chinese Americans" Sponsor: (R21) Rutgers University | National Institutes for Health

Title: "Resource Center for Alzheimer's and Dementia Research in Asian and Pacific Americans" Sponsor: (P30) Rutgers University | National Institutes for Health

Publications and Presentations:

Lim, F. (2023). Machine-Generated Writing and Chatbots: Nursing Education’s fear of the unknown. Nursing Education Perspectives, 44(4), 203–204. https://doi.org/10.1097/01.nep.0000000000001147

Murali, K. P., Brody, A. A., & Stimpfel, A. W. (2023). Nurses, Psychological Distress, and Burnout: Is There an App for That? Annals of the American Thoracic Society, 20(10), 1404–1405. https://doi.org/10.1513/AnnalsATS.202307-629ED

Murali, K.P., & Sadarangani, T.R. (2023). Prioritizing Community-Based Care for People with Alzheimer's Disease and Related Dementias in Ethnically Diverse Communities: The Time Is Now. Research in Gerontological Nursing, 16(5), 214–216. https://doi.org/10.3928/19404921-20230906-01

Gabbard, J., Sadarangani, T. R., Datta, R., Fabius, C. D., Gettel, C. J., Douglas, N. F., Juckett, L. A., Kiselica, A. M., Murali, K.P., McCarthy, E. P., Torke, A. M., & Callahan, C. M. (2023). Career development in pragmatic clinical trials to improve care for people living with dementia. Journal of the American Geriatrics Society. https://doi.org/https://doi.org/10.1111/jgs.18599

Prof. Komal Patel Murali was a presenter during the Virtual 2023 Team Conference for Hospice & Palliative Care hosted by the Hospice & Palliative Nurses Association, the Social Work Hospice and Palliative Care Network (SWHPN), and Transforming Chaplaincy. Their presentation was entitled “Integrating Palliative Care within Home Health care: Assessing Knowledge, Attitudes, and Confidence among Clinicians, Patients, and Caregivers.”