Remarketing of a Failing Nursing Home - Research Proposal Example

Remarketing of a Failing Nursing Home The rise and prevalence of many nursing homes in the 21st century show our dedication and commitment to protect and provide excellent care to our aging population. On the other hand, it also shows a looming trend of institutionalized elderly health care with minimal support from relatives and families. And because of the sudden increase in the number of public and private, either licensed and unlicensed (Bravo et al., 1998) nursing homes, from a forecast of Korkok (1988) that elderly care is a blossoming industry of lucrative prospects, the number has increased from 23,000 in 1991 in the US alone to an estimated 1.3 million in 2002 (Leonard et al., 2006). Thus, there has been a need to continuously set up evolving competent policies and effective regulations for quality care management of nursing homes and efficiency determination. Korkok (1988) states that the rise of nursing care facilities is primarily due to the increasing number of wealthy elderly that constitute a major consumer group in the market and who can afford specialized treatment. In addition, nursing homes are a community in itself and require attention from the government and scientific institutions for its improvement. Also, because of the increase in nursing homes and the demand for it, studies about regulating and reviewing nursing care facilities have also increased in scientific journals especially those assessing its impact on patient and resident outcomes. Unfortunately, however, a consensus on the specific parameters to be used is still lacking, although several publications discuss effective measures for it. This being the case, pinpointing the problem areas and solutions to improving the market strategies of the nursing home in question would be based on these studies. This paper focuses on answering the problem areas as mentioned in the case with the objective of finding strategies to remarket and change the status of the failing nursing home and make it more competitive. Management of the nursing home Case status: Been open twenty- two months; Initial management left; six managers in a year; No communication between management and staff on floor; No clinical supervision given from management Management is responsible for centralizing operations in a nursing home facility. Planning the objectives, the target clientele, the budget and cost allocations, the advertising approach, decision-making and the evaluation and study of the status of nursing homes are part of the priority tasks of the management of any business and are crucial to improving its day-to-day operations. However, certain constraints occur during evaluation of elderly care as there exists no individual marker for assessing nursing home care quality (Anderson et al., 1998). In addition, Gustafson et al. (1980) states that the evaluation of nursing home care is case dependent and is usually relative to a standard or to the evaluator. Although there are several factors that are being considered by modern regulatory bodies and consensus groups that aim to improve health care facilities for the elderly, Linn et al. (1977) have earlier stressed that patient health recovery and outcomes is of utmost importance and should always be considered on the evaluation of nursing home industries. In recent scientific journals, among the factors that should be monitored include the physical structure of the nursing care facility; the mode, nature and allocation of care and delivery strategies; and the improvements on the patient conditions that result in recovery (Donabedian, 1990). The latter is of key significance because of the primary mandate of nursing care (Linn et al. 1977). In addition, the final recipient of all structural and internal changes in a nursing care facility affects its patients. In the same light, Anderson et al. (1998) has also stressed the importance of developing the nursing home in these three aspects; the physical structure and environment of the home, the processes used to deliver health care and the outcomes on patients that result from these services. Zinn et al. (1999) have also noted the effect of the environment, management and organization on improved nursing care facilities as well as in institutionalizing programmes that are suited for residents. Linked factors are also used in evaluating the efficiency of nursing homes. Among the variables considered are common markers, living conditions, patient improvement and others. Anderson et al. (1998) has also scrutinized the correlation of these factors and their positive and negative effects towards each other. In addition, patient safety is also a primary concern of the management which is usually overlooked in assessment (Bates in Roberts, 2005) Management strategy: hiring the right people Management dedication to swerving the path of the nursing home stems from his benefits from the business. An attractive reimbursement package can help deal with this situation. It is however important to remember that cost efficiency is maintained by reimbursement policies and market characteristics (Davis et al., 1998). Tasking and rewarding people with excellent experience on supervising the facility, with substantial knowledge on medical and technical know how, background on nursing home business, possess effective communication skills and genuine care to the elderly and the welfare of nurses and other employees will help alleviate the problem. Management that is usually prone to break down, such as the case of this nursing home, is also terribly affecting the facility. Frequent changes in ownership or management has also proven to be more expensive as a result of higher capital costs. Apparently these expenditures do not necessarily improve patient outcomes (Holmes, 1996).The primary stage of managerial preparations rarely gains momentum when there is staggered transition of different managers because of frequent entry of new ones. The planning of new programmes never ends and, unfortunately, rarely or does not bear fruits. Management strategy: setting up objectives Clear-cut objectives on a weekly, monthly and, even, yearly targets of the institution is formulated by the managers. Nature of care to be given, short term of long term service to residents and programmes should be decided upon initially by the managers. Zinn (1993) states that smaller nursing homes provide better