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I’ve been busy with surveys and issues coming up regarding surveys that I haven’t had the chance to take time to continue writing. I’m taking a few moments now. I just want to comment on something affecting all of us – the current economic climate. I know how it is affecting me, and I’m sure you are feeling the pinch as well.
The current climate is affecting nursing homes and hospitals as well as the regulatory agencies that govern them.
Many of the nursing home and hospital operators, when asked, may say they are taking steps to reduce costs but will pledge to refrain from cuts that could impinge on the care they offer their residents. This is going to be difficult, especially as “private pay” patients become fewer, Medicare starts looking closer at what they are paying for, and Medicaid continues to cut back and not maintain pace with rapidly increasing healthcare costs.
What might you expect to see? You may see an increased dependence on volunteers. This can be good, but it can go sour quickly if things are not monitored well. Volunteers need to have training and monitoring to ensure they are doing only what they are allowed to do, and that they are doing it appropriately.  Volunteers should not be providing care that only a healthcare professional can provide.
You might also see a reduction or lack of maintenance on the physical aspects of the building. It is important, though, that regular maintenance be provided to keep such things as fire sprinklers, washers, dryers, medical equipment, and kitchen equipment working correctly.
On the “state” side of things, you may see a decrease in the number of people willing to do the survey work. It is a hard job, not as easy as many people envision. It takes a lot to go into facilities, find the problems, get enough evidence to support them so they can stand up to a legal challenge, learn to write them up in the correct way (the lack of a word or two, or failing to use one word instead of another can have a whole deficiency thrown out the court window), and then get them issued following proper procedures. In addition, many states think so low of their nursing home and hospital surveyors that they pay those employees very low wages compared to what they could get in the private sector. Now there are many fine high quality people in this line of work who do care and the money is not why they are doing the job. But, when wages are so low as compared to private sector work, where do you think the majority of well-qualified staff go – certainly not to work for the state agency.
So the economic crisis may have the unintended effect of fewer surveys, fewer “substantiated” issues, and more cries of “poor care” unheeded and unheard.

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