Prioritizing Priorities

The world of long term care services is clearly under the microscope right now.  There are actions taking place in our government to dictate the amount of nursing staffing that nursing homes have, there are strong indications that not only will nursing homes be a topic for the 2024 elections, but for many years to come.

It did not take the COVID pandemic to show us that our system of caring for older adults is broken.  But the pandemic did shine a bright light on the issues that exist and the pandemic did increase the pressures on an already stretched industry.  The struggle for staffing is very real and the shortages of clinical staff affect all areas of healthcare. There are not enough nurses and aides to fill the positions that currently exist, not to mention what that will look like in the future when demographics alone indicate that demand will increase dramatically.  Add to that the fact that many of the elders in need of residential care are reliant on Medicaid funds to pay for their care and Medicaid does not come close to covering the costs of that care.  In most long term care settings, Medicaid results in annual losses in the millions, creating yet another pressure on providers.

All of that is well known as is the reality that there are both good, responsible, caring and committed long term care providers and others who are not, whose motivation is not to enhance life but rather to enhance profits.  Sadly, from a regulatory standpoint, and from a public perspective, that differentiation is neither well recognized nor well known.

And with all of this, the financial pressure, the regulation, the staffing crisis and more, what really matters in the care of older adults is rarely discussed and all too often not just ignored, but not even mentioned. When we talk about mandates and requirements, we are approaching older adults as if they are a commodity or a problem to be solved.  We are ignoring the reality we are talking about human beings, individuals with needs and preferences and unique histories.

When we see older adults, whether they live in residential settings or in the community as “them,” as an indistinguishable mass lumped together because of age, we do not just a disservice, we create and endorse a mindset that allows us to treat elders as “other” and as “less than.”  We fail to recognize the very many gifts and skills that individuals have and can contribute.  We fail to remember that each person has the right to make choices and that each person, regardless of age or ability, can still make choices.

Assuming that we know, that we can control the lives of individuals, that we can treat them as a homogeneous group, that we can presume to determine what each person wants and needs is neither accurate nor correct.  In point of fact, it is a travesty.

Yes, the system of elder care needs repair.  Yes, we need to think about the services we provide and the way in which we provide them. But, first and foremost, we must understand that it is people with whom we are working, people for whom we are caring, people who have opinions and people who have value to contribute.