quality due to frequent contacts with residents and easy monitoring while larger ones increase cost and target more difficult cases. All nursing homes have similar patrons, staffs and general objectives but highlighting the uniqueness of the nursing home is also tasked to the managers. An exceptional strategy may be to assess the special needs of the community where the nursing home is located. This may be done through surveys or admission data within the past twenty months of the nursing home’s existence. Identifying potential clientele in the vicinity helps market the nursing home and provides easy access for those in close proximity which might be in need of the services they offer. Thus, studying the treatment and care given for neighboring patients with unusual and special conditions may be a good start off point. By identifying this, the nursing home can develop a programme, which specifically intends to help these groups, and by developing it, the nursing home gets reputation and association with a certain group and attracts customers with the same needs. This technique can eventually cut the cost of the business (Anderson et al., 1998). Similarly, Banaszak- Holl et al. (1996) studied the external and internal factors associated with the success of a nursing home in giving appropriate health care to its patients specifically those with Alzheimer’s and sub acute care. In the study, it was observed that patients with Alzheimer’s are usually housed in smaller, specialized homes that can provide frequent contacts and maximum supervision to patients. This is an example of initiating a plan for residents with certain illnesses and setting up a care unit specially designed for them. Because the growing demand for specific needs of our elderly increases, the institution of specialty care units or programmes are also currently increasing. However, an in-depth research is required before programme initiation as Bravo et al. (1998) point out that nursing home programmes should be apt to patient needs. Management strategy: promoting the right environment According to Binstock and Spector (1997), physical conditions that suit the lifestyle of the residents such as lighting, proximity of usual needs, temperature, utility fixtures, and humidity conditions can also be improved by the management and conform them to resident needs. The nursing facilities floor plan and space allocated to patients are also very important in promoting the right environment for patients and staff. Li et al (1996) observed that patients using compound units are more prone to contracting similar diseases that those in single units. Aesthetic focus on physical fixtures such as required amenities also add to adaptive architectural design, examples include lifts, spacious rooms and safe flooring motorized devices (Binstock & Spector, 1997). For example, Jensen et al. (2002) document how improving a residential home’s physical setting can dramatically reduce the incidence of accidental falls and hip injuries of older residents, this being a major cause of reliance and death among nursing home residents. Their efforts on planning and implementing a set of strategies to reduce injuries caused by falls has resulted in a 12% decrease compared to a control group on a study conducted on nine nursing homes for thirty four weeks. The prevention strategy comprised of steps encompassing several aspects of daily activities in the nursing home. Among these include adjusting the environment and facilities to be less prone to accidents, employing personnel guidance, using aids such as hip protectors, enlightening staff about resident conditions, conducting exercise regimens to strengthen physicality of residents, reviewing dietary and pharmacological requirements and conducting regulatory and evaluation schemes after an accident occurs. In addition, the success of this study proves that the above steps can be redesigned for other important clinical conditions of residents in nursing homes. The environment can also be improved by administering programmes that require resident involvement and entertainment such as group discussions, recreational activities, and religious activities. These activities can reduce depression and aggression as well as increase the self confidence of patients which may aid in their recovery. Patient aggression can be a source of distress and psychological disturbance to other patients and nursing home personnel. Leonard et al. (2006) also includes the patients’ mental and physical conditions as sources of aggression. Among the major factors, which can insinuate aggressive behavior, include delusions, depression, hallucinations and constipation for patients with dementia. Therefore, in cases where dementia patients are present in nursing homes, decreasing these occurrences by promoting a favorable environment, improving treatment and setting up programmes for these specific cases would be helpful in improving the outcomes of patients. Studies also show that nursing home patients with dementia who had less physical activities were more prone to having problems with taking in drugs and are, thus, administered stealthily by the nursing home staff through their foods or beverages (Kirkevold and Engedal, 2004). Management strategy: encouraging good relationships The nursing home personnel and other individuals used to deliver health care in this institution also deserve as much attention from the management as given to patients and delivery of care services. The management also serves as models for other employees in the nursing home, therefore, his/ their behavior must promote good relationships with other employees and build rapport with patients and their families and relatives. This way referrals can be increased and cuts cost on advertising and promotions. Sources of conflict between floor personnel and management or administration people often occur from the varying perspectives of each. The differences in the orientation and objectives of staff and management have also been stressed by Aaronson et al. (1994) as a key improvement factor. The differences in each need to be consolidated in nursing home industries by setting up patient and business improvement goals that both groups will strive for. In their study, they observed that government subsidized or owned and no profit nursing homes are usually better equipped in terms of staff and personnel. The initiative to encourage and improve relationships between personnel also stems from and through excellent management styles. Ways to achieve such may include provision of maximum reimbursement and benefits to employees and competitive remuneration packages. The management also gains respect from good standing employees when they exhibit conscientious and genuine care for patient wellbeing and staff welfare and display unfailing decision making strategies. When goals are set, the management should inspire his people to follow and act on it. Thus, a good relationship with the managing personnel also promotes innovation on the part of the employees as they find novel ways to go around difficult situations in order to meet objectives, solve problems and even attain target profits. A good understanding and relationship among staffs promote interaction and freedom to share knowledge. This environment helps assisting information exchange which can be advantageous to both peer and patient. Sharing improvement tips among management and the nursing home workforce provides allowance for change, this leads to improving conventional techniques to provide for faster, better and safer delivery of health care services. It also allows staffs to be pliant and creative in dealing with patients to meet their needs and demands. Similarly, Piven et al. (2006) show that improving nursing home care includes preserving important factors by administration staff; the staff, management and patient connections, facilitating new knowledge flow, and maintaining cognitive variety in nursing homes. Management strategy: promoting safety Information technology advocate Dr. David Westfall Bates has stressed the importance of safety measures in the environment of nursing homes (Roberts, 2005). The fragile condition of the residents in nursing homes should aptly be considered in creating a programme that promotes safety for both staff and patients. In the construction of assessment profiles for the nursing homes screening criteria led by a group of the Wisconsin State Department of Health and Social Services, patient and staff safety is a major concern. Among the items listed to evaluate the safety of nursing home facilities are physical environments where the nursing home is located, the quality of rooms and fixtures occupied by the patients, floor area, hygienic facilities and the preparedness of staff in cases of untoward incidents (Gustafson et al., 1980). Li et al. (1996) also enumerates the factors that can affect nosocomial infections and communicable outbreaks in elderly residential homes. These are also more frequent occurrences in larger nursing homes. Thus, the size and floor area of the facility is directly related to its disease management practices. Other factors such as staff and personnel patterns, and employee sick leave policies should also be improved to promote safety. Knowledge on the type of infections incurred by staff and personnel during a sick leave should also be identified by the management. This way, appropriate care towards susceptible patients and individuals are taken. Minor factors such as number of beds dedicated to a special group of patients, type of sponsorship, frequency of monitoring laboratory test results, and the number of personnel attending to a patient or specific group of patients have little impact on disease outbreaks but should be given attention as well. The evolution, prevalence and new outbreaks of infectious agents should also be monitored by the management of the nursing care facility. Training programmes and seminars on these topics aid in the continuous education of staff in order to prevent communicable diseases in the nursing home. The health conditions of the staff are also crucial to the success of a nursing home, thus, staff vaccinations and health history of the patients should be identified by the management (Li et al., 1996). Management strategy: implementation Nursing home managers should also enforce the proper documentation of cases, treatments, conditions and other circumstances especially for unusual cases of residents. These rare occasions may also teach a few lessons that can be used for future similar cases and deepen the expertise of nurses, nursing aids and other staffs (Anderson et al., 1998). Implementation of strategies for improving patient conditions and the methods to administer them should also find focus and priority in an operating management scheme. Therefore, the management should also be familiar with the behavior and dealings of the personnel and staff especially to patients. For example, in Norway, a practice of hiding drugs in foods and drinks in order to administer them to patients with dementia are commonly carried out in nursing homes but is not or rarely scientifically reported. Although drugs are successfully administered this way, a major disadvantage includes incorrect dosage of the drugs that are received by the patient and possible errors in documentation and recording. Usual drugs that are administered through this manner include anxiolytics, antiepileptics and antipsychotics (Kirkevold & Engedal, 2005). The various tasks of management and the different strategies used to attain the goals that are primarily set for the nursing home in question are equally as important as the ability to assimilate these objectives. An integrative manner of sewing in these suggestions to effect a positive and substantial transition and improvement in the care facility is also important to augment the competence of the nursing home, as well as its profitability and image (Wan et al., 2001). Staffing and personnel options Case status: People with criminal records employed Staff ratio not correct To complement the hiring of competent managers, nurses should also be innovative, skilled, sociable and experienced (Anderson et al., 1998). In addition, Ganz et al. (2005) noted that the price competency of employing more nurses should change trends in the quality-adjusted life expectancy of residents. Thus, to a great extent, patient improvement is reflected by the number of nurses and their proficiency. But, although hiring competent nurses is an important factor for improved services, it may also be extremely expensive. Thus, substitution of nurses with equally competent nursing aids and LVN’s can also cut back on costs and improve the ratio of staff to patients. However, patient welfare should not be compromised by this move to save on expenditure (Anderson et al., 1998). Nonetheless, these aids are also capable of performing some of the duties of the nurses with little guidance or supervision. In most cases, their assistance to nurses is very important in adult health care. Li et al. (1996) also noted that sharing nursing personnel from one unit to another despite the scheme employed (single or multiple unit patient occupancy) increases the risk of disease outbreaks. Staff improvement and incentives Case status: Committee of managers since staff morale low No incentive for weekends or bank holidays Part of human resources improvement to nursing home facilities includes honing the skills of their personnel as well. Even though increased salaries and financial benefits attract personnel, provision of extensive training programmes, workshops and good working environments are a form of non-financial incentives and are part of the management’s investment for the advancement of the nursing home. Anderson et al. (1998) also suggests that nursing homes should increase their budget for staff and personal allocations because it is an inevitable measure of the outcome of the patients and, eventually, of the business. Satisfied employees can instill a happy disposition to the patients and favor an environment similar to that of a real home. The working hours of the nursing home personnel should also optimize their work efficiency. Improving staff hours reduces fatigue which results in more efficient work (Binstock & Spector, 1997). It is observed that the annual private expenditures for running nursing homes increases despite the increasing market (Binstock & Spector, 1997). The latter may have been countered by increasing competition, competitive pricing, higher quality care offered by other nursing care facilities and the effect of increasing prices of other services and repairs. Holmes (1996) has observed that a big difference of government owned and private nursing homes is their attitude towards spending on patients against home maintenance. Anderson et al. (1998) also noted that an increase in expenditures other than that of personnel and nurse salary, reimbursement or incentives usually have no effect on the performance of the mentioned employees. In the study by Holmes (1996), delineation on the nursing home costs have been made by separating patient care improvement costs and home or plant improvement expenditures. By identifying proper repositories for the assets of the nursing home, a tally of the relative improvements in these two core expenses can be done. This way, the nursing home management knows how much of the profit, stocks or capital is needed for improving patient outcomes and improving personnel skills. Consequently, Davis et al. (1998) states that cost efficiency is maintained by reimbursement policies and marketing characteristics, but extreme frugality on personnel has negative impacts on their morale and performance which in turn affects the working environment of other staffs and living atmosphere of the residents. Other improvements Case status: Initial marketing and research possibly failed Loads of problems Regular monitoring nursing home status Gustafson et al. (1980) noted that once implemented, programmes for long-term care should be monitored regularly. Bravo et al. (1998) stressed that government intervention in the operation of nursing homes is very important. In Quebec, for example, provincial officials require a level of personnel number working at nursing homes. The officials are also tasked to monitor safety through regular surveys and non-compliance may mean that licenses can be revoked. Even so, assessment of a governing body composed of an experienced member of the medical and care-giving field, such as peer evaluators and not just government officials creates a qualified assessment. An advantage of these types of strict regulations also ensure that irregularities in the patients’ medical conditions are not overlooked because officials and doctors especially from those outside the nursing homes can check their conditions regularly. Although Gustafson et al (1980) reiterate that much of government concern have also stemmed from known profit boons of nursing homes. Because of inequities of government monitoring and the lack of programme to examine the quality of care given to residents, in Wisconsin, a group was tasked by the Wisconsin State Department of Health and Social Services to develop criteria for quality care assessment. Among the points considered in the selection include safety of residents, maintenance, and availability of facilities, space, emergency preparedness of staff, skill, number and personnel behavior, conduct of staff towards the management, physical appearance and communication skills of the staff, resident activities including family and community programmes, nursing home population and its connection to other institutions. Areas for improvement and research Binstock and Spector (1997) suggest priority areas for research in long-term health care such as in nursing homes. They observed that more and more hospitals are adapting information technology as a means of providing quality care to patients. Nursing homes are now following the trend in improving efficiency and safety of resident care through modern technology. This specifically helps in providing efficient laboratory results and analysis, database management, and even in the prescription arena of conducting orders and purchases. Inconsistent and faulty drug prescription and patient administration have sometimes caused fatal mistakes in the past. These cases can be avoided by accurate prescription placements using IT. Other advancements include the smart pump, which assists nurses by regulating medicine delivery to patients and the scheme using bar coding in computerized drug administration. In addition, electronic patient records can also improve services, make surveys fast and economical, allow efficient data management and permits easy monitoring of health conditions. This programme has been pushed by several doctors (Bates in Roberts, 2005) and has been supported by the Bush administration. In addition to IT, modern technology also provides innovative care to nursing home residents with respect to improving traditional care of usual programmes. The use of electronic gadgets and information technology also provides wide access to clinical data and flexible time to check records (Binstock & Spector, 1997). 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